Example Usage Scenarios:

The following are example usage scenarios for the US Core-Core Immunization profile:

• Query for immunizations belonging to a Patient
• Record or update immunizations belonging to a Patient

Mandatory and Must Support Data Elements

The following data-elements must always be present (Mandatory definition) or must be supported if the data is present in the sending system (Must Support definition). They are presented below in a simple human-readable explanation. Profile specific guidance and examples are provided as well. The Formal Views below provides the formal summary, definitions, and terminology requirements.

Each Immunization Must Have:

1. a status
2. a vaccine code that identifies the kind of vaccine administered
3. a patient
4. the encounter the immunization was part of
5. a date the vaccine was administered
6. where the vaccine was administered

Each Immunization Must Support:

1. a statusReason if the vaccine wasn’t given
2. a flag to indicate whether the vaccine was reported by someone other than the person who administered the vaccine.

Profile Specific Implementation Guidance:

• Use the status code: not-done to represent that an immunization was not given.
• Based upon the ONC U.S. Core Data for Interoperability (USCDI) v1 requirements, CVX vaccine codes¹ are required, and the NDC vaccine codes SHOULD be supported as a translation.
  • The preferred code system identifiers are http://hl7.org/fhir/sid/cvx for CVX and http://hl7.org/fhir/sid/ndc for NDC vaccine codes. Note that the vaccineCode binding link in the formal definition and the CDC links below use the associated OID as the code system identifiers.
  • Be aware that there is a 10-digit (with dashes) NDC format displayed on drug packaging and an 11-digit (no dashes) NDC format for billing and prescribing (for example, “49281-121-65” and “49281012165”). Normalization may be required to avoid validation errors and warnings.
  • CDC provides the CDC National Drug Code (NDC) Directory – Vaccine NDC Linker Table to assist implementers. The example Immunization-imm-1 illustrates using the CVX and 11-digit NDC codes based on this table.

• Differential Table
• Key Elements Table
• Snapshot Table
• Statistics/References
• All

This structure is derived from Immunization

Name	Flags	Card.	Type	Description & Constraints
Immunization	C	0..*	Immunization	Immunization event information us-core-5: SHOULD have a translation to the NDC value set
status	S	1..1	code	completed | entered-in-error | not-done Binding: ImmunizationStatusCodes (required)
statusReason	S	0..1	CodeableConcept	Reason not done Binding: ImmunizationStatusReasonCodes (example)
vaccineCode	SC	1..1	CodeableConcept	Vaccine Product Type (bind to CVX) Binding: CVX Vaccines Administered Vaccine Set (extensible)
patient	S	1..1	Reference(US Core Patient Profile)	Who was immunized
encounter	S	0..1	Reference(US Core Encounter Profile)	Encounter the immunization was part of
occurrence[x]	S	1..1		Vaccine administration date
occurrenceDateTime			dateTime S
occurrenceString			string
primarySource	S	0..1	boolean	Indicates context the data was recorded in
location	S	0..1	Reference(US Core Location Profile)	Where the vaccine was administered
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet
Immunization.status	required	ImmunizationStatusCodes
Immunization.statusReason	example	ImmunizationStatusReasonCodes
Immunization.vaccineCode	extensible	CVXVaccinesAdministeredVaccineSet

Constraints

Id	Grade	Path(s)	Details	Requirements
us-core-5	best practice	Immunization	SHOULD have a translation to the NDC value set : vaccineCode.coding.where(system='http://hl7.org/fhir/sid/cvx').exists() implies vaccineCode.coding.where(system='http://hl7.org/fhir/sid/ndc').exists()

Name	Flags	Card.	Type	Description & Constraints
Immunization	C	0..*	Immunization	Immunization event information us-core-5: SHOULD have a translation to the NDC value set
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
status	?!SΣ	1..1	code	completed | entered-in-error | not-done Binding: ImmunizationStatusCodes (required)
statusReason	S	0..1	CodeableConcept	Reason not done Binding: ImmunizationStatusReasonCodes (example)
vaccineCode	SΣC	1..1	CodeableConcept	Vaccine Product Type (bind to CVX) Binding: CVX Vaccines Administered Vaccine Set (extensible)
patient	SΣ	1..1	Reference(US Core Patient Profile)	Who was immunized
encounter	S	0..1	Reference(US Core Encounter Profile)	Encounter the immunization was part of
occurrence[x]	SΣ	1..1		Vaccine administration date
occurrenceDateTime			dateTime
primarySource	SΣ	0..1	boolean	Indicates context the data was recorded in
location	S	0..1	Reference(US Core Location Profile)	Where the vaccine was administered
isSubpotent	?!Σ	0..1	boolean	Dose potency
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
Immunization.status	required	ImmunizationStatusCodes
Immunization.statusReason	example	ImmunizationStatusReasonCodes
Immunization.vaccineCode	extensible	CVXVaccinesAdministeredVaccineSet

