2026 US Quality Core Implementation Guide
0.5.0 - cibuild US

2026 US Quality Core Implementation Guide, published by Office of the National Coordinator for Health Information Technology (ONC). This guide is not an authorized publication; it is the continuous build for version 0.5.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/FHIR/us-quality-core/ and changes regularly. See the Directory of published versions

## Resource Profile: USQualityCoreImmunizationRecommendation - JSON Profile

Active as of 2026-05-15

JSON representation of the us-quality-core-immunizationrecommendation resource profile.

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    {
      "resourceType" : "StructureDefinition",
      "id" : "us-quality-core-immunizationrecommendation",
      "text" : {
        "status" : "extensions",
        "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: StructureDefinition us-quality-core-immunizationrecommendation</b></p><a name=\"us-quality-core-immunizationrecommendation\"> </a><a name=\"hcus-quality-core-immunizationrecommendation\"> </a><table border=\"0\" cellpadding=\"0\" cellspacing=\"0\" style=\"border: 0px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top;\"><tr style=\"border: 1px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top\"><th style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px\" class=\"hierarchy\"><a href=\"https://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#table-views\" title=\"The logical name of the element\">Name</a></th><th style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px\" class=\"hierarchy\"><a href=\"https://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#table-views\" title=\"Information about the use of the element\">Flags</a></th><th style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px\" class=\"hierarchy\"><a href=\"https://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#table-views\" title=\"Minimum and Maximum # of times the element can appear in the instance\">Card.</a></th><th style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px; width: 100px\" class=\"hierarchy\"><a href=\"https://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#table-views\" title=\"Reference to the type of the element\">Type</a></th><th style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px\" class=\"hierarchy\"><a href=\"https://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#table-views\" title=\"Additional information about the element\">Description &amp; Constraints</a><span style=\"float: right\"><a href=\"https://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#table-views\" title=\"Legend for this format\"><img src=\"data:image/png;base64,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\" alt=\"doco\" style=\"background-color: inherit\"/></a></span></th></tr><tr style=\"border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1.png)\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon_resource.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"Resource\" class=\"hierarchy\"/> <a href=\"StructureDefinition-us-quality-core-immunizationrecommendation-definitions.html#ImmunizationRecommendation\">ImmunizationRecommendation</a><a name=\"ImmunizationRecommendation\"> </a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><span style=\"opacity: 0.5\">0</span><span style=\"opacity: 0.5\">..</span><span style=\"opacity: 0.5\">*</span></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://hl7.org/fhir/R4/immunizationrecommendation.html\">ImmunizationRecommendation</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><span style=\"opacity: 0.5\">Guidance or advice relating to an immunization</span></td></tr>\r\n<tr style=\"border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon_reference.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"Reference to another Resource\" class=\"hierarchy\"/> <a href=\"StructureDefinition-us-quality-core-immunizationrecommendation-definitions.html#ImmunizationRecommendation.patient\">patient</a><a name=\"ImmunizationRecommendation.patient\"> </a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><span style=\"opacity: 0.5\">1</span><span style=\"opacity: 0.5\">..</span><span style=\"opacity: 0.5\">1</span></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://hl7.org/fhir/R4/references.html\">Reference</a>(<a href=\"StructureDefinition-us-quality-core-patient.html\">US Quality Core Patient</a>)</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Who this profile is for</td></tr>\r\n<tr style=\"border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon_reference.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"Reference to another Resource\" class=\"hierarchy\"/> <a href=\"StructureDefinition-us-quality-core-immunizationrecommendation-definitions.html#ImmunizationRecommendation.authority\">authority</a><a name=\"ImmunizationRecommendation.authority\"> </a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><span style=\"opacity: 0.5\">0</span><span style=\"opacity: 0.5\">..</span><span style=\"opacity: 0.5\">1</span></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://hl7.org/fhir/R4/references.html\">Reference</a>(<a href=\"StructureDefinition-us-quality-core-organization.html\">US Quality Core Organization</a>)</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><span style=\"opacity: 0.5\">Who is responsible for protocol</span></td></tr>\r\n<tr style=\"border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck01.png)\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon_element.gif\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"Element\" class=\"hierarchy\"/> <a href=\"StructureDefinition-us-quality-core-immunizationrecommendation-definitions.html#ImmunizationRecommendation.recommendation\">recommendation</a><a name=\"ImmunizationRecommendation.recommendation\"> </a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><span style=\"opacity: 0.5\">1</span><span style=\"opacity: 0.5\">..</span><span style=\"opacity: 0.5\">*</span></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a style=\"opacity: 0.5; opacity: 0.5\" href=\"http://hl7.org/fhir/R4/datatypes.html#BackboneElement\">BackboneElement</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Vaccine administration recommendations</td></tr>\r\n<tr style=\"border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck010.png)\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon_element.gif\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"Element\" class=\"hierarchy\"/> <a href=\"StructureDefinition-us-quality-core-immunizationrecommendation-definitions.html#ImmunizationRecommendation.recommendation.vaccineCode\">vaccineCode</a><a name=\"ImmunizationRecommendation.recommendation.vaccineCode\"> </a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><span style=\"opacity: 0.5\">0</span><span style=\"opacity: 0.5\">..</span><span style=\"opacity: 0.5\">*</span></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a style=\"opacity: 0.5; opacity: 0.5\" href=\"http://hl7.org/fhir/R4/datatypes.html#CodeableConcept\">CodeableConcept</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Vaccine or vaccine group recommendation applies to<br class=\"binding\"/><span style=\"font-weight:bold\" title=\"null\" class=\"binding\">Binding: </span><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1010.6/expansion\" title=\"http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1010.6\" class=\"binding\">CVX Vaccines Administered Vaccine Set <img src=\"external.png\" alt=\".\"/></a><span title=\"null\" class=\"binding\"> (</span><a href=\"http://hl7.org/fhir/R4/terminologies.html#extensible\" title=\"To be conformant, the concept in this element SHALL be from the specified value set if any of the codes within the value set can apply to the concept being communicated.  If the value set does not cover the concept (based on human review), alternate codings (or, data type allowing, text) may be included instead.\" class=\"binding\">extensible</a><span title=\"null\" class=\"binding\">)</span><span title=\"null\" class=\"binding\">: </span><span title=\"null\" class=\"binding\">CVX Vaccines Administered Vaccine Set</span></td></tr>\r\n<tr style=\"border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck010.png)\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon_element.gif\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"Element\" class=\"hierarchy\"/> <a href=\"StructureDefinition-us-quality-core-immunizationrecommendation-definitions.html#ImmunizationRecommendation.recommendation.doseNumber[x]\">doseNumber[x]</a><a name=\"ImmunizationRecommendation.recommendation.doseNumber_x_\"> </a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><span style=\"opacity: 0.5\">0</span><span style=\"opacity: 0.5\">..