Canadian Baseline
1.1.0 - CI Build Canada flag

Canadian Baseline, published by HL7 Canada - FHIR Implementation Work Group. This guide is not an authorized publication; it is the continuous build for version 1.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7-Canada/ca-baseline/ and changes regularly. See the Directory of published versions

Resource Profile: ImmunizationProfile - Detailed Descriptions

Draft as of 2023-10-26

Definitions for the profile-immunization resource profile.

Guidance on how to interpret the contents of this table can be found here

0. Immunization
2. Immunization.status
Must Supporttrue
4. Immunization.statusReason
Comments

CA Baseline Usage Notes: a reason should be provided if the status is "not-done".

6. Immunization.vaccineCode
Must Supporttrue
8. Immunization.vaccineCode.coding
Comments

CA Baseline Usage Notes: for immunization submission, a server should accept any code a client is able to provide: a Generic code, a Tradename code or both. For immunization retireval, a Trade name is optional, but a Generic code has to be returned if it's known to the server or if it can be derived from the Tradename code.

Control1..?
SlicingThis element introduces a set of slices on Immunization.vaccineCode.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • pattern @ system
  • pattern @ code
  • 10. Immunization.vaccineCode.coding:Generic
    Slice NameGeneric
    Comments

    CA Baseline Usage Notes: either a Generic code or a Tradename code or both have to be present.

    Control0..1
    BindingThe codes SHOULD be taken from https://cvc.canimmunize.ca/v3/ValueSet/Generic
    (preferred to https://cvc.canimmunize.ca/v3/ValueSet/Generic)
    12. Immunization.vaccineCode.coding:Tradename
    Slice NameTradename
    Comments

    CA Baseline Usage Notes: either a Generic code or a Tradename code or both have to be present.

    Control0..1
    BindingThe codes SHOULD be taken from https://cvc.canimmunize.ca/v3/ValueSet/Tradename
    (preferred to https://cvc.canimmunize.ca/v3/ValueSet/Tradename)
    14. Immunization.patient
    TypeReference(Patient Profile)
    Must Supporttrue
    16. Immunization.encounter
    TypeReference(Encounter Profile)
    18. Immunization.occurrence[x]
    Definition

    Date vaccine administered or was to be administered.

    ShortVaccine administration date
    Comments

    CA Baseline Usage Notes: While occurrenceString is allowed given its use in existing Canadian systems - a combination of occurrenceDateTime (full or partial) with the 'estimated' extension is the preferred mechanism for expressing when an exact date is unknown. For example, if a patient recalls that they were immunized in June 1980, occurrenceDateTime will have a partial date '1980-06' with 'estimated'=true. Another example: if in 2020, a 55 y.o. patient recalls that they were immunized at the age of 5, occurrenceDateTime will have a partial date '1970' with 'estimated'=true.

    Control1..1
    TypeChoice of: dateTime, string
    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    SlicingThis element introduces a set of slices on Immunization.occurrence[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
    • type @ $this
    • 20. Immunization.occurrence[x]:occurrenceDateTime
      Slice NameoccurrenceDateTime
      Definition

      Date vaccine administered or was to be administered.

      ShortVaccine administration date
      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.

      Control0..1
      TypedateTime
      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      22. Immunization.occurrence[x]:occurrenceDateTime.extension
      Control0..*
      TypeExtension
      SlicingThis element introduces a set of slices on Immunization.occurrence[x].extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ url
      • 24. Immunization.occurrence[x]:occurrenceDateTime.extension:estimated
        Slice Nameestimated
        Control0..1
        TypeExtension(Extension: Date Estimated Flag) (Extension Type: boolean)
        Must Supportfalse
        26. Immunization.primarySource
        ShortIndicates that data is from the primary record created at the time the vaccine was administered.
        28. Immunization.reportOrigin
        BindingThe codes SHOULD be taken from https://cvc.canimmunize.ca/v3/ValueSet/RepSource
        (preferred to https://cvc.canimmunize.ca/v3/ValueSet/RepSource)
        30. Immunization.location
        TypeReference(Location Profile)
        32. Immunization.manufacturer
        Comments

        CA Baseline Usage Notes: This is a reference to an organization that manufactures the vaccine. TBD: if there is a need to refernce a 'DPD Company', a new extension should be created and used. A 'DPD Company' name, as used in the Health Canada DPF, indicates the organisation (company) that holds the authorization to place the product on the market in Canada. This may not be the company that has manufactured the product, but it is the company that holds the legal responsibility for the use of the product in Canada and should be the same as the company named on the product label/packaging.

