FHIR Release 3 (STU) 5 Preview #3
This page is part of the FHIR Specification (v3.0.2: STU 3). The current version which supercedes this version is 4.0.1 . For a full list of available versions, see the Directory of published versions
Public Health and Emergency Response Work Group Maturity Level : 3   Trial Use Security Category : Patient Compartments : Patient , Practitioner

Detailed Descriptions for the elements in the Immunization resource.

CodeableConcept
Immunization
Element Id Immunization
Definition

Describes the event of a patient being administered a vaccination vaccine or a record of a vaccination an immunization as reported by a patient, a clinician or another party and may include vaccine reaction information and what vaccination protocol was followed. party.

Control Cardinality 1..1 0..*
Invariants Defined on this element imm-1 : If immunization was not administered (notGiven=true) then there SHALL be no reaction nor explanation.reason present ( expression Type : (notGiven = true).not() or (reaction.empty() and explanation.reason.empty()), xpath: not(f:notGiven/@value=true() and (count(f:reaction) > 0 or exists(f:explanation/f:reason)))) imm-2 : If immunization was administered (notGiven=false) then explanation.reasonNotGiven SHALL be absent. ( expression DomainResource : (notGiven = true) or explanation.reasonNotGiven.empty(), xpath: not(f:notGiven/@value=false() and exists(f:explanation/f:reasonNotGiven)))
Immunization.identifier
Element Id Immunization.identifier
Definition

A unique identifier assigned to this immunization record.

Note This is a business identifer, identifier, not a resource identifier (see discussion )
Control Cardinality 0..*
Type Identifier
Immunization.instantiatesCanonical
Element Id Immunization.instantiatesCanonical
Definition

The URL pointing to a FHIR-defined protocol, guideline, orderset or other definition that is adhered to in whole or in part by this Immunization.

Cardinality 0..*
Type canonical ( Definition [ ActivityDefinition , EventDefinition , EvidenceVariable , Measure , OperationDefinition , PlanDefinition , Questionnaire , SubscriptionTopic ])
Summary true
Immunization.instantiatesUri
Element Id Immunization.instantiatesUri
Definition

The URL pointing to an externally maintained protocol, guideline, orderset or other definition that is adhered to in whole or in part by this Immunization.

Cardinality 0..*
Type uri
Summary true
Comments

This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier.

Immunization.basedOn
Element Id Immunization.basedOn
Definition

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

Cardinality 0..*
Type Reference ( CarePlan | MedicationRequest | ImmunizationRecommendation )
Patterns Reference(CarePlan,MedicationRequest,ImmunizationRecommendation): Common patterns = Request
Summary true
Comments

Allows tracing of an authorization for the Immunization.

Immunization.status
Element Id Immunization.status
Definition

Indicates the current status of the vaccination immunization event.

Control Cardinality 1..1
Terminology Binding Immunization Status Codes ( Required )
Type code
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)
Summary true
Comments

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

Immunization.notGiven Immunization.statusReason
Element Id Immunization.statusReason
Definition

Indicates if the vaccination was or reason the immunization event was not given. performed.

Control Cardinality 1..1 0..1
Type Terminology Binding boolean Immunization Status Reason Codes ( Example )
Is Modifier Type true Summary CodeableConcept true
Comments

This element is labeled as a modifier because it indicates that an generally only used for the status of "not-done". The reason for performing the immunization didn't happen. event is captured in reasonCode, not here.

Immunization.vaccineCode
Element Id Immunization.vaccineCode
Definition

Vaccine that was administered or was to be administered.

Control Cardinality 1..1
Terminology Binding Vaccine Administered Value Set ( Example )
Type CodeableConcept
Summary true
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.

Immunization.manufacturer
Element Id Immunization.manufacturer
Definition

Name of vaccine manufacturer.

Cardinality 0..1
Type Reference ( Organization )
Immunization.lotNumber
Element Id Immunization.lotNumber
Definition

Lot number of the vaccine product.

Cardinality 0..1
Type string
Immunization.expirationDate
Element Id Immunization.expirationDate
Definition

Date vaccine batch expires.

Cardinality 0..1
Type date
Immunization.patient
Element Id Immunization.patient
Definition

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

Control Cardinality 1..1
Type Reference ( Patient )
Summary true
Immunization.encounter
Element Id Immunization.encounter
Definition

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

Control Cardinality 0..1
Type Reference ( Encounter )
Immunization.date Immunization.occurrence[x]
Element Id Immunization.occurrence[x]
Definition

Date vaccine administered or was to be administered.

Control Cardinality 0..1 1..1
Type dateTime | string
[x] Note See Choice of Data Types for further information about how to use [x]
Summary true
Comments

When immunizations are given a specific date and time should always be known. When immunizations are patient reported, a specific date might not be known.  Although 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.

