type: resource-definitionsresource: Immunization

Immunization Definitions

Immunization

Immunization event information

Definition: Describes the event of a patient being administered a vaccine or a record of an immunization as reported by a patient, a clinician or another party.

Cardinality: 0..*

Mappings: workflow=Event; v2=VXU_V04; rim=SubstanceAdministration; w5=clinical.medication

Immunization.identifier

Business identifier

Definition: A unique identifier assigned to this immunization record.

Cardinality: 0..*

Type: Identifier

Mappings: workflow=Event.identifier; w5=FiveWs.identifier; rim=.id; cda=ClinicalDocument/component/StructuredBody/component/section/entry/substanceAdministration/id

Immunization.basedOn

Authority that the immunization event is based on

Definition: A plan, order or recommendation fulfilled in whole or in part by this immunization.

Comments: Allows tracing of an authorization for the Immunization.

Cardinality: 0..*

Type: Reference(CarePlan, MedicationRequest, ServiceRequest)

Summary: true

Mappings: workflow=Event.basedOn; rim=N/A

Immunization.status

completed | entered-in-error | not-done

Definition: Indicates the current status of the immunization event.

Comments: Will generally be set to show that the immunization has been completed or not done. This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

Cardinality: 1..1

Type: code

Binding: required:immunization-status

Summary: true

Is Modifier: true (Reason: This element is labeled as a modifier because it is a status element that contains statuses entered-in-error and not-done which means that the resource should not be treated as valid)

Mappings: workflow=Event.status; w5=FiveWs.status; rim=statusCode

Immunization.statusReason

Reason for current status

Definition: Indicates the reason the immunization event was not performed.

Comments: This is generally only used for the status of "not-done". The reason for performing the immunization event is captured in reasonCode, not here.

Cardinality: 0..1

Type: CodeableConcept

Binding: example:immunization-status-reason

Mappings: workflow=Event.statusReason; rim=.inboundRelationship[typeCode=SUBJ].source[classCode=CACT, moodCode=EVN].reasonCOde

Immunization.vaccineCode

Vaccine administered

Definition: Vaccine that was administered or was to be administered.

Comments: The code for the administered vaccine may be reported at various levels of granularity from a very generic code for a general type of vaccine (e.g. the SNOMED or CVX code for the flu vaccine) to a very discrete code for a specific product including the form and packaging (e.g. an NDC code). Because vaccineCode uses the CodeableConcept data type, multiple codes at different levels of granularity may be reported for a single immunization event provided that all codes are appropriate for the same vaccine. For example, both NDC and CVX codes may be provided for a given immunization event by repeating the coding element within vaccineCode.

Cardinality: 1..1

Type: CodeableConcept

Binding: example:vaccine-code

Summary: true

Mappings: workflow=Event.code; w5=FiveWs.what[x]; v2=RXA-5; rim=.code; cda=ClinicalDocument/component/StructuredBody/component/section/entry/substanceAdministration/consumable/manfacturedProduct/manufacturedMaterial/realmCode/code

Immunization.administeredProduct

Product that was administered

Definition: An indication of which product was administered to the patient. This is typically a more detailed representation of the concept conveyed by the vaccineCode data element. If a Medication resource is referenced, it may be to a stand-alone resource or a contained resource within the Immunization resource.

Cardinality: 0..1

Type: CodeableReference

Immunization.manufacturer

Vaccine manufacturer

Definition: Name of vaccine manufacturer.

Cardinality: 0..1

Type: CodeableReference

Mappings: v2=RXA-17; rim=.participation[typeCode=CSM].role[classCode=INST].scopedRole.scoper[classCode=ORG]; cda=ClinicalDocument/component/StructuredBody/component/section/entry/substanceAdministration/consumable/manfacturedProduct/manufacuturerOrganization/name

Immunization.lotNumber

Vaccine lot number

Definition: Lot number of the vaccine product.

Cardinality: 0..1

Type: string

Mappings: v2=RXA-15; rim=.participation[typeCode=CSM].role[classCode=INST].scopedRole.scoper[classCode=MMAT].id; cda=ClinicalDocument/component/StructuredBody/component/section/entry/substanceAdministration/consumable/manfacturedProduct/manufacturedMaterial/lotNumberText

Immunization.expirationDate

Vaccine expiration date

Definition: Date vaccine batch expires.

