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: US Quality Core Immunization

Official URL: http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-immunization | Version: 0.5.0
Active as of 2026-05-15 | Computable Name: USQualityCoreImmunization

Profile of Immunization for decision support/quality metrics. Defines the core set of elements and extensions for quality rule and measure authors.

Usage

The following example illustrates the use of the Immunization profile:

    define "Polio Immunizations":
      ["Immunization": "Inactivated Polio Vaccine (IPV)"] PolioVaccination
        where PolioVaccination.status = 'completed'

See the patterns page for implementation and usage patterns.

### Examples

Example of Influenza immunization shot

USCDI+ Quality Elements:

- status: (USCDI+ Quality) (USCDI) completed | entered-in-error
- statusReason: (USCDI+ Quality) (USCDI) Reason not done
- occurrence[x]: (USCDI+ Quality) (USCDI) Vaccine administration date
- primarySource: (USCDI+ Quality) (USCDI) Indicates context the data was recorded in

Usages:

- Refer to this Profile: US Quality Core AdverseEvent, US Quality Core ImmunizationEvaluation and US Quality Core ImmunizationRecommendation
- Examples for this Profile: Immunization/example and Immunization/statusreason-example
- CapabilityStatements using this Profile: US Quality Core Client CapabilityStatement and US Quality Core Server CapabilityStatement

You can also check for usages in the FHIR IG Statistics

### Formal Views of Profile Content

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

- Key Elements Table
- Differential Table
- Snapshot Table
- Statistics/References
- All

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Immunization | C | 0..* | USCoreImmunizationProfile(6.1.0) | Immunization event information Constraints: us-core-5
id | Σ | 0..1 | id | Logical id of this artifact
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
status | ?!S Σ | 1..1 | code | (USCDI+ Quality) (USCDI) completed | entered-in-error Binding: Non-Negative Immunization Status (required)
statusReason | S | 0..1 | CodeableConcept | (USCDI+ Quality) (USCDI) Reason not done Binding: ImmunizationStatusReasonCodes (preferred)
vaccineCode | S Σ C | 1..1 | CodeableConcept | (USCDI) Vaccine Product Type (bind to CVX) Binding: CVX Vaccines Administered Vaccine Set (extensible)
patient | S Σ | 1..1 | Reference(US Quality Core Patient) | (USCDI) Who was immunized
occurrence[x] | S Σ | 1..1 |  | (USCDI+ Quality) (USCDI) Vaccine administration date
occurrenceDateTime |  |  | dateTime S |
occurrenceString |  |  | string |
recorded |  | 0..1 | dateTime | When the immunization was first captured in the subject's record
primarySource | S Σ | 0..1 | boolean | (USCDI+ Quality) (USCDI) Indicates context the data was recorded in
isSubpotent | ?!Σ | 0..1 | boolean | Dose potency
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Immunization.status | Base | required | Non-Negative Immunization Status | 📦0.5.0 | This IG
Immunization.statusReason | Base | preferred | Immunization Status Reason Codes | 📦4.0.1 | FHIR Std.
Immunization.vaccineCode | Base | extensible | CVX Vaccines Administered Vaccine Set | 📦20230715 | VSAC v0.18

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | Immunization | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Immunization | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource | `contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`
dom-4 | error | Immunization | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5 | error | Immunization | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Immunization | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`
us-core-5 | best practice | Immunization | SHOULD have a translation to the NDC value set | `vaccineCode.coding.where(system='http://hl7.org/fhir/sid/ndc').empty()`

This structure is derived from USCoreImmunizationProfile

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Immunization |  | 0..* | USCoreImmunizationProfile(6.1.0) | Immunization event information
id |  | 0..1 | id | Logical id of this artifact
status |  | 1..1 | code | (USCDI+ Quality) (USCDI) completed | entered-in-error Binding: Non-Negative Immunization Status (required)
statusReason |  | 0..1 | CodeableConcept | (USCDI+ Quality) (USCDI) Reason not done Binding: ImmunizationStatusReasonCodes (preferred)
vaccineCode |  | 1..1 | CodeableConcept | (USCDI) Vaccine Product Type (bind to CVX)
patient |  | 1..1 | Reference(US Quality Core Patient) | (USCDI) Who was immunized
occurrence[x] |  | 1..1 | dateTime, string | (USCDI+ Quality) (USCDI) Vaccine administration date
recorded |  | 0..1 | dateTime | When the immunization was first captured in the subject's record
primarySource |  | 0..1 | boolean | (USCDI+ Quality) (USCDI) Indicates context the data was recorded in
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
Immunization.status | Base | required | Non-Negative Immunization Status | 📦0.5.0 | This IG
Immunization.statusReason | Base | preferred | Immunization Status Reason Codes | 📦4.0.1 | FHIR Std.

