Example Usage Scenarios:

The following are example usage scenarios for the US Core-Core Immunization profile:

• Query for immunizations belonging to a Patient
• Record or update immunizations belonging to a Patient

Mandatory and Must Support Data Elements

The following data elements must always be present (Mandatory definition) or must be supported if the data is present in the sending system (Must Support definition). They are presented below in a simple human-readable explanation. Profile specific guidance and examples are provided as well. The Formal Views below provides the formal summary, definitions, and terminology requirements.

Each Immunization Must Have:

1. a status
2. a vaccine code that identifies the kind of vaccine administered*
3. a patient
4. a date the vaccine was administered

Each Immunization Must Support:

1. a statusReason if the vaccine wasn't given
2. a flag to indicate whether the vaccine was reported by someone other than the person who administered the vaccine.
3. the encounter the immunization was part of
4. where the vaccine was administered
5. vaccine lot number*
6. a performer*

*see guidance below

Profile Specific Implementation Guidance:

• Use the status code: not-done to represent that an immunization was not given.
• Based upon the ONC U.S. Core Data for Interoperability (USCDI) requirements, CVX vaccine codes¹ are required, and the NDC vaccine codes SHOULD be supported as a translation.
  • The preferred code system identifiers are http://hl7.org/fhir/sid/cvx for CVX and http://hl7.org/fhir/sid/ndc for NDC vaccine codes. Note that the vaccineCode binding link in the formal definition and the CDC links below use the associated OID as the code system identifiers.
  • Be aware that there is a 10-digit (with dashes) NDC format displayed on drug packaging and an 11-digit (no dashes) NDC format for billing and prescribing (for example, "49281-121-65" and "49281012165"). Normalization may be required to avoid validation errors and warnings.
  • The CDC provides the CDC National Drug Code (NDC) Directory – Vaccine NDC Linker Table to assist implementers. The example Immunization-imm-1 illustrates using the CVX and 11-digit NDC codes based on this table.
  • *Although there is no guarantee that vaccine lot numbers are globally unique, they effectively are when combined with the vaccine code. NDC codes are defined by manufacturer, and CVX codes, which are much less granular, are often limited to a single product made by a single manufacturer. Implementers MAY communicate the Immunization.manufacturer as well to ensure global uniqueness to lot numbers.

• *The profile element Immunization.performer.actor communicates the individual level provenance author data corresponding to the U.S. Core Data for Interoperability (USCDI) Provenance Author Data Elements.

Changes since version 7.0.0:

Quick Start

Below is an overview of the required Server RESTful FHIR interactions for this profile - for example, search and read operations - when supporting the US Core interactions to access this profile's information (Profile Support + Interaction Support). Note that systems that support only US Core Profiles (Profile Only Support) are not required to support these interactions. See the US Core Server CapabilityStatement for a complete list of supported RESTful interactions for this IG.

• See the Scopes Format section for a description of the SMART scopes syntax.
• See the Search Syntax section for a description of the US Core search syntax.
• See the General Requirements section for additional rules and expectations when a Server requires status parameters.
• See the General Guidance section for additional guidance on searching for multiple patients.

US Core Scopes

Servers providing access to immunization data SHALL support these US Core SMART Scopes:

• resource level scopes: <patient|user|system>/Immunization.rs

Mandatory Search Parameters:

The following search parameters and search parameter combinations SHALL be supported:

1. SHALL support searching for all immunizations for a patient using the patient search parameter:

   GET [base]/Immunization?patient={Type/}[id]

   Example:

   1. GET [base]/Immunization?patient=1137192

   Implementation Notes: Fetches a bundle of all Immunization resources for the specified patient (how to search by reference)

Optional Search Parameters:

The following search parameter combinations SHOULD be supported:

1. SHOULD support searching using the combination of the patient and date search parameters:
   • including support for these date comparators: gt,lt,ge,le
   • including optional support for AND search on date (e.g.date=[date]&date=[date]]&...)

   GET [base]/Immunization?patient={Type/}[id]&date={gt|lt|ge|le}[date]{&date={gt|lt|ge|le}[date]&...}

   Example:

   1. GET [base]/Immunization?patient=1137192&date=ge2019-01-14T00:00:00Z

   Implementation Notes: Fetches a bundle of all Immunization resources for the specified patient and date (how to search by date and how to search by reference)

2. SHOULD support searching using the combination of the patient and status search parameters:

   GET [base]/Immunization?patient={Type/}[id]&status={system|}[code]

   Example:

   1. GET [base]/Immunization?patient=1137192&status=completed

   Implementation Notes: Fetches a bundle of all Immunization resources for the specified patient and status (how to search by reference and how to search by date)

¹ Although the CVX code system contains some concepts that are procedures, medications, or substances rather than immunizations, the value set defined in VSAC has removed those and retained only the vaccine codes (see the exclusion definition in VSAC for more detail)