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11.9 Resource ImmunizationRecommendation - Content

Public Health and Emergency Response

Work Group

Maturity Level: 1

Trial Use

Security Category: Patient

Compartments: Patient

A patient's point-in-time set of recommendations (i.e. forecasting) according to a published schedule with optional supporting justification.

11.9.1 Scope and Usage

The ImmunizationRecommendation resource is intended to cover communication of a specified patient's immunization recommendations and status across all healthcare disciplines in all care settings and all regions. The set of customized (for the patient) recommendations is based on the comparison of the patient's immunization history with a set of published recommendations (protocols).

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

11.9.2 Boundaries and Relationships

This resource references the following resources:

Patient
Organization
Immunization
ImmunizationEvaluation

11.9.3 References

This resource is referenced by CarePlan, DiagnosticReport, MedicationRequest and Observation.

This resource implements the Request pattern.

Structure

Name	Flags	Card.	Type	Description & Constraints
ImmunizationRecommendation	TU		DomainResource	Guidance or advice relating to an immunization Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
identifier	Σ	0..*	Identifier	Business identifier
patient	Σ	1..1	Reference(Patient)	Who this profile is for
date	Σ	1..1	dateTime	Date recommendation(s) created
authority		0..1	Reference(Organization)	Who is responsible for protocol
recommendation	Σ I	1..*	BackboneElement	Vaccine administration recommendations + Rule: One of vaccineCode or targetDisease SHALL be present
vaccineCode	Σ	0..*	CodeableConcept	Vaccine or vaccine group recommendation applies to Vaccine Administered Value Set (Example)
targetDisease	Σ	0..*	CodeableConcept	Disease to be immunized against Immunization Recommendation Target Disease Codes (Example)
contraindicatedVaccineCode	Σ	0..*	CodeableConcept	Vaccine which is contraindicated to fulfill the recommendation Vaccine Administered Value Set (Example)
forecastStatus	?!Σ	1..1	CodeableConcept	Vaccine recommendation status Immunization Recommendation Status Codes (Example)
forecastReason	Σ	0..*	CodeableConcept	Vaccine administration status reason Immunization Recommendation Reason Codes (Example)
dateCriterion		0..*	BackboneElement	Dates governing proposed immunization
code		1..1	CodeableConcept	Type of date Immunization Recommendation Date Criterion Codes (Example)
value		1..1	dateTime	Recommended date
description		0..1	string	Protocol details
series		0..1	string	Name of vaccination series
doseNumber[x]	Σ	0..1		Recommended dose number within series
doseNumberPositiveInt			positiveInt
doseNumberString			string
seriesDoses[x]		0..1		Recommended number of doses for immunity
seriesDosesPositiveInt			positiveInt
seriesDosesString			string
supportingImmunization		0..*	Reference(Immunization \| ImmunizationEvaluation)	Past immunizations supporting recommendation
supportingPatientInformation		0..*	Reference(Any)	Patient observations supporting recommendation
Documentation for this format

UML Diagram (Legend)

XML Template

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

JSON Template

{
  "resourceType" : "ImmunizationRecommendation",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Business identifier
  "patient" : { Reference(Patient) }, // R!  Who this profile is for
  "date" : "<dateTime>", // R!  Date recommendation(s) created
  "authority" : { Reference(Organization) }, // Who is responsible for protocol
  "recommendation" : [{ // R!  Vaccine administration recommendations
    "vaccineCode" : [{ CodeableConcept }], // Vaccine  or vaccine group recommendation applies to
    "targetDisease" : [{ CodeableConcept }], // Disease to be immunized against
    "contraindicatedVaccineCode" : [{ CodeableConcept }], // Vaccine which is contraindicated to fulfill the recommendation
    "forecastStatus" : { CodeableConcept }, // R!  Vaccine recommendation status
    "forecastReason" : [{ CodeableConcept }], // Vaccine administration status reason
    "dateCriterion" : [{ // Dates governing proposed immunization
      "code" : { CodeableConcept }, // R!  Type of date
      "value" : "<dateTime>" // R!  Recommended date
    }],
    "description" : "<string>", // Protocol details
    "series" : "<string>", // Name of vaccination series
    // doseNumber[x]: Recommended dose number within series. One of these 2:
    "doseNumberPositiveInt" : "<positiveInt>",
    "doseNumberString" : "<string>",
    // seriesDoses[x]: Recommended number of doses for immunity. One of these 2:
    "seriesDosesPositiveInt" : "<positiveInt>",
    "seriesDosesString" : "<string>",
    "supportingImmunization" : [{ Reference(Immunization|ImmunizationEvaluation) }], // Past immunizations supporting recommendation
    "supportingPatientInformation" : [{ Reference(Any) }] // Patient observations supporting recommendation
  }]
}