</span><span style=\"opacity: 0.5\">1</span></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a style=\"opacity: 0.5; opacity: 0.5\" href=\"http://hl7.org/fhir/R4/datatypes.html#positiveInt\">positiveInt</a><span style=\"opacity: 0.5\">, </span><a style=\"opacity: 0.5; opacity: 0.5\" href=\"http://hl7.org/fhir/R4/datatypes.html#string\">string</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Recommended dose number within series</td></tr>\r\n<tr style=\"border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck010.png)\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon_reference.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"Reference to another Resource\" class=\"hierarchy\"/> <a href=\"StructureDefinition-us-quality-core-immunizationrecommendation-definitions.html#ImmunizationRecommendation.recommendation.supportingImmunization\">supportingImmunization</a><a name=\"ImmunizationRecommendation.recommendation.supportingImmunization\"> </a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><span style=\"opacity: 0.5\">0</span><span style=\"opacity: 0.5\">..</span><span style=\"opacity: 0.5\">*</span></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://hl7.org/fhir/R4/references.html\">Reference</a>(<a href=\"StructureDefinition-us-quality-core-immunization.html\">US Quality Core Immunization</a> | <a href=\"StructureDefinition-us-quality-core-immunizationevaluation.html\">US Quality Core ImmunizationEvaluation</a>)</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><span style=\"opacity: 0.5\">Past immunizations supporting recommendation</span></td></tr>\r\n<tr style=\"border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck000.png)\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon_reference.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"Reference to another Resource\" class=\"hierarchy\"/> <a href=\"StructureDefinition-us-quality-core-immunizationrecommendation-definitions.html#ImmunizationRecommendation.recommendation.supportingPatientInformation\">supportingPatientInformation</a><a name=\"ImmunizationRecommendation.recommendation.supportingPatientInformation\"> </a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><span style=\"opacity: 0.5\">0</span><span style=\"opacity: 0.5\">..</span><span style=\"opacity: 0.5\">*</span></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://hl7.org/fhir/R4/references.html\">Reference</a>(<a href=\"StructureDefinition-us-quality-core-simple-observation.html\">US Quality Core Simple Observation</a> | <a href=\"StructureDefinition-us-quality-core-allergyintolerance.html\">US Quality Core AllergyIntolerance</a>)</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><span style=\"opacity: 0.5\">Patient observations supporting recommendation</span></td></tr>\r\n<tr><td colspan=\"5\" class=\"hierarchy\"><br/><a href=\"https://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#table-views\" title=\"Legend for this format\"><img src=\"data:image/png;base64,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\" alt=\"doco\" style=\"background-color: inherit\"/> Documentation for this format</a></td></tr></table></div>"
      },
      "url" : "http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-immunizationrecommendation",
      "version" : "0.5.0",
      "name" : "USQualityCoreImmunizationRecommendation",
      "title" : "US Quality Core ImmunizationRecommendation",
      "status" : "active",
      "experimental" : false,
      "date" : "2026-05-15",
      "publisher" : "Office of the National Coordinator for Health Information Technology (ONC)",
      "contact" : [
        {
          "name" : "Office of the National Coordinator for Health Information Technology (ONC)",
          "telecom" : [
            {
              "system" : "url",
              "value" : "https://www.healthit.gov/feedback"
            }
          ]
        }
      ],
      "description" : "Profile of ImmunizationRecommendation for decision support/quality metrics. Defines the core set of elements and extensions for quality rule and measure authors.",
      "jurisdiction" : [
        {
          "coding" : [
            {
              "system" : "urn:iso:std:iso:3166",
              "code" : "US",
              "display" : "United States of America"
            }
          ],
          "text" : "USA"
        }
      ],
      "fhirVersion" : "4.0.1",
      "mapping" : [
        {
          "identity" : "workflow",
          "uri" : "http://hl7.org/fhir/workflow",
          "name" : "Workflow Pattern"
        },
        {
          "identity" : "v2",
          "uri" : "http://hl7.org/v2",
          "name" : "HL7 v2 Mapping"
        },
        {
          "identity" : "rim",
          "uri" : "http://hl7.org/v3",
          "name" : "RIM Mapping"
        },
        {
          "identity" : "w5",
          "uri" : "http://hl7.org/fhir/fivews",
          "name" : "FiveWs Pattern Mapping"
        }
      ],
      "kind" : "resource",
      "abstract" : false,
      "type" : "ImmunizationRecommendation",
      "baseDefinition" : "http://hl7.org/fhir/StructureDefinition/ImmunizationRecommendation",
      "derivation" : "constraint",
      "snapshot" : {
        "extension" : [
          {
            "url" : "http://hl7.org/fhir/tools/StructureDefinition/snapshot-base-version",
            "valueString" : "4.0.1"
          }
        ],
        "element" : [
          {
            "id" : "ImmunizationRecommendation",
            "path" : "ImmunizationRecommendation",
            "short" : "Guidance or advice relating to an immunization",
            "definition" : "A patient's point-in-time set of recommendations (i.e. forecasting) according to a published schedule with optional supporting justification.",
            "min" : 0,
            "max" : "*",
            "base" : {
              "path" : "ImmunizationRecommendation",
              "min" : 0,
              "max" : "*"
            },
            "constraint" : [
              {
                "key" : "dom-2",
                "severity" : "error",
                "human" : "If the resource is contained in another resource, it SHALL NOT contain nested Resources",
                "expression" : "contained.contained.empty()",
                "xpath" : "not(parent::f:contained and f:contained)",
                "source" : "http://hl7.org/fhir/StructureDefinition/DomainResource"
              },
              {
                "key" : "dom-3",
                "severity" : "error",
                "human" : "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",
                "expression" : "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()",
                "xpath" : "not(exists(for $id in f:contained/*/f:id/@value return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))",
                "source" : "http://hl7.org/fhir/StructureDefinition/DomainResource"
              },
              {
                "key" : "dom-4",
                "severity" : "error",
                "human" : "If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated",
                "expression" : "contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()",
                "xpath" : "not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))",
                "source" : "http://hl7.org/fhir/StructureDefinition/DomainResource"
              },
              {
                "key" : "dom-5",
                "severity" : "error",
                "human" : "If a resource is contained in another resource, it SHALL NOT have a security label",
                "expression" : "contained.meta.security.empty()",
                "xpath" : "not(exists(f:contained/*/f:meta/f:security))",
                "source" : "http://hl7.org/fhir/StructureDefinition/DomainResource"
              },
              {
                "extension" : [
                  {
                    "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice",
                    "valueBoolean" : true
                  },
                  {
                    "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice-explanation",
                    "valueMarkdown" : "When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time."