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Immunization | C | 0..* | USCoreImmunizationProfile(6.1.0) | Immunization event information Constraints: us-core-5
id | Σ | 0..1 | id | Logical id of this artifact
meta | Σ | 0..1 | Meta | Metadata about the resource
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
language |  | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained |  | 0..* | Resource | Contained, inline Resources
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier |  | 0..* | Identifier | Business identifier
status | ?!S Σ | 1..1 | code | (USCDI+ Quality) (USCDI) completed | entered-in-error Binding: Non-Negative Immunization Status (required)
statusReason | S | 0..1 | CodeableConcept | (USCDI+ Quality) (USCDI) Reason not done Binding: ImmunizationStatusReasonCodes (preferred)
vaccineCode | S Σ C | 1..1 | CodeableConcept | (USCDI) Vaccine Product Type (bind to CVX) Binding: CVX Vaccines Administered Vaccine Set (extensible)
patient | S Σ | 1..1 | Reference(US Quality Core Patient) | (USCDI) Who was immunized
encounter |  | 0..1 | Reference(Encounter) | Encounter immunization was part of
occurrence[x] | S Σ | 1..1 |  | (USCDI+ Quality) (USCDI) Vaccine administration date
occurrenceDateTime |  |  | dateTime S |
occurrenceString |  |  | string |
recorded |  | 0..1 | dateTime | When the immunization was first captured in the subject's record
primarySource | S Σ | 0..1 | boolean | (USCDI+ Quality) (USCDI) Indicates context the data was recorded in
reportOrigin |  | 0..1 | CodeableConcept | Indicates the source of a secondarily reported record Binding: ImmunizationOriginCodes (example): The source of the data for a record which is not from a primary source.
location |  | 0..1 | Reference(Location) | Where immunization occurred
manufacturer |  | 0..1 | Reference(Organization) | Vaccine manufacturer
lotNumber |  | 0..1 | string | Vaccine lot number
expirationDate |  | 0..1 | date | Vaccine expiration date
site |  | 0..1 | CodeableConcept | Body site vaccine was administered Binding: CodesForImmunizationSiteOfAdministration (example): The site at which the vaccine was administered.
route |  | 0..1 | CodeableConcept | How vaccine entered body Binding: ImmunizationRouteCodes (example): The route by which the vaccine was administered.
doseQuantity |  | 0..1 | SimpleQuantity | Amount of vaccine administered
performer | Σ | 0..* | BackboneElement | Who performed event
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
function | Σ | 0..1 | CodeableConcept | What type of performance was done Binding: ImmunizationFunctionCodes (extensible): The role a practitioner or organization plays in the immunization event.
actor | Σ | 1..1 | Reference(Practitioner | PractitionerRole | Organization) | Individual or organization who was performing
note | Σ | 0..* | Annotation | Additional immunization notes
reasonCode |  | 0..* | CodeableConcept | Why immunization occurred Binding: ImmunizationReasonCodes (example): The reason why a vaccine was administered.
reasonReference |  | 0..* | Reference(Condition | Observation | DiagnosticReport) | Why immunization occurred
isSubpotent | ?!Σ | 0..1 | boolean | Dose potency
subpotentReason |  | 0..* | CodeableConcept | Reason for being subpotent Binding: ImmunizationSubpotentReason (example): The reason why a dose is considered to be subpotent.
education | C | 0..* | BackboneElement | Educational material presented to patient Constraints: imm-1
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
documentType |  | 0..1 | string | Educational material document identifier
reference |  | 0..1 | uri | Educational material reference pointer
publicationDate |  | 0..1 | dateTime | Educational material publication date
presentationDate |  | 0..1 | dateTime | Educational material presentation date
programEligibility |  | 0..* | CodeableConcept | Patient eligibility for a vaccination program Binding: ImmunizationProgramEligibility (example): The patient's eligibility for a vaccation program.
fundingSource |  | 0..1 | CodeableConcept | Funding source for the vaccine Binding: ImmunizationFundingSource (example): The source of funding used to purchase the vaccine administered.
reaction |  | 0..* | BackboneElement | Details of a reaction that follows immunization
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
date |  | 0..1 | dateTime | When reaction started
detail |  | 0..1 | Reference(Observation) | Additional information on reaction
reported |  | 0..1 | boolean | Indicates self-reported reaction
protocolApplied |  | 0..* | BackboneElement | Protocol followed by the provider
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
series |  | 0..1 | string | Name of vaccine series
authority |  | 0..1 | Reference(Organization) | Who is responsible for publishing the recommendations
targetDisease |  | 0..* | CodeableConcept | Vaccine preventatable disease being targetted Binding: ImmunizationTargetDiseaseCodes (example): The vaccine preventable disease the dose is being administered for.
doseNumber[x] |  | 1..1 |  | Dose number within series
doseNumberPositiveInt |  |  | positiveInt |
doseNumberString |  |  | string |
seriesDoses[x] |  | 0..1 |  | Recommended number of doses for immunity
seriesDosesPositiveInt |  |  | positiveInt |
seriesDosesString |  |  | string |
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Immunization.language | Base | preferred | Common Languages | 📦4.0.1 | FHIR Std.
Immunization.status | Base | required | Non-Negative Immunization Status | 📦0.5.0 | This IG
Immunization.statusReason | Base | preferred | Immunization Status Reason Codes | 📦4.0.1 | FHIR Std.
Immunization.vaccineCode | Base | extensible | CVX Vaccines Administered Vaccine Set | 📦20230715 | VSAC v0.18
Immunization.reportOrigin | Base | example | Immunization Origin Codes | 📦4.0.1 | FHIR Std.
Immunization.site | Base | example | Codes for Immunization Site of Administration | 📦4.0.1 | FHIR Std.
Immunization.route | Base | example | Immunization Route Codes | 📦4.0.1 | FHIR Std.
Immunization.performer.​function | Base | extensible | Immunization Function Codes | 📦4.0.1 | FHIR Std.
Immunization.reasonCode | Base | example | Immunization Reason Codes | 📦4.0.1 | FHIR Std.
Immunization.subpotentReason | Base | example | Immunization Subpotent Reason | 📦4.0.1 | FHIR Std.
Immunization.programEligibility | Base | example | Immunization Program Eligibility | 📦4.0.1 | FHIR Std.
Immunization.fundingSource | Base | example | Immunization Funding Source | 📦4.0.1 | FHIR Std.
Immunization.protocolApplied.​targetDisease | Base | example | Immunization Target Disease Codes | 📦4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | Immunization | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Immunization | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource | `contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`
dom-4 | error | Immunization | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5 | error | Immunization | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Immunization | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`
imm-1 | error | Immunization.education | One of documentType or reference SHALL be present | `documentType.exists() or reference.exists()`
us-core-5 | best practice | Immunization | SHOULD have a translation to the NDC value set | `vaccineCode.coding.where(system='http://hl7.org/fhir/sid/ndc').empty()`

