# US Quality Core Immunization Not Done - 2026 US Quality Core Implementation Guide v0.5.0

* [**Table of Contents**](toc.md)
* [**Artifacts Summary**](artifacts.md)
* **US Quality Core Immunization Not Done**

## Resource Profile: US Quality Core Immunization Not Done 

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

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

**Usage**
  See the [patterns](patterns.md) page for implementation and usage patterns.  

The Immunization and ImmunizationNotDone profiles represent the positive and negative statements for an immunization event. 

### Examples

 

| | |
| :--- | :--- |
| [Negation Example using valueset reference](Immunization-negation-example.md) | Immunization not performed due to patient declination for religious reasons; indicates that none of the vaccines in the given "not done value set" were administered. |
| [Negation Example using coding](Immunization-negation-example-code.md) | Immunization not performed due to patient declination for religious reasons; indicates that a specific vaccine, by code, was not administered. |

 

Both of these example instances meet measure intent for exclusion as defined in the following illustrative CQL (informational; not part of conformance requirements): 

```
define "Reason for No Polio Immunization":
  ["ImmunizationNotDone": "Inactivated Polio Vaccine (IPV)"] PolioVaccination
    where PolioVaccination.statusReason in "Medical Reason"
      or PolioVaccination.statusReason in "Patient Refusal"
```

For a more complete discussion of representation of negation within US Quality Core and quality improvement artifacts, see the [Negation in US Quality Core](general-requirements.md#negation-in-us-quality-core) topic.

**USCDI+ Quality Elements:**

* status: (USCDI+ Quality) (USCDI) completed | entered-in-error | not-done
* occurrence[x]: (USCDI+ Quality) (USCDI) Vaccine administration date

**Usages:**

* Examples for this Profile: [Immunization/negation-example-code](Immunization-negation-example-code.md) and [Immunization/negation-example](Immunization-negation-example.md)
* CapabilityStatements using this Profile: [US Quality Core Client CapabilityStatement](CapabilityStatement-us-quality-core-client.md) and [US Quality Core Server CapabilityStatement](CapabilityStatement-us-quality-core-server.md)

You can also check for [usages in the FHIR IG Statistics](https://packages2.fhir.org/xig/resource/fhir.onc.us-quality-core|current/StructureDefinition/StructureDefinition-us-quality-core-immunizationnotdone.json)

### Formal Views of Profile Content

 [Description of Profiles, Differentials, Snapshots and how the different presentations work](http://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#structure-definitions). 

 

Other representations of profile: [CSV](StructureDefinition-us-quality-core-immunizationnotdone.csv), [Excel](StructureDefinition-us-quality-core-immunizationnotdone.xlsx), [Schematron](StructureDefinition-us-quality-core-immunizationnotdone.sch) 



## Resource Content

```json
{
  "resourceType" : "StructureDefinition",
  "id" : "us-quality-core-immunizationnotdone",
  "url" : "http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-immunizationnotdone",
  "version" : "0.5.0",
  "name" : "USQualityCoreImmunizationNotDone",
  "title" : "US Quality Core Immunization Not Done",
  "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" : "Negation profile of Immunization 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"
  },
  {
    "identity" : "cda",
    "uri" : "http://hl7.org/v3/cda",
    "name" : "CDA (R2)"
  }],
  "kind" : "resource",
  "abstract" : false,
  "type" : "Immunization",
  "baseDefinition" : "http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization|6.1.0",
  "derivation" : "constraint",
  "differential" : {
    "element" : [{
      "id" : "Immunization",
      "path" : "Immunization",
      "constraint" : [{
        "key" : "ind-1",
        "severity" : "error",
        "human" : "To indicate what immunization was not done, either at least one coding in the vaccineCode element or a notDoneValueSet extension shall be provided",
        "expression" : "vaccineCode.extension('http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-notDoneValueSet').exists() xor vaccineCode.coding.exists()",
        "xpath" : "exists(f:extension)"
      }],
      "mustSupport" : false
    },
    {
      "id" : "Immunization.status",
      "extension" : [{
        "url" : "http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement",
        "valueBoolean" : true
      },
      {
        "url" : "http://fhir.org/guides/onc/us-quality-core/StructureDefinition/uscdiplusquality",
        "valueBoolean" : true
      }],
      "path" : "Immunization.status",
      "short" : "(USCDI+ Quality) (USCDI) completed | entered-in-error | not-done",
      "type" : [{
        "code" : "code"
      }],
      "fixedCode" : "not-done"
    },
    {
      "id" : "Immunization.statusReason",
      "extension" : [{
        "url" : "http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement",
        "valueBoolean" : true
      }],
      "path" : "Immunization.statusReason",
      "short" : "(USCDI) Reason not done",
      "min" : 1,
      "max" : "1",
      "binding" : {
        "strength" : "extensible",
        "description" : "The reason the service was not requested",
        "valueSet" : "http://fhir.org/guides/onc/us-quality-core/ValueSet/us-quality-core-negation-reason"
      }
    },
    {
      "id" : "Immunization.vaccineCode",
      "extension" : [{
        "url" : "http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement",
        "valueBoolean" : true
      }],
      "path" : "Immunization.vaccineCode",
      "short" : "(USCDI) Vaccine Product Type (bind to CVX)"
    },
    {
      "id" : "Immunization.vaccineCode.extension:notDoneValueSet",
      "path" : "Immunization.vaccineCode.extension",
      "sliceName" : "notDoneValueSet",
      "short" : "What wasn't administered",
      "min" : 0,
      "max" : "1",
      "type" : [{
        "code" : "Extension",
        "profile" : ["http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-notDoneValueSet"]
      }],
      "condition" : ["ind-1"]
    },
    {
      "id" : "Immunization.patient",
      "extension" : [{
        "url" : "http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement",
        "valueBoolean" : true
      }],
      "path" : "Immunization.patient",
      "short" : "(USCDI) Who was immunized",
      "type" : [{
        "code" : "Reference",
        "targetProfile" : ["http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-patient"]
      }]
    },
    {
      "id" : "Immunization.occurrence[x]",
      "extension" : [{
        "url" : "http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement",
        "valueBoolean" : true
      },
      {
        "url" : "http://fhir.org/guides/onc/us-quality-core/StructureDefinition/uscdiplusquality",
        "valueBoolean" : true
      }],
      "path" : "Immunization.occurrence[x]",
      "short" : "(USCDI+ Quality) (USCDI) Vaccine administration date"
    },
    {
      "id" : "Immunization.recorded",
      "path" : "Immunization.recorded",
      "short" : "When the immunization was first captured in the subject's record",
      "min" : 1,
      "max" : "1"
    }]
  }
}

```