                  }
                ],
                "key" : "dom-6",
                "severity" : "warning",
                "human" : "A resource should have narrative for robust management",
                "expression" : "text.`div`.exists()",
                "xpath" : "exists(f:text/h:div)",
                "source" : "http://hl7.org/fhir/StructureDefinition/DomainResource"
              }
            ],
            "mustSupport" : false,
            "isModifier" : false,
            "isSummary" : false,
            "mapping" : [
              {
                "identity" : "rim",
                "map" : "Entity. Role, or Act"
              },
              {
                "identity" : "workflow",
                "map" : "Request"
              },
              {
                "identity" : "v2",
                "map" : "VXU_V04"
              },
              {
                "identity" : "rim",
                "map" : "SubstanceAdministration[moodCode=RMD]"
              }
            ]
          },
          {
            "id" : "ImmunizationRecommendation.id",
            "path" : "ImmunizationRecommendation.id",
            "short" : "Logical id of this artifact",
            "definition" : "The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.",
            "comment" : "The only time that a resource does not have an id is when it is being submitted to the server using a create operation.",
            "min" : 0,
            "max" : "1",
            "base" : {
              "path" : "Resource.id",
              "min" : 0,
              "max" : "1"
            },
            "type" : [
              {
                "extension" : [
                  {
                    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
                    "valueUrl" : "id"
                  }
                ],
                "code" : "http://hl7.org/fhirpath/System.String"
              }
            ],
            "isModifier" : false,
            "isSummary" : true
          },
          {
            "id" : "ImmunizationRecommendation.meta",
            "path" : "ImmunizationRecommendation.meta",
            "short" : "Metadata about the resource",
            "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.",
            "min" : 0,
            "max" : "1",
            "base" : {
              "path" : "Resource.meta",
              "min" : 0,
              "max" : "1"
            },
            "type" : [
              {
                "code" : "Meta"
              }
            ],
            "constraint" : [
              {
                "key" : "ele-1",
                "severity" : "error",
                "human" : "All FHIR elements must have a @value or children",
                "expression" : "hasValue() or (children().count() > id.count())",
                "xpath" : "@value|f:*|h:div",
                "source" : "http://hl7.org/fhir/StructureDefinition/Element"
              }
            ],
            "isModifier" : false,
            "isSummary" : true
          },
          {
            "id" : "ImmunizationRecommendation.implicitRules",
            "path" : "ImmunizationRecommendation.implicitRules",
            "short" : "A set of rules under which this content was created",
            "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.",
            "comment" : "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.",
            "min" : 0,
            "max" : "1",
            "base" : {
              "path" : "Resource.implicitRules",
              "min" : 0,
              "max" : "1"
            },
            "type" : [
              {
                "code" : "uri"
              }
            ],
            "constraint" : [
              {
                "key" : "ele-1",
                "severity" : "error",
                "human" : "All FHIR elements must have a @value or children",
                "expression" : "hasValue() or (children().count() > id.count())",
                "xpath" : "@value|f:*|h:div",
                "source" : "http://hl7.org/fhir/StructureDefinition/Element"
              }
            ],
            "isModifier" : true,
            "isModifierReason" : "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",
            "isSummary" : true
          },
          {
            "id" : "ImmunizationRecommendation.language",
            "path" : "ImmunizationRecommendation.language",
            "short" : "Language of the resource content",
            "definition" : "The base language in which the resource is written.",
            "comment" : "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).",
            "min" : 0,
            "max" : "1",
            "base" : {
              "path" : "Resource.language",
              "min" : 0,
              "max" : "1"
            },
            "type" : [
              {
                "code" : "code"
              }
            ],
            "constraint" : [
              {
                "key" : "ele-1",
                "severity" : "error",
                "human" : "All FHIR elements must have a @value or children",
                "expression" : "hasValue() or (children().count() > id.count())",
                "xpath" : "@value|f:*|h:div",
                "source" : "http://hl7.org/fhir/StructureDefinition/Element"
              }
            ],
            "isModifier" : false,
            "isSummary" : false,
            "binding" : {
              "extension" : [
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet",
                  "valueCanonical" : "http://hl7.org/fhir/ValueSet/all-languages"
                },
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
                  "valueString" : "Language"
                }
              ],
              "strength" : "preferred",
              "description" : "A human language.",
              "valueSet" : "http://hl7.org/fhir/ValueSet/languages|4.0.1"
            }
          },
          {
            "id" : "ImmunizationRecommendation.text",
            "path" : "ImmunizationRecommendation.text",
            "short" : "Text summary of the resource, for human interpretation",
            "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.",
            "comment" : "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.",
            "alias" : [
              "narrative",
              "html",
              "xhtml",
              "display"
            ],
            "min" : 0,
            "max" : "1",
            "base" : {
              "path" : "DomainResource.text",
              "min" : 0,
              "max" : "1"
            },
            "type" : [
              {
                "code" : "Narrative"
              }
            ],
            "constraint" : [
              {
                "key" : "ele-1",
                "severity" : "error",
                "human" : "All FHIR elements must have a @value or children",
                "expression" : "hasValue() or (children().count() > id.count())",
                "xpath" : "@value|f:*|h:div",
                "source" : "http://hl7.org/fhir/StructureDefinition/Element"
              }
            ],
            "isModifier" : false,
            "isSummary" : false,
            "mapping" : [
              {
                "identity" : "rim",
                "map" : "Act.text?"
              }
            ]
          },
          {
            "id" : "ImmunizationRecommendation.contained",
            "path" : "ImmunizationRecommendation.contained",
            "short" : "Contained, inline Resources",
            "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.",
            "comment" : "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.",
            "alias" : [
              "inline resources",
              "anonymous resources",
              "contained resources"
            ],
            "min" : 0,
            "max" : "*",
            "base" : {
              "path" : "DomainResource.contained",
              "min" : 0,
              "max" : "*"
            },
            "type" : [
              {
                "code" : "Resource"
              }
            ],
            "isModifier" : false,
            "isSummary" : false,
            "mapping" : [
              {
                "identity" : "rim",
                "map" : "N/A"
              }
            ]
          },
          {
            "id" : "ImmunizationRecommendation.extension",
            "path" : "ImmunizationRecommendation.extension",
            "short" : "Additional content defined by implementations",
            "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.",
            "comment" : "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.",
            "alias" : [
              "extensions",
              "user content"
            ],
            "min" : 0,
            "max" : "*",
            "base" : {
              "path" : "DomainResource.extension",
              "min" : 0,
              "max" : "*"
            },
            "type" : [
              {
                "code" : "Extension"
              }
            ],
            "constraint" : [
              {
                "key" : "ele-1",
                "severity" : "error",
                "human" : "All FHIR elements must have a @value or children",
                "expression" : "hasValue() or (children().count() > id.count())",
                "xpath" : "@value|f:*|h:div",
                "source" : "http://hl7.org/fhir/StructureDefinition/Element"
              },
              {
                "key" : "ext-1",
                "severity" : "error",
                "human" : "Must have either extensions or value[x], not both",
                "expression" : "extension.exists() != value.exists()",
