Canadian Baseline
1.1.0 - CI Build Canada flag

Canadian Baseline, published by HL7 Canada - FHIR Implementation Work Group. This guide is not an authorized publication; it is the continuous build for version 1.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7-Canada/ca-baseline/ and changes regularly. See the Directory of published versions

Resource Profile: ImmunizationRecommendationProfile - Detailed Descriptions

Draft as of 2020-03-26

Definitions for the profile-immunizationrecommendation resource profile.

Guidance on how to interpret the contents of this table can be found here

0. ImmunizationRecommendation
Definition

The ImmunizationRecommendation Profile is based upon the core FHIR ImmunizationRecommendation Resource

ShortImmunizationRecommendation Profile
2. ImmunizationRecommendation.patient
TypeReference(Patient Profile)
Must Supporttrue
4. ImmunizationRecommendation.date
Must Supporttrue
6. ImmunizationRecommendation.authority
TypeReference(Organization Profile)
8. ImmunizationRecommendation.recommendation
Must Supporttrue
10. ImmunizationRecommendation.recommendation.vaccineCode
Comments

CA Core Usage Notes: the assumption is that ImmunizationRecommendation (forecast) is always on the level of a generic vaccine code and/or target disease. TBD: to confirm that there is no use case when an ImmunizationRecommendation needs to be on the vaccine tradename level (e.g. there is no sitation when a 2nd dose has to be of the same tradename as the 1st dose).

BindingThe codes SHOULD be taken from https://cvc.canimmunize.ca/v3/ValueSet/Generic
(preferred to https://cvc.canimmunize.ca/v3/ValueSet/Generic)
Must Supporttrue
12. ImmunizationRecommendation.recommendation.vaccineCode.coding
SlicingThis element introduces a set of slices on ImmunizationRecommendation.recommendation.vaccineCode.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • pattern @ system
  • pattern @ code
  • 14. ImmunizationRecommendation.recommendation.vaccineCode.coding:Generic
    Slice NameGeneric
    Comments

    CA Baseline Usage Notes: either a Generic code or a Tradename code or both have to be present.

    Control0..1
    BindingThe codes SHOULD be taken from https://cvc.canimmunize.ca/v3/ValueSet/Generic
    (preferred to https://cvc.canimmunize.ca/v3/ValueSet/Generic)
    16. ImmunizationRecommendation.recommendation.vaccineCode.coding:Tradename
    Slice NameTradename
    Comments

    CA Baseline Usage Notes: either a Generic code or a Tradename code or both have to be present.

    Control0..1
    BindingThe codes SHOULD be taken from https://cvc.canimmunize.ca/v3/ValueSet/Tradename
    (preferred to https://cvc.canimmunize.ca/v3/ValueSet/Tradename)
    18. ImmunizationRecommendation.recommendation.targetDisease
    BindingThe codes SHOULD be taken from https://cvc.canimmunize.ca/v3/ValueSet/Disease
    (preferred to https://cvc.canimmunize.ca/v3/ValueSet/Disease)
    Must Supporttrue
    20. ImmunizationRecommendation.recommendation.forecastStatus
    BindingThe codes SHOULD be taken from https://cvc.canimmunize.ca/v3/ValueSet/ForecastStatus
    (preferred to https://cvc.canimmunize.ca/v3/ValueSet/ForecastStatus)
    Must Supporttrue
    22. ImmunizationRecommendation.recommendation.dateCriterion
    Must Supporttrue
    24. ImmunizationRecommendation.recommendation.dateCriterion.code
    Must Supporttrue
    26. ImmunizationRecommendation.recommendation.dateCriterion.value
    Must Supporttrue
    28. ImmunizationRecommendation.recommendation.supportingImmunization
    TypeReference(Immunization Profile, ImmunizationEvaluation)

    Guidance on how to interpret the contents of this table can be found here

    0. ImmunizationRecommendation
    Definition

    The ImmunizationRecommendation Profile is based upon the core FHIR ImmunizationRecommendation Resource


    A patient's point-in-time set of recommendations (i.e. forecasting) according to a published schedule with optional supporting justification.

    ShortImmunizationRecommendation ProfileGuidance or advice relating to an immunization
    Control0..*
    Is Modifierfalse
    Summaryfalse
    Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
    dom-3: 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: 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: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
    dom-6: A resource should have narrative for robust management (text.`div`.exists())
    2. ImmunizationRecommendation.implicitRules
    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.

