Generated Narrative: StructureDefinition ImmunizationActivity Name Flags Card. Type Description & Constraints SubstanceAdministration <a style="padding-left: 3px; padding-right: 3px; border: 1px maroon solid; font-weight: bold; color: #301212; background-color: #fdf4f4;; padding-left: 3px; padding-right: 3px; border: 1px maroon solid; font-weight: bold; color: #301212; background-color: #fdf4f4;" href="http://hl7.org/fhir/R5/conformance-rules.html#constraints" title="This element has or is affected by constraints ( should-text-ref-value, should-doseQuantity, dose-unit-or-admin-unit, should-performer, should-author )">C 1..1 SubstanceAdministration XML Namespace: urn:hl7-org:v3 Base for all types and resources Instance of this type are validated by templateId Logical Container: ClinicalDocument (CDA Class) Constraints: should-text-ref-value, should-doseQuantity, dose-unit-or-admin-unit, should-performer, should-author #xD; Slices for templateId 1..* II Slice: Unordered, Open by value:root, value:extension #xD; templateId:immunization-activity 1..1 II #xD; @root 1..1 oid, uuid, ruid Required Pattern: 2.16.840.1.113883.10.20.22.4.52 #xD; @extension 1..1 st Required Pattern: 2015-08-01 #xD; @classCode 1..1 cs #xD; @moodCode 1..1 cs Binding: MoodCodeEvnInt (required) #xD; id 1..* II #xD; code 0..1 CD SubstanceAdministration.code is an optional field. Per HL7 Pharmacy Committee, "this is intended to further specify the nature of the substance administration act. To date the committee has made no use of this attribute". Because the type of substance administration is generally implicit in the routeCode, in the consumable participant, etc., the field is generally not used and there is no defined value set. #xD; @negationInd 1..1 bl Use negationInd="true" to indicate that the immunization was not given. #xD; text 0..1 ED SHOULD reference the portion of section narrative text corresponding to this entry #xD; reference <a style="padding-left: 3px; padding-right: 3px; border: 1px maroon solid; font-weight: bold; color: #301212; background-color: #fdf4f4;; padding-left: 3px; padding-right: 3px; border: 1px maroon solid; font-weight: bold; color: #301212; background-color: #fdf4f4;" href="http://hl7.org/fhir/R5/conformance-rules.html#constraints" title="This element has or is affected by constraints ( value-starts-octothorpe )">C 0..1 TEL Constraints: value-starts-octothorpe #xD; statusCode 1..1 CS #xD; @nullFlavor 0..0 #xD; @code 1..1 cs Binding: ActStatus (required) #xD; effectiveTime 1..1 SXCM_TS, IVL_TS, EIVL_TS, PIVL_TS, SXPR_TS #xD; repeatNumber C 0..1 IVL_INT In "INT" (intent) mood, the repeatNumber defines the number of allowed administrations. For example, a repeatNumber of "3" means that the substance can be administered up to 3 times. In "EVN" (event) mood, the repeatNumber is the number of occurrences. For example, a repeatNumber of "3" in a substance administration event means that the current administration is the 3rd in a series. Constraints: value-only #xD; @value 0..1 int value should be used instead of low/high #xD; routeCode <a style="padding-left: 3px; padding-right: 3px; border: 1px maroon solid; font-weight: bold; color: #301212; background-color: #fdf4f4;; padding-left: 3px; padding-right: 3px; border: 1px maroon solid; font-weight: bold; color: #301212; background-color: #fdf4f4;" href="http://hl7.org/fhir/R5/conformance-rules.html#constraints" title="This element has or is affected by constraints ( should-translation )">C 0..1 CE Binding: SPL Drug Route of Administration Terminology (required) Constraints: should-translation #xD; translation 0..* CD Binding: Medication Route (preferred) #xD; approachSiteCode 0..1 CD Binding: Body Site Value Set (required) #xD; doseQuantity C 0..1 IVL_PQ Constraints: should-unit #xD; @unit 0..1 cs NOTE: The base CDA R2.0 standard requires @unit to be drawn from UCUM, and best practice is to use case sensitive UCUM units Binding: UnitsOfMeasureCaseSensitive (preferred) #xD; administrationUnitCode 0..1 CE Binding: AdministrationUnitDoseForm (required) #xD; consumable 1..1 InfrastructureRoot #xD; manufacturedProduct 1..1 ImmunizationMedicationInformation #xD; performer 0..1 Performer2 #xD; author 0..* AuthorParticipation #xD; Slices for participant 0..* Participant2 Slice: Unordered, Open by value:typeCode #xD; participant:drugVehicle 0..* Participant2 #xD; @typeCode 1..1 cs Fixed Value: CSM #xD; participantRole 1..1 DrugVehicle #xD; Slices for entryRelationship 0..