WHO Digital Documentation of COVID-19 Certificates (DDCC)
1.0.0 - CI Build International flag

WHO Digital Documentation of COVID-19 Certificates (DDCC), published by WHO. This guide is not an authorized publication; it is the continuous build for version 1.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/WorldHealthOrganization/ddcc/ and changes regularly. See the Directory of published versions

Resource Profile: DDCC Immunization

Official URL: http://smart.who.int/ddcc/StructureDefinition/DDCCImmunization Version: 1.0.0
Draft as of 2024-10-17 Computable Name: DDCCImmunization

A DDCC Immunization contains the content corresponding to a row in the Vaccination Events section of a Paper DDCC. While this is not a further profile of the International Patient Summary (IPS) Immunization resouce, this is intended to map into an IPS Immunization resource.

Usage:

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

This structure is derived from ImmunizationUvIps

NameFlagsCard.TypeDescription & Constraintsdoco
.. Immunization 0..* ImmunizationUvIps Immunization event information
... Slices for extension 2..* Extension Extension
Slice: Unordered, Open by value:url
.... vaccineBrand S 1..1 Coding DDCC Event Brand for Immunization
URL: http://smart.who.int/ddcc/StructureDefinition/DDCCEventBrand
.... vaccineMarketAuthorization S 0..1 Coding DDCC Vaccine Market Authorization for Immunization
URL: http://smart.who.int/ddcc/StructureDefinition/DDCCVaccineMarketAuthorization
.... country S 1..1 code DDCC Country Of Event for Immunization
URL: http://smart.who.int/ddcc/StructureDefinition/DDCCCountryOfEvent
Binding: Iso3166-1-3 (preferred)
.... validFrom S 0..1 date DDCC Vaccine Valid From
URL: http://smart.who.int/ddcc/StructureDefinition/DDCCVaccineValidFrom
... vaccineCode 1..1 CodeableConceptIPS Vaccine that was administered or was to be administered.Several kinds of vaccine product coding could be provided. The IPS assumes that either the type of the vaccine for particular disease or diseases (e.g. MMR vaccine) against which the patient has been immunised is provided; or the known absent / unknown code. Other coded information can be provided as well as: the IDMP Pharmaceutical Product Identifiers (PhPID), Medicinal Product Identifier (MPID), Packaged Medicinal Product Identifier (PCID), when available, or equivalent coded concepts; the WHO ATC codes; or any other kind of code that that identifies, classifies or cluster the administered product.
Binding: WHO Vaccine List (COVID-19) (preferred)
.... coding 1..1 CodingIPS A reference to a code defined by a terminology system
..... system 1..1 uri Identity of the terminology system
..... code 1..1 code Symbol in syntax defined by the system
... patient 1..1 Reference(DDCC Patient) Who was immunized
... location S 1..1 Reference(Location) Where immunization occurred
.... display S 1..1 string Text alternative for the resource
... manufacturer S 0..1 Reference(Organization) Vaccine manufacturer
... lotNumber S 0..1 string Vaccine lot number
... performer
.... actor 1..1 Reference(DDCC Practitioner | DDCC Organization) Individual or organization who was performing
... Slices for protocolApplied S 1..* BackboneElement Protocol followed by the provider
Slice: Unordered, Open by type:authority
.... protocolApplied:protocolAppliedAuthority S 1..* BackboneElement Protocol followed by the provider
..... authority 0..1 Reference(DDCC Organization) Who is responsible for publishing the recommendations
..... targetDisease 0..* CodeableConcept Vaccine preventable disease being targeted
Binding: WHO Disease or Agent Targeted (COVID-19) (preferred)
..... doseNumber[x] S 1..1 positiveInt Dose number within series
..... seriesDoses[x] 0..1 positiveInt Recommended number of doses for immunity

