QI-Core Implementation Guide
4.1.0 - release

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## Resource Profile: QICoreImmunizationRecommendation

Defining URL: | http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-immunizationrec
Version: | 4.1.0
Name: | QICoreImmunizationRecommendation
Status: | Draft as of 8/22/18
Definition: | Profile of ImmunizationRecommendation for decision support/quality metrics. Defines the core set of elements and extensions for quality rule and measure authors.
Publisher: | http://www.hl7.org/Special/committees/cqi/index.cfm
Source Resource: | XML / JSON / Turtle

The official URL for this profile is:

    http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-immunizationrec

Usage

See the patterns page for implementation and usage patterns.

### Examples

Example of immunizationrecommendation using a vaccine code

### Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

- Text Summary
- Differential Table
- Snapshot Table
- Snapshot Table (Must Support)
- All

This structure is derived from ImmunizationRecommendation

Summary

Must-Support: 4 elements

Structures

This structure refers to these other structures:

- QICorePatient (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient)
- QICoreOrganization (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-organization)
- QICoreImmunization (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-immunization)
- QICoreImmunizationEvaluation (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-immunizationevaluation)
- QICoreObservation (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation)
- QICoreAllergyIntolerance (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-allergyintolerance)

This structure is derived from ImmunizationRecommendation

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
ImmunizationRecommendation |  | 0..* | ImmunizationRecommendation | Guidance or advice relating to an immunization
patient | S | 1..1 | Reference(QICorePatient) | Who this profile is for
authority |  | 0..1 | Reference(QICoreOrganization) | Who is responsible for protocol
recommendation | S | 1..* | BackboneElement | Vaccine administration recommendations
vaccineCode | S | 0..* | CodeableConcept | Vaccine or vaccine group recommendation applies to Binding: US Core Vaccine Administered Value Set (CVX) (extensible): This identifies the CVX code system
doseNumber[x] | S | 0..1 | positiveInt, string | Recommended dose number within series
supportingImmunization |  | 0..* | Reference(QICoreImmunization | QICoreImmunizationEvaluation) | Past immunizations supporting recommendation
supportingPatientInformation |  | 0..* | Reference(QICoreObservation | QICoreAllergyIntolerance) | Patient observations supporting recommendation
Documentation for this format

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
ImmunizationRecommendation |  | 0..* | ImmunizationRecommendation | Guidance or advice relating to an immunization
id | Σ | 0..1 | string | Logical id of this artifact
meta | Σ | 0..1 | Meta | Metadata about the resource
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
language |  | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred) Max Binding: AllLanguages: A human language.
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation
contained |  | 0..* | Resource | Contained, inline Resources
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier | Σ | 0..* | Identifier | Business identifier
patient | S Σ | 1..1 | Reference(QICorePatient) | Who this profile is for
date | Σ | 1..1 | dateTime | Date recommendation(s) created
authority |  | 0..1 | Reference(QICoreOrganization) | Who is responsible for protocol
recommendation | S Σ I | 1..* | BackboneElement | Vaccine administration recommendations
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
vaccineCode | S Σ | 0..* | CodeableConcept | Vaccine or vaccine group recommendation applies to Binding: US Core Vaccine Administered Value Set (CVX) (extensible): This identifies the CVX code system
targetDisease | Σ | 0..1 | CodeableConcept | Disease to be immunized against Binding: ImmunizationRecommendationTargetDiseaseCodes (example): The disease that the recommended vaccination targets.
contraindicatedVaccineCode | Σ | 0..* | CodeableConcept | Vaccine which is contraindicated to fulfill the recommendation Binding: VaccineAdministeredValueSet (example): The type of vaccine administered.
forecastStatus | ?!Σ | 1..1 | CodeableConcept | Vaccine recommendation status Binding: ImmunizationRecommendationStatusCodes (example): The patient's status with respect to a vaccination protocol.
forecastReason | Σ | 0..* | CodeableConcept | Vaccine administration status reason Binding: ImmunizationRecommendationReasonCodes (example): The reason for the patient's status with respect to a vaccination protocol.
dateCriterion |  | 0..* | BackboneElement | Dates governing proposed immunization
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
code |  | 1..1 | CodeableConcept | Type of date Binding: ImmunizationRecommendationDateCriterionCodes (example): Classifies date criterion with respect to conveying information about a patient's vaccination status (e.g. due date, latest to give date, etc.).
value |  | 1..1 | dateTime | Recommended date
description |  | 0..1 | string | Protocol details
series |  | 0..1 | string | Name of vaccination series
doseNumber[x] | S Σ | 0..1 |  | Recommended dose number within series
doseNumberPositiveInt |  |  | positiveInt |
doseNumberString |  |  | string |
seriesDoses[x] |  | 0..1 |  | Recommended number of doses for immunity
seriesDosesPositiveInt |  |  | positiveInt |
seriesDosesString |  |  | string |
supportingImmunization |  | 0..* | Reference(QICoreImmunization | QICoreImmunizationEvaluation) | Past immunizations supporting recommendation
supportingPatientInformation |  | 0..* | Reference(QICoreObservation | QICoreAllergyIntolerance) | Patient observations supporting recommendation
Documentation for this format