        TypeReference(Organization Profile)
        34. Immunization.site
        BindingThe codes SHOULD be taken from https://cvc.canimmunize.ca/v3/ValueSet/AnatomicalSite
        (preferred to https://cvc.canimmunize.ca/v3/ValueSet/AnatomicalSite)
        36. Immunization.route
        BindingThe codes SHOULD be taken from https://cvc.canimmunize.ca/v3/ValueSet/RouteOfAdmin
        (preferred to https://cvc.canimmunize.ca/v3/ValueSet/RouteOfAdmin)
        38. Immunization.performer
        40. Immunization.performer.actor
        TypeReference(Practitioner Profile (General), PractitionerRole Profile (General), Organization Profile)
        42. Immunization.reasonReference
        TypeReference(Condition Profile, Observation Profile (General Use), DiagnosticReport Profile for Results Reporting)
        44. Immunization.reaction
        46. Immunization.reaction.detail
        TypeReference(Observation Profile (General Use))
        48. Immunization.protocolApplied
        50. Immunization.protocolApplied.authority
        TypeReference(Organization Profile)
        52. Immunization.protocolApplied.targetDisease
        BindingThe codes SHOULD be taken from https://cvc.canimmunize.ca/v3/ValueSet/Disease
        (preferred to https://cvc.canimmunize.ca/v3/ValueSet/Disease)

        Guidance on how to interpret the contents of this table can be found here

        0. 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.

        ShortImmunization event information
        Control0..*
        Is Modifierfalse
        Summaryfalse
        Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
        dom-3: 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: 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: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
        dom-6: A resource should have narrative for robust management (text.`div`.exists())
        2. Immunization.implicitRules
        Definition

        A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

        ShortA set of rules under which this content was created
        Comments

        Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

        Control0..1
        Typeuri
        Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        4. Immunization.modifierExtension
        Definition

        May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

        Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

        ShortExtensions that cannot be ignored
        Comments

        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

        Control0..*
        TypeExtension
        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
        Summaryfalse
        Requirements

        Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

        Alternate Namesextensions, user content
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        6. Immunization.status
        Definition

        Indicates the current status of the immunization event.

        Shortcompleted | entered-in-error | not-done
        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.

        Control1..1
        BindingThe codes SHALL be taken from ImmunizationStatusCodeshttp://hl7.org/fhir/ValueSet/immunization-status|4.0.1
        (required to http://hl7.org/fhir/ValueSet/immunization-status|4.0.1)

        A set of codes indicating the current status of an Immunization.

        Typecode
        Is Modifiertrue because 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
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supporttrue
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        8. Immunization.statusReason
        Definition

        Indicates the reason the immunization event was not performed.

        ShortReason not done
        Comments

        CA Baseline Usage Notes: a reason should be provided if the status is "not-done".


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

        Control0..1
        BindingFor example codes, see ImmunizationStatusReasonCodeshttp://hl7.org/fhir/ValueSet/immunization-status-reason
        (example to http://hl7.org/fhir/ValueSet/immunization-status-reason)

        The reason why a vaccine was not administered.

        TypeCodeableConcept
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        10. Immunization.vaccineCode
        Definition

        Vaccine that was administered or was to be administered.

        ShortVaccine product administered
        Control1..1
        BindingFor example codes, see VaccineAdministeredValueSethttp://hl7.org/fhir/ValueSet/vaccine-code
        (example to http://hl7.org/fhir/ValueSet/vaccine-code)

        The code for vaccine product administered.

        TypeCodeableConcept
        Is Modifierfalse
        Must Supporttrue
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        12. Immunization.vaccineCode.coding
        Definition

        A reference to a code defined by a terminology system.

        ShortCode defined by a terminology system
        Comments

        CA Baseline Usage Notes: for immunization submission, a server should accept any code a client is able to provide: a Generic code, a Tradename code or both. For immunization retireval, a Trade name is optional, but a Generic code has to be returned if it's known to the server or if it can be derived from the Tradename code.


        Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

        Control10..*
        TypeCoding
        Is Modifierfalse
        Summarytrue
        Requirements

        Allows for alternative encodings within a code system, and translations to other code systems.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        SlicingThis element introduces a set of slices on Immunization.vaccineCode.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • pattern @ system
        • pattern @ code
        • 14. Immunization.vaccineCode.coding:Generic
          Slice NameGeneric
          Definition

          A reference to a code defined by a terminology system.

          ShortCode defined by a terminology system
          Comments

          CA Baseline Usage Notes: either a Generic code or a Tradename code or both have to be present.


          Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

          Control0..1*
          BindingThe codes SHOULD be taken from For codes, see https://cvc.canimmunize.ca/v3/ValueSet/Generic
          (preferred to https://cvc.canimmunize.ca/v3/ValueSet/Generic)
          TypeCoding
          Is Modifierfalse
          Summarytrue
          Requirements

          Allows for alternative encodings within a code system, and translations to other code systems.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          16. Immunization.vaccineCode.coding:Tradename
          Slice NameTradename
          Definition

          A reference to a code defined by a terminology system.

          ShortCode defined by a terminology system
          Comments

          CA Baseline Usage Notes: either a Generic code or a Tradename code or both have to be present.


          Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

          Control0..1*
          BindingThe codes SHOULD be taken from For codes, see https://cvc.canimmunize.ca/v3/ValueSet/Tradename
          (preferred to https://cvc.canimmunize.ca/v3/ValueSet/Tradename)
          TypeCoding
          Is Modifierfalse
          Summarytrue
          Requirements

          Allows for alternative encodings within a code system, and translations to other code systems.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          18. Immunization.patient
          Definition

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

          ShortWho was immunized
          Control1..1
          TypeReference(Patient Profile, Patient)
          Is Modifierfalse
          Must Supporttrue
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          20. Immunization.encounter
          Definition

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

          ShortEncounter immunization was part of
          Control0..1
          TypeReference(Encounter Profile, Encounter)
          Is Modifierfalse
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          22. Immunization.occurrence[x]
          Definition

          Date vaccine administered or was to be administered.

          ShortVaccine administration date
          Comments

          CA Baseline Usage Notes: While occurrenceString is allowed given its use in existing Canadian systems - a combination of occurrenceDateTime (full or partial) with the 'estimated' extension is the preferred mechanism for expressing when an exact date is unknown. For example, if a patient recalls that they were immunized in June 1980, occurrenceDateTime will have a partial date '1980-06' with 'estimated'=true. Another example: if in 2020, a 55 y.o. patient recalls that they were immunized at the age of 5, occurrenceDateTime will have a partial date '1970' with 'estimated'=true.


          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.

          Control1..1
          TypeChoice of: dateTime, string
          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          SlicingThis element introduces a set of slices on Immunization.occurrence[x]. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • type @ $this
          • 24. Immunization.occurrence[x]:occurrenceDateTime
            Slice NameoccurrenceDateTime
            Definition

            Date vaccine administered or was to be administered.

            ShortVaccine administration date
            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.

            Control01..1
            TypedateTime, string
            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            26. Immunization.occurrence[x]:occurrenceDateTime.extension
            Definition

            An Extension


            May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

            ShortExtensionAdditional content defined by implementations
            Comments

            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

            Control0..*
            TypeExtension
            Is Modifierfalse
            Summaryfalse
            Alternate Namesextensions, user content
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            SlicingThis element introduces a set of slices on Immunization.occurrence[x].extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • value @ url
            • 28. Immunization.occurrence[x]:occurrenceDateTime.extension:estimated
              Slice Nameestimated
              Definition

              If true, information entered may not be accurate or precise

              ShortInformation entered is is an estimate
              Control0..1
              This element is affected by the following invariants: ele-1
              TypeExtension(Extension: Date Estimated Flag) (Extension Type: boolean)
              Is Modifierfalse
              Must Supportfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              30. Immunization.primarySource
              Definition

              An indication that the content of the record is based on information from the person who administered the vaccine. This reflects the context under which the data was originally recorded.

              ShortIndicates that data is from the primary record created at the time the vaccine was administered.Indicates context the data was recorded in
              Comments

              Reflects the “reliability” of the content.

              Control0..1
              Typeboolean
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              32. Immunization.reportOrigin
              Definition

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

              ShortIndicates the source of a secondarily reported record
              Comments

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

              Control0..1
              BindingThe codes SHOULD be taken from For example codes, see https://cvc.canimmunize.ca/v3/ValueSet/RepSourcehttp://hl7.org/fhir/ValueSet/immunization-origin
              (preferred to https://cvc.canimmunize.ca/v3/ValueSet/RepSource)
              TypeCodeableConcept
              Is Modifierfalse
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              34. Immunization.location
              Definition

              The service delivery location where the vaccine administration occurred.

              ShortWhere immunization occurred
              Control0..1
              TypeReference(Location Profile, Location)
              Is Modifierfalse
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              36. Immunization.manufacturer
              Definition

              Name of vaccine manufacturer.

              ShortVaccine manufacturer
              Comments

              CA Baseline Usage Notes: This is a reference to an organization that manufactures the vaccine. TBD: if there is a need to refernce a 'DPD Company', a new extension should be created and used. A 'DPD Company' name, as used in the Health Canada DPF, indicates the organisation (company) that holds the authorization to place the product on the market in Canada. This may not be the company that has manufactured the product, but it is the company that holds the legal responsibility for the use of the product in Canada and should be the same as the company named on the product label/packaging.

              Control0..1
              TypeReference(Organization Profile, Organization)
              Is Modifierfalse
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              38. Immunization.site
              Definition

              Body site where vaccine was administered.

              ShortBody site vaccine was administered
              Control0..1
              BindingThe codes SHOULD be taken from For example codes, see https://cvc.canimmunize.ca/v3/ValueSet/AnatomicalSitehttp://hl7.org/fhir/ValueSet/immunization-site
              (preferred to https://cvc.canimmunize.ca/v3/ValueSet/AnatomicalSite)
              TypeCodeableConcept
              Is Modifierfalse
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              40. Immunization.route
              Definition

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

              ShortHow vaccine entered body
              Control0..1
              BindingThe codes SHOULD be taken from For example codes, see https://cvc.canimmunize.ca/v3/ValueSet/RouteOfAdminhttp://hl7.org/fhir/ValueSet/immunization-route
              (preferred to https://cvc.canimmunize.ca/v3/ValueSet/RouteOfAdmin)
              TypeCodeableConcept
              Is Modifierfalse
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              42. Immunization.reasonReference
              Definition

              Condition, Observation or DiagnosticReport that supports why the immunization was administered.

