Scope and Usage

The ImmunizationRecommendation resource is intended to cover the expression of a customized set of immunization recommendations and status for a specific individual with the ultimate goal of achieving long-lasting immunity in the individual. This can include recommending future doses to progress the individual along the path to immunity and/or indicating that vaccination is not needed (e.g., the individual has completed the recommended set of doses and has presumed immunity, a contraindication or other condition would render further doses inadvisable, an acquired immunity negates the need for additional doses, the patient has aged out of a series). Where the individual is not yet fully protected, recommendations may be used to initiate clinical activity such as the ordering and administration of a vaccine. These recommendations may be used for non-clinical purposes such as presentation of vaccination credentials, satisfaction of school enrollment requirements or public health purposes. While not explicitly expressed in the resource itself, the "intent" of an ImmunizationRecommendation resource is always considered to be "proposal".

An individual recommendation in the ImmunizationRecommendation resource will often relate to the recommendation of a specific dose of vaccine. The base ImmunizationRecommendation is silent on the time frame for the recommended administration date for a recommendation contained in the resource. That is, it is a system decision about how far in advance (1 day, 1 week, 6 weeks, 6 months, etc) of the recommendation administration date a recommendation is made. A recommendation may also be used to indicate that additional doses are not needed for some reason (such as the series is complete, the patient has aged out of the series, the patient is immune through some other mechanism or additional doses are contraindicated). This functionality may be important to convey to end users that they should not take action.

The display of immunization recommendations to end users is the responsibility of the system using the data contained in the ImmunizationRecommendation resource. Use case specific Implementation Guides can define specific display or usage expectations (if any) of systems using the recommendations contained in the resource.

Boundaries and Relationships

An ImmunizationRecommendation resource may reference the relevant Immunization and ImmunizationEvaluation resources that underly the recommendation. Additional resources may be referenced where they document other factors (such as underlying medical conditions, behaviors, etc) which impact the recommendation.

The recommendations contained within an ImmunizationRecommendation resource may be used to initiate a set of clinical activities leading to the administration and documentation of one or more doses of vaccine. Where a record of an order to administer a vaccine is required, the MedicationRequest resource is used. The value of MedicationRequest.intent is used to distinguish between a plan to vaccinate and an authorized order. MedicationRequest.basedOn may be used to link the order to the initiating ImmunizationRecommendation. The documentation of the administration of the vaccine should be accomplished through the use of the Immunization resource.

Note that the ImmunizationRecommendation resource allows the inclusion of multiple recommendations in a single instance of the resource. Where the output of the evaluation process results in only a single recommendation, the use of MedicationRequest where .intent is valued "proposal" is allowed as an alternative to the ImmunizationRecommendation resource if it simplifies the subsequent clinical workflow.

Differential View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
ImmunizationRecommendation		0..*	DomainResource	Guidance or advice relating to an immunization Elements defined in Ancestors:id, meta, implicitRules, language, text, contained, extension, modifierExtension
identifier	Σ	0..*	Identifier	Business identifier
patient	Σ	1..1	Reference(Patient)	Who this profile is for
date	Σ	1..1	dateTime	Date recommendation(s) created
authority		0..1	Reference(Organization)	Who is responsible for schedule
recommendation	ΣC	1..*	BackboneElement	Vaccine administration recommendations Constraints: imr-1
vaccineCode	ΣC	0..*	CodeableConcept	Vaccine or vaccine group recommendation applies to Binding: VaccineAdministeredValueSet (example): The type of vaccine administered.
targetDisease	ΣC	0..*	CodeableConcept	Disease to be immunized against Binding: ImmunizationTargetDiseaseCodes (example): The disease that the recommended vaccination targets.
contraindicatedVaccineCode	Σ	0..*	CodeableConcept	Vaccine which is contraindicated to fulfill the recommendation Binding: VaccineAdministeredValueSet (example): The type of vaccine administered.
forecastStatus	?!Σ	1..1	CodeableConcept	Vaccine recommendation status Binding: ImmunizationRecommendationStatusCodes (example): The patient's status with respect to a vaccination protocol.
forecastReason	Σ	0..*	CodeableConcept	Vaccine administration status reason Binding: ImmunizationRecommendationReasonCodes (example): The reason for the patient's status with respect to a vaccination protocol.
dateCriterion		0..*	BackboneElement	Dates governing proposed immunization
code		1..1	CodeableConcept	Type of date Binding: ImmunizationRecommendationDateCriterionCodes (example): Classifies date criterion with respect to conveying information about a patient's vaccination status (e.g. due date, latest to give date, etc.).
value		1..1	dateTime	Recommended date
description		0..1	markdown	Protocol details
series		0..1	string	Name of vaccination series
doseNumber	Σ	0..1	CodeableConcept	Recommended dose number within series Binding Description: (example): A code expressing the vaccine dose number - several coding schemes exist or will be defined for each jurisdiction.
seriesDoses		0..1	CodeableConcept	Recommended number of doses for immunity Binding Description: (example): A code expressing the doses recommended or expected - several coding schemes exist or will be defined for each jurisdiction.
supportingImmunization		0..*	Reference(Immunization | Immunization Evaluation)	Past immunizations supporting recommendation
supportingPatientInformation		0..*	Reference(Resource)	Patient observations supporting recommendation
Documentation for this format

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
ImmunizationRecommendation.​recommendation.vaccineCode	Base	example	Vaccine Administered Value Set	📦6.0.0-ballot3	FHIR Std.
ImmunizationRecommendation.​recommendation.targetDisease	Base	example	Immunization Target Disease Codes	📦6.0.0-ballot3	FHIR Std.
ImmunizationRecommendation.​recommendation.contraindicatedVaccineCode	Base	example	Vaccine Administered Value Set	📦6.0.0-ballot3	FHIR Std.
ImmunizationRecommendation.​recommendation.forecastStatus	Base	example	Immunization Recommendation Status Codes	📦6.0.0-ballot3	FHIR Std.
ImmunizationRecommendation.​recommendation.forecastReason	Base	example	Immunization Recommendation Reason Codes	📦6.0.0-ballot3	FHIR Std.
ImmunizationRecommendation.​recommendation.dateCriterion.​code	Base	example	Immunization Recommendation Date Criterion Codes	📦6.0.0-ballot3	FHIR Std.
ImmunizationRecommendation.​recommendation.doseNumber	Base	example		Not State	Unknown
ImmunizationRecommendation.​recommendation.seriesDoses	Base	example		Not State	Unknown

Constraints

Id	Grade	Path(s)	Description	Expression
imr-1	error	ImmunizationRecommendation.recommendation	One of vaccineCode or targetDisease SHALL be present	vaccineCode.exists() or targetDisease.exists()