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11.7 Resource ImmunizationRecommendation - Content

Public Health and Emergency Response

Work Group

Maturity Level: 1

Trial Use

Compartments: Patient

A patient's point-in-time immunization and recommendation (i.e. forecasting a patient's immunization eligibility according to a published schedule) with optional supporting justification.

11.7.1 Scope and Usage

The ImmunizationRecommendation resource is intended to cover communication of a specified patient's immunization recommendations and status across all healthcare disciplines in all care settings and all regions.

Additionally, the ImmunizationRecommendation resource is expected to cover key concepts related to the querying of a patient's immunization recommendations and status. This resource - through consultation with the PHER work group - is believed to meet key use cases and information requirements as defined in the existing HL7 v3 POIZ domain and Immunization Domain Analysis Model.

11.7.2 Boundaries and Relationships

This resource references the following resources:

Allergy/Intolerance
Patient
Organization
Immunization
Observation

One of the considerations for this resource is if it is better for this resource to be a profile of the CarePlan resource, or if it is more appropriate for this to be a separate resource due to the number of immunization profile-specific data elements.

This resource is referenced by DiagnosticReport and Observation

Structure

Name	Flags	Card.	Type	Description & Constraints
ImmunizationRecommendation			DomainResource	Guidance or advice relating to an immunization Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
identifier	Σ	0..*	Identifier	Business identifier
patient	Σ	1..1	Reference(Patient)	Who this profile is for
recommendation	ΣI	1..*	BackboneElement	Vaccine administration recommendations + One of vaccineCode or targetDisease SHALL be present
date	Σ	1..1	dateTime	Date recommendation created
vaccineCode	Σ	0..1	CodeableConcept	Vaccine recommendation applies to Vaccine Administered Value Set (Example)
targetDisease	Σ	0..1	CodeableConcept	Disease to be immunized against Immunization Recommendation Target Disease Codes (Example)
doseNumber	Σ	0..1	positiveInt	Recommended dose number
forecastStatus	Σ	1..1	CodeableConcept	Vaccine administration status Immunization Recommendation Status Codes (Example)
dateCriterion		0..*	BackboneElement	Dates governing proposed immunization
code		1..1	CodeableConcept	Type of date Immunization Recommendation Date Criterion Codes (Example)
value		1..1	dateTime	Recommended date
protocol		0..1	BackboneElement	Protocol used by recommendation
doseSequence		0..1	positiveInt	Dose number within sequence
description		0..1	string	Protocol details
authority		0..1	Reference(Organization)	Who is responsible for protocol
series		0..1	string	Name of vaccination series
supportingImmunization		0..*	Reference(Immunization)	Past immunizations supporting recommendation
supportingPatientInformation		0..*	Reference(Observation \| AllergyIntolerance)	Patient observations supporting recommendation
Documentation for this format

UML Diagram (Legend)

XML Template

<ImmunizationRecommendation xmlns="http://hl7.org/fhir"> 
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Business identifier --></identifier>
 <patient><!-- 1..1 Reference(Patient) Who this profile is for --></patient>
 <recommendation>  <!-- 1..* Vaccine administration recommendations -->
  <date value="[dateTime]"/><!-- 1..1 Date recommendation created -->
  <vaccineCode><!-- 0..1 CodeableConcept Vaccine recommendation applies to --></vaccineCode>
  <targetDisease><!-- 0..1 CodeableConcept Disease to be immunized against --></targetDisease>
  <doseNumber value="[positiveInt]"/><!-- 0..1 Recommended dose number -->
  <forecastStatus><!-- 1..1 CodeableConcept Vaccine administration status --></forecastStatus>
  <dateCriterion>  <!-- 0..* Dates governing proposed immunization -->
   <code><!-- 1..1 CodeableConcept Type of date --></code>
   <value value="[dateTime]"/><!-- 1..1 Recommended date -->
  </dateCriterion>
  <protocol>  <!-- 0..1 Protocol used by recommendation -->
   <doseSequence value="[positiveInt]"/><!-- 0..1 Dose number within sequence -->
   <description value="[string]"/><!-- 0..1 Protocol details -->
   <authority><!-- 0..1 Reference(Organization) Who is responsible for protocol --></authority>
   <series value="[string]"/><!-- 0..1 Name of vaccination series -->
  </protocol>
  <supportingImmunization><!-- 0..* Reference(Immunization) Past immunizations supporting recommendation --></supportingImmunization>
  <supportingPatientInformation><!-- 0..* Reference(Observation|
    AllergyIntolerance) Patient observations supporting recommendation --></supportingPatientInformation>
 </recommendation>
</ImmunizationRecommendation>