                "xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
                "source" : "http://hl7.org/fhir/StructureDefinition/Extension"
              }
            ],
            "isModifier" : false,
            "isSummary" : false,
            "mapping" : [
              {
                "identity" : "rim",
                "map" : "N/A"
              }
            ]
          },
          {
            "id" : "ImmunizationRecommendation.modifierExtension",
            "path" : "ImmunizationRecommendation.modifierExtension",
            "short" : "Extensions that cannot be ignored",
            "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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
            "comment" : "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.",
            "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](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).",
            "alias" : [
              "extensions",
              "user content"
            ],
            "min" : 0,
            "max" : "*",
            "base" : {
              "path" : "DomainResource.modifierExtension",
              "min" : 0,
              "max" : "*"
            },
            "type" : [
              {
                "code" : "Extension"
              }
            ],
            "constraint" : [
              {
                "key" : "ele-1",
                "severity" : "error",
                "human" : "All FHIR elements must have a @value or children",
                "expression" : "hasValue() or (children().count() > id.count())",
                "xpath" : "@value|f:*|h:div",
                "source" : "http://hl7.org/fhir/StructureDefinition/Element"
              },
              {
                "key" : "ext-1",
                "severity" : "error",
                "human" : "Must have either extensions or value[x], not both",
                "expression" : "extension.exists() != value.exists()",
                "xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
                "source" : "http://hl7.org/fhir/StructureDefinition/Extension"
              }
            ],
            "isModifier" : true,
            "isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them",
            "isSummary" : false,
            "mapping" : [
              {
                "identity" : "rim",
                "map" : "N/A"
              }
            ]
          },
          {
            "id" : "ImmunizationRecommendation.identifier",
            "path" : "ImmunizationRecommendation.identifier",
            "short" : "Business identifier",
            "definition" : "A unique identifier assigned to this particular recommendation record.",
            "min" : 0,
            "max" : "*",
            "base" : {
              "path" : "ImmunizationRecommendation.identifier",
              "min" : 0,
              "max" : "*"
            },
            "type" : [
              {
                "code" : "Identifier"
              }
            ],
            "constraint" : [
              {
                "key" : "ele-1",
                "severity" : "error",
                "human" : "All FHIR elements must have a @value or children",
                "expression" : "hasValue() or (children().count() > id.count())",
                "xpath" : "@value|f:*|h:div",
                "source" : "http://hl7.org/fhir/StructureDefinition/Element"
              }
            ],
            "isModifier" : false,
            "isSummary" : true,
            "mapping" : [
              {
                "identity" : "workflow",
                "map" : "Request.identifier"
              },
              {
                "identity" : "w5",
                "map" : "FiveWs.identifier"
              },
              {
                "identity" : "rim",
                "map" : ".id"
              }
            ]
          },
          {
            "id" : "ImmunizationRecommendation.patient",
            "path" : "ImmunizationRecommendation.patient",
            "short" : "Who this profile is for",
            "definition" : "The patient the recommendation(s) are for.",
            "min" : 1,
            "max" : "1",
            "base" : {
              "path" : "ImmunizationRecommendation.patient",
              "min" : 1,
              "max" : "1"
            },
            "type" : [
              {
                "code" : "Reference",
                "targetProfile" : [
                  🔗 "http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-patient"
                ]
              }
            ],
            "constraint" : [
              {
                "key" : "ele-1",
                "severity" : "error",
                "human" : "All FHIR elements must have a @value or children",
                "expression" : "hasValue() or (children().count() > id.count())",
                "xpath" : "@value|f:*|h:div",
                "source" : "http://hl7.org/fhir/StructureDefinition/Element"
              }
            ],
            "isModifier" : false,
            "isSummary" : true,
            "mapping" : [
              {
                "identity" : "workflow",
                "map" : "Request.subject"
              },
              {
                "identity" : "w5",
                "map" : "FiveWs.subject[x]"
              },
              {
                "identity" : "v2",
                "map" : "PID-3"
              },
              {
                "identity" : "rim",
                "map" : ".partipication[typeCode=SUBJ].role"
              },
              {
                "identity" : "w5",
                "map" : "FiveWs.subject"
              }
            ]
          },
          {
            "id" : "ImmunizationRecommendation.date",
            "path" : "ImmunizationRecommendation.date",
            "short" : "Date recommendation(s) created",
            "definition" : "The date the immunization recommendation(s) were created.",
            "min" : 1,
            "max" : "1",
            "base" : {
              "path" : "ImmunizationRecommendation.date",
              "min" : 1,
              "max" : "1"
            },
            "type" : [
              {
                "code" : "dateTime"
              }
            ],
            "constraint" : [
              {
                "key" : "ele-1",
                "severity" : "error",
                "human" : "All FHIR elements must have a @value or children",
                "expression" : "hasValue() or (children().count() > id.count())",
                "xpath" : "@value|f:*|h:div",
                "source" : "http://hl7.org/fhir/StructureDefinition/Element"
              }
            ],
            "isModifier" : false,
            "isSummary" : true,
            "mapping" : [
              {
                "identity" : "workflow",
                "map" : "Request.authoredOn"
              },
              {
                "identity" : "v2",
                "map" : "OBX-15"
              },
              {
                "identity" : "rim",
                "map" : ".partipication[typeCode=AUTH].time"
              }
            ]
          },
          {
            "id" : "ImmunizationRecommendation.authority",
            "path" : "ImmunizationRecommendation.authority",
            "short" : "Who is responsible for protocol",
            "definition" : "Indicates the authority who published the protocol (e.g. ACIP).",
            "min" : 0,
            "max" : "1",
            "base" : {
              "path" : "ImmunizationRecommendation.authority",
              "min" : 0,
              "max" : "1"
            },
            "type" : [
              {
                "code" : "Reference",
                "targetProfile" : [
                  🔗 "http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-organization"
                ]
              }
            ],
            "constraint" : [
              {
                "key" : "ele-1",
                "severity" : "error",
                "human" : "All FHIR elements must have a @value or children",
                "expression" : "hasValue() or (children().count() > id.count())",
                "xpath" : "@value|f:*|h:div",
                "source" : "http://hl7.org/fhir/StructureDefinition/Element"
              }
            ],
            "mustSupport" : false,
            "isModifier" : false,
            "isSummary" : false,
            "mapping" : [
              {
                "identity" : "v2",
                "map" : "OBX-5 : OBX-3 = 59779-9"
              },
              {
                "identity" : "rim",
                "map" : ".participation[typeCode=AUT]"
              }
            ]
          },
          {
            "id" : "ImmunizationRecommendation.recommendation",
            "path" : "ImmunizationRecommendation.recommendation",
            "short" : "Vaccine administration recommendations",
            "definition" : "Vaccine administration recommendations.",
            "min" : 1,
            "max" : "*",
            "base" : {
              "path" : "ImmunizationRecommendation.recommendation",
              "min" : 1,
              "max" : "*"
            },
            "type" : [
              {
                "code" : "BackboneElement"
              }
            ],
            "constraint" : [
              {
                "key" : "ele-1",
                "severity" : "error",
                "human" : "All FHIR elements must have a @value or children",
                "expression" : "hasValue() or (children().count() > id.count())",
                "xpath" : "@value|f:*|h:div",
                "source" : "http://hl7.org/fhir/StructureDefinition/Element"
              },
              {
                "key" : "imr-1",
