Profile_R2_Immunization_R4B - Definitions - Extensions for Using Data Elements from FHIR DSTU2 in FHIR R4B v0.1.0

Is Modifier false

Must Support false

Summary true

4. Immunization.meta

Definition

The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

Short Metadata about the resource

Control 0..1

Meta

Is Modifier false

Must Support false

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

6. Immunization.meta.id

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Short Unique id for inter-element referencing

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

8. Immunization.meta.extension

Definition

An Extension

Short Extension

Control 0..*

Is Modifier false

Summary false

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())

This element introduces a set of slices on Immunization.meta.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:

value @ url

10. Immunization.meta.extension:meta

Slice Name meta

Definition

DSTU2: Immunization.meta additional types (Meta) additional types from child elements (lastUpdated, profile, security, tag, versionId)

Short DSTU2: meta additional types

Comments

Element Immunization.meta is mapped to FHIR R4B element Immunization.meta as SourceIsBroaderThanTarget. The mappings for Immunization.meta do not cover the following types: Meta. The mappings for Immunization.meta do not cover the following types based on type expansion: lastUpdated, profile, security, tag, versionId.

Control 0..1

Type Extension(DSTU2: meta additional types) (Complex Extension)

Is Modifier false

12. Immunization.meta.versionId

Definition

The version specific identifier, as it appears in the version portion of the URL. This value changes when the resource is created, updated, or deleted.

Short Version specific identifier

Comments

The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes.

Control 0..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

14. Immunization.meta.lastUpdated

Definition

When the resource last changed - e.g. when the version changed.

Short When the resource version last changed

Comments

This value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant. This is equivalent to the HTTP Last-Modified and SHOULD have the same value on a read interaction.

Control 0..1

instant

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

16. Immunization.meta.source

Definition

A uri that identifies the source system of the resource. This provides a minimal amount of Provenance information that can be used to track or differentiate the source of information in the resource. The source may identify another FHIR server, document, message, database, etc.

Short Identifies where the resource comes from

Comments

In the provenance resource, this corresponds to Provenance.entity.what[x]. The exact use of the source (and the implied Provenance.entity.role) is left to implementer discretion. Only one nominated source is allowed; for additional provenance details, a full Provenance resource should be used.

This element can be used to indicate where the current master source of a resource that has a canonical URL if the resource is no longer hosted at the canonical URL.

Control 0..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

18. Immunization.meta.profile

Definition

A list of profiles (references to StructureDefinition resources) that this resource claims to conform to. The URL is a reference to StructureDefinition.url.

Short Profiles this resource claims to conform to

Comments

It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set.

Control 0..*

Type canonical(StructureDefinition)

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

20. Immunization.meta.security

Definition

Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure.

Short Security Labels applied to this resource

Comments

The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored.

Control 0..*

Binding Unless not suitable, these codes SHALL be taken from All Security Labels
(extensible to http://hl7.org/fhir/ValueSet/security-labels|4.3.0)

Coding

Is Modifier false

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

22. Immunization.meta.tag

Definition

Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource.

Short Tags applied to this resource

Comments

The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored.

Control 0..*

Binding For example codes, see CommonTags
(example to http://hl7.org/fhir/ValueSet/common-tags|4.3.0)

Coding

Is Modifier false

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

24. Immunization.implicitRules

Definition

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

Short A set of rules under which this content was created

Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

Control 0..1

Is Modifier true because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Must Support false

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

26. Immunization.language

Definition

The base language in which the resource is written.

Short Language of the resource content

Comments

Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

Control 0..1

Binding

The codes SHOULD be taken from CommonLanguages
(preferred to http://hl7.org/fhir/ValueSet/languages|4.3.0)

IETF language tag

Additional Bindings

Purpose

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Must Support false

Summary false

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

28. Immunization.text

Definition

A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

Short Text summary of the resource, for human interpretation

Comments

Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.

Control 0..1

Narrative

Is Modifier false

Must Support false

Summary false

Alternate Names narrative, html, xhtml, display

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

30. Immunization.text.id

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Short Unique id for inter-element referencing

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

32. Immunization.text.extension

Definition

An Extension

Short Extension

Control 0..*

Is Modifier false

Summary false

This element introduces a set of slices on Immunization.text.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:

value @ url

34. Immunization.text.extension:text

Slice Name text

Definition

DSTU2: Immunization.text additional types (Narrative) additional types from child elements (div, status)

Short DSTU2: text additional types

Comments

Element Immunization.text is mapped to FHIR R4B element Immunization.text as SourceIsBroaderThanTarget. The mappings for Immunization.text do not cover the following types: Narrative. The mappings for Immunization.text do not cover the following types based on type expansion: div, status. Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative.

Control 0..1

Type Extension(DSTU2: text additional types) (Complex Extension)

Is Modifier false

36. Immunization.text.status

Definition

The status of the narrative - whether it's entirely generated (from just the defined data or the extensions too), or whether a human authored it and it may contain additional data.

Short generated | extensions | additional | empty

Control 1..1

Binding The codes SHALL be taken from NarrativeStatus
(required to http://hl7.org/fhir/ValueSet/narrative-status|4.3.0)

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary false

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

38. Immunization.text.div

Definition

The actual narrative content, a stripped down version of XHTML.

Short Limited xhtml content

Comments

The contents of the html element are an XHTML fragment containing only the basic html formatting elements described in chapters 7-11 and 15 of the HTML 4.0 standard, <a> elements (either name or href), images and internally contained stylesheets. The XHTML content SHALL NOT contain a head, a body, external stylesheet references, scripts, forms, base/link/xlink, frames, iframes and objects.