JSON Template

{
  "resourceType" : "ImmunizationRecommendation",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Business identifier
  "patient" : { Reference(Patient) }, // R!  Who this profile is for
  "recommendation" : [{ // R!  Vaccine administration recommendations
    "date" : "<dateTime>", // R!  Date recommendation created
    "vaccineCode" : { CodeableConcept }, // Vaccine recommendation applies to
    "targetDisease" : { CodeableConcept }, // Disease to be immunized against
    "doseNumber" : "<positiveInt>", // Recommended dose number
    "forecastStatus" : { CodeableConcept }, // R!  Vaccine administration status
    "dateCriterion" : [{ // Dates governing proposed immunization
      "code" : { CodeableConcept }, // R!  Type of date
      "value" : "<dateTime>" // R!  Recommended date
    }],
    "protocol" : { // Protocol used by recommendation
      "doseSequence" : "<positiveInt>", // Dose number within sequence
      "description" : "<string>", // Protocol details
      "authority" : { Reference(Organization) }, // Who is responsible for protocol
      "series" : "<string>" // Name of vaccination series
    },
    "supportingImmunization" : [{ Reference(Immunization) }], // Past immunizations supporting recommendation
    "supportingPatientInformation" : [{ Reference(Observation|
    AllergyIntolerance) }] // Patient observations supporting recommendation
  }]
}

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .


[ a fhir:ImmunizationRecommendation;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:ImmunizationRecommendation.identifier [ Identifier ], ... ; # 0..* Business identifier
  fhir:ImmunizationRecommendation.patient [ Reference(Patient) ]; # 1..1 Who this profile is for
  fhir:ImmunizationRecommendation.recommendation [ # 1..* Vaccine administration recommendations
    fhir:ImmunizationRecommendation.recommendation.date [ dateTime ]; # 1..1 Date recommendation created
    fhir:ImmunizationRecommendation.recommendation.vaccineCode [ CodeableConcept ]; # 0..1 Vaccine recommendation applies to
    fhir:ImmunizationRecommendation.recommendation.targetDisease [ CodeableConcept ]; # 0..1 Disease to be immunized against
    fhir:ImmunizationRecommendation.recommendation.doseNumber [ positiveInt ]; # 0..1 Recommended dose number
    fhir:ImmunizationRecommendation.recommendation.forecastStatus [ CodeableConcept ]; # 1..1 Vaccine administration status
    fhir:ImmunizationRecommendation.recommendation.dateCriterion [ # 0..* Dates governing proposed immunization
      fhir:ImmunizationRecommendation.recommendation.dateCriterion.code [ CodeableConcept ]; # 1..1 Type of date
      fhir:ImmunizationRecommendation.recommendation.dateCriterion.value [ dateTime ]; # 1..1 Recommended date
    ], ...;
    fhir:ImmunizationRecommendation.recommendation.protocol [ # 0..1 Protocol used by recommendation
      fhir:ImmunizationRecommendation.recommendation.protocol.doseSequence [ positiveInt ]; # 0..1 Dose number within sequence
      fhir:ImmunizationRecommendation.recommendation.protocol.description [ string ]; # 0..1 Protocol details
      fhir:ImmunizationRecommendation.recommendation.protocol.authority [ Reference(Organization) ]; # 0..1 Who is responsible for protocol
      fhir:ImmunizationRecommendation.recommendation.protocol.series [ string ]; # 0..1 Name of vaccination series
    ];
    fhir:ImmunizationRecommendation.recommendation.supportingImmunization [ Reference(Immunization) ], ... ; # 0..* Past immunizations supporting recommendation
    fhir:ImmunizationRecommendation.recommendation.supportingPatientInformation [ Reference(Observation|AllergyIntolerance) ], ... ; # 0..* Patient observations supporting recommendation
  ], ...;
]