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	Immunization	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Immunization	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Immunization	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Immunization	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Immunization	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
us-core-5	best practice	Immunization	SHOULD have a translation to the NDC value set : vaccineCode.coding.where(system='http://hl7.org/fhir/sid/cvx').exists() implies vaccineCode.coding.where(system='http://hl7.org/fhir/sid/ndc').exists()

Name	Flags	Card.	Type	Description & Constraints
Immunization	C	0..*	Immunization	Immunization event information us-core-5: SHOULD have a translation to the NDC value set
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier		0..*	Identifier	Business identifier
status	?!SΣ	1..1	code	completed | entered-in-error | not-done Binding: ImmunizationStatusCodes (required)
statusReason	S	0..1	CodeableConcept	Reason not done Binding: ImmunizationStatusReasonCodes (example)
vaccineCode	SΣC	1..1	CodeableConcept	Vaccine Product Type (bind to CVX) Binding: CVX Vaccines Administered Vaccine Set (extensible)
patient	SΣ	1..1	Reference(US Core Patient Profile)	Who was immunized
encounter	S	0..1	Reference(US Core Encounter Profile)	Encounter the immunization was part of
occurrence[x]	SΣ	1..1		Vaccine administration date
occurrenceDateTime			dateTime S
occurrenceString			string
recorded		0..1	dateTime	When the immunization was first captured in the subject's record
primarySource	SΣ	0..1	boolean	Indicates context the data was recorded in
reportOrigin		0..1	CodeableConcept	Indicates the source of a secondarily reported record Binding: ImmunizationOriginCodes (example): The source of the data for a record which is not from a primary source.
location	S	0..1	Reference(US Core Location Profile)	Where the vaccine was administered
manufacturer		0..1	Reference(Organization)	Vaccine manufacturer
lotNumber		0..1	string	Vaccine lot number
expirationDate		0..1	date	Vaccine expiration date
site		0..1	CodeableConcept	Body site vaccine was administered Binding: CodesForImmunizationSiteOfAdministration (example): The site at which the vaccine was administered.
route		0..1	CodeableConcept	How vaccine entered body Binding: ImmunizationRouteCodes (example): The route by which the vaccine was administered.
doseQuantity		0..1	SimpleQuantity	Amount of vaccine administered
performer	Σ	0..*	BackboneElement	Who performed event
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
function	Σ	0..1	CodeableConcept	What type of performance was done Binding: ImmunizationFunctionCodes (extensible): The role a practitioner or organization plays in the immunization event.
actor	Σ	1..1	Reference(Practitioner | PractitionerRole | Organization)	Individual or organization who was performing
note	Σ	0..*	Annotation	Additional immunization notes
reasonCode		0..*	CodeableConcept	Why immunization occurred Binding: ImmunizationReasonCodes (example): The reason why a vaccine was administered.
reasonReference		0..*	Reference(Condition | Observation | DiagnosticReport)	Why immunization occurred
isSubpotent	?!Σ	0..1	boolean	Dose potency
subpotentReason		0..*	CodeableConcept	Reason for being subpotent Binding: ImmunizationSubpotentReason (example): The reason why a dose is considered to be subpotent.
education	C	0..*	BackboneElement	Educational material presented to patient
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
documentType		0..1	string	Educational material document identifier
reference		0..1	uri	Educational material reference pointer
publicationDate		0..1	dateTime	Educational material publication date
presentationDate		0..1	dateTime	Educational material presentation date
programEligibility		0..*	CodeableConcept	Patient eligibility for a vaccination program Binding: ImmunizationProgramEligibility (example): The patient's eligibility for a vaccation program.
fundingSource		0..1	CodeableConcept	Funding source for the vaccine Binding: ImmunizationFundingSource (example): The source of funding used to purchase the vaccine administered.
reaction		0..*	BackboneElement	Details of a reaction that follows immunization
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
date		0..1	dateTime	When reaction started
detail		0..1	Reference(Observation)	Additional information on reaction
reported		0..1	boolean	Indicates self-reported reaction
protocolApplied		0..*	BackboneElement	Protocol followed by the provider
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
series		0..1	string	Name of vaccine series
authority		0..1	Reference(Organization)	Who is responsible for publishing the recommendations
targetDisease		0..*	CodeableConcept	Vaccine preventatable disease being targetted Binding: ImmunizationTargetDiseaseCodes (example): The vaccine preventable disease the dose is being administered for.
doseNumber[x]		1..1		Dose number within series
doseNumberPositiveInt			positiveInt
doseNumberString			string
seriesDoses[x]		0..1		Recommended number of doses for immunity
seriesDosesPositiveInt			positiveInt
seriesDosesString			string
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
Immunization.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding
Immunization.status	required	ImmunizationStatusCodes
Immunization.statusReason	example	ImmunizationStatusReasonCodes
Immunization.vaccineCode	extensible	CVXVaccinesAdministeredVaccineSet
Immunization.reportOrigin	example	ImmunizationOriginCodes
Immunization.site	example	CodesForImmunizationSiteOfAdministration
Immunization.route	example	ImmunizationRouteCodes
Immunization.performer.function	extensible	ImmunizationFunctionCodes
Immunization.reasonCode	example	ImmunizationReasonCodes
Immunization.subpotentReason	example	ImmunizationSubpotentReason
Immunization.programEligibility	example	ImmunizationProgramEligibility
Immunization.fundingSource	example	ImmunizationFundingSource
Immunization.protocolApplied.targetDisease	example	ImmunizationTargetDiseaseCodes