Control 1..1

xhtml

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary false

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
txt-1: The narrative SHALL contain only the basic html formatting elements and attributes described in chapters 7-11 (except section 4 of chapter 9) and 15 of the HTML 4.0 standard, <a> elements (either name or href), images and internally contained style attributes (htmlChecks())
txt-2: The narrative SHALL have some non-whitespace content (htmlChecks())

40. Immunization.contained

Definition

These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

Short Contained, inline Resources

Comments

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

Control 0..*

Resource

Is Modifier false

Must Support false

Summary false

Alternate Names inline resources, anonymous resources, contained resources

Invariants dom-r4b: Containing new R4B resources within R4 resources may cause interoperability issues if instances are shared with R4 systems (($this is Citation or $this is Evidence or $this is EvidenceReport or $this is EvidenceVariable or $this is MedicinalProductDefinition or $this is PackagedProductDefinition or $this is AdministrableProductDefinition or $this is Ingredient or $this is ClinicalUseDefinition or $this is RegulatedAuthorization or $this is SubstanceDefinition or $this is SubscriptionStatus or $this is SubscriptionTopic) implies (%resource is Citation or %resource is Evidence or %resource is EvidenceReport or %resource is EvidenceVariable or %resource is MedicinalProductDefinition or %resource is PackagedProductDefinition or %resource is AdministrableProductDefinition or %resource is Ingredient or %resource is ClinicalUseDefinition or %resource is RegulatedAuthorization or %resource is SubstanceDefinition or %resource is SubscriptionStatus or %resource is SubscriptionTopic))

42. Immunization.extension

Definition

An Extension

Short Extension

Control 1..*

Is Modifier false

Must Support false

Summary false

This element introduces a set of slices on Immunization.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:

value @ url

44. Immunization.extension:reported

Slice Name reported

Definition

DSTU2: Immunization.reported (new:boolean)

Short DSTU2: Indicates a self-reported record (new)

Comments

Element Immunization.reported has a context of Immunization based on following the parent source element upwards and mapping to Immunization. Element Immunization.reported has no mapping targets in FHIR R4B. Typically, this is because the element has been added (is a new element). May need source of reported info (e.g. parent), but leave out for now.

Control 1..1
This element is affected by the following invariants: ele-1

Type Extension(DSTU2: Indicates a self-reported record (new)) (Extension Type: boolean)

Is Modifier false

Must Support false

Summary false

Invariants ele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())

46. Immunization.modifierExtension

Definition

An Extension

Short Extension

Control 0..*

Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them

Must Support false

Summary false

This element introduces a set of slices on Immunization.modifierExtension. The slices areUnordered and Open, and can be differentiated using the following discriminators:

value @ url

48. Immunization.modifierExtension:wasNotGiven

Slice Name wasNotGiven

Definition

DSTU2: Immunization.wasNotGiven additional types (boolean) additional types from child elements (value)

Short DSTU2: Flag for whether immunization was given additional types

Comments

Element Immunization.wasNotGiven is mapped to FHIR R4B element Immunization.status as SourceIsBroaderThanTarget. Element Immunization.wasNotGiven is mapped to FHIR R4B element Immunization.statusReason as SourceIsBroaderThanTarget. The mappings for Immunization.wasNotGiven do not cover the following types: boolean. The mappings for Immunization.wasNotGiven do not cover the following types based on type expansion: value.

Control 0..1
This element is affected by the following invariants: ele-1

Type Extension(DSTU2: Flag for whether immunization was given additional types) (Extension Type: boolean)

Is Modifier true because This extension is a modifier because the source element `Immunization.wasNotGiven` is flagged as a modifier element.

Must Support false

Summary false

50. Immunization.identifier

Definition

A unique identifier assigned to this immunization record.

Short Business identifier

Note This is a business identifier, not a resource identifier (see discussion)

Control 0..*

Is Modifier false

Must Support false

Summary false

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

52. Immunization.identifier.id

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Short Unique id for inter-element referencing

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

54. Immunization.identifier.extension

Definition

An Extension

Short Extension

Control 0..*

Is Modifier false

Summary false

This element introduces a set of slices on Immunization.identifier.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:

value @ url

56. Immunization.identifier.extension:identifier

Slice Name identifier

Definition

DSTU2: Immunization.identifier additional types (Identifier) additional types from child elements (assigner, period, system, type, use, value)

Short DSTU2: identifier additional types

Comments

Element Immunization.identifier is mapped to FHIR R4B element Immunization.identifier as SourceIsBroaderThanTarget. The mappings for Immunization.identifier do not cover the following types: Identifier. The mappings for Immunization.identifier do not cover the following types based on type expansion: assigner, period, system, type, use, value.

Control 0..*

Type Extension(DSTU2: identifier additional types) (Extension Type: Identifier)

Is Modifier false

Summary false

58. Immunization.identifier.use

Definition

The purpose of this identifier.

Short usual | official | temp | secondary | old (If known)

Comments

Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

Control 0..1

Binding The codes SHALL be taken from IdentifierUse
(required to http://hl7.org/fhir/ValueSet/identifier-use|4.3.0)

Is Modifier true because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Requirements

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

60. Immunization.identifier.type

Definition

A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

Short Description of identifier

Comments

This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

Control 0..1

Binding Unless not suitable, these codes SHALL be taken from Identifier Type Codes
(extensible to http://hl7.org/fhir/ValueSet/identifier-type|4.3.0)

Is Modifier false

Summary true

Requirements

Allows users to make use of identifiers when the identifier system is not known.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

62. Immunization.identifier.system

Definition

Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

Short The namespace for the identifier value

Comments

Identifier.system is always case sensitive.