* EntryRelationship Slice: Unordered, Open by profile:act, profile:observation, profile:supply #xD; entryRelationship:indication 0..* EntryRelationship #xD; @typeCode 1..1 cs Fixed Value: RSON #xD; observation 1..1 Indication #xD; code 1..1 CD Indication for Immunization #xD; @code 1..1 cs Required Pattern: 59785-6 #xD; @codeSystem 1..1 oid, uuid, ruid LOINC Required Pattern: 2.16.840.1.113883.6.1 #xD; entryRelationship:instruction 0..1 EntryRelationship #xD; @typeCode 1..1 cs Fixed Value: SUBJ #xD; @inversionInd 1..1 bl Fixed Value: true #xD; observation 1..1 InstructionObservation #xD; entryRelationship:medSupplyOrder 0..1 EntryRelationship #xD; @typeCode 1..1 cs Fixed Value: REFR #xD; supply 1..1 MedicationSupplyOrder #xD; entryRelationship:medDispense 0..1 EntryRelationship #xD; @typeCode 1..1 cs Fixed Value: REFR #xD; supply 1..1 MedicationDispense #xD; entryRelationship:reactionObs 0..1 EntryRelationship #xD; @typeCode 1..1 cs Fixed Value: CAUS #xD; observation 1..1 ReactionObservation #xD; entryRelationship:immunizationNotGiven 0..1 EntryRelationship #xD; @typeCode 1..1 cs Fixed Value: RSON #xD; observation 1..1 ImmunizationNotGivenReason #xD; entryRelationship:substanceAdmin 0..* EntryRelationship The following entryRelationship is used to indicate a given immunization's order in a series. The nested Substance Administered Act identifies an administration in the series. The entryRelationship/sequenceNumber shows the order of this particular administration in that series. #xD; @typeCode 1..1 cs Fixed Value: COMP #xD; @inversionInd 1..1 bl Fixed Value: true #xD; sequenceNumber 0..1 INT #xD; act 1..1 SubstanceAdministeredAct #xD; Slices for precondition 0..* Precondition Slice: Unordered, Open by profile:criterion #xD; precondition:substanceAdmin 0..* Precondition #xD; @typeCode 1..1 cs #xD; criterion 1..1 PreconditionforSubstanceAdministration #xD; Documentation for this format
HL7 International - Structured Documents
An Immunization Activity describes immunization substance administrations that have actually occurred or are intended to occur. Immunization Activities in "INT" mood are reflections of immunizations a clinician intends a patient to receive. Immunization Activities in "EVN" mood reflect immunizations actually received. An Immunization Activity is very similar to a Medication Activity with some key differentiators. The drug code system is constrained to CVX codes. Administration timing is less complex. Patient refusal reasons should be captured. All vaccines administered should be fully documented in the patient's permanent medical record. Healthcare providers who administer vaccines covered by the National Childhood Vaccine Injury Act are required to ensure that the permanent medical record of the recipient indicates: 1. Date of administration 2. Vaccine manufacturer 3. Vaccine lot number 4. Name and title of the person who administered the vaccine and the address of the clinic or facility where the permanent record will reside 5. Vaccine information statement (VIS) 1. Date printed on the VIS 2. Date VIS given to patient or parent/guardian. This information should be included in an Immunization Activity when available. Reference: [CDC Instructions](https://www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/c/vis-instruct.pdf) #### Templates Used Although open templates may contain any valid CDA content, the following templates are specifically called out by this template: **Optional EntryRelationships**: [ImmunizationNotGivenReason](StructureDefinition-ImmunizationNotGivenReason.html), [Indication](StructureDefinition-Indication.html), [InstructionObservation](StructureDefinition-InstructionObservation.html), [MedicationDispense](StructureDefinition-MedicationDispense.html), [MedicationSupplyOrder](StructureDefinition-MedicationSupplyOrder.html), [ReactionObservation](StructureDefinition-ReactionObservation.html), [SubstanceAdministeredAct](StructureDefinition-SubstanceAdministeredAct.html)
Defines the basic properties of every data value. This is an abstract type, meaning that no value can be just a data value without belonging to any concrete type. Every concrete type is a specialization of this general abstract DataValue type.
If doseQuantity/@unit is present, then administrationUnitCode SHALL NOT be present.
doseQuantity.unit.exists() implies administrationUnitCode.empty()
If a value is an exceptional value (NULL-value), this specifies in what way and why proper information is missing.