              ShortWhy immunization occurred
              Control0..*
              TypeReference(Condition Profile, Observation Profile (General Use), DiagnosticReport Profile for Results Reporting, Condition, Observation, DiagnosticReport)
              Is Modifierfalse
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              44. Immunization.isSubpotent
              Definition

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

              ShortDose potency
              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.

              Control0..1
              Typeboolean
              Is Modifiertrue because 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.
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Meaning if MissingBy default, a dose should be considered to be potent.
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

              Guidance on how to interpret the contents of this table can be found here

              0. 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.

              ShortImmunization event information
              Control0..*
              Is Modifierfalse
              Summaryfalse
              Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
              dom-3: 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: 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: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
              dom-6: A resource should have narrative for robust management (text.`div`.exists())
              2. Immunization.id
              Definition

              The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

              ShortLogical id of this artifact
              Comments

              The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

              Control0..1
              Typeid
              Is Modifierfalse
              Summarytrue
              4. Immunization.meta
              Definition

              The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

              ShortMetadata about the resource
              Control0..1
              TypeMeta
              Is Modifierfalse
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              6. Immunization.implicitRules
              Definition

              A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

              ShortA set of rules under which this content was created
              Comments

              Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

              Control0..1
              Typeuri
              Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              8. Immunization.language
              Definition

              The base language in which the resource is written.

              ShortLanguage of the resource content
              Comments

              Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

              Control0..1
              BindingThe codes SHOULD be taken from CommonLanguages
              (preferred to http://hl7.org/fhir/ValueSet/languages)

              A human language.

              Additional BindingsPurpose
              AllLanguagesMax Binding
              Typecode
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              10. Immunization.text
              Definition

              A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

              ShortText summary of the resource, for human interpretation
              Comments

              Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.

              Control0..1
              TypeNarrative
              Is Modifierfalse
              Summaryfalse
              Alternate Namesnarrative, html, xhtml, display
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              12. Immunization.contained
              Definition

              These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

              ShortContained, inline Resources
              Comments

              This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

              Control0..*
              TypeResource
              Is Modifierfalse
              Summaryfalse
              Alternate Namesinline resources, anonymous resources, contained resources
              14. Immunization.extension
              Definition

              May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

              ShortAdditional content defined by implementations
              Comments

              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

              Control0..*
              TypeExtension
              Is Modifierfalse
              Summaryfalse
              Alternate Namesextensions, user content
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              16. Immunization.modifierExtension
              Definition

              May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

              Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

              ShortExtensions that cannot be ignored
              Comments

              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

              Control0..*
              TypeExtension
              Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
              Summaryfalse
              Requirements

              Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

              Alternate Namesextensions, user content
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              18. Immunization.identifier
              Definition

              A unique identifier assigned to this immunization record.

              ShortBusiness identifier
              NoteThis is a business identifier, not a resource identifier (see discussion)
              Control0..*
              TypeIdentifier
              Is Modifierfalse
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              20. Immunization.status
              Definition

              Indicates the current status of the immunization event.

              Shortcompleted | entered-in-error | not-done
              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.

              Control1..1
              BindingThe codes SHALL be taken from ImmunizationStatusCodes
              (required to http://hl7.org/fhir/ValueSet/immunization-status|4.0.1)

              A set of codes indicating the current status of an Immunization.

              Typecode
              Is Modifiertrue because 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
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supporttrue
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              22. Immunization.statusReason
              Definition

              Indicates the reason the immunization event was not performed.

              ShortReason not done
              Comments

              CA Baseline Usage Notes: a reason should be provided if the status is "not-done".

              Control0..1
              BindingFor example codes, see ImmunizationStatusReasonCodes
              (example to http://hl7.org/fhir/ValueSet/immunization-status-reason)

              The reason why a vaccine was not administered.

              TypeCodeableConcept
              Is Modifierfalse
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              24. Immunization.vaccineCode
              Definition

              Vaccine that was administered or was to be administered.

              ShortVaccine product administered
              Control1..1
              BindingFor example codes, see VaccineAdministeredValueSet
              (example to http://hl7.org/fhir/ValueSet/vaccine-code)

              The code for vaccine product administered.