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	Immunization	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Immunization	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Immunization	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Immunization	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Immunization	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
imm-1	error	Immunization.education	One of documentType or reference SHALL be present : documentType.exists() or reference.exists()
us-core-5	best practice	Immunization	SHOULD have a translation to the NDC value set : vaccineCode.coding.where(system='http://hl7.org/fhir/sid/cvx').exists() implies vaccineCode.coding.where(system='http://hl7.org/fhir/sid/ndc').exists()

Differential View

This structure is derived from Immunization

Name	Flags	Card.	Type	Description & Constraints
Immunization	C	0..*	Immunization	Immunization event information us-core-5: SHOULD have a translation to the NDC value set
status	S	1..1	code	completed | entered-in-error | not-done Binding: ImmunizationStatusCodes (required)
statusReason	S	0..1	CodeableConcept	Reason not done Binding: ImmunizationStatusReasonCodes (example)
vaccineCode	SC	1..1	CodeableConcept	Vaccine Product Type (bind to CVX) Binding: CVX Vaccines Administered Vaccine Set (extensible)
patient	S	1..1	Reference(US Core Patient Profile)	Who was immunized
encounter	S	0..1	Reference(US Core Encounter Profile)	Encounter the immunization was part of
occurrence[x]	S	1..1		Vaccine administration date
occurrenceDateTime			dateTime S
occurrenceString			string
primarySource	S	0..1	boolean	Indicates context the data was recorded in
location	S	0..1	Reference(US Core Location Profile)	Where the vaccine was administered
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet
Immunization.status	required	ImmunizationStatusCodes
Immunization.statusReason	example	ImmunizationStatusReasonCodes
Immunization.vaccineCode	extensible	CVXVaccinesAdministeredVaccineSet

Constraints

Id	Grade	Path(s)	Details	Requirements
us-core-5	best practice	Immunization	SHOULD have a translation to the NDC value set : vaccineCode.coding.where(system='http://hl7.org/fhir/sid/cvx').exists() implies vaccineCode.coding.where(system='http://hl7.org/fhir/sid/ndc').exists()

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
Immunization	C	0..*	Immunization	Immunization event information us-core-5: SHOULD have a translation to the NDC value set
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
status	?!SΣ	1..1	code	completed | entered-in-error | not-done Binding: ImmunizationStatusCodes (required)
statusReason	S	0..1	CodeableConcept	Reason not done Binding: ImmunizationStatusReasonCodes (example)
vaccineCode	SΣC	1..1	CodeableConcept	Vaccine Product Type (bind to CVX) Binding: CVX Vaccines Administered Vaccine Set (extensible)
patient	SΣ	1..1	Reference(US Core Patient Profile)	Who was immunized
encounter	S	0..1	Reference(US Core Encounter Profile)	Encounter the immunization was part of
occurrence[x]	SΣ	1..1		Vaccine administration date
occurrenceDateTime			dateTime
primarySource	SΣ	0..1	boolean	Indicates context the data was recorded in
location	S	0..1	Reference(US Core Location Profile)	Where the vaccine was administered
isSubpotent	?!Σ	0..1	boolean	Dose potency
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
Immunization.status	required	ImmunizationStatusCodes
Immunization.statusReason	example	ImmunizationStatusReasonCodes
Immunization.vaccineCode	extensible	CVXVaccinesAdministeredVaccineSet