Cardinality: 0..1

Type: date

Mappings: v2=RXA-16; rim=.participation[typeCode=CSM].role[classCode=INST].scopedRole.scoper[classCode=MMAT].expirationTime

Immunization.patient

Who was immunized

Definition: The patient who either received or did not receive the immunization.

Cardinality: 1..1

Type: Reference(Patient)

Summary: true

Mappings: workflow=Event.subject; w5=FiveWs.subject; v2=PID-3; rim=.partipication[ttypeCode=].role

Immunization.encounter

Encounter immunization was part of

Definition: The visit or admission or other contact between patient and health care provider the immunization was performed as part of.

Cardinality: 0..1

Type: Reference(Encounter)

Mappings: workflow=Event.encounter; w5=FiveWs.context; v2=PV1-19; rim=component->EncounterEvent

Immunization.supportingInformation

Additional information in support of the immunization

Definition: Additional information that is relevant to the immunization (e.g. for a vaccine recipient who is pregnant, the gestational age of the fetus). The reason why a vaccine was given (e.g. occupation, underlying medical condition) should be conveyed in Immunization.reason, not as supporting information. The reason why a vaccine was not given (e.g. contraindication) should be conveyed in Immunization.statusReason, not as supporting information.

Cardinality: 0..*

Type: Reference(Resource)

Mappings: w5=FiveWs.context

Immunization.occurrence[x]

Vaccine administration date

Definition: Date vaccine administered or was to be administered.

Comments: When immunizations are given, a specific date and time should always be recorded if known. If the time is not known, it should not be included. However, systems primarily rely on the date component of the immunization record for determining dose validity and future dose forecasting. For this reason, immunization records should preserve the immunization date as recorded for the time zone where the dose was administered. Care should be taken when recording and transmitting time and time zone information, as adjustments based on time zone can shift the recorded date. Additionally, because Patient.birthDate does not include a time component, systems should ensure that comparisons between occurrence date and birth date do not introduce inconsistencies in determining patient age at vaccination. When immunizations are patient reported, a specific date might not be known. Although partial dates are allowed, an adult patient might not be able to recall the year a childhood immunization was given. An exact date is always preferable, but the use of the String data type is acceptable when an exact date is not known. A small number of vaccines (e.g. live oral typhoid vaccine) are given as a series of patient self-administered dose over a span of time. In cases like this, often, only the first dose (typically a provider supervised dose) is recorded with the occurrence indicating the date/time of the first dose.

Cardinality: 1..1

Type: dateTime, string

Summary: true

Mappings: workflow=Event.occurrence[x]; w5=FiveWs.done[x]; v2=RXA-3; rim=.effectiveTime; cda=ClinicalDocument/component/StructuredBody/component/section/entry/substanceAdministration/effectiveTime/value

Immunization.primarySource

Indicates context the data was captured in

Definition: Indicates whether the data contained in the resource was captured by the individual/organization which was responsible for the administration of the vaccine rather than as 'secondary reported' data documented by a third party. A value of 'true' means this data originated with the individual/organization which was responsible for the administration of the vaccine.

Comments: Reflects the “reliability” of the content.

Cardinality: 0..1

Type: boolean

Summary: true

Mappings: workflow=Event.reported; w5=FiveWs.source; v2=RXA-9; rim=immunization.uncertaintycode (if primary source=false, uncertainty=U)

Immunization.informationSource

Indicates the source of a reported record

Definition: Typically the source of the data when the report of the immunization event is not based on information from the person who administered the vaccine.

Comments: Typically will not be populated if primarySource = True, not required even if primarySource = False.

Cardinality: 0..1

Type: CodeableReference

Binding: example:immunization-origin

Mappings: workflow=Event.reported; w5=FiveWs.source; v2=RXA-9; rim=.participation[typeCode=INF].role[classCode=PAT] (this syntax for self-reported) .participation[typeCode=INF].role[classCode=LIC] (this syntax for health care professional) .participation[typeCode=INF].role[classCode=PRS] (this syntax for family member)

Immunization.location

The service delivery location

Definition: The service delivery location where the vaccine administration occurred.

