Release 4 5 Snapshot #1

This page is part of the FHIR Specification (v4.0.1: R4 - Mixed Normative and STU ) in it's permanent home (it will always be available at this URL). (v5.0.0-snapshot1: R5 Snapshot #1). The current version which supercedes this version is 5.0.0 . For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R4 R3 R2

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.

Immunization
Element Id Immunization
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..*
Type DomainResource
Summary false
Immunization.identifier
Element Id Immunization.identifier
Definition

A unique identifier assigned to this immunization record.

Note This is a business identifier, not a resource identifier (see discussion )
Cardinality 0..*
Type Identifier
Summary false
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 , ArtifactAssessment , 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 immunization event.

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 or not done. This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

Immunization.statusReason
Element Id Immunization.statusReason
Definition

Indicates the reason the immunization event was not performed.

Cardinality 0..1
Terminology Binding Immunization Status Reason Codes ( Example )
Type CodeableConcept
Summary false
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.

Immunization.vaccineCode
Element Id Immunization.vaccineCode
Definition

Vaccine that was administered or was to be administered.

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 )
Summary false
Immunization.lotNumber
Element Id Immunization.lotNumber
Definition

Lot number of the vaccine product.

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

Date vaccine batch expires.

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

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

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.

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

Date vaccine administered or was to be administered.

Cardinality 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 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.recorded
Element Id Immunization.recorded
Definition

The date the occurrence of the immunization was first captured in the record - potentially significantly after the occurrence of the event.

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

An indication that the content of the Indicates if this record is based on information from the person who administered the vaccine. This reflects the context under which the data was originally recorded. captured as a secondary 'reported' record rather than as an original primary source-of-truth record.

Cardinality 0..1
Type boolean
Summary true
Comments

Reflects the “reliability” of the content.

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

Cardinality 0..1
Terminology Binding Immunization Origin Codes ( Example )
Type CodeableConcept Comments Should not be populated if primarySource = True, not required even if primarySource = False. Immunization.location Element Id Immunization.location Definition The service delivery location where the vaccine administration occurred. Cardinality 0..1 Type | Reference ( Location Patient | Practitioner | PractitionerRole | RelatedPerson | Organization )
Patterns Immunization.manufacturer Element Id Reference(Patient,Practitioner,PractitionerRole,RelatedPerson,Organization): Common patterns = Participant Immunization.manufacturer
Definition [x] Note Name See Choice of vaccine manufacturer. Data Types for further information about how to use [x]
Cardinality Summary 0..1 false
Type Comments Reference ( Organization )

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

Immunization.lotNumber Immunization.location
Element Id Immunization.lotNumber Immunization.location
Definition

Lot number of The service delivery location where the vaccine product. administration occurred.

Cardinality 0..1
Type string Reference Immunization.expirationDate Element Id Immunization.expirationDate Definition Date vaccine batch expires. Cardinality ( Location 0..1 )
Type Summary date false
Immunization.site
Element Id Immunization.site
Definition

Body site where vaccine was administered.

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

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

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

The quantity of vaccine product that was administered.

Cardinality 0..1
Type SimpleQuantity
Summary false
Immunization.performer
Element Id Immunization.performer
Definition

Indicates who performed the immunization event.

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

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

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

The practitioner or organization who performed the action.

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.

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

Reasons Describes why the vaccine was administered. immunization occurred in coded or textual form, or Indicates another resource (Condition, Observation or DiagnosticReport) whose existence justifies this immunization.

Cardinality 0..*
Terminology Binding Immunization Reason Codes ( Example )
Type CodeableConcept CodeableReference ( Condition Immunization.reasonReference Element Id Immunization.reasonReference Definition Condition, | Observation or | DiagnosticReport that supports why the immunization was administered. )
Cardinality Patterns 0..* CodeableReference(Condition,Observation,DiagnosticReport): Common patterns = Event
Type Summary Reference ( Condition | Observation | DiagnosticReport ) false
Immunization.isSubpotent
Element Id Immunization.isSubpotent
Definition

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

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

Reason why a dose is considered to be subpotent.

Cardinality 0..*
Terminology Binding Immunization Subpotent Reason ( Example )
Type CodeableConcept
Summary false
Immunization.education
Element Id Immunization.education
Definition

Educational material presented to the patient (or guardian) at the time of vaccine administration.

Cardinality 0..*
Summary false
Invariants
Defined on this element
imm-1 Rule One of documentType or reference SHALL be present documentType.exists() or reference.exists()
Immunization.education.documentType
Element Id Immunization.education.documentType
Definition

Identifier of the material presented to the patient.

Cardinality 0..1
Type string
Summary false
Immunization.education.reference
Element Id Immunization.education.reference
Definition

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

Cardinality 0..1
Type uri
Summary false
Immunization.education.publicationDate
Element Id Immunization.education.publicationDate
Definition

Date the educational material was published.

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

Date the educational material was given to the patient.

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

Indicates a patient's eligibility for a funding program.

Cardinality 0..*
Terminology Binding Immunization Program Eligibility ( Example )
Type CodeableConcept
Summary false
Immunization.fundingSource
Element Id Immunization.fundingSource
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 publically purchased vaccine but due to inventory issues, vaccine purchased with private funds was actually administered).

Cardinality 0..1
Terminology Binding Immunization Funding Source ( Example )
Type CodeableConcept
Summary false
Immunization.reaction
Element Id Immunization.reaction
Definition

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

Cardinality 0..*
Summary false
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.

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

Date of reaction to the immunization.

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

Details of the reaction.

Cardinality 0..1
Type Reference ( Observation )
Summary false
Immunization.reaction.reported
Element Id Immunization.reaction.reported
Definition

Self-reported indicator.

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

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

Cardinality 0..*
Summary false
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.

Cardinality 0..1
Type string
Summary false
Immunization.protocolApplied.authority
Element Id Immunization.protocolApplied.authority
Definition

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

Cardinality 0..1
Type Reference ( Organization )
Summary false
Immunization.protocolApplied.targetDisease
Element Id Immunization.protocolApplied.targetDisease
Definition

The vaccine preventable disease the dose is being administered against.

Cardinality 0..*
Terminology Binding Immunization Target Disease Codes ( Example )
Type CodeableConcept
Summary false
Immunization.protocolApplied.doseNumber[x] Immunization.protocolApplied.doseNumber
Element Id Immunization.protocolApplied.doseNumber[x] Immunization.protocolApplied.doseNumber
Definition

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

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

The use of an integer is preferred if known. A string Text should only be used in cases where an integer is not available (such as when documenting a recurring booster dose).

Immunization.protocolApplied.seriesDoses[x] Immunization.protocolApplied.seriesDoses
Element Id Immunization.protocolApplied.seriesDoses[x] Immunization.protocolApplied.seriesDoses
Definition

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

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

The use of an integer is preferred if known. A string should only be used in cases where an integer is not available (such as when documenting a recurring booster dose).