                "severity" : "error",
                "human" : "One of vaccineCode or targetDisease SHALL be present",
                "expression" : "vaccineCode.exists() or targetDisease.exists()",
                "xpath" : "exists(f:vaccineCode) or exists(f:targetDisease)",
                "source" : "http://hl7.org/fhir/StructureDefinition/ImmunizationRecommendation"
              }
            ],
            "isModifier" : false,
            "isSummary" : true,
            "mapping" : [
              {
                "identity" : "rim",
                "map" : ".outboundRelationship[typeCode='COMP'].target[classCode=SBADM, moodCode=RMD]"
              }
            ]
          },
          {
            "id" : "ImmunizationRecommendation.recommendation.id",
            "path" : "ImmunizationRecommendation.recommendation.id",
            "representation" : [
              "xmlAttr"
            ],
            "short" : "Unique id for inter-element referencing",
            "definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
            "min" : 0,
            "max" : "1",
            "base" : {
              "path" : "Element.id",
              "min" : 0,
              "max" : "1"
            },
            "type" : [
              {
                "extension" : [
                  {
                    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
                    "valueUrl" : "string"
                  }
                ],
                "code" : "http://hl7.org/fhirpath/System.String"
              }
            ],
            "isModifier" : false,
            "isSummary" : false,
            "mapping" : [
              {
                "identity" : "rim",
                "map" : "n/a"
              }
            ]
          },
          {
            "id" : "ImmunizationRecommendation.recommendation.extension",
            "path" : "ImmunizationRecommendation.recommendation.extension",
            "short" : "Additional content defined by implementations",
            "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.",
            "comment" : "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.",
            "alias" : [
              "extensions",
              "user content"
            ],
            "min" : 0,
            "max" : "*",
            "base" : {
              "path" : "Element.extension",
              "min" : 0,
              "max" : "*"
            },
            "type" : [
              {
                "code" : "Extension"
              }
            ],
            "constraint" : [
              {
                "key" : "ele-1",
                "severity" : "error",
                "human" : "All FHIR elements must have a @value or children",
                "expression" : "hasValue() or (children().count() > id.count())",
                "xpath" : "@value|f:*|h:div",
                "source" : "http://hl7.org/fhir/StructureDefinition/Element"
              },
              {
                "key" : "ext-1",
                "severity" : "error",
                "human" : "Must have either extensions or value[x], not both",
                "expression" : "extension.exists() != value.exists()",
                "xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
                "source" : "http://hl7.org/fhir/StructureDefinition/Extension"
              }
            ],
            "isModifier" : false,
            "isSummary" : false,
            "mapping" : [
              {
                "identity" : "rim",
                "map" : "n/a"
              }
            ]
          },
          {
            "id" : "ImmunizationRecommendation.recommendation.modifierExtension",
            "path" : "ImmunizationRecommendation.recommendation.modifierExtension",
            "short" : "Extensions that cannot be ignored even if unrecognized",
            "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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
            "comment" : "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.",
            "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](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).",
            "alias" : [
              "extensions",
              "user content",
              "modifiers"
            ],
            "min" : 0,
            "max" : "*",
            "base" : {
              "path" : "BackboneElement.modifierExtension",
              "min" : 0,
              "max" : "*"
            },
            "type" : [
              {
                "code" : "Extension"
              }
            ],
            "constraint" : [
              {
                "key" : "ele-1",
                "severity" : "error",
                "human" : "All FHIR elements must have a @value or children",
                "expression" : "hasValue() or (children().count() > id.count())",
                "xpath" : "@value|f:*|h:div",
                "source" : "http://hl7.org/fhir/StructureDefinition/Element"
              },
              {
                "key" : "ext-1",
                "severity" : "error",
                "human" : "Must have either extensions or value[x], not both",
                "expression" : "extension.exists() != value.exists()",
                "xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
                "source" : "http://hl7.org/fhir/StructureDefinition/Extension"
              }
            ],
            "isModifier" : true,
            "isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
            "isSummary" : true,
            "mapping" : [
              {
                "identity" : "rim",
                "map" : "N/A"
              }
            ]
          },
          {
            "id" : "ImmunizationRecommendation.recommendation.vaccineCode",
            "path" : "ImmunizationRecommendation.recommendation.vaccineCode",
            "short" : "Vaccine or vaccine group recommendation applies to",
            "definition" : "Vaccine(s) or vaccine group that pertain to the recommendation.",
            "min" : 0,
            "max" : "*",
            "base" : {
              "path" : "ImmunizationRecommendation.recommendation.vaccineCode",
              "min" : 0,
              "max" : "*"
            },
            "type" : [
              {
                "code" : "CodeableConcept"
              }
            ],
            "constraint" : [
              {
                "key" : "ele-1",
                "severity" : "error",
                "human" : "All FHIR elements must have a @value or children",
                "expression" : "hasValue() or (children().count() > id.count())",
                "xpath" : "@value|f:*|h:div",
                "source" : "http://hl7.org/fhir/StructureDefinition/Element"
              }
            ],
            "isModifier" : false,
            "isSummary" : true,
            "binding" : {
              "strength" : "extensible",
              "description" : "CVX Vaccines Administered Vaccine Set",
              "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1010.6"
            },
            "mapping" : [
              {
                "identity" : "workflow",
                "map" : "Request.code"
              },
              {
                "identity" : "v2",
                "map" : "OBX-5 : OBX-3 = ( 30956-7 | 38890-0 )"
              },
              {
                "identity" : "rim",
                "map" : ".partipication[typeCode=CSM].role[classCode=ADMM].code"
              }
            ]
          },
          {
            "id" : "ImmunizationRecommendation.recommendation.targetDisease",
            "path" : "ImmunizationRecommendation.recommendation.targetDisease",
            "short" : "Disease to be immunized against",
            "definition" : "The targeted disease for the recommendation.",
            "min" : 0,
            "max" : "1",
            "base" : {
              "path" : "ImmunizationRecommendation.recommendation.targetDisease",
              "min" : 0,
              "max" : "1"
            },
            "type" : [
              {
                "code" : "CodeableConcept"
              }
            ],
            "constraint" : [
              {
                "key" : "ele-1",
                "severity" : "error",
                "human" : "All FHIR elements must have a @value or children",
                "expression" : "hasValue() or (children().count() > id.count())",
                "xpath" : "@value|f:*|h:div",
                "source" : "http://hl7.org/fhir/StructureDefinition/Element"
              }
            ],
            "isModifier" : false,
            "isSummary" : true,
            "binding" : {
              "extension" : [
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
                  "valueString" : "TargetDisease"
                }
              ],
              "strength" : "example",
              "description" : "The disease that the recommended vaccination targets.",
              "valueSet" : "http://hl7.org/fhir/ValueSet/immunization-recommendation-target-disease|4.0.1"
            },
            "mapping" : [
              {
                "identity" : "v2",
                "map" : "OBX-5 : OBX-3 = ( 30956-7 | 38890-0 )"
              },
              {
                "identity" : "rim",
                "map" : ".partipication[typeCode=CSM].role[classCode=ADMM].code"
              }
            ]
          },
          {
            "id" : "ImmunizationRecommendation.recommendation.contraindicatedVaccineCode",
            "path" : "ImmunizationRecommendation.recommendation.contraindicatedVaccineCode",
            "short" : "Vaccine which is contraindicated to fulfill the recommendation",