              TypeCodeableConcept
              Is Modifierfalse
              Must Supporttrue
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              26. Immunization.vaccineCode.id
              Definition

              Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

              ShortUnique id for inter-element referencing
              Control0..1
              Typestring
              Is Modifierfalse
              XML FormatIn the XML format, this property is represented as an attribute.
              Summaryfalse
              28. Immunization.vaccineCode.extension
              Definition

              May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

              ShortAdditional content defined by implementations
              Comments

              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

              Control0..*
              TypeExtension
              Is Modifierfalse
              Summaryfalse
              Alternate Namesextensions, user content
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              SlicingThis element introduces a set of slices on Immunization.vaccineCode.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
              • value @ url
              • 30. Immunization.vaccineCode.coding
                Definition

                A reference to a code defined by a terminology system.

                ShortCode defined by a terminology system
                Comments

                CA Baseline Usage Notes: for immunization submission, a server should accept any code a client is able to provide: a Generic code, a Tradename code or both. For immunization retireval, a Trade name is optional, but a Generic code has to be returned if it's known to the server or if it can be derived from the Tradename code.

                Control1..*
                TypeCoding
                Is Modifierfalse
                Summarytrue
                Requirements

                Allows for alternative encodings within a code system, and translations to other code systems.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                SlicingThis element introduces a set of slices on Immunization.vaccineCode.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                • pattern @ system
                • pattern @ code
                • 32. Immunization.vaccineCode.coding:Generic
                  Slice NameGeneric
                  Definition

                  A reference to a code defined by a terminology system.

                  ShortCode defined by a terminology system
                  Comments

                  CA Baseline Usage Notes: either a Generic code or a Tradename code or both have to be present.

                  Control0..1
                  BindingThe codes SHOULD be taken from https://cvc.canimmunize.ca/v3/ValueSet/Generic
                  (preferred to https://cvc.canimmunize.ca/v3/ValueSet/Generic)
                  TypeCoding
                  Is Modifierfalse
                  Summarytrue
                  Requirements

                  Allows for alternative encodings within a code system, and translations to other code systems.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  34. Immunization.vaccineCode.coding:Tradename
                  Slice NameTradename
                  Definition

                  A reference to a code defined by a terminology system.

                  ShortCode defined by a terminology system
                  Comments

                  CA Baseline Usage Notes: either a Generic code or a Tradename code or both have to be present.

                  Control0..1
                  BindingThe codes SHOULD be taken from https://cvc.canimmunize.ca/v3/ValueSet/Tradename
                  (preferred to https://cvc.canimmunize.ca/v3/ValueSet/Tradename)
                  TypeCoding
                  Is Modifierfalse
                  Summarytrue
                  Requirements

                  Allows for alternative encodings within a code system, and translations to other code systems.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  36. Immunization.vaccineCode.text
                  Definition

                  A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

                  ShortPlain text representation of the concept
                  Comments

                  Very often the text is the same as a displayName of one of the codings.

                  Control0..1
                  Typestring
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Summarytrue
                  Requirements

                  The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  38. Immunization.patient
                  Definition

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

                  ShortWho was immunized
                  Control1..1
                  TypeReference(Patient Profile)
                  Is Modifierfalse
                  Must Supporttrue
                  Summarytrue
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  40. Immunization.encounter
                  Definition

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

                  ShortEncounter immunization was part of
                  Control0..1
                  TypeReference(Encounter Profile)
                  Is Modifierfalse
                  Summaryfalse
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  42. Immunization.occurrence[x]
                  Definition

                  Date vaccine administered or was to be administered.

                  ShortVaccine administration date
                  Comments

                  CA Baseline Usage Notes: While occurrenceString is allowed given its use in existing Canadian systems - a combination of occurrenceDateTime (full or partial) with the 'estimated' extension is the preferred mechanism for expressing when an exact date is unknown. For example, if a patient recalls that they were immunized in June 1980, occurrenceDateTime will have a partial date '1980-06' with 'estimated'=true. Another example: if in 2020, a 55 y.o. patient recalls that they were immunized at the age of 5, occurrenceDateTime will have a partial date '1970' with 'estimated'=true.

                  Control1..1
                  TypeChoice of: dateTime, string
                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Summarytrue
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  SlicingThis element introduces a set of slices on Immunization.occurrence[x]. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                  • type @ $this
                  • 44. Immunization.occurrence[x]:occurrenceDateTime
                    Slice NameoccurrenceDateTime
                    Definition

                    Date vaccine administered or was to be administered.

                    ShortVaccine administration date
                    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.