Control 0..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Requirements

There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

Example General: http://www.acme.com/identifiers/patient

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

64. Immunization.identifier.value

Definition

The portion of the identifier typically relevant to the user and which is unique within the context of the system.

Short The value that is unique

Comments

If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

Control 0..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Example General: 123456

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

66. Immunization.identifier.period

Definition

Time period during which identifier is/was valid for use.

Short Time period when id is/was valid for use

Control 0..1

Period

Is Modifier false

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

68. Immunization.identifier.assigner

Definition

Organization that issued/manages the identifier.

Short Organization that issued id (may be just text)

Comments

The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

Control 0..1

Type Reference(Organization)

Is Modifier false

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

70. Immunization.status

Definition

Indicates the current status of the immunization event.

Short completed | entered-in-error | not-done

Comments

Will generally be set to show that the immunization has been completed or not done. This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

Control 1..1

Binding The codes SHALL be taken from ImmunizationStatusCodes
(required to http://hl7.org/fhir/ValueSet/immunization-status|4.3.0)

Is Modifier true because This element is labeled as a modifier because it is a status element that contains statuses entered-in-error and not-done which means that the resource should not be treated as valid

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Must Support false

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

72. Immunization.status.id

Definition

unique id for the element within a resource (for internal references)

Short xml:id (or equivalent in JSON)

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

74. Immunization.status.extension

Definition

An Extension

Short Extension

Control 0..*

Is Modifier false

Summary false

This element introduces a set of slices on Immunization.status.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:

value @ url

76. Immunization.status.extension:status

Slice Name status

Definition

DSTU2: Immunization.status additional codes

Short DSTU2: in-progress | on-hold | completed | entered-in-error | stopped additional codes

Comments

Element Immunization.status is mapped to FHIR R4B element Immunization.status as RelatedTo. The mappings for Immunization.status do not allow expression of the necessary codes, per the bindings on the source and target. The target context Immunization.status is a modifier element, so this extension does not need to be defined as a modifier. Will generally be set to show that the immunization has been completed.

Control 0..1
This element is affected by the following invariants: ele-1

Type Extension(DSTU2: in-progress | on-hold | completed | entered-in-error | stopped additional codes) (Extension Type: code)

Is Modifier false

Summary false

78. Immunization.status.value

Definition

Primitive value for code

Short Primitive value for code

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

80. Immunization.statusReason

Definition

Indicates the reason the immunization event was not performed.

Short Reason not done

Comments

This is generally only used for the status of "not-done". The reason for performing the immunization event is captured in reasonCode, not here.

Control 0..1

Binding For example codes, see ImmunizationStatusReasonCodes
(example to http://hl7.org/fhir/ValueSet/immunization-status-reason|4.3.0)

Is Modifier false

Must Support false

Summary false

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

82. Immunization.vaccineCode

Definition

Vaccine that was administered or was to be administered.

Short Vaccine product administered

Control 1..1

Binding For example codes, see VaccineAdministeredValueSet
(example to http://hl7.org/fhir/ValueSet/vaccine-code|4.3.0)

Is Modifier false

Must Support false

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

84. Immunization.patient

Definition

The patient who either received or did not receive the immunization.

Short Who was immunized

Control 1..1

Type Reference(Patient)

Is Modifier false

Must Support false

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

86. Immunization.patient.id

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Short Unique id for inter-element referencing

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

88. Immunization.patient.extension

Definition

An Extension

Short Extension

Control 0..*

Is Modifier false

Summary false

This element introduces a set of slices on Immunization.patient.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:

value @ url

90. Immunization.patient.extension:patient

Slice Name patient

Definition

DSTU2: Immunization.patient additional types from child elements (display, reference)

Short DSTU2: patient additional types

Comments

Element Immunization.patient is mapped to FHIR R4B element Immunization.patient as SourceIsBroaderThanTarget. The mappings for Immunization.patient do not cover the following types based on type expansion: display, reference. The standard extension alternate-reference has been mapped as the representation of FHIR DSTU2 element Immunization.patient with unmapped reference targets: Patient.

Control 0..1

Type Extension(Alternate Reference) (Extension Type: Reference(Resource))

Is Modifier false

Summary false

92. Immunization.patient.reference

Definition

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Short Literal reference, Relative, internal or absolute URL

Comments

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

Control 0..1
This element is affected by the following invariants: ref-1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

94. Immunization.patient.type

Definition

The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

Short Type the reference refers to (e.g. "Patient")

Comments

This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

Control 0..1

Binding Unless not suitable, these codes SHALL be taken from ResourceType
(extensible to http://hl7.org/fhir/ValueSet/resource-types|4.3.0)

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

96. Immunization.patient.identifier

Definition

An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

Short Logical reference, when literal reference is not known

Comments

When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

Note This is a business identifier, not a resource identifier (see discussion)

Control 0..1

Is Modifier false

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

98. Immunization.patient.display

Definition

Plain text narrative that identifies the resource in addition to the resource reference.

Short Text alternative for the resource

Comments

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

Control 0..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

100. Immunization.encounter

Definition

The visit or admission or other contact between patient and health care provider the immunization was performed as part of.