            "definition" : "Vaccine(s) which should not be used to fulfill the recommendation.",
            "min" : 0,
            "max" : "*",
            "base" : {
              "path" : "ImmunizationRecommendation.recommendation.contraindicatedVaccineCode",
              "min" : 0,
              "max" : "*"
            },
            "type" : [
              {
                "code" : "CodeableConcept"
              }
            ],
            "constraint" : [
              {
                "key" : "ele-1",
                "severity" : "error",
                "human" : "All FHIR elements must have a @value or children",
                "expression" : "hasValue() or (children().count() > id.count())",
                "xpath" : "@value|f:*|h:div",
                "source" : "http://hl7.org/fhir/StructureDefinition/Element"
              }
            ],
            "isModifier" : false,
            "isSummary" : true,
            "binding" : {
              "extension" : [
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
                  "valueString" : "VaccineCode"
                }
              ],
              "strength" : "example",
              "description" : "The type of vaccine administered.",
              "valueSet" : "http://hl7.org/fhir/ValueSet/vaccine-code|4.0.1"
            }
          },
          {
            "id" : "ImmunizationRecommendation.recommendation.forecastStatus",
            "path" : "ImmunizationRecommendation.recommendation.forecastStatus",
            "short" : "Vaccine recommendation status",
            "definition" : "Indicates the patient status with respect to the path to immunity for the target disease.",
            "min" : 1,
            "max" : "1",
            "base" : {
              "path" : "ImmunizationRecommendation.recommendation.forecastStatus",
              "min" : 1,
              "max" : "1"
            },
            "type" : [
              {
                "code" : "CodeableConcept"
              }
            ],
            "constraint" : [
              {
                "key" : "ele-1",
                "severity" : "error",
                "human" : "All FHIR elements must have a @value or children",
                "expression" : "hasValue() or (children().count() > id.count())",
                "xpath" : "@value|f:*|h:div",
                "source" : "http://hl7.org/fhir/StructureDefinition/Element"
              }
            ],
            "isModifier" : true,
            "isModifierReason" : "This element is labeled as a modifier because the forecastStatus indicates whether a patient needs additional doses (due, overdue, etc) or not  (contraindicated, complete, etc).",
            "isSummary" : true,
            "binding" : {
              "extension" : [
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
                  "valueString" : "ImmunizationRecommendationStatus"
                }
              ],
              "strength" : "example",
              "description" : "The patient's status with respect to a vaccination protocol.",
              "valueSet" : "http://hl7.org/fhir/ValueSet/immunization-recommendation-status|4.0.1"
            },
            "mapping" : [
              {
                "identity" : "v2",
                "map" : "OBX-5 : OBX-3 = 59783-1"
              },
              {
                "identity" : "rim",
                "map" : ".inboundRelationship[typeCode=SUBJ] .source[classCode=OBS, moodCode=EVN, code=\"Immunization Forecast Status\"].value"
              }
            ]
          },
          {
            "id" : "ImmunizationRecommendation.recommendation.forecastReason",
            "path" : "ImmunizationRecommendation.recommendation.forecastReason",
            "short" : "Vaccine administration status reason",
            "definition" : "The reason for the assigned forecast status.",
            "min" : 0,
            "max" : "*",
            "base" : {
              "path" : "ImmunizationRecommendation.recommendation.forecastReason",
              "min" : 0,
              "max" : "*"
            },
            "type" : [
              {
                "code" : "CodeableConcept"
              }
            ],
            "constraint" : [
              {
                "key" : "ele-1",
                "severity" : "error",
                "human" : "All FHIR elements must have a @value or children",
                "expression" : "hasValue() or (children().count() > id.count())",
                "xpath" : "@value|f:*|h:div",
                "source" : "http://hl7.org/fhir/StructureDefinition/Element"
              }
            ],
            "isModifier" : false,
            "isSummary" : true,
            "binding" : {
              "extension" : [
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
                  "valueString" : "ImmunizationRecommendationReason"
                }
              ],
              "strength" : "example",
              "description" : "The reason for the patient's status with respect to a vaccination protocol.",
              "valueSet" : "http://hl7.org/fhir/ValueSet/immunization-recommendation-reason|4.0.1"
            },
            "mapping" : [
              {
                "identity" : "v2",
                "map" : "OBX-5 : OBX-3 = 30982-3"
              },
              {
                "identity" : "rim",
                "map" : "N/A"
              }
            ]
          },
          {
            "id" : "ImmunizationRecommendation.recommendation.dateCriterion",
            "path" : "ImmunizationRecommendation.recommendation.dateCriterion",
            "short" : "Dates governing proposed immunization",
            "definition" : "Vaccine date recommendations.  For example, earliest date to administer, latest date to administer, etc.",
            "min" : 0,
            "max" : "*",
            "base" : {
              "path" : "ImmunizationRecommendation.recommendation.dateCriterion",
              "min" : 0,
              "max" : "*"
            },
            "type" : [
              {
                "code" : "BackboneElement"
              }
            ],
            "constraint" : [
              {
                "key" : "ele-1",
                "severity" : "error",
                "human" : "All FHIR elements must have a @value or children",
                "expression" : "hasValue() or (children().count() > id.count())",
                "xpath" : "@value|f:*|h:div",
                "source" : "http://hl7.org/fhir/StructureDefinition/Element"
              }
            ],
            "isModifier" : false,
            "isSummary" : false,
            "mapping" : [
              {
                "identity" : "workflow",
                "map" : "Request.occurrence[x]"
              },
              {
                "identity" : "v2",
                "map" : "OBX-3: 30980-7 = Next dose recommended, 59777-3 = Latest next dose should be given, 59778-1 = Dose is overdue"
              },
              {
                "identity" : "rim",
                "map" : ".outboundRelationship[typeCode='LIMIT'].target[classCode=OBS, moodCode=EVN, isCriterionInd=true]"
              }
            ]
          },
          {
            "id" : "ImmunizationRecommendation.recommendation.dateCriterion.id",
            "path" : "ImmunizationRecommendation.recommendation.dateCriterion.id",
            "representation" : [
              "xmlAttr"
            ],
            "short" : "Unique id for inter-element referencing",
            "definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
            "min" : 0,
            "max" : "1",
            "base" : {
              "path" : "Element.id",
              "min" : 0,
              "max" : "1"
            },
            "type" : [
              {
                "extension" : [
                  {
                    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
                    "valueUrl" : "string"
                  }
                ],
                "code" : "http://hl7.org/fhirpath/System.String"
              }
            ],
            "isModifier" : false,
            "isSummary" : false,
            "mapping" : [
              {
                "identity" : "rim",
                "map" : "n/a"
              }
            ]
          },
          {
            "id" : "ImmunizationRecommendation.recommendation.dateCriterion.extension",
            "path" : "ImmunizationRecommendation.recommendation.dateCriterion.extension",
            "short" : "Additional content defined by implementations",
            "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.",
            "comment" : "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.",
            "alias" : [
              "extensions",
              "user content"
            ],
            "min" : 0,
            "max" : "*",
            "base" : {
              "path" : "Element.extension",
              "min" : 0,
              "max" : "*"
            },
            "type" : [
              {
                "code" : "Extension"
              }
            ],
            "constraint" : [
              {
                "key" : "ele-1",
                "severity" : "error",
                "human" : "All FHIR elements must have a @value or children",
                "expression" : "hasValue() or (children().count() > id.count())",
                "xpath" : "@value|f:*|h:div",
                "source" : "http://hl7.org/fhir/StructureDefinition/Element"
              },
              {
                "key" : "ext-1",
                "severity" : "error",
                "human" : "Must have either extensions or value[x], not both",
                "expression" : "extension.exists() != value.exists()",
                "xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