Cardinality: 0..1

Type: Reference(Location)

Mappings: workflow=Event.location; w5=FiveWs.where[x]; v2=RXA-27 (or RXA-11, deprecated as of v2.7); rim=.participation[typeCode=LOC].COCT_MT240000UV

Immunization.site

Body site vaccine was administered

Definition: Body site where vaccine was administered.

Cardinality: 0..1

Type: CodeableConcept

Binding: example:immunization-site

Mappings: v2=RXR-2; rim=observation.targetSiteCode; cda=ClinicalDocument/component/StructuredBody/component/section/entry/substanceAdministration/approachSiteCode/code

Immunization.route

How vaccine entered body

Definition: The path by which the vaccine product is taken into the body.

Cardinality: 0..1

Type: CodeableConcept

Binding: example:immunization-route

Mappings: v2=RXR-1; rim=.routeCode; cda=ClinicalDocument/component/StructuredBody/component/section/entry/substanceAdministration/routeCode/code

Immunization.doseQuantity

Amount of vaccine administered

Definition: The quantity of vaccine product that was administered.

Cardinality: 0..1

Type: Quantity(SimpleQuantity)

Mappings: v2=RXA-6 / RXA-7; rim=.doseQuantity

Immunization.performer

Who performed event

Definition: Indicates who performed the immunization event.

Cardinality: 0..*

Type: BackboneElement

Summary: true

Mappings: workflow=Event.performer; v2=ORC-12 / RXA-10; rim=.participation[typeCode=PRF].role[scoper.determinerCode=INSTANCE]

Immunization.performer.function

Type of performance

Definition: Describes the function played by the performer in the immunization event (e.g. ordering provider, administering provider, etc.).

Cardinality: 0..1

Type: CodeableConcept

Binding: extensible:immunization-function

Summary: true

Mappings: workflow=Event.performer.function; rim=.participation.functionCode

Immunization.performer.actor

Individual or organization who performed the event

Definition: The practitioner or organization who performed the action.

Comments: When the individual practitioner who performed the action is known, it is best to send.

Cardinality: 1..1

Type: Reference(Practitioner, PractitionerRole, Organization, Patient, RelatedPerson)

Summary: true

Mappings: workflow=Event.performer.actor; w5=FiveWs.actor; rim=.player

Immunization.note

Additional immunization notes

Definition: Extra information about the immunization that is not conveyed by the other attributes.

Cardinality: 0..*

Type: Annotation

Summary: true

Mappings: workflow=Event.note; v2=OBX-5 : OBX-3 = 48767-8; rim=note

Immunization.reason

Why immunization occurred

Definition: Describes why the immunization occurred in coded or textual form, or indicates another resource (Condition, Observation or DiagnosticReport) whose existence justifies this immunization.

Cardinality: 0..*

Type: CodeableReference

Binding: example:immunization-reason

Mappings: workflow=Event.reason; rim=[actionNegationInd=false].reasonCode

Immunization.isSubpotent

Dose potency

Definition: Indication if a dose is considered to be subpotent. By default, a dose should be considered to be potent.

Comments: Typically, the recognition of the dose being sub-potent is retrospective, after the administration (ex. notification of a manufacturer recall after administration). However, in the case of a partial administration (the patient moves unexpectedly and only some of the dose is actually administered), subpotency may be recognized immediately, but it is still important to record the event.

Meaning if Missing: By default, a dose should be considered to be potent.

Cardinality: 0..1

Type: boolean

Summary: true

Is Modifier: true (Reason: This element is labeled as a modifier because an immunization event with a subpotent vaccine doesn't protect the patient the same way as a potent dose.)

Mappings: v2=RXA-20 = PA (partial administration); rim=N/A

Immunization.subpotentReason

Reason for being subpotent

Definition: Reason why a dose is considered to be subpotent.

Cardinality: 0..*

Type: CodeableConcept

Binding: example:immunization-subpotent-reason

Mappings: rim=N/A

Immunization.programEligibility

Patient eligibility for a specific vaccination program

Definition: Indicates a patient's eligibility for a funding program.