Short Encounter immunization was part of

Control 0..1

Type Reference(Encounter)

Is Modifier false

Must Support false

Summary false

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

102. Immunization.encounter.id

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Short Unique id for inter-element referencing

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

104. Immunization.encounter.extension

Definition

An Extension

Short Extension

Control 0..*

Is Modifier false

Summary false

This element introduces a set of slices on Immunization.encounter.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:

value @ url

106. Immunization.encounter.extension:encounter

Slice Name encounter

Definition

DSTU2: Immunization.encounter additional types from child elements (display, reference)

Short DSTU2: Encounter administered as part of additional types

Comments

Element Immunization.encounter is mapped to FHIR R4B element Immunization.encounter as SourceIsBroaderThanTarget. The mappings for Immunization.encounter do not cover the following types based on type expansion: display, reference. The standard extension alternate-reference has been mapped as the representation of FHIR DSTU2 element Immunization.encounter with unmapped reference targets: Encounter.

Control 0..1

Type Extension(Alternate Reference) (Extension Type: Reference(Resource))

Is Modifier false

Summary false

108. Immunization.encounter.reference

Definition

Short Literal reference, Relative, internal or absolute URL

Comments

Control 0..1
This element is affected by the following invariants: ref-1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

110. Immunization.encounter.type

Definition

The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

Short Type the reference refers to (e.g. "Patient")

Comments

Control 0..1

Binding Unless not suitable, these codes SHALL be taken from ResourceType
(extensible to http://hl7.org/fhir/ValueSet/resource-types|4.3.0)

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

112. Immunization.encounter.identifier

Definition

Short Logical reference, when literal reference is not known

Comments

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Note This is a business identifier, not a resource identifier (see discussion)

Control 0..1

Is Modifier false

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

114. Immunization.encounter.display

Definition

Plain text narrative that identifies the resource in addition to the resource reference.

Short Text alternative for the resource

Comments

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

Control 0..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

116. Immunization.occurrence[x]

Definition

Date vaccine administered or was to be administered.

Short Vaccine administration date

Comments

When immunizations are given a specific date and time should always be known. When immunizations are patient reported, a specific date might not be known. Although partial dates are allowed, an adult patient might not be able to recall the year a childhood immunization was given. An exact date is always preferable, but the use of the String data type is acceptable when an exact date is not known. A small number of vaccines (e.g. live oral typhoid vaccine) are given as a series of patient self-administered dose over a span of time. In cases like this, often, only the first dose (typically a provider supervised dose) is recorded with the occurrence indicating the date/time of the first dose.

Control 1..1

Type Choice of: dateTime, string

[x] Note SeeChoice of Data Typesfor further information about how to use [x]

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Must Support false

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

118. Immunization.recorded

Definition

The date the occurrence of the immunization was first captured in the record - potentially significantly after the occurrence of the event.

Short When the immunization was first captured in the subject's record

Control 0..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Must Support false

Summary false

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

120. Immunization.primarySource

Definition

An indication that the content of the record is based on information from the person who administered the vaccine. This reflects the context under which the data was originally recorded.

Short Indicates context the data was recorded in

Comments

Reflects the “reliability” of the content.

Control 0..1

boolean

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Must Support false

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

122. Immunization.reportOrigin

Definition

The source of the data when the report of the immunization event is not based on information from the person who administered the vaccine.

Short Indicates the source of a secondarily reported record

Comments

Should not be populated if primarySource = True, not required even if primarySource = False.

Control 0..1

Binding For example codes, see ImmunizationOriginCodes
(example to http://hl7.org/fhir/ValueSet/immunization-origin|4.3.0)

Is Modifier false

Must Support false

Summary false

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

124. Immunization.location

Definition

The service delivery location where the vaccine administration occurred.

Short Where immunization occurred

Control 0..1

Type Reference(Location)

Is Modifier false

Must Support false

Summary false

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

126. Immunization.location.id

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Short Unique id for inter-element referencing

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

128. Immunization.location.extension

Definition

An Extension

Short Extension

Control 0..*

Is Modifier false

Summary false

This element introduces a set of slices on Immunization.location.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:

value @ url

130. Immunization.location.extension:location

Slice Name location

Definition

DSTU2: Immunization.location additional types from child elements (display, reference)

Short DSTU2: Where vaccination occurred additional types

Comments

Element Immunization.location is mapped to FHIR R4B element Immunization.location as SourceIsBroaderThanTarget. The mappings for Immunization.location do not cover the following types based on type expansion: display, reference. The standard extension alternate-reference has been mapped as the representation of FHIR DSTU2 element Immunization.location with unmapped reference targets: Location.

Control 0..1

Type Extension(Alternate Reference) (Extension Type: Reference(Resource))

Is Modifier false

Summary false

132. Immunization.location.reference

Definition

Short Literal reference, Relative, internal or absolute URL

Comments

Control 0..1
This element is affected by the following invariants: ref-1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

134. Immunization.location.type

Definition

The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

Short Type the reference refers to (e.g. "Patient")

Comments

Control 0..1

Binding Unless not suitable, these codes SHALL be taken from ResourceType
(extensible to http://hl7.org/fhir/ValueSet/resource-types|4.3.0)

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

136. Immunization.location.identifier

Definition

Short Logical reference, when literal reference is not known

Comments

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Note This is a business identifier, not a resource identifier (see discussion)

Control 0..1

Is Modifier false

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

138. Immunization.location.display

Definition

Plain text narrative that identifies the resource in addition to the resource reference.