                "source" : "http://hl7.org/fhir/StructureDefinition/Extension"
              }
            ],
            "isModifier" : false,
            "isSummary" : false,
            "mapping" : [
              {
                "identity" : "rim",
                "map" : "n/a"
              }
            ]
          },
          {
            "id" : "ImmunizationRecommendation.recommendation.dateCriterion.modifierExtension",
            "path" : "ImmunizationRecommendation.recommendation.dateCriterion.modifierExtension",
            "short" : "Extensions that cannot be ignored even if unrecognized",
            "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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
            "comment" : "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.",
            "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](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).",
            "alias" : [
              "extensions",
              "user content",
              "modifiers"
            ],
            "min" : 0,
            "max" : "*",
            "base" : {
              "path" : "BackboneElement.modifierExtension",
              "min" : 0,
              "max" : "*"
            },
            "type" : [
              {
                "code" : "Extension"
              }
            ],
            "constraint" : [
              {
                "key" : "ele-1",
                "severity" : "error",
                "human" : "All FHIR elements must have a @value or children",
                "expression" : "hasValue() or (children().count() > id.count())",
                "xpath" : "@value|f:*|h:div",
                "source" : "http://hl7.org/fhir/StructureDefinition/Element"
              },
              {
                "key" : "ext-1",
                "severity" : "error",
                "human" : "Must have either extensions or value[x], not both",
                "expression" : "extension.exists() != value.exists()",
                "xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
                "source" : "http://hl7.org/fhir/StructureDefinition/Extension"
              }
            ],
            "isModifier" : true,
            "isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
            "isSummary" : true,
            "mapping" : [
              {
                "identity" : "rim",
                "map" : "N/A"
              }
            ]
          },
          {
            "id" : "ImmunizationRecommendation.recommendation.dateCriterion.code",
            "path" : "ImmunizationRecommendation.recommendation.dateCriterion.code",
            "short" : "Type of date",
            "definition" : "Date classification of recommendation.  For example, earliest date to give, latest date to give, etc.",
            "min" : 1,
            "max" : "1",
            "base" : {
              "path" : "ImmunizationRecommendation.recommendation.dateCriterion.code",
              "min" : 1,
              "max" : "1"
            },
            "type" : [
              {
                "code" : "CodeableConcept"
              }
            ],
            "constraint" : [
              {
                "key" : "ele-1",
                "severity" : "error",
                "human" : "All FHIR elements must have a @value or children",
                "expression" : "hasValue() or (children().count() > id.count())",
                "xpath" : "@value|f:*|h:div",
                "source" : "http://hl7.org/fhir/StructureDefinition/Element"
              }
            ],
            "isModifier" : false,
            "isSummary" : false,
            "binding" : {
              "extension" : [
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
                  "valueString" : "ImmunizationRecommendationDateCriterion"
                }
              ],
              "strength" : "example",
              "description" : "Classifies date criterion with respect to conveying information about a patient's vaccination status (e.g. due date, latest to give date, etc.).",
              "valueSet" : "http://hl7.org/fhir/ValueSet/immunization-recommendation-date-criterion|4.0.1"
            },
            "mapping" : [
              {
                "identity" : "v2",
                "map" : "OBX-3"
              },
              {
                "identity" : "rim",
                "map" : ".code"
              }
            ]
          },
          {
            "id" : "ImmunizationRecommendation.recommendation.dateCriterion.value",
            "path" : "ImmunizationRecommendation.recommendation.dateCriterion.value",
            "short" : "Recommended date",
            "definition" : "The date whose meaning is specified by dateCriterion.code.",
            "min" : 1,
            "max" : "1",
            "base" : {
              "path" : "ImmunizationRecommendation.recommendation.dateCriterion.value",
              "min" : 1,
              "max" : "1"
            },
            "type" : [
              {
                "code" : "dateTime"
              }
            ],
            "constraint" : [
              {
                "key" : "ele-1",
                "severity" : "error",
                "human" : "All FHIR elements must have a @value or children",
                "expression" : "hasValue() or (children().count() > id.count())",
                "xpath" : "@value|f:*|h:div",
                "source" : "http://hl7.org/fhir/StructureDefinition/Element"
              }
            ],
            "isModifier" : false,
            "isSummary" : false,
            "mapping" : [
              {
                "identity" : "v2",
                "map" : "OBX-5"
              },
              {
                "identity" : "rim",
                "map" : ".value"
              }
            ]
          },
          {
            "id" : "ImmunizationRecommendation.recommendation.description",
            "path" : "ImmunizationRecommendation.recommendation.description",
            "short" : "Protocol details",
            "definition" : "Contains the description about the protocol under which the vaccine was administered.",
            "min" : 0,
            "max" : "1",
            "base" : {
              "path" : "ImmunizationRecommendation.recommendation.description",
              "min" : 0,
              "max" : "1"
            },
            "type" : [
              {
                "code" : "string"
              }
            ],
            "constraint" : [
              {
                "key" : "ele-1",
                "severity" : "error",
                "human" : "All FHIR elements must have a @value or children",
                "expression" : "hasValue() or (children().count() > id.count())",
                "xpath" : "@value|f:*|h:div",
                "source" : "http://hl7.org/fhir/StructureDefinition/Element"
              }
            ],
            "isModifier" : false,
            "isSummary" : false,
            "mapping" : [
              {
                "identity" : "v2",
                "map" : "OBX-5 : OBX-3 = 30956-7"
              },
              {
                "identity" : "rim",
                "map" : ".text"
              }
            ]
          },
          {
            "id" : "ImmunizationRecommendation.recommendation.series",
            "path" : "ImmunizationRecommendation.recommendation.series",
            "short" : "Name of vaccination series",
            "definition" : "One possible path to achieve presumed immunity against a disease - within the context of an authority.",
            "min" : 0,
            "max" : "1",
            "base" : {
              "path" : "ImmunizationRecommendation.recommendation.series",
              "min" : 0,
              "max" : "1"
            },
            "type" : [
              {
                "code" : "string"
              }
            ],
            "constraint" : [
              {
                "key" : "ele-1",
                "severity" : "error",
                "human" : "All FHIR elements must have a @value or children",
                "expression" : "hasValue() or (children().count() > id.count())",
                "xpath" : "@value|f:*|h:div",
                "source" : "http://hl7.org/fhir/StructureDefinition/Element"
              }
            ],
            "isModifier" : false,
            "isSummary" : false,
            "mapping" : [
              {
                "identity" : "v2",
                "map" : "RXA-5-administered code"
              },
              {
                "identity" : "rim",
                "map" : ".title"
              }
            ]
          },
          {
            "id" : "ImmunizationRecommendation.recommendation.doseNumber[x]",
            "path" : "ImmunizationRecommendation.recommendation.doseNumber[x]",
            "short" : "Recommended dose number within series",
            "definition" : "Nominal position of the recommended dose in a series (e.g. dose 2 is the next recommended dose).",
            "comment" : "The use of an integer is prefered if known. A string should only be used in cases where an interger is not available (such as when documenting a recurring booster dose).",
            "min" : 0,
            "max" : "1",
            "base" : {
              "path" : "ImmunizationRecommendation.recommendation.doseNumber[x]",
              "min" : 0,
              "max" : "1"
            },
            "type" : [
              {
                "code" : "positiveInt"
              },
              {
                "code" : "string"
              }
            ],
            "constraint" : [
              {
                "key" : "ele-1",
                "severity" : "error",