    ShortA set of rules under which this content was created
    Comments

    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.

    Control0..1
    Typeuri
    Is Modifiertrue because 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
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    4. ImmunizationRecommendation.modifierExtension
    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.

    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

    ShortExtensions that cannot be ignored
    Comments

    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.

    Control0..*
    TypeExtension
    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
    Summaryfalse
    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.

    Alternate Namesextensions, user content
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    6. ImmunizationRecommendation.patient
    Definition

    The patient the recommendation(s) are for.

    ShortWho this profile is for
    Control1..1
    TypeReference(Patient Profile, Patient)
    Is Modifierfalse
    Must Supporttrue
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    8. ImmunizationRecommendation.date
    Definition

    The date the immunization recommendation(s) were created.

    ShortDate recommendation(s) created
    Control1..1
    TypedateTime
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Must Supporttrue
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    10. ImmunizationRecommendation.authority
    Definition

    Indicates the authority who published the protocol (e.g. ACIP).

    ShortWho is responsible for protocol
    Control0..1
    TypeReference(Organization Profile, Organization)
    Is Modifierfalse
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    12. ImmunizationRecommendation.recommendation
    Definition

    Vaccine administration recommendations.

    ShortVaccine administration recommendations
    Control1..*
    TypeBackboneElement
    Is Modifierfalse
    Must Supporttrue
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    imr-1: One of vaccineCode or targetDisease SHALL be present (vaccineCode.exists() or targetDisease.exists())
    imr-1: One of vaccineCode or targetDisease SHALL be present (vaccineCode.exists() or targetDisease.exists())
    14. ImmunizationRecommendation.recommendation.modifierExtension
    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.

    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

    ShortExtensions that cannot be ignored even if unrecognized
    Comments

    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.

    Control0..*
    TypeExtension
    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
    Summarytrue
    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.

    Alternate Namesextensions, user content, modifiers
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    16. ImmunizationRecommendation.recommendation.vaccineCode
    Definition

    Vaccine(s) or vaccine group that pertain to the recommendation.

    ShortVaccine or vaccine group recommendation applies to
    Comments

    CA Core Usage Notes: the assumption is that ImmunizationRecommendation (forecast) is always on the level of a generic vaccine code and/or target disease. TBD: to confirm that there is no use case when an ImmunizationRecommendation needs to be on the vaccine tradename level (e.g. there is no sitation when a 2nd dose has to be of the same tradename as the 1st dose).

    Control0..*
    BindingThe codes SHOULD be taken from For example codes, see https://cvc.canimmunize.ca/v3/ValueSet/Generichttp://hl7.org/fhir/ValueSet/vaccine-code
    (preferred to https://cvc.canimmunize.ca/v3/ValueSet/Generic)
    TypeCodeableConcept
    Is Modifierfalse
    Must Supporttrue
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    18. ImmunizationRecommendation.recommendation.vaccineCode.coding
    Definition

    A reference to a code defined by a terminology system.

    ShortCode defined by a terminology system
    Comments

    Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

    Control0..*
    TypeCoding
    Is Modifierfalse
    Summarytrue
    Requirements

    Allows for alternative encodings within a code system, and translations to other code systems.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    SlicingThis element introduces a set of slices on ImmunizationRecommendation.recommendation.vaccineCode.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • pattern @ system
    • pattern @ code
    • 20. ImmunizationRecommendation.recommendation.vaccineCode.coding:Generic
      Slice NameGeneric
      Definition

      A reference to a code defined by a terminology system.

      ShortCode defined by a terminology system
      Comments

      CA Baseline Usage Notes: either a Generic code or a Tradename code or both have to be present.


      Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

      Control0..1*
      BindingThe codes SHOULD be taken from For codes, see https://cvc.canimmunize.ca/v3/ValueSet/Generic
      (preferred to https://cvc.canimmunize.ca/v3/ValueSet/Generic)
      TypeCoding
      Is Modifierfalse
      Summarytrue
      Requirements

      Allows for alternative encodings within a code system, and translations to other code systems.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      22. ImmunizationRecommendation.recommendation.vaccineCode.coding:Tradename
      Slice NameTradename
      Definition

      A reference to a code defined by a terminology system.