Short Text alternative for the resource

Comments

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

Control 0..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

140. Immunization.manufacturer

Definition

Name of vaccine manufacturer.

Short Vaccine manufacturer

Control 0..1

Type Reference(Organization)

Is Modifier false

Must Support false

Summary false

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

142. Immunization.manufacturer.id

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Short Unique id for inter-element referencing

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

144. Immunization.manufacturer.extension

Definition

An Extension

Short Extension

Control 0..*

Is Modifier false

Summary false

This element introduces a set of slices on Immunization.manufacturer.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:

value @ url

146. Immunization.manufacturer.extension:manufacturer

Slice Name manufacturer

Definition

DSTU2: Immunization.manufacturer additional types from child elements (display, reference)

Short DSTU2: manufacturer additional types

Comments

Element Immunization.manufacturer is mapped to FHIR R4B element Immunization.manufacturer as SourceIsBroaderThanTarget. The mappings for Immunization.manufacturer do not cover the following types based on type expansion: display, reference. The standard extension alternate-reference has been mapped as the representation of FHIR DSTU2 element Immunization.manufacturer with unmapped reference targets: Organization.

Control 0..1

Type Extension(Alternate Reference) (Extension Type: Reference(Resource))

Is Modifier false

Summary false

148. Immunization.manufacturer.reference

Definition

Short Literal reference, Relative, internal or absolute URL

Comments

Control 0..1
This element is affected by the following invariants: ref-1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

150. Immunization.manufacturer.type

Definition

The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

Short Type the reference refers to (e.g. "Patient")

Comments

Control 0..1

Binding Unless not suitable, these codes SHALL be taken from ResourceType
(extensible to http://hl7.org/fhir/ValueSet/resource-types|4.3.0)

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

152. Immunization.manufacturer.identifier

Definition

Short Logical reference, when literal reference is not known

Comments

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Note This is a business identifier, not a resource identifier (see discussion)

Control 0..1

Is Modifier false

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

154. Immunization.manufacturer.display

Definition

Plain text narrative that identifies the resource in addition to the resource reference.

Short Text alternative for the resource

Comments

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

Control 0..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

156. Immunization.lotNumber

Definition

Lot number of the vaccine product.

Short Vaccine lot number

Control 0..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Must Support false

Summary false

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

158. Immunization.expirationDate

Definition

Date vaccine batch expires.

Short Vaccine expiration date

Control 0..1

date

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Must Support false

Summary false

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

160. Immunization.site

Definition

Body site where vaccine was administered.

Short Body site vaccine was administered

Control 0..1

Binding For example codes, see CodesForImmunizationSiteOfAdministration
(example to http://hl7.org/fhir/ValueSet/immunization-site|4.3.0)

Is Modifier false

Must Support false

Summary false

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

162. Immunization.route

Definition

The path by which the vaccine product is taken into the body.

Short How vaccine entered body

Control 0..1

Binding For example codes, see ImmunizationRouteCodes
(example to http://hl7.org/fhir/ValueSet/immunization-route|4.3.0)

Is Modifier false

Must Support false

Summary false

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

164. Immunization.doseQuantity

Definition

The quantity of vaccine product that was administered.

Short Amount of vaccine administered

Control 0..1

Type Quantity(SimpleQuantity)

Is Modifier false

Must Support false

Summary false

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

166. Immunization.performer

Definition

Indicates who performed the immunization event.

Short Who performed event

Control 0..*

Is Modifier false

Must Support false

Summary true

Invariants ele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)

168. Immunization.performer.id

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Short Unique id for inter-element referencing

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

170. Immunization.performer.extension

Definition

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Short Additional content defined by implementations

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control 0..*

Is Modifier false

Summary false

Alternate Names extensions, user content

172. Immunization.performer.modifierExtension

Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Short Extensions that cannot be ignored even if unrecognized

Comments

Control 0..*

Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them

Summary true

Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Names extensions, user content, modifiers

174. Immunization.performer.function

Definition

Describes the type of performance (e.g. ordering provider, administering provider, etc.).

Short What type of performance was done

Control 0..1

Binding Unless not suitable, these codes SHALL be taken from ImmunizationFunctionCodes
(extensible to http://hl7.org/fhir/ValueSet/immunization-function|4.3.0)

Is Modifier false

Must Support false

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

176. Immunization.performer.actor

Definition

The practitioner or organization who performed the action.

Short Individual or organization who was performing

Comments

When the individual practitioner who performed the action is known, it is best to send.

Control 1..1

Type Reference(Practitioner, PractitionerRole, Organization)

Is Modifier false

Must Support false

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

178. Immunization.performer.actor.id

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Short Unique id for inter-element referencing

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

180. Immunization.performer.actor.extension

Definition

An Extension

Short Extension

Control 0..*

Is Modifier false

Summary false

This element introduces a set of slices on Immunization.performer.actor.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:

value @ url

182. Immunization.performer.actor.extension:performer

Slice Name performer

Definition

DSTU2: Immunization.performer additional types from child elements (display, reference)

Short DSTU2: Who administered vaccine additional types

Comments

Element Immunization.performer is mapped to FHIR R4B element Immunization.performer.actor as RelatedTo. The mappings for Immunization.performer do not cover the following types based on type expansion: display, reference. The standard extension alternate-reference has been mapped as the representation of FHIR DSTU2 element Immunization.performer with unmapped reference targets: Practitioner.