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
ImmunizationRecommendation |  | 0..* | ImmunizationRecommendation | Guidance or advice relating to an immunization
patient | Σ | 1..1 | Reference(QICorePatient) | Who this profile is for
recommendation | Σ I | 1..* | BackboneElement | Vaccine administration recommendations
vaccineCode | Σ | 0..* | CodeableConcept | Vaccine or vaccine group recommendation applies to Binding: US Core Vaccine Administered Value Set (CVX) (extensible): This identifies the CVX code system
doseNumber[x] | Σ | 0..1 |  | Recommended dose number within series
doseNumberPositiveInt |  |  | positiveInt |
doseNumberString |  |  | string |
Documentation for this format

This structure is derived from ImmunizationRecommendation

Summary

Must-Support: 4 elements

Structures

This structure refers to these other structures:

- QICorePatient (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient)
- QICoreOrganization (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-organization)
- QICoreImmunization (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-immunization)
- QICoreImmunizationEvaluation (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-immunizationevaluation)
- QICoreObservation (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation)
- QICoreAllergyIntolerance (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-allergyintolerance)

Differential View

This structure is derived from ImmunizationRecommendation

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
ImmunizationRecommendation |  | 0..* | ImmunizationRecommendation | Guidance or advice relating to an immunization
patient | S | 1..1 | Reference(QICorePatient) | Who this profile is for
authority |  | 0..1 | Reference(QICoreOrganization) | Who is responsible for protocol
recommendation | S | 1..* | BackboneElement | Vaccine administration recommendations
vaccineCode | S | 0..* | CodeableConcept | Vaccine or vaccine group recommendation applies to Binding: US Core Vaccine Administered Value Set (CVX) (extensible): This identifies the CVX code system
doseNumber[x] | S | 0..1 | positiveInt, string | Recommended dose number within series
supportingImmunization |  | 0..* | Reference(QICoreImmunization | QICoreImmunizationEvaluation) | Past immunizations supporting recommendation
supportingPatientInformation |  | 0..* | Reference(QICoreObservation | QICoreAllergyIntolerance) | Patient observations supporting recommendation
Documentation for this format

Snapshot View

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
ImmunizationRecommendation |  | 0..* | ImmunizationRecommendation | Guidance or advice relating to an immunization
id | Σ | 0..1 | string | Logical id of this artifact
meta | Σ | 0..1 | Meta | Metadata about the resource
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
language |  | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred) Max Binding: AllLanguages: A human language.
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation
contained |  | 0..* | Resource | Contained, inline Resources
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier | Σ | 0..* | Identifier | Business identifier
patient | S Σ | 1..1 | Reference(QICorePatient) | Who this profile is for
date | Σ | 1..1 | dateTime | Date recommendation(s) created
authority |  | 0..1 | Reference(QICoreOrganization) | Who is responsible for protocol
recommendation | S Σ I | 1..* | BackboneElement | Vaccine administration recommendations
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
vaccineCode | S Σ | 0..* | CodeableConcept | Vaccine or vaccine group recommendation applies to Binding: US Core Vaccine Administered Value Set (CVX) (extensible): This identifies the CVX code system
targetDisease | Σ | 0..1 | CodeableConcept | Disease to be immunized against Binding: ImmunizationRecommendationTargetDiseaseCodes (example): The disease that the recommended vaccination targets.
contraindicatedVaccineCode | Σ | 0..* | CodeableConcept | Vaccine which is contraindicated to fulfill the recommendation Binding: VaccineAdministeredValueSet (example): The type of vaccine administered.
forecastStatus | ?!Σ | 1..1 | CodeableConcept | Vaccine recommendation status Binding: ImmunizationRecommendationStatusCodes (example): The patient's status with respect to a vaccination protocol.
forecastReason | Σ | 0..* | CodeableConcept | Vaccine administration status reason Binding: ImmunizationRecommendationReasonCodes (example): The reason for the patient's status with respect to a vaccination protocol.
dateCriterion |  | 0..* | BackboneElement | Dates governing proposed immunization
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
code |  | 1..1 | CodeableConcept | Type of date Binding: ImmunizationRecommendationDateCriterionCodes (example): Classifies date criterion with respect to conveying information about a patient's vaccination status (e.g. due date, latest to give date, etc.).
value |  | 1..1 | dateTime | Recommended date
description |  | 0..1 | string | Protocol details
series |  | 0..1 | string | Name of vaccination series
doseNumber[x] | S Σ | 0..1 |  | Recommended dose number within series
doseNumberPositiveInt |  |  | positiveInt |
doseNumberString |  |  | string |
seriesDoses[x] |  | 0..1 |  | Recommended number of doses for immunity
seriesDosesPositiveInt |  |  | positiveInt |
seriesDosesString |  |  | string |
supportingImmunization |  | 0..* | Reference(QICoreImmunization | QICoreImmunizationEvaluation) | Past immunizations supporting recommendation
supportingPatientInformation |  | 0..* | Reference(QICoreObservation | QICoreAllergyIntolerance) | Patient observations supporting recommendation
Documentation for this format