      ShortCode defined by a terminology system
      Comments

      CA Baseline Usage Notes: either a Generic code or a Tradename code or both have to be present.


      Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

      Control0..1*
      BindingThe codes SHOULD be taken from For codes, see https://cvc.canimmunize.ca/v3/ValueSet/Tradename
      (preferred to https://cvc.canimmunize.ca/v3/ValueSet/Tradename)
      TypeCoding
      Is Modifierfalse
      Summarytrue
      Requirements

      Allows for alternative encodings within a code system, and translations to other code systems.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      24. ImmunizationRecommendation.recommendation.targetDisease
      Definition

      The targeted disease for the recommendation.

      ShortDisease to be immunized against
      Control0..1
      BindingThe codes SHOULD be taken from For example codes, see https://cvc.canimmunize.ca/v3/ValueSet/Diseasehttp://hl7.org/fhir/ValueSet/immunization-recommendation-target-disease
      (preferred to https://cvc.canimmunize.ca/v3/ValueSet/Disease)
      TypeCodeableConcept
      Is Modifierfalse
      Must Supporttrue
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      26. ImmunizationRecommendation.recommendation.forecastStatus
      Definition

      Indicates the patient status with respect to the path to immunity for the target disease.

      ShortVaccine recommendation status
      Control1..1
      BindingThe codes SHOULD be taken from For example codes, see https://cvc.canimmunize.ca/v3/ValueSet/ForecastStatushttp://hl7.org/fhir/ValueSet/immunization-recommendation-status
      (preferred to https://cvc.canimmunize.ca/v3/ValueSet/ForecastStatus)
      TypeCodeableConcept
      Is Modifiertrue because 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).
      Must Supporttrue
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      28. ImmunizationRecommendation.recommendation.dateCriterion
      Definition

      Vaccine date recommendations. For example, earliest date to administer, latest date to administer, etc.

      ShortDates governing proposed immunization
      Control0..*
      TypeBackboneElement
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      30. ImmunizationRecommendation.recommendation.dateCriterion.modifierExtension
      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.

      Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

      ShortExtensions that cannot be ignored even if unrecognized
      Comments

      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.

      Control0..*
      TypeExtension
      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
      Summarytrue
      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.

      Alternate Namesextensions, user content, modifiers
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      32. ImmunizationRecommendation.recommendation.dateCriterion.code
      Definition

      Date classification of recommendation. For example, earliest date to give, latest date to give, etc.

      ShortType of date
      Control1..1
      BindingFor example codes, see ImmunizationRecommendationDateCriterionCodeshttp://hl7.org/fhir/ValueSet/immunization-recommendation-date-criterion
      (example to http://hl7.org/fhir/ValueSet/immunization-recommendation-date-criterion)

      Classifies date criterion with respect to conveying information about a patient's vaccination status (e.g. due date, latest to give date, etc.).

      TypeCodeableConcept
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      34. ImmunizationRecommendation.recommendation.dateCriterion.value
      Definition

      The date whose meaning is specified by dateCriterion.code.

      ShortRecommended date
      Control1..1
      TypedateTime
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      36. ImmunizationRecommendation.recommendation.supportingImmunization
      Definition

      Immunization event history and/or evaluation that supports the status and recommendation.

      ShortPast immunizations supporting recommendation
      Control0..*
      TypeReference(Immunization Profile, ImmunizationEvaluation, Immunization)
      Is Modifierfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

      Guidance on how to interpret the contents of this table can be found here

      0. ImmunizationRecommendation
      Definition

      The ImmunizationRecommendation Profile is based upon the core FHIR ImmunizationRecommendation Resource

      ShortImmunizationRecommendation Profile
      Control0..*
      Is Modifierfalse
      Summaryfalse
      Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
      dom-3: 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: 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: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
      dom-6: A resource should have narrative for robust management (text.`div`.exists())
      2. ImmunizationRecommendation.id
      Definition

      The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

      ShortLogical id of this artifact
      Comments

      The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

      Control0..1
      Typeid
      Is Modifierfalse
      Summarytrue
      4. ImmunizationRecommendation.meta
      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.

      ShortMetadata about the resource
      Control0..1
      TypeMeta
      Is Modifierfalse
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      6. ImmunizationRecommendation.implicitRules
      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.

      ShortA set of rules under which this content was created
      Comments

      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.