Control 0..1

Type Extension(Alternate Reference) (Extension Type: Reference(Resource))

Is Modifier false

Summary false

184. Immunization.performer.actor.extension:requester

Slice Name requester

Definition

DSTU2: Immunization.requester additional types from child elements (display, reference)

Short DSTU2: Who ordered vaccination additional types

Comments

Element Immunization.requester is mapped to FHIR R4B element Immunization.performer.actor as RelatedTo. The mappings for Immunization.requester do not cover the following types based on type expansion: display, reference. The standard extension alternate-reference has been mapped as the representation of FHIR DSTU2 element Immunization.requester with unmapped reference targets: Practitioner. Other participants - delegate to Provenance resource.

Control 0..1

Type Extension(Alternate Reference) (Extension Type: Reference(Resource))

Is Modifier false

Summary false

186. Immunization.performer.actor.reference

Definition

Short Literal reference, Relative, internal or absolute URL

Comments

Control 0..1
This element is affected by the following invariants: ref-1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

188. Immunization.performer.actor.type

Definition

The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

Short Type the reference refers to (e.g. "Patient")

Comments

Control 0..1

Binding Unless not suitable, these codes SHALL be taken from ResourceType
(extensible to http://hl7.org/fhir/ValueSet/resource-types|4.3.0)

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

190. Immunization.performer.actor.identifier

Definition

Short Logical reference, when literal reference is not known

Comments

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Note This is a business identifier, not a resource identifier (see discussion)

Control 0..1

Is Modifier false

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

192. Immunization.performer.actor.display

Definition

Plain text narrative that identifies the resource in addition to the resource reference.

Short Text alternative for the resource

Comments

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

Control 0..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

194. Immunization.note

Definition

Extra information about the immunization that is not conveyed by the other attributes.

Short Additional immunization notes

Control 0..*

Annotation

Is Modifier false

Must Support false

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

196. Immunization.note.id

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Short Unique id for inter-element referencing

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

198. Immunization.note.extension

Definition

An Extension

Short Extension

Control 0..*

Is Modifier false

Summary false

This element introduces a set of slices on Immunization.note.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:

value @ url

200. Immunization.note.extension:note

Slice Name note

Definition

DSTU2: Immunization.note additional types (Annotation) additional types from child elements (author[x], text, time)

Short DSTU2: Vaccination notes additional types

Comments

Element Immunization.note is mapped to FHIR R4B element Immunization.note as SourceIsBroaderThanTarget. The mappings for Immunization.note do not cover the following types: Annotation. The mappings for Immunization.note do not cover the following types based on type expansion: author[x], text, time.

Control 0..*

Type Extension(DSTU2: Vaccination notes additional types) (Extension Type: Annotation)

Is Modifier false

Summary false

202. Immunization.note.author[x]

Definition

The individual responsible for making the annotation.

Short Individual responsible for the annotation

Comments

Organization is used when there's no need for specific attribution as to who made the comment.

Control 0..1

Type Choice of: Reference(Practitioner, Patient, RelatedPerson, Organization), string

[x] Note SeeChoice of Data Typesfor further information about how to use [x]

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

204. Immunization.note.time

Definition

Indicates when this particular annotation was made.

Short When the annotation was made

Control 0..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

206. Immunization.note.text

Definition

The text of the annotation in markdown format.

Short The annotation - text content (as markdown)

Control 1..1

markdown

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

208. Immunization.reasonCode

Definition

Reasons why the vaccine was administered.

Short Why immunization occurred

Control 0..*

Binding For example codes, see ImmunizationReasonCodes
(example to http://hl7.org/fhir/ValueSet/immunization-reason|4.3.0)

Is Modifier false

Must Support false

Summary false

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

210. Immunization.reasonReference

Definition

Condition, Observation or DiagnosticReport that supports why the immunization was administered.

Short Why immunization occurred

Control 0..*

Type Reference(Condition, Observation, DiagnosticReport)

Is Modifier false

Must Support false

Summary false

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

212. Immunization.isSubpotent

Definition

Indication if a dose is considered to be subpotent. By default, a dose should be considered to be potent.

Short Dose potency

Comments

Typically, the recognition of the dose being sub-potent is retrospective, after the administration (ex. notification of a manufacturer recall after administration). However, in the case of a partial administration (the patient moves unexpectedly and only some of the dose is actually administered), subpotency may be recognized immediately, but it is still important to record the event.

Control 0..1

boolean

Is Modifier true because This element is labeled as a modifier because an immunization event with a subpotent vaccine doesn't protect the patient the same way as a potent dose.

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Must Support false

Summary true

Meaning if Missing By default, a dose should be considered to be potent.

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

214. Immunization.subpotentReason

Definition

Reason why a dose is considered to be subpotent.

Short Reason for being subpotent

Control 0..*

Binding

For example codes, see ImmunizationSubpotentReason
(example to http://hl7.org/fhir/ValueSet/immunization-subpotent-reason|4.3.0)

The reason why a dose is considered to be subpotent.

Is Modifier false

Must Support false

Summary false

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

216. Immunization.education

Definition

Educational material presented to the patient (or guardian) at the time of vaccine administration.

