The US Core Immunization Profile sets minimum expectations for the Immunization Resource to record, search, and fetch immunizations associated with a patient. It identifies which core elements, extensions, vocabularies and value sets SHALL be present in the resource when using this profile. In addition to the requirements set forth in US Core Immunization Profile this derived profile is designed to add requirements to the following elements:

• MCCImmunization.extension:resource-pertainsToGoal (Must Support) to encourage linking a goal to the immunization occurance in hopes to facilitate and/or to encourage systems to be able to receive and understand a goal linkage if present.

No additional value sets were defined for use in this profile beyond the US Core Immunization profile.

Comments are welcome with respect to the pragmatic use of the “Must Support” rules defined on these elements.

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

This structure is derived from USCoreImmunizationProfile

Name	Flags	Card.	Type	Description & Constraints
Immunization		0..*	USCoreImmunizationProfile	Immunization event information
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
resource-pertainsToGoal	S	0..*	Reference(Goal)	The resource-pertainsToGoal relates the resource to the goal(s) that pertain to it. Whenever there is a goal associated with a health concern or problem, this extension should be present and populated in activity (event or intent) resources. URL: http://hl7.org/fhir/StructureDefinition/resource-pertainsToGoal
Documentation for this format

Name	Flags	Card.	Type	Description & Constraints
Immunization	C	0..*	USCoreImmunizationProfile	Immunization event information
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
resource-pertainsToGoal	S	0..*	Reference(Goal)	The resource-pertainsToGoal relates the resource to the goal(s) that pertain to it. Whenever there is a goal associated with a health concern or problem, this extension should be present and populated in activity (event or intent) resources. URL: http://hl7.org/fhir/StructureDefinition/resource-pertainsToGoal
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
status	?!SΣ	1..1	code	(USCDI) completed | entered-in-error | not-done Binding: ImmunizationStatusCodes (required)
statusReason	S	0..1	CodeableConcept	(USCDI) Reason not done Binding: ImmunizationStatusReasonCodes (example)
vaccineCode	SΣC	1..1	CodeableConcept	(USCDI) Vaccine Product Type (bind to CVX) Binding: CVX Vaccines Administered Vaccine Set (extensible)
patient	SΣ	1..1	Reference(US Core Patient Profile)	(USCDI) Who was immunized
occurrence[x]	SΣ	1..1		(USCDI) Vaccine administration date
occurrenceDateTime			dateTime
primarySource	SΣ	0..1	boolean	(USCDI) Indicates context the data was recorded in
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/ndc').empty()

Name	Flags	Card.	Type	Description & Constraints
Immunization	C	0..*	USCoreImmunizationProfile	Immunization event information
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
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
resource-pertainsToGoal	S	0..*	Reference(Goal)	The resource-pertainsToGoal relates the resource to the goal(s) that pertain to it. Whenever there is a goal associated with a health concern or problem, this extension should be present and populated in activity (event or intent) resources. URL: http://hl7.org/fhir/StructureDefinition/resource-pertainsToGoal
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier		0..*	Identifier	Business identifier
status	?!SΣ	1..1	code	(USCDI) completed | entered-in-error | not-done Binding: ImmunizationStatusCodes (required)
statusReason	S	0..1	CodeableConcept	(USCDI) Reason not done Binding: ImmunizationStatusReasonCodes (example)
vaccineCode	SΣC	1..1	CodeableConcept	(USCDI) Vaccine Product Type (bind to CVX) Binding: CVX Vaccines Administered Vaccine Set (extensible)
patient	SΣ	1..1	Reference(US Core Patient Profile)	(USCDI) Who was immunized
encounter		0..1	Reference(Encounter)	Encounter immunization was part of
occurrence[x]	SΣ	1..1		(USCDI) 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	(USCDI) 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		0..1	Reference(Location)	Where immunization occurred
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
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()

Differential View

This structure is derived from USCoreImmunizationProfile

Name	Flags	Card.	Type	Description & Constraints
Immunization		0..*	USCoreImmunizationProfile	Immunization event information
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
resource-pertainsToGoal	S	0..*	Reference(Goal)	The resource-pertainsToGoal relates the resource to the goal(s) that pertain to it. Whenever there is a goal associated with a health concern or problem, this extension should be present and populated in activity (event or intent) resources. URL: http://hl7.org/fhir/StructureDefinition/resource-pertainsToGoal
Documentation for this format

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
Immunization	C	0..*	USCoreImmunizationProfile	Immunization event information
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
resource-pertainsToGoal	S	0..*	Reference(Goal)	The resource-pertainsToGoal relates the resource to the goal(s) that pertain to it. Whenever there is a goal associated with a health concern or problem, this extension should be present and populated in activity (event or intent) resources. URL: http://hl7.org/fhir/StructureDefinition/resource-pertainsToGoal
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
status	?!SΣ	1..1	code	(USCDI) completed | entered-in-error | not-done Binding: ImmunizationStatusCodes (required)
statusReason	S	0..1	CodeableConcept	(USCDI) Reason not done Binding: ImmunizationStatusReasonCodes (example)
vaccineCode	SΣC	1..1	CodeableConcept	(USCDI) Vaccine Product Type (bind to CVX) Binding: CVX Vaccines Administered Vaccine Set (extensible)
patient	SΣ	1..1	Reference(US Core Patient Profile)	(USCDI) Who was immunized
occurrence[x]	SΣ	1..1		(USCDI) Vaccine administration date
occurrenceDateTime			dateTime
primarySource	SΣ	0..1	boolean	(USCDI) Indicates context the data was recorded in
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/ndc').empty()

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
Immunization	C	0..*	USCoreImmunizationProfile	Immunization event information
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
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
resource-pertainsToGoal	S	0..*	Reference(Goal)	The resource-pertainsToGoal relates the resource to the goal(s) that pertain to it. Whenever there is a goal associated with a health concern or problem, this extension should be present and populated in activity (event or intent) resources. URL: http://hl7.org/fhir/StructureDefinition/resource-pertainsToGoal
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier		0..*	Identifier	Business identifier
status	?!SΣ	1..1	code	(USCDI) completed | entered-in-error | not-done Binding: ImmunizationStatusCodes (required)
statusReason	S	0..1	CodeableConcept	(USCDI) Reason not done Binding: ImmunizationStatusReasonCodes (example)
vaccineCode	SΣC	1..1	CodeableConcept	(USCDI) Vaccine Product Type (bind to CVX) Binding: CVX Vaccines Administered Vaccine Set (extensible)
patient	SΣ	1..1	Reference(US Core Patient Profile)	(USCDI) Who was immunized
encounter		0..1	Reference(Encounter)	Encounter immunization was part of
occurrence[x]	SΣ	1..1		(USCDI) 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	(USCDI) 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		0..1	Reference(Location)	Where immunization occurred
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
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()

This structure is derived from USCoreImmunizationProfile

Summary

Must-Support: 1 element

Extensions

This structure refers to these extensions:

• http://hl7.org/fhir/StructureDefinition/resource-pertainsToGoal