      Control0..1
      Typeuri
      Is Modifiertrue because 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
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      8. ImmunizationRecommendation.language
      Definition

      The base language in which the resource is written.

      ShortLanguage of the resource content
      Comments

      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).

      Control0..1
      BindingThe codes SHOULD be taken from CommonLanguages
      (preferred to http://hl7.org/fhir/ValueSet/languages)

      A human language.

      Additional BindingsPurpose
      AllLanguagesMax Binding
      Typecode
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      10. ImmunizationRecommendation.text
      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.

      ShortText summary of the resource, for human interpretation
      Comments

      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.

      Control0..1
      TypeNarrative
      Is Modifierfalse
      Summaryfalse
      Alternate Namesnarrative, html, xhtml, display
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      12. ImmunizationRecommendation.contained
      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.

      ShortContained, inline Resources
      Comments

      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.

      Control0..*
      TypeResource
      Is Modifierfalse
      Summaryfalse
      Alternate Namesinline resources, anonymous resources, contained resources
      14. ImmunizationRecommendation.extension
      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.

      ShortAdditional content defined by implementations
      Comments

      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.

      Control0..*
      TypeExtension
      Is Modifierfalse
      Summaryfalse
      Alternate Namesextensions, user content
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      16. ImmunizationRecommendation.modifierExtension
      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.

      Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

      ShortExtensions that cannot be ignored
      Comments

      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.

      Control0..*
      TypeExtension
      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
      Summaryfalse
      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.

      Alternate Namesextensions, user content
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      18. ImmunizationRecommendation.identifier
      Definition

      A unique identifier assigned to this particular recommendation record.

      ShortBusiness identifier
      NoteThis is a business identifier, not a resource identifier (see discussion)
      Control0..*
      TypeIdentifier
      Is Modifierfalse
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      20. ImmunizationRecommendation.patient
      Definition

      The patient the recommendation(s) are for.

      ShortWho this profile is for
      Control1..1
      TypeReference(Patient Profile)
      Is Modifierfalse
      Must Supporttrue
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      22. ImmunizationRecommendation.date
      Definition

      The date the immunization recommendation(s) were created.

      ShortDate recommendation(s) created
      Control1..1
      TypedateTime
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      24. ImmunizationRecommendation.authority
      Definition

      Indicates the authority who published the protocol (e.g. ACIP).

      ShortWho is responsible for protocol
      Control0..1
      TypeReference(Organization Profile)
      Is Modifierfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      26. ImmunizationRecommendation.recommendation
      Definition

      Vaccine administration recommendations.

      ShortVaccine administration recommendations
      Control1..*
      TypeBackboneElement
      Is Modifierfalse
      Must Supporttrue
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      imr-1: One of vaccineCode or targetDisease SHALL be present (vaccineCode.exists() or targetDisease.exists())
      28. ImmunizationRecommendation.recommendation.id
      Definition

      Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

      ShortUnique id for inter-element referencing
      Control0..1
      Typestring
      Is Modifierfalse
      XML FormatIn the XML format, this property is represented as an attribute.
      Summaryfalse
      30. ImmunizationRecommendation.recommendation.extension
      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.

      ShortAdditional content defined by implementations
      Comments

      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.

      Control0..*
      TypeExtension
      Is Modifierfalse
      Summaryfalse
      Alternate Namesextensions, user content
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      32. ImmunizationRecommendation.recommendation.modifierExtension
      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.

      Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

      ShortExtensions that cannot be ignored even if unrecognized
      Comments

      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.

      Control0..*
      TypeExtension
      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
      Summarytrue
      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.

      Alternate Namesextensions, user content, modifiers
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      34. ImmunizationRecommendation.recommendation.vaccineCode
      Definition

      Vaccine(s) or vaccine group that pertain to the recommendation.

      ShortVaccine or vaccine group recommendation applies to
      Comments

      CA Core Usage Notes: the assumption is that ImmunizationRecommendation (forecast) is always on the level of a generic vaccine code and/or target disease. TBD: to confirm that there is no use case when an ImmunizationRecommendation needs to be on the vaccine tradename level (e.g. there is no sitation when a 2nd dose has to be of the same tradename as the 1st dose).