Short Educational material presented to patient

Control 0..*

Is Modifier false

Must Support false

Summary false

Invariants ele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
imm-1: One of documentType or reference SHALL be present (documentType.exists() or reference.exists())

218. Immunization.education.id

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Short Unique id for inter-element referencing

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

220. Immunization.education.extension

Definition

Short Additional content defined by implementations

Comments

Control 0..*

Is Modifier false

Summary false

Alternate Names extensions, user content

222. Immunization.education.modifierExtension

Definition

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Short Extensions that cannot be ignored even if unrecognized

Comments

Control 0..*

Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them

Summary true

Requirements

Alternate Names extensions, user content, modifiers

224. Immunization.education.documentType

Definition

Identifier of the material presented to the patient.

Short Educational material document identifier

Control 0..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Must Support false

Summary false

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

226. Immunization.education.reference

Definition

Reference pointer to the educational material given to the patient if the information was on line.

Short Educational material reference pointer

Control 0..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Must Support false

Summary false

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

228. Immunization.education.publicationDate

Definition

Date the educational material was published.

Short Educational material publication date

Control 0..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Must Support false

Summary false

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

230. Immunization.education.presentationDate

Definition

Date the educational material was given to the patient.

Short Educational material presentation date

Control 0..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Must Support false

Summary false

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

232. Immunization.programEligibility

Definition

Indicates a patient's eligibility for a funding program.

Short Patient eligibility for a vaccination program

Control 0..*

Binding For example codes, see ImmunizationProgramEligibility
(example to http://hl7.org/fhir/ValueSet/immunization-program-eligibility|4.3.0)

Is Modifier false

Must Support false

Summary false

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

234. Immunization.fundingSource

Definition

Indicates the source of the vaccine actually administered. This may be different than the patient eligibility (e.g. the patient may be eligible for a publically purchased vaccine but due to inventory issues, vaccine purchased with private funds was actually administered).

Short Funding source for the vaccine

Control 0..1

Binding For example codes, see ImmunizationFundingSource
(example to http://hl7.org/fhir/ValueSet/immunization-funding-source|4.3.0)

Is Modifier false

Must Support false

Summary false

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

236. Immunization.reaction

Definition

Categorical data indicating that an adverse event is associated in time to an immunization.

Short Details of a reaction that follows immunization

Comments

A reaction may be an indication of an allergy or intolerance and, if this is determined to be the case, it should be recorded as a new AllergyIntolerance resource instance as most systems will not query against past Immunization.reaction elements.

Control 0..*

Is Modifier false

Must Support false

Summary false

Invariants ele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)

238. Immunization.reaction.id

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Short Unique id for inter-element referencing

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

240. Immunization.reaction.extension

Definition

Short Additional content defined by implementations

Comments

Control 0..*

Is Modifier false

Summary false

Alternate Names extensions, user content

242. Immunization.reaction.modifierExtension

Definition

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Short Extensions that cannot be ignored even if unrecognized

Comments

Control 0..*

Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them

Summary true

Requirements

Alternate Names extensions, user content, modifiers

244. Immunization.reaction.date

Definition

Date of reaction to the immunization.

Short When reaction started

Control 0..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Must Support false

Summary false

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

246. Immunization.reaction.detail

Definition

Details of the reaction.

Short Additional information on reaction

Control 0..1

Type Reference(Observation)

Is Modifier false

Must Support false

Summary false

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

248. Immunization.reaction.detail.id

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Short Unique id for inter-element referencing

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

250. Immunization.reaction.detail.extension

Definition

An Extension

Short Extension

Control 0..*

Is Modifier false

Summary false

This element introduces a set of slices on Immunization.reaction.detail.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:

value @ url

252. Immunization.reaction.detail.extension:detail

Slice Name detail

Definition

DSTU2: Immunization.reaction.detail additional types from child elements (display, reference)

Short DSTU2: detail additional types

Comments

Element Immunization.reaction.detail is mapped to FHIR R4B element Immunization.reaction.detail as SourceIsBroaderThanTarget. The mappings for Immunization.reaction.detail do not cover the following types based on type expansion: display, reference. The standard extension alternate-reference has been mapped as the representation of FHIR DSTU2 element Immunization.reaction.detail with unmapped reference targets: Observation.

Control 0..1

Type Extension(Alternate Reference) (Extension Type: Reference(Resource))

Is Modifier false

Summary false

254. Immunization.reaction.detail.reference

Definition

Short Literal reference, Relative, internal or absolute URL

Comments

Control 0..1
This element is affected by the following invariants: ref-1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

256. Immunization.reaction.detail.type

Definition

The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

Short Type the reference refers to (e.g. "Patient")

Comments

Control 0..1

Binding Unless not suitable, these codes SHALL be taken from ResourceType
(extensible to http://hl7.org/fhir/ValueSet/resource-types|4.3.0)

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

258. Immunization.reaction.detail.identifier

Definition

Short Logical reference, when literal reference is not known

Comments

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Note This is a business identifier, not a resource identifier (see discussion)

Control 0..1

Is Modifier false

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

260. Immunization.reaction.detail.display

Definition

Plain text narrative that identifies the resource in addition to the resource reference.

Short Text alternative for the resource

Comments

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

Control 0..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

262. Immunization.reaction.reported

Definition

Self-reported indicator.

Short Indicates self-reported reaction

Control 0..1

boolean

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Must Support false

Summary false

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

264. Immunization.protocolApplied

Definition

The protocol (set of recommendations) being followed by the provider who administered the dose.