                "human" : "All FHIR elements must have a @value or children",
                "expression" : "hasValue() or (children().count() > id.count())",
                "xpath" : "@value|f:*|h:div",
                "source" : "http://hl7.org/fhir/StructureDefinition/Element"
              }
            ],
            "isModifier" : false,
            "isSummary" : true,
            "mapping" : [
              {
                "identity" : "v2",
                "map" : "OBX-5 : OBX-3 = 30973-2"
              },
              {
                "identity" : "rim",
                "map" : ".inboundRelationship[typeCode=COMP, .source[classCode=SBADM, moodCode=INT]].sequenceNumber"
              }
            ]
          },
          {
            "id" : "ImmunizationRecommendation.recommendation.seriesDoses[x]",
            "path" : "ImmunizationRecommendation.recommendation.seriesDoses[x]",
            "short" : "Recommended number of doses for immunity",
            "definition" : "The recommended number of doses to achieve immunity.",
            "comment" : "The use of an integer is prefered if known. A string should only be used in cases where an interger is not available (such as when documenting a recurring booster dose).",
            "min" : 0,
            "max" : "1",
            "base" : {
              "path" : "ImmunizationRecommendation.recommendation.seriesDoses[x]",
              "min" : 0,
              "max" : "1"
            },
            "type" : [
              {
                "code" : "positiveInt"
              },
              {
                "code" : "string"
              }
            ],
            "constraint" : [
              {
                "key" : "ele-1",
                "severity" : "error",
                "human" : "All FHIR elements must have a @value or children",
                "expression" : "hasValue() or (children().count() > id.count())",
                "xpath" : "@value|f:*|h:div",
                "source" : "http://hl7.org/fhir/StructureDefinition/Element"
              }
            ],
            "isModifier" : false,
            "isSummary" : false,
            "mapping" : [
              {
                "identity" : "v2",
                "map" : "OBX-5 : OBX-3 = 59782-3"
              },
              {
                "identity" : "rim",
                "map" : ".inboundRelationship[typeCode=COMP, .source[classCode=SBADM, moodCode=DEF]].sequenceNumber"
              }
            ]
          },
          {
            "id" : "ImmunizationRecommendation.recommendation.supportingImmunization",
            "path" : "ImmunizationRecommendation.recommendation.supportingImmunization",
            "short" : "Past immunizations supporting recommendation",
            "definition" : "Immunization event history and/or evaluation that supports the status and recommendation.",
            "min" : 0,
            "max" : "*",
            "base" : {
              "path" : "ImmunizationRecommendation.recommendation.supportingImmunization",
              "min" : 0,
              "max" : "*"
            },
            "type" : [
              {
                "code" : "Reference",
                "targetProfile" : [
                  🔗 "http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-immunization"🔗 ,
                  "http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-immunizationevaluation"
                ]
              }
            ],
            "constraint" : [
              {
                "key" : "ele-1",
                "severity" : "error",
                "human" : "All FHIR elements must have a @value or children",
                "expression" : "hasValue() or (children().count() > id.count())",
                "xpath" : "@value|f:*|h:div",
                "source" : "http://hl7.org/fhir/StructureDefinition/Element"
              }
            ],
            "mustSupport" : false,
            "isModifier" : false,
            "isSummary" : false,
            "mapping" : [
              {
                "identity" : "v2",
                "map" : "? No clear way to associate in HL7 v2 or IG"
              },
              {
                "identity" : "rim",
                "map" : ".outboundRelationship[typeCode=RSON].target[classCode=SBADM, moodCode=EVN, code=\"immunization\"]"
              }
            ]
          },
          {
            "id" : "ImmunizationRecommendation.recommendation.supportingPatientInformation",
            "path" : "ImmunizationRecommendation.recommendation.supportingPatientInformation",
            "short" : "Patient observations supporting recommendation",
            "definition" : "Patient Information that supports the status and recommendation.  This includes patient observations, adverse reactions and allergy/intolerance information.",
            "min" : 0,
            "max" : "*",
            "base" : {
              "path" : "ImmunizationRecommendation.recommendation.supportingPatientInformation",
              "min" : 0,
              "max" : "*"
            },
            "type" : [
              {
                "code" : "Reference",
                "targetProfile" : [
                  🔗 "http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-simple-observation"🔗 ,
                  "http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-allergyintolerance"
                ]
              }
            ],
            "constraint" : [
              {
                "key" : "ele-1",
                "severity" : "error",
                "human" : "All FHIR elements must have a @value or children",
                "expression" : "hasValue() or (children().count() > id.count())",
                "xpath" : "@value|f:*|h:div",
                "source" : "http://hl7.org/fhir/StructureDefinition/Element"
              }
            ],
            "mustSupport" : false,
            "isModifier" : false,
            "isSummary" : false,
            "mapping" : [
              {
                "identity" : "workflow",
                "map" : "Request.supportingInfo"
              },
              {
                "identity" : "v2",
                "map" : "OBX If OBX is associated with ( RXA : RXA-5-administered code = '998^No vaccine administered^CVX'), could contain the reason the vaccine was not administered"
              },
              {
                "identity" : "rim",
                "map" : ".outboundRelationship[typeCode=RSON].target[classCode=OBS, moodCode=EVN]"
              }
            ]
          }
        ]
      },
      "differential" : {
        "element" : [
          {
            "id" : "ImmunizationRecommendation",
            "path" : "ImmunizationRecommendation",
            "mustSupport" : false
          },
          {
            "id" : "ImmunizationRecommendation.patient",
            "path" : "ImmunizationRecommendation.patient",
            "short" : "Who this profile is for",
            "type" : [
              {
                "code" : "Reference",
                "targetProfile" : [
                  🔗 "http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-patient"
                ]
              }
            ]
          },
          {
            "id" : "ImmunizationRecommendation.authority",
            "path" : "ImmunizationRecommendation.authority",
            "type" : [
              {
                "code" : "Reference",
                "targetProfile" : [
                  🔗 "http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-organization"
                ]
              }
            ],
            "mustSupport" : false
          },
          {
            "id" : "ImmunizationRecommendation.recommendation",
            "path" : "ImmunizationRecommendation.recommendation",
            "short" : "Vaccine administration recommendations"
          },
          {
            "id" : "ImmunizationRecommendation.recommendation.vaccineCode",
            "path" : "ImmunizationRecommendation.recommendation.vaccineCode",
            "short" : "Vaccine or vaccine group recommendation applies to",
            "binding" : {
              "strength" : "extensible",
              "description" : "CVX Vaccines Administered Vaccine Set",
              "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1010.6"
            }
          },
          {
            "id" : "ImmunizationRecommendation.recommendation.doseNumber[x]",
            "path" : "ImmunizationRecommendation.recommendation.doseNumber[x]",
            "short" : "Recommended dose number within series"
          },
          {
            "id" : "ImmunizationRecommendation.recommendation.supportingImmunization",
            "path" : "ImmunizationRecommendation.recommendation.supportingImmunization",
            "type" : [
              {
                "code" : "Reference",
                "targetProfile" : [
                  🔗 "http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-immunization"🔗 ,
                  "http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-immunizationevaluation"
                ]
              }
            ],
            "mustSupport" : false
          },
          {
            "id" : "ImmunizationRecommendation.recommendation.supportingPatientInformation",
            "path" : "ImmunizationRecommendation.recommendation.supportingPatientInformation",
            "type" : [
              {
                "code" : "Reference",
                "targetProfile" : [
                  🔗 "http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-simple-observation"🔗 ,
                  "http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-allergyintolerance"
                ]
              }
            ],
            "mustSupport" : false
          }
        ]
      }
    }