      Control0..*
      BindingThe codes SHOULD be taken from https://cvc.canimmunize.ca/v3/ValueSet/Generic
      (preferred to https://cvc.canimmunize.ca/v3/ValueSet/Generic)
      TypeCodeableConcept
      Is Modifierfalse
      Must Supporttrue
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      36. ImmunizationRecommendation.recommendation.vaccineCode.id
      Definition

      Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

      ShortUnique id for inter-element referencing
      Control0..1
      Typestring
      Is Modifierfalse
      XML FormatIn the XML format, this property is represented as an attribute.
      Summaryfalse
      38. ImmunizationRecommendation.recommendation.vaccineCode.extension
      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.

      ShortAdditional content defined by implementations
      Comments

      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.

      Control0..*
      TypeExtension
      Is Modifierfalse
      Summaryfalse
      Alternate Namesextensions, user content
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      SlicingThis element introduces a set of slices on ImmunizationRecommendation.recommendation.vaccineCode.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ url
      • 40. ImmunizationRecommendation.recommendation.vaccineCode.coding
        Definition

        A reference to a code defined by a terminology system.

        ShortCode defined by a terminology system
        Comments

        Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

        Control0..*
        TypeCoding
        Is Modifierfalse
        Summarytrue
        Requirements

        Allows for alternative encodings within a code system, and translations to other code systems.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        SlicingThis element introduces a set of slices on ImmunizationRecommendation.recommendation.vaccineCode.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • pattern @ system
        • pattern @ code
        • 42. ImmunizationRecommendation.recommendation.vaccineCode.coding:Generic
          Slice NameGeneric
          Definition

          A reference to a code defined by a terminology system.

          ShortCode defined by a terminology system
          Comments

          CA Baseline Usage Notes: either a Generic code or a Tradename code or both have to be present.

          Control0..1
          BindingThe codes SHOULD be taken from https://cvc.canimmunize.ca/v3/ValueSet/Generic
          (preferred to https://cvc.canimmunize.ca/v3/ValueSet/Generic)
          TypeCoding
          Is Modifierfalse
          Summarytrue
          Requirements

          Allows for alternative encodings within a code system, and translations to other code systems.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          44. ImmunizationRecommendation.recommendation.vaccineCode.coding:Tradename
          Slice NameTradename
          Definition

          A reference to a code defined by a terminology system.

          ShortCode defined by a terminology system
          Comments

          CA Baseline Usage Notes: either a Generic code or a Tradename code or both have to be present.

          Control0..1
          BindingThe codes SHOULD be taken from https://cvc.canimmunize.ca/v3/ValueSet/Tradename
          (preferred to https://cvc.canimmunize.ca/v3/ValueSet/Tradename)
          TypeCoding
          Is Modifierfalse
          Summarytrue
          Requirements

          Allows for alternative encodings within a code system, and translations to other code systems.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          46. ImmunizationRecommendation.recommendation.vaccineCode.text
          Definition

          A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

          ShortPlain text representation of the concept
          Comments

          Very often the text is the same as a displayName of one of the codings.

          Control0..1
          Typestring
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summarytrue
          Requirements

          The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          48. ImmunizationRecommendation.recommendation.targetDisease
          Definition

          The targeted disease for the recommendation.

          ShortDisease to be immunized against
          Control0..1
          BindingThe codes SHOULD be taken from https://cvc.canimmunize.ca/v3/ValueSet/Disease
          (preferred to https://cvc.canimmunize.ca/v3/ValueSet/Disease)
          TypeCodeableConcept
          Is Modifierfalse
          Must Supporttrue
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          50. ImmunizationRecommendation.recommendation.contraindicatedVaccineCode
          Definition

          Vaccine(s) which should not be used to fulfill the recommendation.

          ShortVaccine which is contraindicated to fulfill the recommendation
          Control0..*
          BindingFor example codes, see VaccineAdministeredValueSet
          (example to http://hl7.org/fhir/ValueSet/vaccine-code)

          The type of vaccine administered.

          TypeCodeableConcept
          Is Modifierfalse
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          52. ImmunizationRecommendation.recommendation.forecastStatus
          Definition

          Indicates the patient status with respect to the path to immunity for the target disease.

