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11.7 Resource Immunization - Content

Public Health icon Work GroupMaturity Level: 5 Trial UseSecurity Category: Patient Compartments: Patient, Practitioner

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.

11.7.1 Scope and Usage

The Immunization resource is intended to cover the recording of current and historical administration of vaccines to patients across all healthcare disciplines in all care settings and all regions. This includes immunization of both humans and animals but does not include the administration of non-vaccine agents, even those that may have or claim to have immunological effects. While the terms "immunization" and "vaccination" are not clinically identical, for the purposes of the FHIR resources, the terms are used synonymously.

Additionally, the Immunization resource is expected to cover key concepts related to the creation, revision and querying of a patient's immunization history. This resource - through consultation with the Public Health work group - is believed to meet key use cases and information requirements as defined in the existing HL7 V2 icon immunization implementation guide, HL7 v3 icon POIZ domain and Immunization Domain Analysis Model.

11.7.2 Boundaries and Relationships

Administration of vaccines is intended to be handled using the Immunization resource. MedicationAdministration is intended for tracking the administration of non-vaccine medications. Some systems treat immunizations in the same way as any other medication administration. Such systems SHOULD use an immunization resource to represent these. If systems need to use a MedicationAdministration resource to capture vaccinations for workflow or other reasons, they SHOULD also expose an equivalent Immunization instance.

While the Immunization and MedicationAdministration resources are distinct, they are both able to capture specific details of the administered product. The Immunization resource uses Immunization.vaccineCode to indicate the nature of the vaccine administered to the patient. The Immunization.administeredProduct may additionally be used to identify the specific product used (either as a coded value or as a reference to a Medication resource). The Immunization resource also contains data about the administered vaccine including the manufacturer, lot number and expiration date. However, the data elements contained within Immunization are expected to only be used when Immunization.administeredProduct does not reference a Medication resource which contains the same information about the product.

Similarly, MedicationAdministration.medication references a Medication resource which is used to identify the administered product. Medication.marketingAuthorizationHolder, Medication.batch.lotNumber and Medication.batch.expirationDate are all analogous to the Immunization resource elements and are similarly used to capture details of the administered product.

Immunization.reaction may be an indication of an allergy or intolerance. If this is deemed to be the case, a separate AllergyIntolerance resource instance should be created to indicate it, as most systems will not query against past Immunization.reaction.

Some workflows may require documenting that specific educational materials were presented to the patient (or other responsible party) at the time of or before the immunization event. Conveyance of this information should be accomplished using the Communication resource. This resource can be linked to an Immunization resource and indicate the timing and nature of the educational material provided. The Communication resource may be a standalone resource or may be contained within the Immunization resource as appropriate. Feedback on this approach is welcome.

11.7.3 References to this Resource

11.7.4 Resource Content

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. Immunization TU DomainResource Immunization event information

Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
... identifier 0..* Identifier Business identifier

... basedOn Σ 0..* Reference(CarePlan | MedicationRequest | ServiceRequest | ImmunizationRecommendation) Authority that the immunization event is based on

... status ?!Σ 1..1 code completed | entered-in-error | not-done
Binding: Immunization Status Codes (Required)
... statusReason 0..1 CodeableConcept Reason for current status
Binding: Immunization Status Reason Codes (Example)
... vaccineCode Σ 1..1 CodeableConcept Vaccine administered
Binding: Vaccine Administered Value Set (Example)
... administeredProduct 0..1 CodeableReference(Medication) Product that was administered
... manufacturer 0..1 CodeableReference(Organization) Vaccine manufacturer
... lotNumber 0..1 string Vaccine lot number
... expirationDate 0..1 date Vaccine expiration date
... patient Σ 1..1 Reference(Patient) Who was immunized
... encounter 0..1 Reference(Encounter) Encounter immunization was part of
... supportingInformation 0..* Reference(Any) Additional information in support of the immunization

... occurrence[x] Σ 1..1 Vaccine administration date
.... occurrenceDateTime dateTime
.... occurrenceString string
... primarySource Σ 0..1 boolean Indicates context the data was captured in
... informationSource 0..1 CodeableReference(Patient | Practitioner | PractitionerRole | RelatedPerson | Organization) Indicates the source of a reported record
Binding: Immunization Origin Codes (Example)
... location 0..1 Reference(Location) The service delivery location
... site 0..1 CodeableConcept Body site vaccine was administered
Binding: Codes for Immunization Site of Administration (Example)
... route 0..1 CodeableConcept How vaccine entered body
Binding: Immunization Route Codes (Example)
... doseQuantity 0..1 SimpleQuantity Amount of vaccine administered
... performer Σ 0..* BackboneElement Who performed event

.... function Σ 0..1 CodeableConcept Type of performance
Binding: Immunization Function Codes (Extensible)
.... actor Σ 1..1 Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson) Individual or organization who was performing
... note Σ 0..* Annotation Additional immunization notes

... reason 0..* CodeableReference(Condition | Observation | DiagnosticReport) Why immunization occurred
Binding: Immunization Reason Codes (Example)

... isSubpotent ?!Σ 0..1 boolean Dose potency
... subpotentReason 0..* CodeableConcept Reason for being subpotent
Binding: Immunization Subpotent Reason (Example)

... programEligibility 0..* BackboneElement Patient eligibility for a specific vaccination program

.... program 1..1 CodeableConcept The program that eligibility is declared for
Binding: Vaccine Funding Programs (Example)
.... programStatus 1..1 CodeableConcept The patient's eligibility status for the program
Binding: Immunization Program Eligibility (Example)
... fundingSource 0..1 CodeableConcept Funding source for the vaccine
Binding: Immunization Funding Source (Example)
... reaction 0..* BackboneElement Details of a reaction that follows immunization

