Consolidated CDA (C-CDA)
3.0.0 - STU3 United States of America flag

This page is part of the CCDA: Consolidated CDA Release (v3.0.0: CCDA 3.0) generated with FHIR (HL7® FHIR® Standard) v5.0.0. This is the current published version. For a full list of available versions, see the Directory of published versions

Example Binary: Immunization Activity Example

This content is an example of the Immunization Activity Logical Model and is not a FHIR Resource

    
<substanceAdministration classCode="SBADM" moodCode="EVN" negationInd="false" xmlns="urn:hl7-org:v3">
  <!-- ** Immunization activity ** -->
  <templateId root="2.16.840.1.113883.10.20.22.4.52" extension="2015-08-01" />
  <id root="e6f1ba43-c0ed-4b9b-9f12-f435d8ad8f92" />
  <statusCode code="completed" />
  <effectiveTime value="19981215" />
  <routeCode code="C28161" codeSystem="2.16.840.1.113883.3.26.1.1" codeSystemName="National Cancer Institute (NCI) Thesaurus" displayName="INTRAMUSCULAR">
		<translation code="78421000" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED" displayName="Intramuscular route"/>
	</routeCode>
  <doseQuantity value="50" unit="ug" />
  <consumable>
    <manufacturedProduct classCode="MANU">
      <!-- ** Immunization medication information ** -->
      <templateId root="2.16.840.1.113883.10.20.22.4.54" extension="2014-06-09" />
      <manufacturedMaterial>
        <code code="33" codeSystem="2.16.840.1.113883.12.292" displayName="pneumococcal polysaccharide PPV23" codeSystemName="CVX">
          <translation code="854981" displayName="Pneumovax 23 (Pneumococcal vaccine polyvalent) Injectable Solution" codeSystemName="RxNORM" codeSystem="2.16.840.1.113883.6.88" />
        </code>
        <lotNumberText>1</lotNumberText>
      </manufacturedMaterial>
      <manufacturerOrganization>
        <name>Health LS - Immuno Inc.</name>
      </manufacturerOrganization>
    </manufacturedProduct>
  </consumable>
  <performer>
    <assignedEntity>
      <id root="2.16.840.1.113883.19.5.9999.456" extension="2981824" />
      <addr>
        <streetAddressLine>1007 Health Drive</streetAddressLine>
        <city>Portland</city>
        <state>OR</state>
        <postalCode>99123</postalCode>
        <country>US</country>
      </addr>
      <telecom use="WP" value="tel:+(555)-555-1030" />
      <assignedPerson>
        <name>
          <given>Harold</given>
          <family>Hippocrates</family>
        </name>
      </assignedPerson>
      <representedOrganization>
        <id root="2.16.840.1.113883.19.5.9999.1394" />
        <name>Good Health Clinic</name>
        <telecom use="WP" value="tel:+(555)-555-1030" />
        <addr>
          <streetAddressLine>1007 Health Drive</streetAddressLine>
          <city>Portland</city>
          <state>OR</state>
          <postalCode>99123</postalCode>
          <country>US</country>
        </addr>
      </representedOrganization>
    </assignedEntity>
  </performer>
</substanceAdministration>