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSetURI
Immunization.vaccineCodepreferredWHODDCCVaccinesCOVID19
http://smart.who.int/ddcc/ValueSet/WHODDCCVaccinesCOVID19
from this IG
Immunization.protocolApplied:protocolAppliedAuthority.targetDiseasepreferredWHODDCCDiseaseTargetedCOVID19
http://smart.who.int/ddcc/ValueSet/WHODDCCDiseaseTargetedCOVID19
from this IG
NameFlagsCard.TypeDescription & Constraintsdoco
.. Immunization 0..* ImmunizationUvIps Immunization event information
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... Slices for extension 2..* Extension Extension
Slice: Unordered, Open by value:url
.... vaccineBrand S 1..1 Coding DDCC Event Brand for Immunization
URL: http://smart.who.int/ddcc/StructureDefinition/DDCCEventBrand
.... vaccineMarketAuthorization S 0..1 Coding DDCC Vaccine Market Authorization for Immunization
URL: http://smart.who.int/ddcc/StructureDefinition/DDCCVaccineMarketAuthorization
.... country S 1..1 code DDCC Country Of Event for Immunization
URL: http://smart.who.int/ddcc/StructureDefinition/DDCCCountryOfEvent
Binding: Iso3166-1-3 (preferred)
.... validFrom S 0..1 date DDCC Vaccine Valid From
URL: http://smart.who.int/ddcc/StructureDefinition/DDCCVaccineValidFrom
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... vaccineCode S 1..1 CodeableConceptIPS Vaccine that was administered or was to be administered.Several kinds of vaccine product coding could be provided. The IPS assumes that either the type of the vaccine for particular disease or diseases (e.g. MMR vaccine) against which the patient has been immunised is provided; or the known absent / unknown code. Other coded information can be provided as well as: the IDMP Pharmaceutical Product Identifiers (PhPID), Medicinal Product Identifier (MPID), Packaged Medicinal Product Identifier (PCID), when available, or equivalent coded concepts; the WHO ATC codes; or any other kind of code that that identifies, classifies or cluster the administered product.
Binding: WHO Vaccine List (COVID-19) (preferred)
Additional BindingsPurposeDocumentation
Vaccines - SNOMED CT IPS Free Set candidate
For when codes from the SNOMED CT IPS free set are preferred
Vaccines WHO ATC - IPS candidate
For when WHO ATC code system is preferred
Absent or Unknown Immunization - IPS candidate
"known absent" and "not known", for use with other value sets
.... coding S 1..1 CodingIPS A reference to a code defined by a terminology system
..... system SΣ 1..1 uri Identity of the terminology system
..... code SΣ 1..1 code Symbol in syntax defined by the system
..... display SΣ 0..1 string Representation defined by the system
...... Slices for extension Content/Rules for all slices
....... translation 0..* (Complex) Language Translation (Localization)
URL: http://hl7.org/fhir/StructureDefinition/translation
.... text SΣ 0..1 string Plain text representation of the concept
... patient SΣ 1..1 Reference(DDCC Patient) Who was immunized
.... reference SΣC 1..1 string Literal reference, Relative, internal or absolute URL
... occurrence[x] SΣ 1..1 dateTime Vaccine administration date
.... Slices for extension Content/Rules for all slices
..... data-absent-reason S 0..1 code occurrence[x] absence reason
URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason
Binding: DataAbsentReason (required)
... location S 1..1 Reference(Location) Where immunization occurred
.... display SΣ 1..1 string Text alternative for the resource
... manufacturer S 0..1 Reference(Organization) Vaccine manufacturer
... lotNumber S 0..1 string Vaccine lot number
... isSubpotent ?!Σ 0..1 boolean Dose potency
... Slices for protocolApplied S 1..* BackboneElement Protocol followed by the provider
Slice: Unordered, Open by type:authority
.... protocolApplied:All Slices Content/Rules for all slices
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... doseNumber[x] 1..1 Dose number within series
...... doseNumberPositiveInt positiveInt
...... doseNumberString string
.... protocolApplied:protocolAppliedAuthority S 1..* BackboneElement Protocol followed by the provider
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... authority 0..1 Reference(DDCC Organization) Who is responsible for publishing the recommendations
..... targetDisease 0..* CodeableConcept Vaccine preventable disease being targeted
Binding: WHO Disease or Agent Targeted (COVID-19) (preferred)
Additional BindingsPurpose
Vaccine Target Diseases - SNOMED CT IPS Free Set candidate