Changes since DSTU2

ImmunizationRecommendation

ImmunizationRecommendation.recommendation.vaccineCode

Min Cardinality changed from 1 to 0

ImmunizationRecommendation.recommendation.targetDisease

Added Element

ImmunizationRecommendation.recommendation.protocol.doseSequence

Type changed from integer to positiveInt

See the Full Difference for further information

This analysis is available as XML or JSON.

See R2 <--> R3 Conversion Maps (status = 1 test that all execute ok. All tests pass round-trip testing and all r3 resources are valid.).

Structure

Name	Flags	Card.	Type	Description & Constraints
ImmunizationRecommendation			DomainResource	Guidance or advice relating to an immunization Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
identifier	Σ	0..*	Identifier	Business identifier
patient	Σ	1..1	Reference(Patient)	Who this profile is for
recommendation	ΣI	1..*	BackboneElement	Vaccine administration recommendations + One of vaccineCode or targetDisease SHALL be present
date	Σ	1..1	dateTime	Date recommendation created
vaccineCode	Σ	0..1	CodeableConcept	Vaccine recommendation applies to Vaccine Administered Value Set (Example)
targetDisease	Σ	0..1	CodeableConcept	Disease to be immunized against Immunization Recommendation Target Disease Codes (Example)
doseNumber	Σ	0..1	positiveInt	Recommended dose number
forecastStatus	Σ	1..1	CodeableConcept	Vaccine administration status Immunization Recommendation Status Codes (Example)
dateCriterion		0..*	BackboneElement	Dates governing proposed immunization
code		1..1	CodeableConcept	Type of date Immunization Recommendation Date Criterion Codes (Example)
value		1..1	dateTime	Recommended date
protocol		0..1	BackboneElement	Protocol used by recommendation
doseSequence		0..1	positiveInt	Dose number within sequence
description		0..1	string	Protocol details
authority		0..1	Reference(Organization)	Who is responsible for protocol
series		0..1	string	Name of vaccination series
supportingImmunization		0..*	Reference(Immunization)	Past immunizations supporting recommendation
supportingPatientInformation		0..*	Reference(Observation \| AllergyIntolerance)	Patient observations supporting recommendation
Documentation for this format

UML Diagram (Legend)

XML Template

<ImmunizationRecommendation xmlns="http://hl7.org/fhir"> 
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Business identifier --></identifier>
 <patient><!-- 1..1 Reference(Patient) Who this profile is for --></patient>
 <recommendation>  <!-- 1..* Vaccine administration recommendations -->
  <date value="[dateTime]"/><!-- 1..1 Date recommendation created -->
  <vaccineCode><!-- 0..1 CodeableConcept Vaccine recommendation applies to --></vaccineCode>
  <targetDisease><!-- 0..1 CodeableConcept Disease to be immunized against --></targetDisease>
  <doseNumber value="[positiveInt]"/><!-- 0..1 Recommended dose number -->
  <forecastStatus><!-- 1..1 CodeableConcept Vaccine administration status --></forecastStatus>
  <dateCriterion>  <!-- 0..* Dates governing proposed immunization -->
   <code><!-- 1..1 CodeableConcept Type of date --></code>
   <value value="[dateTime]"/><!-- 1..1 Recommended date -->
  </dateCriterion>
  <protocol>  <!-- 0..1 Protocol used by recommendation -->
   <doseSequence value="[positiveInt]"/><!-- 0..1 Dose number within sequence -->
   <description value="[string]"/><!-- 0..1 Protocol details -->
   <authority><!-- 0..1 Reference(Organization) Who is responsible for protocol --></authority>
   <series value="[string]"/><!-- 0..1 Name of vaccination series -->
  </protocol>
  <supportingImmunization><!-- 0..* Reference(Immunization) Past immunizations supporting recommendation --></supportingImmunization>
  <supportingPatientInformation><!-- 0..* Reference(Observation|
    AllergyIntolerance) Patient observations supporting recommendation --></supportingPatientInformation>
 </recommendation>
</ImmunizationRecommendation>

