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 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
<section xmlns="urn:hl7-org:v3">
<templateId root="2.16.840.1.113883.10.20.22.2.2.1" extension="2015-08-01"/>
<!-- ******** Immunizations section template ******** -->
<code displayName="History of immunizations" codeSystemName="LOINC"
codeSystem="2.16.840.1.113883.6.1" code="11369-6"/>
<title>Immunizations</title>
<text>
<table width="100%" border="1">
<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 negationInd="false" moodCode="EVN"
classCode="SBADM">
<!-- ** 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 xsi:type="SXCM-TS" value="19981215"/>
<routeCode displayName="INTRAMUSCULAR"
codeSystemName="National Cancer Institute (NCI) Thesaurus" codeSystem="2.16.840.1.113883.3.26.1.1" code="C28161">
<translation xsi:type="CD" displayName="Intramuscular route"
codeSystemName="SNOMED" codeSystem="2.16.840.1.113883.6.96" code="78421000"/>
</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 displayName="pneumococcal polysaccharide PPV23"
codeSystemName="CVX" codeSystem="2.16.840.1.113883.12.292" code="33">
<translation xsi:type="CD"
displayName="Pneumovax 23 (Pneumococcal vaccine polyvalent) Injectable Solution" codeSystemName="RxNORM"
codeSystem="2.16.840.1.113883.6.88" code="854981"/>
</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 value="tel:+(555)-555-1030" use="WP"/>
<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 value="tel:+(555)-555-1030" use="WP"/>
<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>