Cardinality: 0..*

Type: BackboneElement

Mappings: v2=OBX-5 : OBX-3 = 64994-7; rim=n/a

Immunization.programEligibility.program

The program that eligibility is declared for

Definition: Indicates which program the patient had their eligibility evaluated for.

Cardinality: 1..1

Type: CodeableConcept

Binding: example:immunization-vaccine-funding-program

Mappings: rim=n/a

Immunization.programEligibility.programStatus

The patient's eligibility status for the program

Definition: Indicates the patient's eligibility status for a specific payment program.

Cardinality: 1..1

Type: CodeableConcept

Binding: example:immunization-program-eligibility

Mappings: rim=n/a

Immunization.fundingSource

Funding source for the vaccine

Definition: Indicates the source of the vaccine actually administered. This may be different than the patient eligibility (e.g. the patient may be eligible for a publicly purchased vaccine but due to inventory issues, vaccine purchased with private funds was actually administered).

Cardinality: 0..1

Type: CodeableConcept

Binding: example:immunization-funding-source

Mappings: rim=N/A

Immunization.reaction

Details of a reaction that followed the immunization

Definition: Categorical data indicating that an adverse event is associated in time to an immunization.

Comments: A reaction may be an indication of an allergy or intolerance and, if this is determined to be the case, it should be recorded as a new AllergyIntolerance resource instance as most systems will not query against past Immunization.reaction elements.

Cardinality: 0..*

Type: BackboneElement

Mappings: v2=OBX-3; rim=Observation[classCode=obs].code

Immunization.reaction.date

When reaction started

Definition: Date of reaction to the immunization.

Cardinality: 0..1

Type: dateTime

Mappings: v2=OBX-14 (ideally this would be reported in an IAM segment, but IAM is not part of the HL7 V2 VXU message - most likely would appear in OBX segments if at all); rim=.effectiveTime

Immunization.reaction.manifestation

Additional information on reaction

Definition: Details of the reaction.

Cardinality: 0..1

Type: CodeableReference

Mappings: v2=OBX-5; rim=.value

Immunization.reaction.reported

Indicates self-reported reaction

Definition: Self-reported indicator.

Cardinality: 0..1

Type: boolean

Mappings: v2=(HL7 V2 doesn't seem to provide for this); rim=.participation[typeCode=INF].role[classCode=PAT] (this syntax for self-reported=true)

Immunization.protocolApplied

Protocol followed by the provider

Definition: The protocol (set of recommendations) being followed by the provider who administered the dose.

Cardinality: 0..*

Type: BackboneElement

Mappings: rim=N/A

Immunization.protocolApplied.series

Name of vaccine series

Definition: One possible path to achieve presumed immunity against a disease - within the context of an authority.

Cardinality: 0..1

Type: string

Mappings: rim=N/A

Immunization.protocolApplied.authority

Who is responsible for publishing the recommendations

Definition: Indicates the authority who published the protocol (e.g. ACIP) that is being followed.

Cardinality: 0..1

Type: Reference(Organization)

Mappings: rim=N/A

Immunization.protocolApplied.targetDisease

Vaccine preventable disease being targeted

Definition: The vaccine preventable disease the dose is being administered against.

Cardinality: 0..*

Type: CodeableConcept

Binding: example:immunization-target-disease

Mappings: rim=N/A

Immunization.protocolApplied.doseNumber

Dose number within series

Definition: Nominal position in a series as intended by the practitioner administering the dose.

Comments: The dose number may be communicated as either a coded concept (for example Dose 1, Dose 2 or Booster) or as free text as needed by the use case.

Cardinality: 0..1

Type: CodeableConcept

Binding: example

Mappings: rim=N/A

Immunization.protocolApplied.seriesDoses

Recommended number of doses for immunity

Definition: The recommended number of doses to achieve immunity as intended by the practitioner administering the dose.

Comments: The number of doses in a series may be communicated as either a coded concept or as free text as needed by the use case.

Cardinality: 0..1

Type: CodeableConcept

Binding: example

Mappings: rim=N/A