C-CDA on FHIR
1.2.0-ballot - CI Build United States of America flag

This page is part of the C-CDA on FHIR Implementation Guide (v1.2.0-ballot: STU 1 Ballot 4) based on FHIR R4. The current version which supercedes this version is 1.1.0. For a full list of available versions, see the Directory of published versions

Binary: FC-immunization

    
<entry typeCode="DRIV">
  <substanceAdministration classCode="SBADM" moodCode="EVN" negationInd="false">
    <templateId root="2.16.840.1.113883.10.20.22.4.52"/>
    <templateId root="2.16.840.1.113883.10.20.22.4.52" extension="2015-08-01"/>
    <!--identifier[0]->system identifier[0]->value -->
    <id root="e6f1ba43-c0ed-4b9b-9f12-f435d8ad8f92"/>
    <!--status-->
    <statusCode code="completed"/>
    <!--recorded-->
    <effectiveTime value="20100815"/>
    <consumable>
      <manufacturedProduct classCode="MANU">
        <templateId root="2.16.840.1.113883.10.20.22.4.54"/>
        <templateId root="2.16.840.1.113883.10.20.22.4.54" extension="2014-06-09"/>
        <manufacturedMaterial>
          <!-- vaccineCode->coding[0] -->
          <code code="88" codeSystem="2.16.840.1.113883.12.292" displayName="Influenza virus vaccine">
            <originalText>
              <reference value="#immunization1"/>
            </originalText>
          </code>
          <!-- lotNumber-->
          <lotNumberText>1</lotNumberText>
        </manufacturedMaterial>
      </manufacturedProduct>
    </consumable>
    <performer>
      <assignedEntity>
        <id root="2.16.840.1.113883.19.5.9999.456" extension="2981824"/>
        <addr nullFlavor="UNK">
          <streetAddressLine nullFlavor="NI"/>
          <city nullFlavor="NI"/>
          <country nullFlavor="NI"/>
        </addr>
        <telecom nullFlavor="UNK"/>
        <assignedPerson>
          <name>
            <given>Amanda</given>
            <family>Assigned</family>
          </name>
        </assignedPerson>
      </assignedEntity>
    </performer>
  </substanceAdministration>
</entry>