When valued in an instance, this attribute signals the imposition of realm-specific constraints. The value of this attribute identifies the realm in question
When valued in an instance, this attribute signals the imposition of constraints defined in an HL7-specified message type. This might be a common type (also known as CMET in the messaging communication environment), or content included within a wrapper. The value of this attribute provides a unique identifier for the type in question.
An II instance must have either a root or an nullFlavor.
A human readable name or mnemonic for the assigning authority. The Assigning Authority Name has no computational value. The purpose of a Assigning Authority Name is to assist an unaided human interpreter of an II value to interpret the authority. Note: no automated processing must depend on the assigning authority name to be present in any form.
Specifies if the identifier is intended for human display and data entry (displayable = true) as opposed to pure machine interoperation (displayable = false).
Identifies the type as an HL7 Registered model
A character string as a unique identifier within the scope of the identifier root.
When valued in an instance, this attribute signals the imposition of a set of template-defined constraints. The value of this attribute provides a unique identifier for the templates in question
A unique identifier that guarantees the global uniqueness of the instance identifier. The root alone may be the entire instance identifier.
SHALL contain exactly one [1..1] @classCode="SBADM" (CodeSystem: HL7ActClass urn:oid:2.16.840.1.113883.5.6 STATIC) (CONF:1198-8826).
SHALL contain exactly one [1..1] @moodCode, which SHALL be selected from ValueSet MoodCodeEvnInt urn:oid:2.16.840.1.113883.11.20.9.18 STATIC (CONF:1198-8827).
SHALL contain at least one [1..*] id (CONF:1198-8829).
SubstanceAdministration.code is an optional field. Per HL7 Pharmacy Committee, "this is intended to further specify the nature of the substance administration act. To date the committee has made no use of this attribute". Because the type of substance administration is generally implicit in the routeCode, in the consumable participant, etc., the field is generally not used and there is no defined value set.
MAY contain zero or one [0..1] code (CONF:1198-8830).
Use negationInd="true" to indicate that the immunization was not given.
SHALL contain exactly one [1..1] @negationInd (CONF:1198-8985).
SHOULD reference the portion of section narrative text corresponding to this entry
Indicates whether the raw byte data is compressed, and what compression algorithm was used.
The integrity check is a short binary value representing a cryptographically strong checksum that is calculated over the binary data. The purpose of this property, when communicated with a reference is for anyone to validate later whether the reference still resolved to the same data that the reference resolved to when the encapsulated data value with reference was created.
Specifies the algorithm used to compute the integrityCheck value. The cryptographically strong checksum algorithm Secure Hash Algorithm-1 (SHA-1) is currently the industry standard. It has superseded the MD5 algorithm only a couple of years ago, when certain flaws in the security of MD5 were discovered. Currently the SHA-1 hash algorithm is the default choice for the integrity check algorithm. Note that SHA-256 is also entering widespread usage.
For character based information the language property specifies the human language of the text.
Identifies the type of the encapsulated data and identifies a method to interpret or render the data.
Allows for mixed text content. If @representation='B64', this SHALL be a base64binary string.
Data that is primarily intended for human interpretation or for further machine processing is outside the scope of HL7. This includes unformatted or formatted written language, multimedia data, or structured information as defined by a different standard (e.g., XML-signatures.)
This element is represented in XML as textual content. The actual name "xmlText" will not appear in a CDA instance.
A telecommunication address (TEL), such as a URL for HTTP or FTP, which will resolve to precisely the same binary data that could as well have been provided as inline data.
If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative
value.exists() implies value.startsWith('#')
An abbreviated rendition of the full data. A thumbnail requires significantly fewer resources than the full data, while still maintaining some distinctive similarity with the full data. A thumbnail is typically used with by-reference encapsulated data. It allows a user to select data more efficiently before actually downloading through the reference.
SHALL contain exactly one [1..1] statusCode (CONF:1198-8833).
The plain code symbol defined by the code system. For example, "784.0" is the code symbol of the ICD-9 code "784.0" for headache.
Specifies the code system that defines the code.
If applicable, a version descriptor defined specifically for the given code system.
A name or title for the code, under which the sending system shows the code value to its users.
The valueSet extension adds an attribute for elements with a CD dataType which indicates the particular value set constraining the coded concept.
The valueSetVersion extension adds an attribute for elements with a CD dataType which indicates the version of the particular value set constraining the coded concept.
The text or phrase used as the basis for the coding.
Specifies additional codes that increase the specificity of the the primary code.
A set of other concept descriptors that translate this concept descriptor into other code systems.