                    Control0..1
                    TypedateTime
                    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summarytrue
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    46. Immunization.occurrence[x]:occurrenceDateTime.id
                    Definition

                    unique id for the element within a resource (for internal references)

                    Shortxml:id (or equivalent in JSON)
                    Control0..1
                    Typestring
                    Is Modifierfalse
                    XML FormatIn the XML format, this property is represented as an attribute.
                    Summaryfalse
                    48. Immunization.occurrence[x]:occurrenceDateTime.extension
                    Definition

                    An Extension

                    ShortExtension
                    Control0..*
                    TypeExtension
                    Is Modifierfalse
                    Summaryfalse
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                    SlicingThis element introduces a set of slices on Immunization.occurrence[x].extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                    • value @ url
                    • 50. Immunization.occurrence[x]:occurrenceDateTime.extension:estimated
                      Slice Nameestimated
                      Definition

                      If true, information entered may not be accurate or precise

                      ShortInformation entered is is an estimate
                      Control0..1
                      This element is affected by the following invariants: ele-1
                      TypeExtension(Extension: Date Estimated Flag) (Extension Type: boolean)
                      Is Modifierfalse
                      Must Supportfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                      52. Immunization.occurrence[x]:occurrenceDateTime.value
                      Definition

                      The actual value

                      ShortPrimitive value for dateTime
                      Control0..1
                      TypedateTime
                      Is Modifierfalse
                      XML FormatIn the XML format, this property is represented as an attribute.
                      Summaryfalse
                      54. Immunization.recorded
                      Definition

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

                      ShortWhen the immunization was first captured in the subject's record
                      Control0..1
                      TypedateTime
                      Is Modifierfalse
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Summaryfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      56. Immunization.primarySource
                      Definition

                      An indication that the content of the record is based on information from the person who administered the vaccine. This reflects the context under which the data was originally recorded.

                      ShortIndicates that data is from the primary record created at the time the vaccine was administered.
                      Comments

                      Reflects the “reliability” of the content.

                      Control0..1
                      Typeboolean
                      Is Modifierfalse
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Summarytrue
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      58. Immunization.reportOrigin
                      Definition

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

                      ShortIndicates the source of a secondarily reported record
                      Comments

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

                      Control0..1
                      BindingThe codes SHOULD be taken from https://cvc.canimmunize.ca/v3/ValueSet/RepSource
                      (preferred to https://cvc.canimmunize.ca/v3/ValueSet/RepSource)
                      TypeCodeableConcept
                      Is Modifierfalse
                      Summaryfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      60. Immunization.location
                      Definition

                      The service delivery location where the vaccine administration occurred.

                      ShortWhere immunization occurred
                      Control0..1
                      TypeReference(Location Profile)
                      Is Modifierfalse
                      Summaryfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      62. Immunization.manufacturer
                      Definition

                      Name of vaccine manufacturer.

                      ShortVaccine manufacturer
                      Comments

                      CA Baseline Usage Notes: This is a reference to an organization that manufactures the vaccine. TBD: if there is a need to refernce a 'DPD Company', a new extension should be created and used. A 'DPD Company' name, as used in the Health Canada DPF, indicates the organisation (company) that holds the authorization to place the product on the market in Canada. This may not be the company that has manufactured the product, but it is the company that holds the legal responsibility for the use of the product in Canada and should be the same as the company named on the product label/packaging.

                      Control0..1
                      TypeReference(Organization Profile)
                      Is Modifierfalse
                      Summaryfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      64. Immunization.lotNumber
                      Definition

                      Lot number of the vaccine product.

                      ShortVaccine lot number
                      Control0..1
                      Typestring
                      Is Modifierfalse
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Summaryfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      66. Immunization.expirationDate
                      Definition

                      Date vaccine batch expires.

                      ShortVaccine expiration date
                      Control0..1
                      Typedate
                      Is Modifierfalse
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Summaryfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      68. Immunization.site
                      Definition

                      Body site where vaccine was administered.

                      ShortBody site vaccine was administered
                      Control0..1
                      BindingThe codes SHOULD be taken from https://cvc.canimmunize.ca/v3/ValueSet/AnatomicalSite
                      (preferred to https://cvc.canimmunize.ca/v3/ValueSet/AnatomicalSite)
                      TypeCodeableConcept
                      Is Modifierfalse
                      Summaryfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      70. Immunization.route
                      Definition

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

                      ShortHow vaccine entered body
                      Control0..1
                      BindingThe codes SHOULD be taken from https://cvc.canimmunize.ca/v3/ValueSet/RouteOfAdmin
                      (preferred to https://cvc.canimmunize.ca/v3/ValueSet/RouteOfAdmin)
                      TypeCodeableConcept
                      Is Modifierfalse
                      Summaryfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      72. Immunization.doseQuantity
                      Definition

                      The quantity of vaccine product that was administered.

                      ShortAmount of vaccine administered
                      Control0..1
                      TypeQuantity(SimpleQuantity)
                      Is Modifierfalse
                      Summaryfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      74. Immunization.performer
                      Definition

                      Indicates who performed the immunization event.

