Consolidated CDA (C-CDA), published by Health Level Seven. This guide is not an authorized publication; it is the continuous build for version 4.0.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/CDA-ccda/ and changes regularly. See the Directory of published versions
This content is an example of the Immunizations Section Logical Model and is not a FHIR Resource
<section xmlns="urn:hl7-org:v3" xmlns:sdtc="urn:hl7-org:sdtc" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<templateId root="2.16.840.1.113883.10.20.22.2.2.1" extension="2015-08-01" />
<!-- ******** Immunizations section template ******** -->
<code code="11369-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="History of immunizations" />
<title>Immunizations</title>
<text>
<table border="1" width="100%">
<thead>
<tr>
<th>Vaccine</th>
<th>Date</th>
<th>Status</th>
</tr>
</thead>
<tbody>
<tr>
<td>
<content ID="immun1" />Influenza virus vaccine, IM
</td>
<td>Nov 1999</td>
<td>Completed</td>
</tr>
<tr>
<td>
<content ID="immun2" />Influenza virus vaccine, IM
</td>
<td>Dec 1998</td>
<td>Completed</td>
</tr>
<tr>
<td>
<content ID="immun3" />
Pneumococcal polysaccharide vaccine, IM
</td>
<td>Dec 1998</td>
<td>Completed</td>
</tr>
<tr>
<td>
<content ID="immun4" />Tetanus and diphtheria toxoids, IM
</td>
<td>1997</td>
<td>Refused</td>
</tr>
</tbody>
</table>
</text>
<entry typeCode="DRIV">
<substanceAdministration classCode="SBADM" moodCode="EVN" negationInd="false" xmlns="urn:hl7-org:v3">
<!-- ** Immunization activity ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.52" extension="2015-08-01" />
<id root="e6f1ba43-c0ed-4b9b-9f12-f435d8ad8f92" />
<statusCode code="completed" />
<effectiveTime value="19981215" />
<routeCode code="C28161" codeSystem="2.16.840.1.113883.3.26.1.1" codeSystemName="National Cancer Institute (NCI) Thesaurus" displayName="INTRAMUSCULAR">
<translation code="78421000" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED" displayName="Intramuscular route"/>
</routeCode>
<doseQuantity value="50" unit="ug" />
<consumable>
<manufacturedProduct classCode="MANU">
<!-- ** Immunization medication information ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.54" extension="2014-06-09" />
<manufacturedMaterial>
<code code="33" codeSystem="2.16.840.1.113883.12.292" displayName="pneumococcal polysaccharide PPV23" codeSystemName="CVX">
<translation code="854981" displayName="Pneumovax 23 (Pneumococcal vaccine polyvalent) Injectable Solution" codeSystemName="RxNORM" codeSystem="2.16.840.1.113883.6.88" />
</code>
<lotNumberText>1</lotNumberText>
</manufacturedMaterial>
<manufacturerOrganization>
<name>Health LS - Immuno Inc.</name>
</manufacturerOrganization>
</manufacturedProduct>
</consumable>
<performer>
<assignedEntity>
<id root="2.16.840.1.113883.19.5.9999.456" extension="2981824" />
<addr>
<streetAddressLine>1007 Health Drive</streetAddressLine>
<city>Portland</city>
<state>OR</state>
<postalCode>99123</postalCode>
<country>US</country>
</addr>
<telecom use="WP" value="tel:+(555)-555-1030" />
<assignedPerson>
<name>
<given>Harold</given>
<family>Hippocrates</family>
</name>
</assignedPerson>
<representedOrganization>
<id root="2.16.840.1.113883.19.5.9999.1394" />
<name>Good Health Clinic</name>
<telecom use="WP" value="tel:+(555)-555-1030" />
<addr>
<streetAddressLine>1007 Health Drive</streetAddressLine>
<city>Portland</city>
<state>OR</state>
<postalCode>99123</postalCode>
<country>US</country>
</addr>
</representedOrganization>
</assignedEntity>
</performer>
</substanceAdministration>
</entry>
</section>