SHALL contain exactly one [1..1] effectiveTime (CONF:1198-8834).
In "INT" (intent) mood, the repeatNumber defines the number of allowed administrations. For example, a repeatNumber of "3" means that the substance can be administered up to 3 times. In "EVN" (event) mood, the repeatNumber is the number of occurrences. For example, a repeatNumber of "3" in a substance administration event means that the current administration is the 3rd in a series.
value should be used instead of low/high
A code specifying whether the set component is included (union) or excluded (set-difference) from the set, or other set operations with the current set component and the set as constructed from the representation stream up to the current point.
The arithmetic mean of the interval (low plus high divided by 2). The purpose of distinguishing the center as a semantic property is for conversions of intervals from and to point values.
The difference between high and low boundary. The purpose of distinguishing a width property is to handle all cases of incomplete information symmetrically. In any interval representation only two of the three properties high, low, and width need to be stated and the third can be derived.
MAY contain zero or one [0..1] routeCode, which SHALL be selected from ValueSet SPL Drug Route of Administration Terminology urn:oid:2.16.840.1.113883.3.88.12.3221.8.7 DYNAMIC (CONF:1198-8839).
The routeCode, if present, SHOULD contain zero or more [0..*] translation, which SHOULD be selected from ValueSet Medication Route urn:oid:2.16.840.1.113762.1.4.1099.12 DYNAMIC (CONF:1198-32960).
MAY contain zero or one [0..1] approachSiteCode, where the code SHALL be selected from ValueSet Body Site Value Set urn:oid:2.16.840.1.113883.3.88.12.3221.8.9 DYNAMIC (CONF:1198-8840).
SHOULD contain zero or one [0..1] doseQuantity (CONF:1198-8841).
NOTE: The base CDA R2.0 standard requires @unit to be drawn from UCUM, and best practice is to use case sensitive UCUM units
The unit of measure specified in the Unified Code for Units of Measure (UCUM) [].
The doseQuantity, if present, SHOULD contain zero or one [0..1] @unit, which SHOULD be selected from ValueSet UnitsOfMeasureCaseSensitive urn:oid:2.16.840.1.113883.1.11.12839 DYNAMIC (CONF:1198-8842).
The magnitude of the quantity measured in terms of the unit.
An alternative representation of the same physical quantity expressed in a different unit, of a different unit code system and possibly with a different value.
MAY contain zero or one [0..1] administrationUnitCode, which SHALL be selected from ValueSet AdministrationUnitDoseForm urn:oid:2.16.840.1.113762.1.4.1021.30 DYNAMIC (CONF:1198-8846).
The consumable participation is used to bring in the LabeledDrug or Material entity that describes the administered substance. The LabeledDrug class, which is an Entity class playing the Role of Manufactured Product, identifies the drug that is consumed in the substance administration. The medication is identified by means of the LabeledDrug.code or the LabeledDrug.name. The Material entity is used to identify non-drug administered substances such as vaccines and blood products.
SHALL contain exactly one [1..1] consumable (CONF:1198-8847).
This consumable SHALL contain exactly one [1..1] Immunization Medication Information (identifier: urn:hl7ii:2.16.840.1.113883.10.20.22.4.54:2014-06-09) (CONF:1198-15546).
SHOULD contain zero or one [0..1] performer (CONF:1198-8849).
SHOULD contain zero or more [0..*] Author Participation (identifier: urn:oid:2.16.840.1.113883.10.20.22.4.119) (CONF:1198-31151).
MAY contain zero or more [0..*] participant (CONF:1198-8850) such that it
SHALL contain exactly one [1..1] @typeCode="CSM" (CodeSystem: HL7ParticipationType urn:oid:2.16.840.1.113883.5.90 STATIC) (CONF:1198-8851).
MAY contain zero or more [0..*] entryRelationship (CONF:1198-8853) such that it
SHALL contain exactly one [1..1] @typeCode="RSON" (CodeSystem: HL7ActRelationshipType urn:oid:2.16.840.1.113883.5.1002 STATIC) (CONF:1198-8854).
The entryRelationship.inversionInd can be set to "true" to indicate that the relationship should be interpreted as if the roles of the source and target entries were reversed.
The entryRelationship.contextConductionInd differs from the otherwise common use of this attribute in that in all other cases where this attribute is used, the value is fixed at "true", whereas here the value is defaulted to "true", and can be changed to "false" when referencing an entry in the same document. Setting the context conduction to false when referencing an entry in the same document keeps clear the fact that the referenced object retains its original context.
SHALL contain exactly one [1..1] @classCode="OBS" (CodeSystem: HL7ActClass urn:oid:2.16.840.1.113883.5.6 STATIC) (CONF:4537-7480).