                      ShortWho performed event
                      Control0..*
                      TypeBackboneElement
                      Is Modifierfalse
                      Summarytrue
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      76. Immunization.performer.id
                      Definition

                      Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                      ShortUnique id for inter-element referencing
                      Control0..1
                      Typestring
                      Is Modifierfalse
                      XML FormatIn the XML format, this property is represented as an attribute.
                      Summaryfalse
                      78. Immunization.performer.extension
                      Definition

                      May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                      ShortAdditional content defined by implementations
                      Comments

                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                      Control0..*
                      TypeExtension
                      Is Modifierfalse
                      Summaryfalse
                      Alternate Namesextensions, user content
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                      80. Immunization.performer.modifierExtension
                      Definition

                      May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                      Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                      ShortExtensions that cannot be ignored even if unrecognized
                      Comments

                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                      Control0..*
                      TypeExtension
                      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                      Summarytrue
                      Requirements

                      Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                      Alternate Namesextensions, user content, modifiers
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                      82. Immunization.performer.function
                      Definition

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

                      ShortWhat type of performance was done
                      Control0..1
                      BindingUnless not suitable, these codes SHALL be taken from ImmunizationFunctionCodes
                      (extensible to http://hl7.org/fhir/ValueSet/immunization-function)

                      The role a practitioner or organization plays in the immunization event.

                      TypeCodeableConcept
                      Is Modifierfalse
                      Summarytrue
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      84. Immunization.performer.actor
                      Definition

                      The practitioner or organization who performed the action.

                      ShortIndividual or organization who was performing
                      Comments

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

                      Control1..1
                      TypeReference(Practitioner Profile (General), PractitionerRole Profile (General), Organization Profile)
                      Is Modifierfalse
                      Summarytrue
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      86. Immunization.note
                      Definition

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

                      ShortAdditional immunization notes
                      Control0..*
                      TypeAnnotation
                      Is Modifierfalse
                      Summarytrue
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      88. Immunization.reasonCode
                      Definition

                      Reasons why the vaccine was administered.

                      ShortWhy immunization occurred
                      Control0..*
                      BindingFor example codes, see ImmunizationReasonCodes
                      (example to http://hl7.org/fhir/ValueSet/immunization-reason)

                      The reason why a vaccine was administered.

                      TypeCodeableConcept
                      Is Modifierfalse
                      Summaryfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      90. Immunization.reasonReference
                      Definition

                      Condition, Observation or DiagnosticReport that supports why the immunization was administered.

                      ShortWhy immunization occurred
                      Control0..*
                      TypeReference(Condition Profile, Observation Profile (General Use), DiagnosticReport Profile for Results Reporting)
                      Is Modifierfalse
                      Summaryfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      92. Immunization.isSubpotent
                      Definition

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

                      ShortDose potency
                      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.

                      Control0..1
                      Typeboolean
                      Is Modifiertrue because 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.
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Summarytrue
                      Meaning if MissingBy default, a dose should be considered to be potent.
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      94. Immunization.subpotentReason
                      Definition

                      Reason why a dose is considered to be subpotent.

                      ShortReason for being subpotent
                      Control0..*
                      BindingFor example codes, see ImmunizationSubpotentReason
                      (example to http://hl7.org/fhir/ValueSet/immunization-subpotent-reason)

                      The reason why a dose is considered to be subpotent.

                      TypeCodeableConcept
                      Is Modifierfalse
                      Summaryfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      96. Immunization.education
                      Definition

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

                      ShortEducational material presented to patient
                      Control0..*
                      TypeBackboneElement
                      Is Modifierfalse
                      Summaryfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      imm-1: One of documentType or reference SHALL be present (documentType.exists() or reference.exists())
                      98. Immunization.education.id
                      Definition

                      Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                      ShortUnique id for inter-element referencing
                      Control0..1
                      Typestring
                      Is Modifierfalse
                      XML FormatIn the XML format, this property is represented as an attribute.
                      Summaryfalse
                      100. Immunization.education.extension
                      Definition

                      May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                      ShortAdditional content defined by implementations
                      Comments

                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                      Control0..*
                      TypeExtension
                      Is Modifierfalse
                      Summaryfalse
                      Alternate Namesextensions, user content
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                      102. Immunization.education.modifierExtension
                      Definition

                      May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                      Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                      ShortExtensions that cannot be ignored even if unrecognized
                      Comments

                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                      Control0..*
                      TypeExtension
                      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                      Summarytrue
                      Requirements

                      Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                      Alternate Namesextensions, user content, modifiers
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                      104. Immunization.education.documentType
                      Definition

                      Identifier of the material presented to the patient.

                      ShortEducational material document identifier
                      Control0..1
                      Typestring
                      Is Modifierfalse
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Summaryfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      106. Immunization.education.reference
                      Definition

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

                      ShortEducational material reference pointer
                      Control0..1
                      Typeuri
                      Is Modifierfalse
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Summaryfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      108. Immunization.education.publicationDate
                      Definition

                      Date the educational material was published.

                      ShortEducational material publication date
                      Control0..1
                      TypedateTime
                      Is Modifierfalse
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Summaryfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      110. Immunization.education.presentationDate
                      Definition

                      Date the educational material was given to the patient.

                      ShortEducational material presentation date
                      Control0..1
                      TypedateTime
                      Is Modifierfalse
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Summaryfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      112. Immunization.programEligibility
                      Definition

                      Indicates a patient's eligibility for a funding program.