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	Immunization	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Immunization	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Immunization	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Immunization	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Immunization	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
us-core-5	best practice	Immunization	SHOULD have a translation to the NDC value set : vaccineCode.coding.where(system='http://hl7.org/fhir/sid/cvx').exists() implies vaccineCode.coding.where(system='http://hl7.org/fhir/sid/ndc').exists()

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
Immunization	C	0..*	Immunization	Immunization event information us-core-5: SHOULD have a translation to the NDC value set
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier		0..*	Identifier	Business identifier
status	?!SΣ	1..1	code	completed | entered-in-error | not-done Binding: ImmunizationStatusCodes (required)
statusReason	S	0..1	CodeableConcept	Reason not done Binding: ImmunizationStatusReasonCodes (example)
vaccineCode	SΣC	1..1	CodeableConcept	Vaccine Product Type (bind to CVX) Binding: CVX Vaccines Administered Vaccine Set (extensible)
patient	SΣ	1..1	Reference(US Core Patient Profile)	Who was immunized
encounter	S	0..1	Reference(US Core Encounter Profile)	Encounter the immunization was part of
occurrence[x]	SΣ	1..1		Vaccine administration date
occurrenceDateTime			dateTime S
occurrenceString			string
recorded		0..1	dateTime	When the immunization was first captured in the subject's record
primarySource	SΣ	0..1	boolean	Indicates context the data was recorded in
reportOrigin		0..1	CodeableConcept	Indicates the source of a secondarily reported record Binding: ImmunizationOriginCodes (example): The source of the data for a record which is not from a primary source.
location	S	0..1	Reference(US Core Location Profile)	Where the vaccine was administered
manufacturer		0..1	Reference(Organization)	Vaccine manufacturer
lotNumber		0..1	string	Vaccine lot number
expirationDate		0..1	date	Vaccine expiration date
site		0..1	CodeableConcept	Body site vaccine was administered Binding: CodesForImmunizationSiteOfAdministration (example): The site at which the vaccine was administered.
route		0..1	CodeableConcept	How vaccine entered body Binding: ImmunizationRouteCodes (example): The route by which the vaccine was administered.
doseQuantity		0..1	SimpleQuantity	Amount of vaccine administered
performer	Σ	0..*	BackboneElement	Who performed event
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
function	Σ	0..1	CodeableConcept	What type of performance was done Binding: ImmunizationFunctionCodes (extensible): The role a practitioner or organization plays in the immunization event.
actor	Σ	1..1	Reference(Practitioner | PractitionerRole | Organization)	Individual or organization who was performing
note	Σ	0..*	Annotation	Additional immunization notes
reasonCode		0..*	CodeableConcept	Why immunization occurred Binding: ImmunizationReasonCodes (example): The reason why a vaccine was administered.
reasonReference		0..*	Reference(Condition | Observation | DiagnosticReport)	Why immunization occurred
isSubpotent	?!Σ	0..1	boolean	Dose potency
subpotentReason		0..*	CodeableConcept	Reason for being subpotent Binding: ImmunizationSubpotentReason (example): The reason why a dose is considered to be subpotent.
education	C	0..*	BackboneElement	Educational material presented to patient
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
documentType		0..1	string	Educational material document identifier
reference		0..1	uri	Educational material reference pointer
publicationDate		0..1	dateTime	Educational material publication date
presentationDate		0..1	dateTime	Educational material presentation date
programEligibility		0..*	CodeableConcept	Patient eligibility for a vaccination program Binding: ImmunizationProgramEligibility (example): The patient's eligibility for a vaccation program.
fundingSource		0..1	CodeableConcept	Funding source for the vaccine Binding: ImmunizationFundingSource (example): The source of funding used to purchase the vaccine administered.
reaction		0..*	BackboneElement	Details of a reaction that follows immunization
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
date		0..1	dateTime	When reaction started
detail		0..1	Reference(Observation)	Additional information on reaction
reported		0..1	boolean	Indicates self-reported reaction
protocolApplied		0..*	BackboneElement	Protocol followed by the provider
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
series		0..1	string	Name of vaccine series
authority		0..1	Reference(Organization)	Who is responsible for publishing the recommendations
targetDisease		0..*	CodeableConcept	Vaccine preventatable disease being targetted Binding: ImmunizationTargetDiseaseCodes (example): The vaccine preventable disease the dose is being administered for.
doseNumber[x]		1..1		Dose number within series
doseNumberPositiveInt			positiveInt
doseNumberString			string
seriesDoses[x]		0..1		Recommended number of doses for immunity
seriesDosesPositiveInt			positiveInt
seriesDosesString			string
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
Immunization.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding
Immunization.status	required	ImmunizationStatusCodes
Immunization.statusReason	example	ImmunizationStatusReasonCodes
Immunization.vaccineCode	extensible	CVXVaccinesAdministeredVaccineSet
Immunization.reportOrigin	example	ImmunizationOriginCodes
Immunization.site	example	CodesForImmunizationSiteOfAdministration
Immunization.route	example	ImmunizationRouteCodes
Immunization.performer.function	extensible	ImmunizationFunctionCodes
Immunization.reasonCode	example	ImmunizationReasonCodes
Immunization.subpotentReason	example	ImmunizationSubpotentReason
Immunization.programEligibility	example	ImmunizationProgramEligibility
Immunization.fundingSource	example	ImmunizationFundingSource
Immunization.protocolApplied.targetDisease	example	ImmunizationTargetDiseaseCodes