SHALL contain exactly one [1..1] @moodCode="EVN" (CodeSystem: HL7ActMood urn:oid:2.16.840.1.113883.5.1001 STATIC) (CONF:4537-7481).
If the id element is used to reference a problem recorded elsewhere in the document then this id must equal another entry/id in the same document instance. Application Software must be responsible for resolving the identifier back to its original object and then rendering the information in the correct place in the containing section's narrative text. Its purpose is to obviate the need to repeat the complete XML representation of the referred to entry when relating one entry to another.
SHALL contain at least one [1..*] id (CONF:4537-7483).
SHALL contain exactly one [1..1] code, which MAY be selected from ValueSet Problem Type urn:oid:2.16.840.1.113762.1.4.1267.1.
SHALL contain exactly one [1..1] statusCode (CONF:4537-7487).
This statusCode SHALL contain exactly one [1..1] @code="completed" Completed (CodeSystem: HL7ActStatus urn:oid:2.16.840.1.113883.5.14 STATIC) (CONF:4537-19105).
SHOULD contain zero or one [0..1] effectiveTime (CONF:4537-7488).
If the ID element does not reference a problem recorded elsewhere in the document, then observation/value must be populated with a coded entry.
MAY contain zero or one [0..1] value with @xsi:type="CD", where the code MAY be selected from ValueSet US Core Condition Codes.
Relates an Observation to the ObservationRange class, where the expected range of values for a particular observation can be specified.
MAY contain zero or one [0..1] entryRelationship (CONF:1198-8856) such that it
SHALL contain exactly one [1..1] @typeCode="SUBJ" (CodeSystem: HL7ActRelationshipType urn:oid:2.16.840.1.113883.5.1002 STATIC) (CONF:1198-8857).
SHALL contain exactly one [1..1] @inversionInd="true" True (CONF:1198-8858).
MAY contain zero or one [0..1] entryRelationship (CONF:1198-8860) such that it
SHALL contain exactly one [1..1] @typeCode="REFR" (CodeSystem: HL7ActRelationshipType urn:oid:2.16.840.1.113883.5.1002 STATIC) (CONF:1198-8861).
MAY contain zero or one [0..1] entryRelationship (CONF:1198-8863) such that it
SHALL contain exactly one [1..1] @typeCode="REFR" (CodeSystem: HL7ActRelationshipType urn:oid:2.16.840.1.113883.5.1002 STATIC) (CONF:1198-8864).
MAY contain zero or one [0..1] entryRelationship (CONF:1198-8866) such that it
SHALL contain exactly one [1..1] @typeCode="CAUS" (CodeSystem: HL7ActRelationshipType urn:oid:2.16.840.1.113883.5.1002 STATIC) (CONF:1198-8867).
MAY contain zero or one [0..1] entryRelationship (CONF:1198-8988) such that it
SHALL contain exactly one [1..1] @typeCode="RSON" (CodeSystem: HL7ActRelationshipType urn:oid:2.16.840.1.113883.5.1002 STATIC) (CONF:1198-8989).
SHALL contain exactly one [1..1] Immunization Not Given Reason (identifier: urn:oid:2.16.840.1.113883.10.20.22.4.53:2024-05-01) (CONF:1198-15542).
The following entryRelationship is used to indicate a given immunization's order in a series. The nested Substance Administered Act identifies an administration in the series. The entryRelationship/sequenceNumber shows the order of this particular administration in that series.
SHOULD contain zero or more [0..*] entryRelationship (CONF:1198-31510) such that it
SHALL contain exactly one [1..1] @typeCode="COMP" Component (CodeSystem: HL7ActRelationshipType urn:oid:2.16.840.1.113883.5.1002) (CONF:1198-31511).
SHALL contain exactly one [1..1] @inversionInd="true" (CONF:1198-31512).
MAY contain zero or one [0..1] sequenceNumber (CONF:1198-31513).
SHALL contain exactly one [1..1] Substance Administered Act (identifier: urn:oid:2.16.840.1.113883.10.20.22.4.118) (CONF:1198-31514).
MAY contain zero or more [0..*] precondition (CONF:1198-8869) such that it
SHALL contain exactly one [1..1] @typeCode="PRCN" (CodeSystem: HL7ActRelationshipType urn:oid:2.16.840.1.113883.5.1002 STATIC) (CONF:1198-8870).
SHALL contain exactly one [1..1] Precondition for Substance Administration (identifier: urn:hl7ii:2.16.840.1.113883.10.20.22.4.25:2014-06-09) (CONF:1198-15548).