This structure is derived from USCoreImmunizationProfile

Summary

Structures

This structure refers to these other structures:

- US Quality Core Patient (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-patient)

Key Elements View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Immunization | C | 0..* | USCoreImmunizationProfile(6.1.0) | Immunization event information Constraints: us-core-5
id | Σ | 0..1 | id | Logical id of this artifact
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
status | ?!S Σ | 1..1 | code | (USCDI+ Quality) (USCDI) completed | entered-in-error Binding: Non-Negative Immunization Status (required)
statusReason | S | 0..1 | CodeableConcept | (USCDI+ Quality) (USCDI) Reason not done Binding: ImmunizationStatusReasonCodes (preferred)
vaccineCode | S Σ C | 1..1 | CodeableConcept | (USCDI) Vaccine Product Type (bind to CVX) Binding: CVX Vaccines Administered Vaccine Set (extensible)
patient | S Σ | 1..1 | Reference(US Quality Core Patient) | (USCDI) Who was immunized
occurrence[x] | S Σ | 1..1 |  | (USCDI+ Quality) (USCDI) Vaccine administration date
occurrenceDateTime |  |  | dateTime S |
occurrenceString |  |  | string |
recorded |  | 0..1 | dateTime | When the immunization was first captured in the subject's record
primarySource | S Σ | 0..1 | boolean | (USCDI+ Quality) (USCDI) Indicates context the data was recorded in
isSubpotent | ?!Σ | 0..1 | boolean | Dose potency
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Immunization.status | Base | required | Non-Negative Immunization Status | 📦0.5.0 | This IG
Immunization.statusReason | Base | preferred | Immunization Status Reason Codes | 📦4.0.1 | FHIR Std.
Immunization.vaccineCode | Base | extensible | CVX Vaccines Administered Vaccine Set | 📦20230715 | VSAC v0.18