Turtle Template

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


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

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:ImmunizationRecommendation.identifier [ Identifier ], ... ; # 0..* Business identifier
  fhir:ImmunizationRecommendation.patient [ Reference(Patient) ]; # 1..1 Who this profile is for
  fhir:ImmunizationRecommendation.date [ dateTime ]; # 1..1 Date recommendation(s) created
  fhir:ImmunizationRecommendation.authority [ Reference(Organization) ]; # 0..1 Who is responsible for protocol
  fhir:ImmunizationRecommendation.recommendation [ # 1..* Vaccine administration recommendations
    fhir:ImmunizationRecommendation.recommendation.vaccineCode [ CodeableConcept ], ... ; # 0..* Vaccine  or vaccine group recommendation applies to
    fhir:ImmunizationRecommendation.recommendation.targetDisease [ CodeableConcept ], ... ; # 0..* Disease to be immunized against
    fhir:ImmunizationRecommendation.recommendation.contraindicatedVaccineCode [ CodeableConcept ], ... ; # 0..* Vaccine which is contraindicated to fulfill the recommendation
    fhir:ImmunizationRecommendation.recommendation.forecastStatus [ CodeableConcept ]; # 1..1 Vaccine recommendation status
    fhir:ImmunizationRecommendation.recommendation.forecastReason [ CodeableConcept ], ... ; # 0..* Vaccine administration status reason
    fhir:ImmunizationRecommendation.recommendation.dateCriterion [ # 0..* Dates governing proposed immunization
      fhir:ImmunizationRecommendation.recommendation.dateCriterion.code [ CodeableConcept ]; # 1..1 Type of date
      fhir:ImmunizationRecommendation.recommendation.dateCriterion.value [ dateTime ]; # 1..1 Recommended date
    ], ...;
    fhir:ImmunizationRecommendation.recommendation.description [ string ]; # 0..1 Protocol details
    fhir:ImmunizationRecommendation.recommendation.series [ string ]; # 0..1 Name of vaccination series
    # ImmunizationRecommendation.recommendation.doseNumber[x] : 0..1 Recommended dose number within series. One of these 2
      fhir:ImmunizationRecommendation.recommendation.doseNumberPositiveInt [ positiveInt ]
      fhir:ImmunizationRecommendation.recommendation.doseNumberString [ string ]
    # ImmunizationRecommendation.recommendation.seriesDoses[x] : 0..1 Recommended number of doses for immunity. One of these 2
      fhir:ImmunizationRecommendation.recommendation.seriesDosesPositiveInt [ positiveInt ]
      fhir:ImmunizationRecommendation.recommendation.seriesDosesString [ string ]
    fhir:ImmunizationRecommendation.recommendation.supportingImmunization [ Reference(Immunization|ImmunizationEvaluation) ], ... ; # 0..* Past immunizations supporting recommendation
    fhir:ImmunizationRecommendation.recommendation.supportingPatientInformation [ Reference(Any) ], ... ; # 0..* Patient observations supporting recommendation
  ], ...;
]

Changes since R3

ImmunizationRecommendation

ImmunizationRecommendation.recommendation.targetDisease

Max Cardinality changed from 1 to *

See the Full Difference for further information

This analysis is available as XML or JSON.

See R3 <--> R4 Conversion Maps (status = 1 test that all execute ok. All tests pass round-trip testing and all r3 resources are valid.)

Structure

Name	Flags	Card.	Type	Description & Constraints
ImmunizationRecommendation	TU		DomainResource	Guidance or advice relating to an immunization Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
identifier	Σ	0..*	Identifier	Business identifier
patient	Σ	1..1	Reference(Patient)	Who this profile is for
date	Σ	1..1	dateTime	Date recommendation(s) created
authority		0..1	Reference(Organization)	Who is responsible for protocol
recommendation	Σ I	1..*	BackboneElement	Vaccine administration recommendations + Rule: One of vaccineCode or targetDisease SHALL be present
vaccineCode	Σ	0..*	CodeableConcept	Vaccine or vaccine group recommendation applies to Vaccine Administered Value Set (Example)
targetDisease	Σ	0..*	CodeableConcept	Disease to be immunized against Immunization Recommendation Target Disease Codes (Example)
contraindicatedVaccineCode	Σ	0..*	CodeableConcept	Vaccine which is contraindicated to fulfill the recommendation Vaccine Administered Value Set (Example)
forecastStatus	?!Σ	1..1	CodeableConcept	Vaccine recommendation status Immunization Recommendation Status Codes (Example)
forecastReason	Σ	0..*	CodeableConcept	Vaccine administration status reason Immunization Recommendation Reason Codes (Example)
dateCriterion		0..*	BackboneElement	Dates governing proposed immunization
code		1..1	CodeableConcept	Type of date Immunization Recommendation Date Criterion Codes (Example)
value		1..1	dateTime	Recommended date
description		0..1	string	Protocol details
series		0..1	string	Name of vaccination series
doseNumber[x]	Σ	0..1		Recommended dose number within series
doseNumberPositiveInt			positiveInt
doseNumberString			string
seriesDoses[x]		0..1		Recommended number of doses for immunity
seriesDosesPositiveInt			positiveInt
seriesDosesString			string
supportingImmunization		0..*	Reference(Immunization \| ImmunizationEvaluation)	Past immunizations supporting recommendation
supportingPatientInformation		0..*	Reference(Any)	Patient observations supporting recommendation
Documentation for this format

