C-CDA on FHIR
1.2.0 - STU 1 United States of America flag

This page is part of the C-CDA on FHIR Implementation Guide (v1.2.0: STU 1) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

Binary: CF-immunization

    
<entry typeCode="DRIV">
  <substanceAdministration classCode="SBADM" moodCode="EVN" negationInd="false">
    <templateId root="2.16.840.1.113883.10.20.22.4.52"/>
    <templateId root="2.16.840.1.113883.10.20.22.4.52" extension="2015-08-01"/>
    <id root="e6f1ba43-c0ed-4b9b-9f12-f435d8ad8f92"/>
    <text>
      <reference value="#immun1"/>
    </text>
    <statusCode code="completed"/>
    <effectiveTime value="20100815"/>
    <consumable>
      <manufacturedProduct classCode="MANU">
        <templateId root="2.16.840.1.113883.10.20.22.4.54"/>
        <templateId root="2.16.840.1.113883.10.20.22.4.54" extension="2014-06-09"/>
        <manufacturedMaterial>
          <code code="88" codeSystem="2.16.840.1.113883.12.292"
                                displayName="Influenza virus vaccine" codeSystemName="CVX">
            <originalText>
              <reference value="#ImmunizationProduct_100"/>
            </originalText>
          </code>
          <lotNumberText>1</lotNumberText>
        </manufacturedMaterial>
      </manufacturedProduct>
    </consumable>
    <performer>
      <assignedEntity>
        <id root="2.16.840.1.113883.19.5.9999.456" extension="2981824"/>
        <addr>
          <streetAddressLine>1021 Health Drive</streetAddressLine>
          <city>Ann Arbor</city>
          <state>MI</state>
          <postalCode>99099</postalCode>
          <country>US</country>
        </addr>
        <telecom nullFlavor="UNK"/>
        <assignedPerson>
          <name>
            <given>Amanda</given>
            <family>Assigned</family>
          </name>
        </assignedPerson>
        <representedOrganization>
          <id root="2.16.840.1.113883.19.5.9999.1394"/>
          <name>Good Health Clinic</name>
          <telecom nullFlavor="UNK"/>
          <addr nullFlavor="UNK"/>
        </representedOrganization>
      </assignedEntity>
    </performer>
    <author>
      <templateId root="2.16.840.1.113883.10.20.22.4.119"/>
      <time value="20100816"/>
      <assignedAuthor>
        <id extension="99999999" root="2.16.840.1.113883.4.6"/>
        <code code="207Q00000X" codeSystem="2.16.840.1.113883.6.101" codeSystemName="Health Care Provider Taxonomy" displayName="Family Medicine" />
        <telecom use="WP" value="tel:555-555-1002"/>
        <assignedPerson>
          <name>
            <given>Henry</given>
            <family>Seven</family>
          </name>
        </assignedPerson>
      </assignedAuthor>
    </author>
  </substanceAdministration>
</entry>