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | Immunization | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Immunization | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource | `contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`
dom-4 | error | Immunization | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5 | error | Immunization | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Immunization | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`
us-core-5 | best practice | Immunization | SHOULD have a translation to the NDC value set | `vaccineCode.coding.where(system='http://hl7.org/fhir/sid/ndc').empty()`

Differential View

This structure is derived from USCoreImmunizationProfile

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Immunization |  | 0..* | USCoreImmunizationProfile(6.1.0) | Immunization event information
id |  | 0..1 | id | Logical id of this artifact
status |  | 1..1 | code | (USCDI+ Quality) (USCDI) completed | entered-in-error Binding: Non-Negative Immunization Status (required)
statusReason |  | 0..1 | CodeableConcept | (USCDI+ Quality) (USCDI) Reason not done Binding: ImmunizationStatusReasonCodes (preferred)
vaccineCode |  | 1..1 | CodeableConcept | (USCDI) Vaccine Product Type (bind to CVX)
patient |  | 1..1 | Reference(US Quality Core Patient) | (USCDI) Who was immunized
occurrence[x] |  | 1..1 | dateTime, string | (USCDI+ Quality) (USCDI) Vaccine administration date
recorded |  | 0..1 | dateTime | When the immunization was first captured in the subject's record
primarySource |  | 0..1 | boolean | (USCDI+ Quality) (USCDI) Indicates context the data was recorded in
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
Immunization.status | Base | required | Non-Negative Immunization Status | 📦0.5.0 | This IG
Immunization.statusReason | Base | preferred | Immunization Status Reason Codes | 📦4.0.1 | FHIR Std.