Immunization.primarySource Immunization.recorded
Element Id Immunization.recorded
Definition

An indication that The date the content occurrence of the record is based on information from the person who administered immunization was first captured in the vaccine. This reflects record - potentially significantly after the context under which occurrence of the data event.

Cardinality 0..1
Type dateTime
Summary false
Immunization.primarySource
Element Id Immunization.primarySource
Definition

Indicates if this record was originally recorded. captured as a secondary 'reported' record rather than as an original primary source-of-truth record.

Control Cardinality 1..1 0..1
Type boolean
Summary true
Comments

Reflects the “reliability” of the content.

Immunization.reportOrigin Immunization.informationSource[x]
Element Id Immunization.informationSource[x]
Definition

The 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.

Control Cardinality 0..1
Terminology Binding Immunization Origin Codes ( Example )
Type CodeableConcept | Reference ( Patient | Practitioner | PractitionerRole | RelatedPerson | Organization )
Patterns Reference(Patient,Practitioner,PractitionerRole,RelatedPerson,Organization): Common patterns = Participant
[x] Note See Choice of Data Types for further information about how to use [x]
Comments

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

Immunization.location
Element Id Immunization.location
Definition

The service delivery location where the vaccine administration occurred.

Control Cardinality 0..1
Type Reference ( Location )
Immunization.manufacturer Definition Name of vaccine manufacturer. Control 0..1 Type Reference ( Organization ) Immunization.lotNumber Definition Lot number of the vaccine product. Control 0..1 Type string Immunization.expirationDate Immunization.site
Definition Date vaccine batch expires. Control 0..1 Type Element Id date Immunization.site
Definition

Body site where vaccine was administered.

Control Cardinality 0..1
Terminology Binding Codes for Immunization Site of Administration ( Example )
Type CodeableConcept
Immunization.route
Element Id Immunization.route
Definition

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

Control Cardinality 0..1
Terminology Binding Immunization Route Codes ( Example )
Type CodeableConcept
Immunization.doseQuantity
Element Id Immunization.doseQuantity
Definition

The quantity of vaccine product that was administered.

Control Cardinality 0..1
Type SimpleQuantity
Immunization.practitioner Immunization.performer
Element Id Immunization.performer
Definition

Indicates who or what performed the immunization event.

Control Cardinality 0..*
Summary true
Immunization.practitioner.role Immunization.performer.function
Element Id Immunization.performer.function
Definition

Describes the type of performance (e.g. ordering provider, administering provider, etc.).

Control Cardinality 0..1
Terminology Binding Immunization Role Function Codes ( Extensible )
Type CodeableConcept
Summary true
Immunization.practitioner.actor Immunization.performer.actor
Element Id Immunization.performer.actor
Definition

The device, practitioner, etc. practitioner or organization who performed the action.

Control Cardinality 1..1
Type Reference ( Practitioner | PractitionerRole | Organization )
Patterns Reference(Practitioner,PractitionerRole,Organization): Common patterns = Participant
Summary true
Comments

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

Immunization.note
Element Id Immunization.note
Definition

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

Control Cardinality 0..*
Type Annotation
Summary true
Immunization.explanation Immunization.reason
Element Id Immunization.reason
Definition

Reasons Describes why a vaccine was the immunization occurred in coded or was not administered. textual form, or Indicates another resource (Condition, Observation or DiagnosticReport) whose existence justifies this immunization.

Control Cardinality 0..1 0..*
Terminology Binding Immunization Reason Codes ( Example )
Type CodeableReference ( Condition | Observation | DiagnosticReport )
Patterns CodeableReference(Condition,Observation,DiagnosticReport): Common patterns = Event
Immunization.explanation.reason Immunization.isSubpotent
Element Id Immunization.isSubpotent
Definition

Reasons why Indication if a vaccine was administered. dose is considered to be subpotent. By default, a dose should be considered to be potent.

Control Cardinality 0..* 0..1
Terminology Binding Type Immunization Reason Codes ( Example boolean )
Type 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.)
Meaning if Missing By default, a dose should be considered to be potent.
Summary true
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.

Immunization.explanation.reasonNotGiven Immunization.subpotentReason
Element Id Immunization.subpotentReason
Definition

Reason why a vaccine was not administered. dose is considered to be subpotent.

Control Cardinality 0..*
Terminology Binding Immunization Reasons for Not Immunizing Codes Subpotent Reason ( Example )
Type CodeableConcept
Immunization.reaction Immunization.education
Element Id Immunization.education
Definition

Categorical data indicating that an adverse event is associated in time Educational material presented to an immunization. the patient (or guardian) at the time of vaccine administration.