.... date 0..1 dateTime When reaction started
.... manifestation 0..1 CodeableReference(Observation) Additional information on reaction
.... reported 0..1 boolean Indicates self-reported reaction
... protocolApplied 0..* BackboneElement Protocol followed by the provider

.... series 0..1 string Name of vaccine series
.... authority 0..1 Reference(Organization) Who is responsible for publishing the recommendations
.... targetDisease 0..* CodeableConcept Vaccine preventatable disease being targeted
Binding: Immunization Target Disease Codes (Example)

.... doseNumber 0..1 CodeableConcept Dose number within series
Binding: DoseNumber (Example)
.... seriesDoses 0..1 CodeableConcept Recommended number of doses for immunity
Binding: SeriesDoses (Example)

doco Documentation for this format icon

See the Extensions for this resource

 

Additional definitions: Master Definition XML + JSON, XML Schema/Schematron + JSON Schema, ShEx (for Turtle) + see the extensions, the spreadsheet version & the dependency analysis

11.7.4.1 Terminology Bindings

Path ValueSet Type Documentation
Immunization.status ImmunizationStatusCodes Required

The value set to instantiate this attribute should be drawn from a terminologically robust code system that consists of or contains concepts to support describing the current status of the administered dose of vaccine.
Immunization.statusReason ImmunizationStatusReasonCodes Example

The value set to instantiate this attribute should be drawn from a terminologically robust code system that consists of or contains concepts to support describing the reason why a dose of vaccine was not administered. This value set is provided as a suggestive example.
Immunization.vaccineCode VaccineAdministeredValueSet Example

This identifies the vaccine substance administered - CVX codes.
Immunization.informationSource ImmunizationOriginCodes Example

The value set to instantiate this attribute should be drawn from a terminologically robust code system that consists of or contains concepts to support describing the source of the data when the report of the immunization event is not based on information from the person, entity or organization who administered the vaccine. This value set is provided as a suggestive example.
Immunization.site CodesForImmunizationSiteOfAdministration Example

The value set to instantiate this attribute should be drawn from a terminologically robust code system that consists of or contains concepts to support describing the body site where the vaccination occurred. This value set is provided as a suggestive example.
Immunization.route ImmunizationRouteCodes Example

The value set to instantiate this attribute should be drawn from a terminologically robust code system that consists of or contains concepts to support describing the administrative routes used during vaccination. This value set is provided as a suggestive example.
Immunization.performer.function ImmunizationFunctionCodes Extensible

The value set to instantiate this attribute should be drawn from a terminologically robust code system that consists of or contains concepts to support describing the function a practitioner or organization may play in the immunization event. This value set is provided as a suggestive example.
Immunization.reason ImmunizationReasonCodes Example

The value set to instantiate this attribute should be drawn from a terminologically robust code system that consists of or contains concepts to support describing the reason why a dose of vaccine was administered. This value set is provided as a suggestive example.
Immunization.subpotentReason ImmunizationSubpotentReason Example

The value set to instantiate this attribute should be drawn from a terminologically robust code system that consists of or contains concepts to support describing the reason why a dose is considered to be subpotent. This value set is provided as a suggestive example.
Immunization.programEligibility.program CodesForVaccineFundingPrograms Example

The value set to instantiate this attribute should be drawn from a terminologically robust code system that consists of or contains concepts to support describing programs that a patient may be eligible for to cover vaccine administration costs. This value set is provided as a suggestive example.
Immunization.programEligibility.programStatus ImmunizationProgramEligibility Example

The value set to instantiate this attribute should be drawn from a terminologically robust code system that consists of or contains concepts to support describing the patient's eligibility for a vaccination program. This value set is provided as a suggestive example.
Immunization.fundingSource ImmunizationFundingSource Example

The value set to instantiate this attribute should be drawn from a terminologically robust code system that consists of or contains concepts to support describing the source of the vaccine administered. This value set is provided as a suggestive example.
Immunization.protocolApplied.targetDisease ImmunizationTargetDiseaseCodes Example

The value set to instantiate this attribute should be drawn from a terminologically robust code system that consists of or contains concepts to support describing the disease that the dose is being administered against. This value set is provided as a suggestive example and includes SNOMED CT concepts from the 64572001 (Disease) hierarchy.
Immunization.protocolApplied.doseNumber Example
Immunization.protocolApplied.seriesDoses Example

11.7.5 Search Parameters

Search parameters for this resource. See also the full list of search parameters for this resource, and check the Extensions registry for search parameters on extensions related to this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.

Name Type Description Expression In Common
date date Vaccination (non)-Administration Date (Immunization.occurrence.ofType(dateTime)) 26 Resources
identifier token Business identifier Immunization.identifier 65 Resources
location reference The service delivery location or facility in which the vaccine was / was to be administered Immunization.location
(Location)
lot-number string Vaccine Lot Number Immunization.lotNumber
manufacturer reference Vaccine Manufacturer Immunization.manufacturer.reference
patient reference The patient for the vaccination record Immunization.patient
(Patient)		 65 Resources
performer reference The practitioner, individual or organization who played a role in the vaccination Immunization.performer.actor
(Practitioner, Organization, Patient, PractitionerRole, RelatedPerson)
reaction reference Additional information on reaction Immunization.reaction.manifestation.reference
reaction-date date When reaction started Immunization.reaction.date
reason-code token Reason why the vaccine was administered Immunization.reason.concept
reason-reference reference Reference to a resource (by instance) Immunization.reason.reference
series string The series being followed by the provider Immunization.protocolApplied.series
status token Immunization event status Immunization.status
status-reason token Reason why the vaccine was not administered Immunization.statusReason
target-disease token The target disease the dose is being administered against Immunization.protocolApplied.targetDisease
vaccine-code token Vaccine Product Administered Immunization.vaccineCode