                      ShortPatient eligibility for a vaccination program
                      Control0..*
                      BindingFor example codes, see ImmunizationProgramEligibility
                      (example to http://hl7.org/fhir/ValueSet/immunization-program-eligibility)

                      The patient's eligibility for a vaccation program.

                      TypeCodeableConcept
                      Is Modifierfalse
                      Summaryfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      114. 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).

                      ShortFunding source for the vaccine
                      Control0..1
                      BindingFor example codes, see ImmunizationFundingSource
                      (example to http://hl7.org/fhir/ValueSet/immunization-funding-source)

                      The source of funding used to purchase the vaccine administered.

                      TypeCodeableConcept
                      Is Modifierfalse
                      Summaryfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      116. Immunization.reaction
                      Definition

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

                      ShortDetails of a reaction that follows 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.

                      Control0..*
                      TypeBackboneElement
                      Is Modifierfalse
                      Summaryfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      118. Immunization.reaction.id
                      Definition

                      Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                      ShortUnique id for inter-element referencing
                      Control0..1
                      Typestring
                      Is Modifierfalse
                      XML FormatIn the XML format, this property is represented as an attribute.
                      Summaryfalse
                      120. Immunization.reaction.extension
                      Definition

                      May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                      ShortAdditional content defined by implementations
                      Comments

                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                      Control0..*
                      TypeExtension
                      Is Modifierfalse
                      Summaryfalse
                      Alternate Namesextensions, user content
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                      122. Immunization.reaction.modifierExtension
                      Definition

                      May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                      Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                      ShortExtensions that cannot be ignored even if unrecognized
                      Comments

                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                      Control0..*
                      TypeExtension
                      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                      Summarytrue
                      Requirements

                      Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                      Alternate Namesextensions, user content, modifiers
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                      124. Immunization.reaction.date
                      Definition

                      Date of reaction to the immunization.

                      ShortWhen reaction started
                      Control0..1
                      TypedateTime
                      Is Modifierfalse
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Summaryfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      126. Immunization.reaction.detail
                      Definition

                      Details of the reaction.

                      ShortAdditional information on reaction
                      Control0..1
                      TypeReference(Observation Profile (General Use))
                      Is Modifierfalse
                      Summaryfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      128. Immunization.reaction.reported
                      Definition

                      Self-reported indicator.

                      ShortIndicates self-reported reaction
                      Control0..1
                      Typeboolean
                      Is Modifierfalse
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Summaryfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      130. Immunization.protocolApplied
                      Definition

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

                      ShortProtocol followed by the provider
                      Control0..*
                      TypeBackboneElement
                      Is Modifierfalse
                      Summaryfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      132. Immunization.protocolApplied.id
                      Definition

                      Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                      ShortUnique id for inter-element referencing
                      Control0..1
                      Typestring
                      Is Modifierfalse
                      XML FormatIn the XML format, this property is represented as an attribute.
                      Summaryfalse
                      134. Immunization.protocolApplied.extension
                      Definition

                      May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                      ShortAdditional content defined by implementations
                      Comments

                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                      Control0..*
                      TypeExtension
                      Is Modifierfalse
                      Summaryfalse
                      Alternate Namesextensions, user content
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                      136. Immunization.protocolApplied.modifierExtension
                      Definition

                      May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                      Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                      ShortExtensions that cannot be ignored even if unrecognized
                      Comments

                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                      Control0..*
                      TypeExtension
                      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                      Summarytrue
                      Requirements

                      Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                      Alternate Namesextensions, user content, modifiers
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                      138. Immunization.protocolApplied.series
                      Definition

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

                      ShortName of vaccine series
                      Control0..1
                      Typestring
                      Is Modifierfalse
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Summaryfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      140. Immunization.protocolApplied.authority
                      Definition

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

                      ShortWho is responsible for publishing the recommendations
                      Control0..1
                      TypeReference(Organization Profile)
                      Is Modifierfalse
                      Summaryfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      142. Immunization.protocolApplied.targetDisease
                      Definition

                      The vaccine preventable disease the dose is being administered against.

                      ShortVaccine preventatable disease being targetted
                      Control0..*
                      BindingThe codes SHOULD be taken from https://cvc.canimmunize.ca/v3/ValueSet/Disease
                      (preferred to https://cvc.canimmunize.ca/v3/ValueSet/Disease)
                      TypeCodeableConcept
                      Is Modifierfalse
                      Summaryfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      144. Immunization.protocolApplied.doseNumber[x]
                      Definition

                      Nominal position in a series.

                      ShortDose number within series
                      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).

                      Control1..1
                      TypeChoice of: positiveInt, string
                      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                      Is Modifierfalse
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Summaryfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      146. Immunization.protocolApplied.seriesDoses[x]
                      Definition

                      The recommended number of doses to achieve immunity.

                      ShortRecommended number of doses for immunity
                      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).

                      Control0..1
                      TypeChoice of: positiveInt, string
                      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                      Is Modifierfalse
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Summaryfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))