JSON Template

{
  "resourceType" : "ImmunizationRecommendation",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Business identifier
  "patient" : { Reference(Patient) }, // R!  Who this profile is for
  "recommendation" : [{ // R!  Vaccine administration recommendations
    "date" : "<dateTime>", // R!  Date recommendation created
    "vaccineCode" : { CodeableConcept }, // Vaccine recommendation applies to
    "targetDisease" : { CodeableConcept }, // Disease to be immunized against
    "doseNumber" : "<positiveInt>", // Recommended dose number
    "forecastStatus" : { CodeableConcept }, // R!  Vaccine administration status
    "dateCriterion" : [{ // Dates governing proposed immunization
      "code" : { CodeableConcept }, // R!  Type of date
      "value" : "<dateTime>" // R!  Recommended date
    }],
    "protocol" : { // Protocol used by recommendation
      "doseSequence" : "<positiveInt>", // Dose number within sequence
      "description" : "<string>", // Protocol details
      "authority" : { Reference(Organization) }, // Who is responsible for protocol
      "series" : "<string>" // Name of vaccination series
    },
    "supportingImmunization" : [{ Reference(Immunization) }], // Past immunizations supporting recommendation
    "supportingPatientInformation" : [{ Reference(Observation|
    AllergyIntolerance) }] // Patient observations supporting recommendation
  }]
}

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .


[ a fhir:ImmunizationRecommendation;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:ImmunizationRecommendation.identifier [ Identifier ], ... ; # 0..* Business identifier
  fhir:ImmunizationRecommendation.patient [ Reference(Patient) ]; # 1..1 Who this profile is for
  fhir:ImmunizationRecommendation.recommendation [ # 1..* Vaccine administration recommendations
    fhir:ImmunizationRecommendation.recommendation.date [ dateTime ]; # 1..1 Date recommendation created
    fhir:ImmunizationRecommendation.recommendation.vaccineCode [ CodeableConcept ]; # 0..1 Vaccine recommendation applies to
    fhir:ImmunizationRecommendation.recommendation.targetDisease [ CodeableConcept ]; # 0..1 Disease to be immunized against
    fhir:ImmunizationRecommendation.recommendation.doseNumber [ positiveInt ]; # 0..1 Recommended dose number
    fhir:ImmunizationRecommendation.recommendation.forecastStatus [ CodeableConcept ]; # 1..1 Vaccine administration status
    fhir:ImmunizationRecommendation.recommendation.dateCriterion [ # 0..* Dates governing proposed immunization
      fhir:ImmunizationRecommendation.recommendation.dateCriterion.code [ CodeableConcept ]; # 1..1 Type of date
      fhir:ImmunizationRecommendation.recommendation.dateCriterion.value [ dateTime ]; # 1..1 Recommended date
    ], ...;
    fhir:ImmunizationRecommendation.recommendation.protocol [ # 0..1 Protocol used by recommendation
      fhir:ImmunizationRecommendation.recommendation.protocol.doseSequence [ positiveInt ]; # 0..1 Dose number within sequence
      fhir:ImmunizationRecommendation.recommendation.protocol.description [ string ]; # 0..1 Protocol details
      fhir:ImmunizationRecommendation.recommendation.protocol.authority [ Reference(Organization) ]; # 0..1 Who is responsible for protocol
      fhir:ImmunizationRecommendation.recommendation.protocol.series [ string ]; # 0..1 Name of vaccination series
    ];
    fhir:ImmunizationRecommendation.recommendation.supportingImmunization [ Reference(Immunization) ], ... ; # 0..* Past immunizations supporting recommendation
    fhir:ImmunizationRecommendation.recommendation.supportingPatientInformation [ Reference(Observation|AllergyIntolerance) ], ... ; # 0..* Patient observations supporting recommendation
  ], ...;
]

