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: Immunizations Section Example

This content is an example of the Immunizations Section Logical Model and is not a FHIR Resource

    
<section  xmlns="urn:hl7-org:v3" xmlns:sdtc="urn:hl7-org:sdtc" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
  <templateId root="2.16.840.1.113883.10.20.22.2.2.1" extension="2015-08-01" />
  <!--  ********  Immunizations section template   ******** -->
  <code code="11369-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="History of immunizations" />
  <title>Immunizations</title>
  <text>
    <table border="1" width="100%">
      <thead>
        <tr>
          <th>Vaccine</th>
          <th>Date</th>
          <th>Status</th>
        </tr>
      </thead>
      <tbody>
        <tr>
          <td>
            <content ID="immun1" />Influenza virus vaccine, IM
                    
                    
          </td>
          <td>Nov 1999</td>
          <td>Completed</td>
        </tr>
        <tr>
          <td>
            <content ID="immun2" />Influenza virus vaccine, IM
                    
                    
          </td>
          <td>Dec 1998</td>
          <td>Completed</td>
        </tr>
        <tr>
          <td>
            <content ID="immun3" />
            Pneumococcal polysaccharide vaccine, IM
                    
                    
          </td>
          <td>Dec 1998</td>
          <td>Completed</td>
        </tr>
        <tr>
          <td>
            <content ID="immun4" />Tetanus and diphtheria toxoids, IM
                    
                    
          </td>
          <td>1997</td>
          <td>Refused</td>
        </tr>
      </tbody>
    </table>
  </text>
  <entry typeCode="DRIV">
		<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>
  </entry>
</section>