Control Cardinality 0..*
Comments Invariants A reaction may be an indication
Defined on this element
imm-1 Rule One of an allergy documentType or intolerance and, if this is determined to be the case, it should reference SHALL be recorded as a new AllergyIntolerance resource instance as most systems will not query against past Immunization.reaction elements. present documentType.exists() or reference.exists()
Immunization.reaction.date Immunization.education.documentType
Element Id Immunization.education.documentType
Definition

Date Identifier of reaction the material presented to the immunization. patient.

Control Cardinality 0..1
Type dateTime string
Immunization.reaction.detail Immunization.education.reference
Element Id Immunization.education.reference
Definition

Details of Reference pointer to the reaction. educational material given to the patient if the information was on line.

Control Cardinality 0..1
Type Reference ( Observation uri )
Immunization.reaction.reported Immunization.education.publicationDate
Element Id Immunization.education.publicationDate
Definition

Self-reported indicator. Date the educational material was published.

Control Cardinality 0..1
Type boolean dateTime
Immunization.vaccinationProtocol Immunization.education.presentationDate
Element Id Immunization.education.presentationDate
Definition

Contains information about the protocol(s) under which Date the vaccine educational material was administered. given to the patient.

Control Cardinality 0..* 0..1
Type dateTime
Immunization.vaccinationProtocol.doseSequence Immunization.programEligibility
Element Id Immunization.programEligibility
Definition

Nominal position in Indicates a series. patient's eligibility for a funding program.

Control Cardinality 0..1 0..*
Terminology Binding Immunization Program Eligibility ( Example )
Type positiveInt CodeableConcept
Immunization.vaccinationProtocol.description Immunization.fundingSource
Element Id Immunization.fundingSource
Definition

Contains Indicates the description about source of the protocol under which vaccine actually administered. This may be different than the patient eligibility (e.g. the patient may be eligible for a publically purchased vaccine but due to inventory issues, vaccine purchased with private funds was administered. actually administered).

Control Cardinality 0..1
Terminology Binding Immunization Funding Source ( Example )
Type string CodeableConcept
Immunization.vaccinationProtocol.authority Immunization.reaction
Element Id Immunization.reaction
Definition

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

Cardinality 0..*
Comments

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

Immunization.reaction.date
Element Id Immunization.reaction.date
Definition

Date of reaction to the protocol. E.g. ACIP. immunization.

Control Cardinality 0..1
Type dateTime
Immunization.reaction.detail
Element Id Immunization.reaction.detail
Definition

Details of the reaction.

Cardinality 0..1
Type Reference ( Organization Observation )
Immunization.vaccinationProtocol.series Immunization.reaction.reported
Element Id Immunization.reaction.reported
Definition

Self-reported indicator.

Cardinality 0..1
Type boolean
Immunization.protocolApplied
Element Id Immunization.protocolApplied
Definition

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

Cardinality 0..*
Immunization.protocolApplied.series
Element Id Immunization.protocolApplied.series
Definition

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

Control Cardinality 0..1
Type string
Immunization.vaccinationProtocol.seriesDoses Immunization.protocolApplied.authority
Element Id Immunization.protocolApplied.authority
Definition

The recommended number of doses to achieve immunity. Indicates the authority who published the protocol (e.g. ACIP) that is being followed.

Control Cardinality 0..1
Type positiveInt Reference ( Organization )
Immunization.vaccinationProtocol.targetDisease Immunization.protocolApplied.targetDisease
Element Id Immunization.protocolApplied.targetDisease
Definition

The targeted disease. vaccine preventable disease the dose is being administered against.

Control Cardinality 1..* 0..*
Terminology Binding Vaccination Protocol Dose Immunization Target Disease Codes ( Example )
Type CodeableConcept
Immunization.vaccinationProtocol.doseStatus Immunization.protocolApplied.doseNumber
Element Id Immunization.protocolApplied.doseNumber
Definition

Indicates if Nominal position in a series as intended by the immunization event should "count" against practitioner administering the protocol. dose.

Control Cardinality 1..1
Terminology Binding Vaccination Protocol Dose Status codes ( Example ) Type CodeableConcept string
Comments

May need to differentiate between status declarations by a provider vs. The use of an integer is preferred if known. Text should only be used in cases where an integer is not available (such as when documenting a CDS engine. recurring booster dose).

Immunization.vaccinationProtocol.doseStatusReason Immunization.protocolApplied.seriesDoses
Element Id Immunization.protocolApplied.seriesDoses
Definition

Provides an explanation as The recommended number of doses to why an immunization event should or should not count against achieve immunity as intended by the protocol. practitioner administering the dose.

Control Cardinality 0..1
Terminology Binding Type Vaccination Protocol Dose Status Reason codes ( Example string )
Type Comments CodeableConcept

The use of an integer is preferred if known.