..... doseNumber[x] S 1..1 positiveInt Dose number within series
..... seriesDoses[x] 0..1 positiveInt Recommended number of doses for immunity

doco Documentation for this format

Terminology Bindings

PathConformanceValueSetURI
Immunization.statusrequiredImmunizationStatusCodes
http://hl7.org/fhir/ValueSet/immunization-status|4.0.1
from the FHIR Standard
Immunization.vaccineCodepreferredWHODDCCVaccinesCOVID19
http://smart.who.int/ddcc/ValueSet/WHODDCCVaccinesCOVID19
from this IG
Immunization.protocolApplied:protocolAppliedAuthority.targetDiseasepreferredWHODDCCDiseaseTargetedCOVID19
http://smart.who.int/ddcc/ValueSet/WHODDCCDiseaseTargetedCOVID19
from this IG

Constraints

IdGradePath(s)DetailsRequirements
dom-2errorImmunizationIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorImmunizationIf 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-4errorImmunizationIf 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-5errorImmunizationIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceImmunizationA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()
NameFlagsCard.TypeDescription & Constraintsdoco
.. Immunization 0..* ImmunizationUvIps Immunization event information
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): A human language.

Additional BindingsPurpose
AllLanguages Max Binding
... text 0..1 Narrative Text summary of the resource, for human interpretation
... contained 0..* Resource Contained, inline Resources
... Slices for extension 2..* Extension Extension
Slice: Unordered, Open by value:url
.... vaccineBrand S 1..1 Coding DDCC Event Brand for Immunization
URL: http://smart.who.int/ddcc/StructureDefinition/DDCCEventBrand
.... vaccineMarketAuthorization S 0..1 Coding DDCC Vaccine Market Authorization for Immunization
URL: http://smart.who.int/ddcc/StructureDefinition/DDCCVaccineMarketAuthorization
.... country S 1..1 code DDCC Country Of Event for Immunization
URL: http://smart.who.int/ddcc/StructureDefinition/DDCCCountryOfEvent
Binding: Iso3166-1-3 (preferred)
.... validFrom S 0..1 date DDCC Vaccine Valid From
URL: http://smart.who.int/ddcc/StructureDefinition/DDCCVaccineValidFrom
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier 0..* Identifier Business identifier
... status ?!SΣ 1..1 code completed | entered-in-error | not-done
Binding: ImmunizationStatusCodes (required): A set of codes indicating the current status of an Immunization.

... statusReason 0..1 CodeableConcept Reason not done
Binding: ImmunizationStatusReasonCodes (example): The reason why a vaccine was not administered.

... vaccineCode S 1..1 CodeableConceptIPS Vaccine that was administered or was to be administered.Several kinds of vaccine product coding could be provided. The IPS assumes that either the type of the vaccine for particular disease or diseases (e.g. MMR vaccine) against which the patient has been immunised is provided; or the known absent / unknown code. Other coded information can be provided as well as: the IDMP Pharmaceutical Product Identifiers (PhPID), Medicinal Product Identifier (MPID), Packaged Medicinal Product Identifier (PCID), when available, or equivalent coded concepts; the WHO ATC codes; or any other kind of code that that identifies, classifies or cluster the administered product.
Binding: WHO Vaccine List (COVID-19) (preferred)
Additional BindingsPurposeDocumentation
Vaccines - SNOMED CT IPS Free Set candidate
For when codes from the SNOMED CT IPS free set are preferred
Vaccines WHO ATC - IPS candidate
For when WHO ATC code system is preferred
Absent or Unknown Immunization - IPS candidate
"known absent" and "not known", for use with other value sets
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... coding S 1..1 CodingIPS A reference to a code defined by a terminology system
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... system SΣ 1..1 uri Identity of the terminology system
..... version Σ 0..1 string Version of the system - if relevant
..... code SΣ 1..1 code Symbol in syntax defined by the system
..... display SΣ 0..1 string Representation defined by the system
...... id 0..1 string xml:id (or equivalent in JSON)
...... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
....... translation 0..* (Complex) Language Translation (Localization)
URL: http://hl7.org/fhir/StructureDefinition/translation
...... value 0..1 string Primitive value for string
Max Length: 1048576
..... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
.... text SΣ 0..1 string Plain text representation of the concept
... patient SΣ 1..1 Reference(DDCC Patient) Who was immunized
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... reference SΣC 1..1 string Literal reference, Relative, internal or absolute URL
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).

.... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
.... display Σ 0..1 string Text alternative for the resource
... encounter 0..1 Reference(Encounter) Encounter immunization was part of
... occurrence[x] SΣ 1..1 dateTime Vaccine administration date
.... id 0..1 string Unique id for inter-element referencing
.... Slices for extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... data-absent-reason S 0..1 code occurrence[x] absence reason
URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason
Binding: DataAbsentReason (required)
... recorded 0..1 dateTime When the immunization was first captured in the subject's record
... primarySource Σ 0..1 boolean Indicates context the data was recorded in
... reportOrigin 0..1 CodeableConcept Indicates the source of a secondarily reported record
Binding: ImmunizationOriginCodes (example): The source of the data for a record which is not from a primary source.

... location S 1..1 Reference(Location) Where immunization occurred
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... reference ΣC 0..1 string Literal reference, Relative, internal or absolute URL
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).

.... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
.... display SΣ 1..1 string Text alternative for the resource
... manufacturer S 0..1 Reference(Organization) Vaccine manufacturer
... lotNumber S 0..1 string Vaccine lot number
... expirationDate 0..1 date Vaccine expiration date
... site 0..1 CodeableConceptIPS Concept - reference to a terminology or just text
Binding: SNOMEDCTBodyStructures (preferred)
... route 0..1 CodeableConceptIPS Concept - reference to a terminology or just text
Binding: Medicine Route of Administration - IPS (preferred)
... doseQuantity 0..1 SimpleQuantity Amount of vaccine administered
... performer Σ 0..* BackboneElement Who performed event
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... function Σ 0..1 CodeableConcept What type of performance was done
Binding: ImmunizationFunctionCodes (extensible): The role a practitioner or organization plays in the immunization event.

.... actor Σ 1..1 Reference(DDCC Practitioner | DDCC Organization) Individual or organization who was performing
... note Σ 0..* Annotation Additional immunization notes
... reasonCode 0..* CodeableConcept Why immunization occurred
Binding: ImmunizationReasonCodes (example): The reason why a vaccine was administered.


... reasonReference 0..* Reference(Condition | Observation | DiagnosticReport) Why immunization occurred
... isSubpotent ?!Σ 0..1 boolean Dose potency
... subpotentReason 0..* CodeableConcept Reason for being subpotent
Binding: ImmunizationSubpotentReason (example): The reason why a dose is considered to be subpotent.


... education C 0..* BackboneElement Educational material presented to patient
imm-1: One of documentType or reference SHALL be present
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... documentType 0..1 string Educational material document identifier
.... reference 0..1 uri Educational material reference pointer
.... publicationDate 0..1 dateTime Educational material publication date
.... presentationDate 0..1 dateTime Educational material presentation date
... programEligibility 0..* CodeableConcept Patient eligibility for a vaccination program
Binding: ImmunizationProgramEligibility (example): The patient's eligibility for a vaccation program.


... fundingSource 0..1 CodeableConcept Funding source for the vaccine
Binding: ImmunizationFundingSource (example): The source of funding used to purchase the vaccine administered.