UML Diagram (Legend)

XML Template

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

JSON Template

{
  "resourceType" : "ImmunizationRecommendation",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Business identifier
  "patient" : { Reference(Patient) }, // R!  Who this profile is for
  "date" : "<dateTime>", // R!  Date recommendation(s) created
  "authority" : { Reference(Organization) }, // Who is responsible for protocol
  "recommendation" : [{ // R!  Vaccine administration recommendations
    "vaccineCode" : [{ CodeableConcept }], // Vaccine  or vaccine group recommendation applies to
    "targetDisease" : [{ CodeableConcept }], // Disease to be immunized against
    "contraindicatedVaccineCode" : [{ CodeableConcept }], // Vaccine which is contraindicated to fulfill the recommendation
    "forecastStatus" : { CodeableConcept }, // R!  Vaccine recommendation status
    "forecastReason" : [{ CodeableConcept }], // Vaccine administration status reason
    "dateCriterion" : [{ // Dates governing proposed immunization
      "code" : { CodeableConcept }, // R!  Type of date
      "value" : "<dateTime>" // R!  Recommended date
    }],
    "description" : "<string>", // Protocol details
    "series" : "<string>", // Name of vaccination series
    // doseNumber[x]: Recommended dose number within series. One of these 2:
    "doseNumberPositiveInt" : "<positiveInt>",
    "doseNumberString" : "<string>",
    // seriesDoses[x]: Recommended number of doses for immunity. One of these 2:
    "seriesDosesPositiveInt" : "<positiveInt>",
    "seriesDosesString" : "<string>",
    "supportingImmunization" : [{ Reference(Immunization|ImmunizationEvaluation) }], // Past immunizations supporting recommendation
    "supportingPatientInformation" : [{ Reference(Any) }] // Patient observations supporting recommendation
  }]
}

Turtle Template

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


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

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:ImmunizationRecommendation.identifier [ Identifier ], ... ; # 0..* Business identifier
  fhir:ImmunizationRecommendation.patient [ Reference(Patient) ]; # 1..1 Who this profile is for
  fhir:ImmunizationRecommendation.date [ dateTime ]; # 1..1 Date recommendation(s) created
  fhir:ImmunizationRecommendation.authority [ Reference(Organization) ]; # 0..1 Who is responsible for protocol
  fhir:ImmunizationRecommendation.recommendation [ # 1..* Vaccine administration recommendations
    fhir:ImmunizationRecommendation.recommendation.vaccineCode [ CodeableConcept ], ... ; # 0..* Vaccine  or vaccine group recommendation applies to
    fhir:ImmunizationRecommendation.recommendation.targetDisease [ CodeableConcept ], ... ; # 0..* Disease to be immunized against
    fhir:ImmunizationRecommendation.recommendation.contraindicatedVaccineCode [ CodeableConcept ], ... ; # 0..* Vaccine which is contraindicated to fulfill the recommendation
    fhir:ImmunizationRecommendation.recommendation.forecastStatus [ CodeableConcept ]; # 1..1 Vaccine recommendation status
    fhir:ImmunizationRecommendation.recommendation.forecastReason [ CodeableConcept ], ... ; # 0..* Vaccine administration status reason
    fhir:ImmunizationRecommendation.recommendation.dateCriterion [ # 0..* Dates governing proposed immunization
      fhir:ImmunizationRecommendation.recommendation.dateCriterion.code [ CodeableConcept ]; # 1..1 Type of date
      fhir:ImmunizationRecommendation.recommendation.dateCriterion.value [ dateTime ]; # 1..1 Recommended date
    ], ...;
    fhir:ImmunizationRecommendation.recommendation.description [ string ]; # 0..1 Protocol details
    fhir:ImmunizationRecommendation.recommendation.series [ string ]; # 0..1 Name of vaccination series
    # ImmunizationRecommendation.recommendation.doseNumber[x] : 0..1 Recommended dose number within series. One of these 2
      fhir:ImmunizationRecommendation.recommendation.doseNumberPositiveInt [ positiveInt ]
      fhir:ImmunizationRecommendation.recommendation.doseNumberString [ string ]
    # ImmunizationRecommendation.recommendation.seriesDoses[x] : 0..1 Recommended number of doses for immunity. One of these 2
      fhir:ImmunizationRecommendation.recommendation.seriesDosesPositiveInt [ positiveInt ]
      fhir:ImmunizationRecommendation.recommendation.seriesDosesString [ string ]
    fhir:ImmunizationRecommendation.recommendation.supportingImmunization [ Reference(Immunization|ImmunizationEvaluation) ], ... ; # 0..* Past immunizations supporting recommendation
    fhir:ImmunizationRecommendation.recommendation.supportingPatientInformation [ Reference(Any) ], ... ; # 0..* Patient observations supporting recommendation
  ], ...;
]