Changes since DSTU2

ImmunizationRecommendation

ImmunizationRecommendation.recommendation.vaccineCode

Min Cardinality changed from 1 to 0

ImmunizationRecommendation.recommendation.targetDisease

Added Element

ImmunizationRecommendation.recommendation.protocol.doseSequence

Type changed from integer to positiveInt

See the Full Difference for further information

This analysis is available as XML or JSON.

See R2 <--> R3 Conversion Maps (status = 1 test that all execute ok. All tests pass round-trip testing and all r3 resources are valid.).

Alternate definitions: Master Definition (XML, JSON), XML Schema/Schematron (for ) + JSON Schema, ShEx (for Turtle)

11.7.3.1 Terminology Bindings

Path	Definition	Type	Reference
ImmunizationRecommendation.recommendation.vaccineCode	The type of vaccine administered	Example	Vaccine Administered Value Set
ImmunizationRecommendation.recommendation.targetDisease	The disease that the recommended vaccination targets	Example	Immunization Recommendation Target Disease Codes
ImmunizationRecommendation.recommendation.forecastStatus	The patient's status with respect to a vaccination protocol	Example	Immunization Recommendation Status Codes
ImmunizationRecommendation.recommendation.dateCriterion.code	Classifies date criterion with respect to conveying information about a patient's vaccination status (e.g. due date, latest to give date, etc.)	Example	Immunization Recommendation Date Criterion Codes

Path

Definition

Type

Reference

ImmunizationRecommendation.recommendation.vaccineCode

The type of vaccine administered

Example

Vaccine Administered Value Set

ImmunizationRecommendation.recommendation.targetDisease

The disease that the recommended vaccination targets

Example

Immunization Recommendation Target Disease Codes

ImmunizationRecommendation.recommendation.forecastStatus

The patient's status with respect to a vaccination protocol

Example

Immunization Recommendation Status Codes

ImmunizationRecommendation.recommendation.dateCriterion.code

Classifies date criterion with respect to conveying information about a patient's vaccination status (e.g. due date, latest to give date, etc.)

Example

Immunization Recommendation Date Criterion Codes

11.7.3.2 Constraints

imr-1: On ImmunizationRecommendation.recommendation: One of vaccineCode or targetDisease SHALL be present (expression on ImmunizationRecommendation.recommendation: vaccineCode.exists() or targetDisease.exists())

11.7.4 Search Parameters

Search parameters for this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.

Name	Type	Description	Expression	In Common
date	date	Date recommendation created	ImmunizationRecommendation.recommendation.date
dose-number	number	Recommended dose number	ImmunizationRecommendation.recommendation.doseNumber
dose-sequence	number	Dose number within sequence	ImmunizationRecommendation.recommendation.protocol.doseSequence
identifier	token	Business identifier	ImmunizationRecommendation.identifier
information	reference	Patient observations supporting recommendation	ImmunizationRecommendation.recommendation.supportingPatientInformation (AllergyIntolerance, Observation)
patient	reference	Who this profile is for	ImmunizationRecommendation.patient (Patient)
status	token	Vaccine administration status	ImmunizationRecommendation.recommendation.forecastStatus
support	reference	Past immunizations supporting recommendation	ImmunizationRecommendation.recommendation.supportingImmunization (Immunization)
target-disease	token	Disease to be immunized against	ImmunizationRecommendation.recommendation.targetDisease
vaccine-type	token	Vaccine recommendation applies to	ImmunizationRecommendation.recommendation.vaccineCode