          ShortVaccine recommendation status
          Control1..1
          BindingThe codes SHOULD be taken from https://cvc.canimmunize.ca/v3/ValueSet/ForecastStatus
          (preferred to https://cvc.canimmunize.ca/v3/ValueSet/ForecastStatus)
          TypeCodeableConcept
          Is Modifiertrue because 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).
          Must Supporttrue
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          54. ImmunizationRecommendation.recommendation.forecastReason
          Definition

          The reason for the assigned forecast status.

          ShortVaccine administration status reason
          Control0..*
          BindingFor example codes, see ImmunizationRecommendationReasonCodes
          (example to http://hl7.org/fhir/ValueSet/immunization-recommendation-reason)

          The reason for the patient's status with respect to a vaccination protocol.

          TypeCodeableConcept
          Is Modifierfalse
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          56. ImmunizationRecommendation.recommendation.dateCriterion
          Definition

          Vaccine date recommendations. For example, earliest date to administer, latest date to administer, etc.

          ShortDates governing proposed immunization
          Control0..*
          TypeBackboneElement
          Is Modifierfalse
          Must Supporttrue
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          58. ImmunizationRecommendation.recommendation.dateCriterion.id
          Definition

          Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

          ShortUnique id for inter-element referencing
          Control0..1
          Typestring
          Is Modifierfalse
          XML FormatIn the XML format, this property is represented as an attribute.
          Summaryfalse
          60. ImmunizationRecommendation.recommendation.dateCriterion.extension
          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.

          ShortAdditional content defined by implementations
          Comments

          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.

          Control0..*
          TypeExtension
          Is Modifierfalse
          Summaryfalse
          Alternate Namesextensions, user content
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          62. ImmunizationRecommendation.recommendation.dateCriterion.modifierExtension
          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.

          Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

          ShortExtensions that cannot be ignored even if unrecognized
          Comments

          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.

          Control0..*
          TypeExtension
          Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
          Summarytrue
          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.

          Alternate Namesextensions, user content, modifiers
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          64. ImmunizationRecommendation.recommendation.dateCriterion.code
          Definition

          Date classification of recommendation. For example, earliest date to give, latest date to give, etc.

          ShortType of date
          Control1..1
          BindingFor example codes, see ImmunizationRecommendationDateCriterionCodes
          (example to http://hl7.org/fhir/ValueSet/immunization-recommendation-date-criterion)

          Classifies date criterion with respect to conveying information about a patient's vaccination status (e.g. due date, latest to give date, etc.).

          TypeCodeableConcept
          Is Modifierfalse
          Must Supporttrue
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          66. ImmunizationRecommendation.recommendation.dateCriterion.value
          Definition

          The date whose meaning is specified by dateCriterion.code.

          ShortRecommended date
          Control1..1
          TypedateTime
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supporttrue
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          68. ImmunizationRecommendation.recommendation.description
          Definition

          Contains the description about the protocol under which the vaccine was administered.

          ShortProtocol details
          Control0..1
          Typestring
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          70. ImmunizationRecommendation.recommendation.series
          Definition

          One possible path to achieve presumed immunity against a disease - within the context of an authority.

          ShortName of vaccination series
          Control0..1
          Typestring
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          72. ImmunizationRecommendation.recommendation.doseNumber[x]
          Definition

          Nominal position of the recommended dose in a series (e.g. dose 2 is the next recommended dose).

          ShortRecommended dose number within series
          Comments

          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).

          Control0..1
          TypeChoice of: positiveInt, string
          [x] NoteSee Choice of Data Types for further information about how to use [x]
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          74. ImmunizationRecommendation.recommendation.seriesDoses[x]
          Definition

          The recommended number of doses to achieve immunity.

          ShortRecommended number of doses for immunity
          Comments

          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).

          Control0..1
          TypeChoice of: positiveInt, string
          [x] NoteSee Choice of Data Types for further information about how to use [x]
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          76. ImmunizationRecommendation.recommendation.supportingImmunization
          Definition

          Immunization event history and/or evaluation that supports the status and recommendation.

          ShortPast immunizations supporting recommendation
          Control0..*
          TypeReference(Immunization Profile, ImmunizationEvaluation)
          Is Modifierfalse
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          78. ImmunizationRecommendation.recommendation.supportingPatientInformation
          Definition

          Patient Information that supports the status and recommendation. This includes patient observations, adverse reactions and allergy/intolerance information.

          ShortPatient observations supporting recommendation
          Control0..*
          TypeReference(Resource)
          Is Modifierfalse
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))