Snapshot View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Immunization | C | 0..* | USCoreImmunizationProfile(6.1.0) | Immunization event information Constraints: us-core-5
id | Σ | 0..1 | id | Logical id of this artifact
meta | Σ | 0..1 | Meta | Metadata about the resource
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
language |  | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained |  | 0..* | Resource | Contained, inline Resources
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier |  | 0..* | Identifier | Business identifier
status | ?!S Σ | 1..1 | code | (USCDI+ Quality) (USCDI) completed | entered-in-error Binding: Non-Negative Immunization Status (required)
statusReason | S | 0..1 | CodeableConcept | (USCDI+ Quality) (USCDI) Reason not done Binding: ImmunizationStatusReasonCodes (preferred)
vaccineCode | S Σ C | 1..1 | CodeableConcept | (USCDI) Vaccine Product Type (bind to CVX) Binding: CVX Vaccines Administered Vaccine Set (extensible)
patient | S Σ | 1..1 | Reference(US Quality Core Patient) | (USCDI) Who was immunized
encounter |  | 0..1 | Reference(Encounter) | Encounter immunization was part of
occurrence[x] | S Σ | 1..1 |  | (USCDI+ Quality) (USCDI) Vaccine administration date
occurrenceDateTime |  |  | dateTime S |
occurrenceString |  |  | string |
recorded |  | 0..1 | dateTime | When the immunization was first captured in the subject's record
primarySource | S Σ | 0..1 | boolean | (USCDI+ Quality) (USCDI) Indicates context the data was recorded in
reportOrigin |  | 0..1 | CodeableConcept | Indicates the source of a secondarily reported record Binding: ImmunizationOriginCodes (example): The source of the data for a record which is not from a primary source.
location |  | 0..1 | Reference(Location) | Where immunization occurred
manufacturer |  | 0..1 | Reference(Organization) | Vaccine manufacturer
lotNumber |  | 0..1 | string | Vaccine lot number
expirationDate |  | 0..1 | date | Vaccine expiration date
site |  | 0..1 | CodeableConcept | Body site vaccine was administered Binding: CodesForImmunizationSiteOfAdministration (example): The site at which the vaccine was administered.
route |  | 0..1 | CodeableConcept | How vaccine entered body Binding: ImmunizationRouteCodes (example): The route by which the vaccine was administered.
doseQuantity |  | 0..1 | SimpleQuantity | Amount of vaccine administered
performer | Σ | 0..* | BackboneElement | Who performed event
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
function | Σ | 0..1 | CodeableConcept | What type of performance was done Binding: ImmunizationFunctionCodes (extensible): The role a practitioner or organization plays in the immunization event.
actor | Σ | 1..1 | Reference(Practitioner | PractitionerRole | Organization) | Individual or organization who was performing
note | Σ | 0..* | Annotation | Additional immunization notes
reasonCode |  | 0..* | CodeableConcept | Why immunization occurred Binding: ImmunizationReasonCodes (example): The reason why a vaccine was administered.
reasonReference |  | 0..* | Reference(Condition | Observation | DiagnosticReport) | Why immunization occurred
isSubpotent | ?!Σ | 0..1 | boolean | Dose potency
subpotentReason |  | 0..* | CodeableConcept | Reason for being subpotent Binding: ImmunizationSubpotentReason (example): The reason why a dose is considered to be subpotent.
education | C | 0..* | BackboneElement | Educational material presented to patient Constraints: imm-1
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
documentType |  | 0..1 | string | Educational material document identifier
reference |  | 0..1 | uri | Educational material reference pointer
publicationDate |  | 0..1 | dateTime | Educational material publication date
presentationDate |  | 0..1 | dateTime | Educational material presentation date
programEligibility |  | 0..* | CodeableConcept | Patient eligibility for a vaccination program Binding: ImmunizationProgramEligibility (example): The patient's eligibility for a vaccation program.
fundingSource |  | 0..1 | CodeableConcept | Funding source for the vaccine Binding: ImmunizationFundingSource (example): The source of funding used to purchase the vaccine administered.
reaction |  | 0..* | BackboneElement | Details of a reaction that follows immunization
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
date |  | 0..1 | dateTime | When reaction started
detail |  | 0..1 | Reference(Observation) | Additional information on reaction
reported |  | 0..1 | boolean | Indicates self-reported reaction
protocolApplied |  | 0..* | BackboneElement | Protocol followed by the provider
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
series |  | 0..1 | string | Name of vaccine series
authority |  | 0..1 | Reference(Organization) | Who is responsible for publishing the recommendations
targetDisease |  | 0..* | CodeableConcept | Vaccine preventatable disease being targetted Binding: ImmunizationTargetDiseaseCodes (example): The vaccine preventable disease the dose is being administered for.
doseNumber[x] |  | 1..1 |  | Dose number within series
doseNumberPositiveInt |  |  | positiveInt |
doseNumberString |  |  | string |
seriesDoses[x] |  | 0..1 |  | Recommended number of doses for immunity
seriesDosesPositiveInt |  |  | positiveInt |
seriesDosesString |  |  | string |
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Immunization.language | Base | preferred | Common Languages | 📦4.0.1 | FHIR Std.
Immunization.status | Base | required | Non-Negative Immunization Status | 📦0.5.0 | This IG
Immunization.statusReason | Base | preferred | Immunization Status Reason Codes | 📦4.0.1 | FHIR Std.
Immunization.vaccineCode | Base | extensible | CVX Vaccines Administered Vaccine Set | 📦20230715 | VSAC v0.18
Immunization.reportOrigin | Base | example | Immunization Origin Codes | 📦4.0.1 | FHIR Std.
Immunization.site | Base | example | Codes for Immunization Site of Administration | 📦4.0.1 | FHIR Std.
Immunization.route | Base | example | Immunization Route Codes | 📦4.0.1 | FHIR Std.
Immunization.performer.​function | Base | extensible | Immunization Function Codes | 📦4.0.1 | FHIR Std.
Immunization.reasonCode | Base | example | Immunization Reason Codes | 📦4.0.1 | FHIR Std.
Immunization.subpotentReason | Base | example | Immunization Subpotent Reason | 📦4.0.1 | FHIR Std.
Immunization.programEligibility | Base | example | Immunization Program Eligibility | 📦4.0.1 | FHIR Std.
Immunization.fundingSource | Base | example | Immunization Funding Source | 📦4.0.1 | FHIR Std.
Immunization.protocolApplied.​targetDisease | Base | example | Immunization Target Disease Codes | 📦4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | Immunization | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Immunization | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource | `contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`
dom-4 | error | Immunization | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5 | error | Immunization | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Immunization | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`
imm-1 | error | Immunization.education | One of documentType or reference SHALL be present | `documentType.exists() or reference.exists()`
us-core-5 | best practice | Immunization | SHOULD have a translation to the NDC value set | `vaccineCode.coding.where(system='http://hl7.org/fhir/sid/ndc').empty()`

This structure is derived from USCoreImmunizationProfile

Summary

Structures

This structure refers to these other structures:

- US Quality Core Patient (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-patient)

Other representations of profile: CSV, Excel, Schematron