Changes since Release 3

ImmunizationRecommendation

ImmunizationRecommendation.recommendation.targetDisease

Max Cardinality changed from 1 to *

See the Full Difference for further information

This analysis is available as XML or JSON.

See R3 <--> R4 Conversion Maps (status = 1 test that all execute ok. All tests pass round-trip testing and all r3 resources are valid.)

See the Profiles & Extensions and the alternate definitions: Master Definition XML + JSON, XML Schema/Schematron + JSON Schema, ShEx (for Turtle) + see the extensions, the spreadsheet version & the dependency analysis a

11.9.4.1 Terminology Bindings

Path	Definition	Type	Reference
ImmunizationRecommendation.recommendation.vaccineCode ImmunizationRecommendation.recommendation.contraindicatedVaccineCode	The type of vaccine administered.	Example	VaccineAdministeredValueSet
ImmunizationRecommendation.recommendation.targetDisease	The disease that the recommended vaccination targets.	Example	ImmunizationRecommendationTargetDiseaseCodes
ImmunizationRecommendation.recommendation.forecastStatus	The patient's status with respect to a vaccination protocol.	Example	ImmunizationRecommendationStatusCodes
ImmunizationRecommendation.recommendation.forecastReason	The reason for the patient's status with respect to a vaccination protocol.	Example	ImmunizationRecommendationReasonCodes
ImmunizationRecommendation.recommendation.dateCriterion.code	Classifies date criterion with respect to conveying information about a patient's vaccination status (e.g. due date, latest to give date, etc.).	Example	ImmunizationRecommendationDateCriterionCodes

Path

Definition

Type

Reference

ImmunizationRecommendation.recommendation.vaccineCode
ImmunizationRecommendation.recommendation.contraindicatedVaccineCode

The type of vaccine administered.

Example

VaccineAdministeredValueSet

ImmunizationRecommendation.recommendation.targetDisease

The disease that the recommended vaccination targets.

Example

ImmunizationRecommendationTargetDiseaseCodes

ImmunizationRecommendation.recommendation.forecastStatus

The patient's status with respect to a vaccination protocol.

Example

ImmunizationRecommendationStatusCodes

ImmunizationRecommendation.recommendation.forecastReason

The reason for the patient's status with respect to a vaccination protocol.

Example

ImmunizationRecommendationReasonCodes

ImmunizationRecommendation.recommendation.dateCriterion.code

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

Example

ImmunizationRecommendationDateCriterionCodes

11.9.4.2 Constraints

Level

Location

Description

Expression

imr-1

Rule

ImmunizationRecommendation.recommendation

One of vaccineCode or targetDisease SHALL be present

vaccineCode.exists() or targetDisease.exists()

11.9.5 Search Parameters

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

Name	Type	Description	Expression	In Common
date N	date	Date recommendation(s) created	ImmunizationRecommendation.date
identifier	token	Business identifier	ImmunizationRecommendation.identifier
information	reference	Patient observations supporting recommendation	ImmunizationRecommendation.recommendation.supportingPatientInformation (Any)
patient	reference	Who this profile is for	ImmunizationRecommendation.patient (Patient)
status	token	Vaccine recommendation status	ImmunizationRecommendation.recommendation.forecastStatus
support	reference	Past immunizations supporting recommendation	ImmunizationRecommendation.recommendation.supportingImmunization (Immunization, ImmunizationEvaluation)
target-disease	token	Disease to be immunized against	ImmunizationRecommendation.recommendation.targetDisease
vaccine-type	token	Vaccine or vaccine group recommendation applies to	ImmunizationRecommendation.recommendation.vaccineCode