Other representations of profile: CSV, Excel, Schematron

#### Terminology Bindings

Path | Conformance | ValueSet
ImmunizationRecommendation.language | preferred | CommonLanguages Max Binding: AllLanguages
ImmunizationRecommendation.recommendation.vaccineCode | extensible | USCoreVaccineAdministeredValueSetCvx
ImmunizationRecommendation.recommendation.targetDisease | example | ImmunizationRecommendationTargetDiseaseCodes
ImmunizationRecommendation.recommendation.contraindicatedVaccineCode | example | VaccineAdministeredValueSet
ImmunizationRecommendation.recommendation.forecastStatus | example | ImmunizationRecommendationStatusCodes
ImmunizationRecommendation.recommendation.forecastReason | example | ImmunizationRecommendationReasonCodes
ImmunizationRecommendation.recommendation.dateCriterion.code | example | ImmunizationRecommendationDateCriterionCodes

#### Constraints

Id | Grade | Path | Details | Requirements
dom-2 | error | ImmunizationRecommendation | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() |
dom-3 | error | ImmunizationRecommendation | 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 | error | ImmunizationRecommendation | 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 | error | ImmunizationRecommendation | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() |
dom-6 | Best Practice | ImmunizationRecommendation | A resource should have narrative for robust management : text.`div`.exists() |
ele-1 | error | ImmunizationRecommendation.meta | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | ImmunizationRecommendation.implicitRules | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | ImmunizationRecommendation.language | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | ImmunizationRecommendation.text | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | ImmunizationRecommendation.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ext-1 | error | ImmunizationRecommendation.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
ele-1 | error | ImmunizationRecommendation.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ext-1 | error | ImmunizationRecommendation.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
ele-1 | error | ImmunizationRecommendation.identifier | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | ImmunizationRecommendation.patient | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | ImmunizationRecommendation.date | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | ImmunizationRecommendation.authority | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | ImmunizationRecommendation.recommendation | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
imr-1 | error | ImmunizationRecommendation.recommendation | One of vaccineCode or targetDisease SHALL be present : vaccineCode.exists() or targetDisease.exists() |
ele-1 | error | ImmunizationRecommendation.recommendation.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ext-1 | error | ImmunizationRecommendation.recommendation.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
ele-1 | error | ImmunizationRecommendation.recommendation.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ext-1 | error | ImmunizationRecommendation.recommendation.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
ele-1 | error | ImmunizationRecommendation.recommendation.vaccineCode | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | ImmunizationRecommendation.recommendation.targetDisease | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | ImmunizationRecommendation.recommendation.contraindicatedVaccineCode | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | ImmunizationRecommendation.recommendation.forecastStatus | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | ImmunizationRecommendation.recommendation.forecastReason | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | ImmunizationRecommendation.recommendation.dateCriterion | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | ImmunizationRecommendation.recommendation.dateCriterion.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ext-1 | error | ImmunizationRecommendation.recommendation.dateCriterion.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
ele-1 | error | ImmunizationRecommendation.recommendation.dateCriterion.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ext-1 | error | ImmunizationRecommendation.recommendation.dateCriterion.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
ele-1 | error | ImmunizationRecommendation.recommendation.dateCriterion.code | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | ImmunizationRecommendation.recommendation.dateCriterion.value | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | ImmunizationRecommendation.recommendation.description | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | ImmunizationRecommendation.recommendation.series | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | ImmunizationRecommendation.recommendation.doseNumber[x] | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | ImmunizationRecommendation.recommendation.seriesDoses[x] | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | ImmunizationRecommendation.recommendation.supportingImmunization | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | ImmunizationRecommendation.recommendation.supportingPatientInformation | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |