臺灣核心實作指引(TW Core IG)
0.3.1 - Trial Use
臺灣核心實作指引(TW Core IG)
0.3.1 - Trial Use
This page is part of the 臺灣核心實作指引(TW Core IG) (v0.3.1: Releases) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions
{
"resourceType" : "AllergyIntolerance",
"id" : "all-medication-example",
"meta" : {
"profile" : [
🔗 "https://twcore.mohw.gov.tw/ig/twcore/StructureDefinition/AllergyIntolerance-twcore"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><h3><b>藥物過敏</b></h3><p><b>臨床狀態</b>：Active <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\">( <a href=\"http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical\">AllergyIntoleranceClinicalStatusCodes</a>#active)</span></p><p><b>驗證狀態</b>：Confirmed <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\">( <a href=\"http://terminology.hl7.org/CodeSystem/allergyintolerance-verification\">AllergyIntoleranceVerificationStatusCodes</a>#confirmed)</span></p><p><b>根本原因或運作機制</b>：Allergy <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\">( <a href=\"http://hl7.org/fhir/allergy-intolerance-type\">AllergyIntoleranceType</a>#allergy)</span></p><p><b>確定的物質的類別</b>：Medication <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\">( <a href=\"http://hl7.org/fhir/allergy-intolerance-category\">AllergyIntoleranceCategory</a>#medication)</span></p><p><b>嚴重程度</b>：High Risk <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\">( <a href=\"http://hl7.org/fhir/allergy-intolerance-criticality\">AllergyIntoleranceCriticality</a>#high)</span></p><p><b>過敏或不耐症的識別</b>：青黴素過敏(Penicillin allergy) <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\">( <a href=\"http://snomed.info/sct\">SNOMED CT</a>#91936005)</span></p><p><b>過敏或不耐症被識別的時間</b>：2023-10-15T08:45:00</p><p><b>病人</b>：<a href=\"Patient-pat-example.html\">Patient/pat-example</a> \"陳加玲\"</p><p><b>紀錄者</b>：<a href=\"Practitioner-pra-dr-example.html\">Practitioner/pra-dr-example</a> \"王依昇\"</p><p><b>被記錄的日期</b>：2023-10-15T12:00:00</p><p><b>關於過敏的資訊來源</b>：<a href=\"Practitioner-pra-nurse-example.html\">Practitioner/pra-nurse-example</a> \"陳莉\"</p><p><b>最後一次已知反應發生的日期與時間</b>：2023-12-05T15:30:00</p><p><b>過敏或不耐受物質的不良反應紀錄</b>：</p><blockquote><p><b>過敏產生的特定物質或醫藥產品</b>：青黴素(Medicinal product containing penicillin and acting as antibacterial agent (product)) <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\">( <a href=\"http://snomed.info/sct\">SNOMED CT</a>#6369005)</span></p><p><b>與此事件相關的臨床症狀/體徵)</b>：Upper respiratory tract hypersensitivity reaction <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\">( <a href=\"http://snomed.info/sct\">SNOMED CT</a>#490008)</span></p><p><b>對整個過敏事件的描述</b>：呼吸急促、皮膚發紅</p><p><b>嚴重程度</b>：Severe <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\">( <a href=\"http://hl7.org/fhir/reaction-event-severity\">AllergyIntoleranceSeverity</a>#severe)</span></p><p><b>如何接觸到該物質</b>：口服(Oral use) <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\">( <a href=\"http://snomed.info/sct\">SNOMED CT</a>#26643006)</span></p><p><b>備註</b>：患者在服用青黴素後出現呼吸急促和皮膚發紅，症狀於2023年10月15日中午12:00發作</p></blockquote></div>"
},
"clinicalStatus" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical",
"code" : "active",
"display" : "Active"
}
],
"text" : "Active"
},
"verificationStatus" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/allergyintolerance-verification",
"code" : "confirmed",
"display" : "Confirmed"
}
],
"text" : "Confirmed"
},
"type" : "allergy",
"category" : [
"medication"
],
"criticality" : "high",
"code" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "91936005",
"display" : "Penicillin allergy"
}
],
"text" : "青黴素過敏"
},
"patient" : {
🔗 "reference" : "Patient/pat-example",
"display" : "陳加玲"
},
"onsetDateTime" : "2023-10-15T08:45:00Z",
"recordedDate" : "2023-10-15T12:00:00Z",
"recorder" : {
🔗 "reference" : "Practitioner/pra-dr-example",
"display" : "王依昇"
},
"asserter" : {
🔗 "reference" : "Practitioner/pra-nurse-example",
"display" : "陳莉"
},
"lastOccurrence" : "2023-10-15T12:00:00Z",
"note" : [
{
"text" : "患者對青黴素過敏，可能導致呼吸急促、皮膚發紅"
}
],
"reaction" : [
{
"substance" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "6369005",
"display" : "Medicinal product containing penicillin and acting as antibacterial agent (product)"
}
],
"text" : "青黴素"
},
"manifestation" : [
{
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "490008",
"display" : "Upper respiratory tract hypersensitivity reaction"
}
]
}
],
"description" : "呼吸急促、皮膚發紅",
"severity" : "severe",
"exposureRoute" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "26643006",
"display" : "Oral use"
}
],
"text" : "口服"
},
"note" : [
{
"text" : "患者在服用青黴素後出現呼吸急促和皮膚發紅，症狀於2023年10月15日中午12:00發作"
}
]
}
]
}