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	Immunization	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Immunization	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Immunization	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Immunization	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Immunization	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
imm-1	error	Immunization.education	One of documentType or reference SHALL be present : documentType.exists() or reference.exists()
us-core-5	best practice	Immunization	SHOULD have a translation to the NDC value set : vaccineCode.coding.where(system='http://hl7.org/fhir/sid/cvx').exists() implies vaccineCode.coding.where(system='http://hl7.org/fhir/sid/ndc').exists()

This structure is derived from Immunization

Summary

Must-Support: 8 elements

Structures

This structure refers to these other structures:

• US Core Patient Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient)
• US Core Encounter Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter)
• US Core Location Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-location)

Maturity: 3

Quick Start

Below is an overview of the required Server RESTful FHIR interactions for this profile - for example, search and read operations - when supporting the US Core interactions to access this profile’s information (Profile Support + Interaction Support). Note that systems that support only US Core Profiles (Profile Only Support) are not required to support these interactions. See the US Core Server CapabilityStatement for a complete list of supported RESTful interactions for this IG.

• The syntax used to describe the interactions is described here.
• See the General Requirements section for additional rules and expectations when a server requires status parameters.
• See the General Guidance section for additional guidance on searching for multiple patients.

Mandatory Search Parameters:

The following search parameters and search parameter combinations SHALL be supported:

1. SHALL support searching for all immunizations for a patient using the patient search parameter:

   GET [base]/Immunization?patient={Type/}[id]

   Example:

   1. GET [base]/Immunization?patient=1137192

   Implementation Notes: Fetches a bundle of all Immunization resources for the specified patient (how to search by reference)

Optional Search Parameters:

The following search parameter combinations SHOULD be supported:

1. SHOULD support searching using the combination of the patient and date search parameters:
   • including support for these date comparators: gt,lt,ge,le
   • including optional support for AND search on date (e.g.date=[date]&date=[date]]&...)

   GET [base]/Immunization?patient={Type/}[id]&date={gt|lt|ge|le}[date]{&date={gt|lt|ge|le}[date]&...}

   Example:

   1. GET [base]/Immunization?patient=1137192&date=ge2019-01-14T00:00:00Z

   Implementation Notes: Fetches a bundle of all Immunization resources for the specified patient and date (how to search by date and how to search by reference)

2. SHOULD support searching using the combination of the patient and status search parameters:

   GET [base]/Immunization?patient={Type/}[id]&status={system|}[code]

   Example:

   1. GET [base]/Immunization?patient=1137192&status=completed

   Implementation Notes: Fetches a bundle of all Immunization resources for the specified patient and status (how to search by reference and how to search by date)

¹ Although the CVX code system contains some concepts that are procedures, medications, or substances rather than immunizations, the value set defined in VSAC has removed those and retained only the vaccine codes (see the exclusion definition in VSAC for more detail)