Short Protocol followed by the provider

Control 0..*

Is Modifier false

Must Support false

Summary false

Invariants ele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)

266. Immunization.protocolApplied.id

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Short Unique id for inter-element referencing

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

268. Immunization.protocolApplied.extension

Definition

An Extension

Short Extension

Control 1..*

Is Modifier false

Summary false

This element introduces a set of slices on Immunization.protocolApplied.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:

value @ url

270. Immunization.protocolApplied.extension:description

Slice Name description

Definition

DSTU2: Immunization.vaccinationProtocol.description (new:string)

Short DSTU2: Details of vaccine protocol (new)

Comments

Element Immunization.vaccinationProtocol.description has a context of Immunization.protocolApplied based on following the parent source element upwards and mapping to Immunization. Element Immunization.vaccinationProtocol.description has no mapping targets in FHIR R4B. Typically, this is because the element has been added (is a new element).

Control 0..1
This element is affected by the following invariants: ele-1

Type Extension(DSTU2: Details of vaccine protocol (new)) (Extension Type: string)

Is Modifier false

Summary false

272. Immunization.protocolApplied.extension:doseStatus

Slice Name doseStatus

Definition

DSTU2: Immunization.vaccinationProtocol.doseStatus (new:CodeableConcept)

Short DSTU2: Indicates if dose counts towards immunity (new)

Comments

Element Immunization.vaccinationProtocol.doseStatus has a context of Immunization.protocolApplied based on following the parent source element upwards and mapping to Immunization. Element Immunization.vaccinationProtocol.doseStatus has no mapping targets in FHIR R4B. Typically, this is because the element has been added (is a new element). May need to differentiate between status declarations by a provider vs. a CDS engine.

Control 1..1
This element is affected by the following invariants: ele-1

Type Extension(DSTU2: Indicates if dose counts towards immunity (new)) (Extension Type: CodeableConcept)

Is Modifier false

Summary false

274. Immunization.protocolApplied.extension:doseStatusReason

Slice Name doseStatusReason

Definition

DSTU2: Immunization.vaccinationProtocol.doseStatusReason (new:CodeableConcept)

Short DSTU2: Why dose does (not) count (new)

Comments

Element Immunization.vaccinationProtocol.doseStatusReason has a context of Immunization.protocolApplied based on following the parent source element upwards and mapping to Immunization. Element Immunization.vaccinationProtocol.doseStatusReason has no mapping targets in FHIR R4B. Typically, this is because the element has been added (is a new element).

Control 0..1
This element is affected by the following invariants: ele-1

Type Extension(DSTU2: Why dose does (not) count (new)) (Extension Type: CodeableConcept)

Is Modifier false

Summary false

276. Immunization.protocolApplied.modifierExtension

Definition

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Short Extensions that cannot be ignored even if unrecognized

Comments

Control 0..*

Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them

Summary true

Requirements

Alternate Names extensions, user content, modifiers

278. Immunization.protocolApplied.series

Definition

One possible path to achieve presumed immunity against a disease - within the context of an authority.

Short Name of vaccine series

Control 0..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Must Support false

Summary false

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

280. Immunization.protocolApplied.authority

Definition

Indicates the authority who published the protocol (e.g. ACIP) that is being followed.

Short Who is responsible for publishing the recommendations

Control 0..1

Type Reference(Organization)

Is Modifier false

Must Support false

Summary false

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

282. Immunization.protocolApplied.authority.id

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Short Unique id for inter-element referencing

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

284. Immunization.protocolApplied.authority.extension

Definition

An Extension

Short Extension

Control 0..*

Is Modifier false

Summary false

This element introduces a set of slices on Immunization.protocolApplied.authority.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:

value @ url

286. Immunization.protocolApplied.authority.extension:authority

Slice Name authority

Definition

DSTU2: Immunization.vaccinationProtocol.authority additional types from child elements (display, reference)

Short DSTU2: Who is responsible for protocol additional types

Comments

Element Immunization.vaccinationProtocol.authority is mapped to FHIR R4B element Immunization.protocolApplied.authority as SourceIsBroaderThanTarget. The mappings for Immunization.vaccinationProtocol.authority do not cover the following types based on type expansion: display, reference. The standard extension alternate-reference has been mapped as the representation of FHIR DSTU2 element Immunization.vaccinationProtocol.authority with unmapped reference targets: Organization.

Control 0..1

Type Extension(Alternate Reference) (Extension Type: Reference(Resource))

Is Modifier false

Summary false

288. Immunization.protocolApplied.authority.reference

Definition

Short Literal reference, Relative, internal or absolute URL

Comments

Control 0..1
This element is affected by the following invariants: ref-1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

290. Immunization.protocolApplied.authority.type

Definition

The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

Short Type the reference refers to (e.g. "Patient")

Comments

Control 0..1

Binding Unless not suitable, these codes SHALL be taken from ResourceType
(extensible to http://hl7.org/fhir/ValueSet/resource-types|4.3.0)

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

292. Immunization.protocolApplied.authority.identifier

Definition

Short Logical reference, when literal reference is not known

Comments

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Note This is a business identifier, not a resource identifier (see discussion)

Control 0..1

Is Modifier false

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

294. Immunization.protocolApplied.authority.display

Definition

Plain text narrative that identifies the resource in addition to the resource reference.

Short Text alternative for the resource

Comments

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

Control 0..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

296. Immunization.protocolApplied.targetDisease

Definition

The vaccine preventable disease the dose is being administered against.

Short Vaccine preventatable disease being targetted

Control 0..*

Binding For example codes, see ImmunizationTargetDiseaseCodes
(example to http://hl7.org/fhir/ValueSet/immunization-target-disease|4.3.0)