... reaction 0..* BackboneElement Details of a reaction that follows immunization
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... date 0..1 dateTime When reaction started
.... detail 0..1 Reference(Observation) Additional information on reaction
.... reported 0..1 boolean Indicates self-reported reaction
... Slices for protocolApplied S 1..* BackboneElement Protocol followed by the provider
Slice: Unordered, Open by type:authority
.... protocolApplied:All Slices Content/Rules for all slices
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... series 0..1 string Name of vaccine series
..... authority 0..1 Reference(Organization) Who is responsible for publishing the recommendations
..... targetDisease 0..* CodeableConcept Vaccine preventable disease being targeted
Binding: Vaccine Target Diseases - IPS (preferred): The particular disease or diseases against which the patient has been immunized.

Additional BindingsPurpose
Vaccine Target Diseases - SNOMED CT IPS Free Set candidate

..... doseNumber[x] 1..1 Dose number within series
...... doseNumberPositiveInt positiveInt
...... doseNumberString string
..... seriesDoses[x] 0..1 Recommended number of doses for immunity
...... seriesDosesPositiveInt positiveInt
...... seriesDosesString string
.... protocolApplied:protocolAppliedAuthority S 1..* BackboneElement Protocol followed by the provider
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... series 0..1 string Name of vaccine series
..... authority 0..1 Reference(DDCC Organization) Who is responsible for publishing the recommendations
..... targetDisease 0..* CodeableConcept Vaccine preventable disease being targeted
Binding: WHO Disease or Agent Targeted (COVID-19) (preferred)
Additional BindingsPurpose
Vaccine Target Diseases - SNOMED CT IPS Free Set candidate

..... doseNumber[x] S 1..1 positiveInt Dose number within series
..... seriesDoses[x] 0..1 positiveInt Recommended number of doses for immunity

doco Documentation for this format

Terminology Bindings

PathConformanceValueSetURI
Immunization.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
http://hl7.org/fhir/ValueSet/languages
from the FHIR Standard
Immunization.statusrequiredImmunizationStatusCodes
http://hl7.org/fhir/ValueSet/immunization-status|4.0.1
from the FHIR Standard
Immunization.statusReasonexampleImmunizationStatusReasonCodes
http://hl7.org/fhir/ValueSet/immunization-status-reason
from the FHIR Standard
Immunization.vaccineCodepreferredWHODDCCVaccinesCOVID19
http://smart.who.int/ddcc/ValueSet/WHODDCCVaccinesCOVID19
from this IG
Immunization.patient.typeextensibleResourceType
http://hl7.org/fhir/ValueSet/resource-types
from the FHIR Standard
Immunization.reportOriginexampleImmunizationOriginCodes
http://hl7.org/fhir/ValueSet/immunization-origin
from the FHIR Standard
Immunization.location.typeextensibleResourceType
http://hl7.org/fhir/ValueSet/resource-types
from the FHIR Standard
Immunization.sitepreferredSNOMEDCTBodyStructures
http://hl7.org/fhir/ValueSet/body-site
from the FHIR Standard
Immunization.routepreferredMedicineRouteOfAdministrationUvIps
http://hl7.org/fhir/uv/ips/ValueSet/medicine-route-of-administration
Immunization.performer.functionextensibleImmunizationFunctionCodes
http://hl7.org/fhir/ValueSet/immunization-function
from the FHIR Standard
Immunization.reasonCodeexampleImmunizationReasonCodes
http://hl7.org/fhir/ValueSet/immunization-reason
from the FHIR Standard
Immunization.subpotentReasonexampleImmunizationSubpotentReason
http://hl7.org/fhir/ValueSet/immunization-subpotent-reason
from the FHIR Standard
Immunization.programEligibilityexampleImmunizationProgramEligibility
http://hl7.org/fhir/ValueSet/immunization-program-eligibility
from the FHIR Standard
Immunization.fundingSourceexampleImmunizationFundingSource
http://hl7.org/fhir/ValueSet/immunization-funding-source
from the FHIR Standard
Immunization.protocolApplied.targetDiseasepreferredVaccineTargetDiseasesUvIps
http://hl7.org/fhir/uv/ips/ValueSet/target-diseases-uv-ips
Immunization.protocolApplied:protocolAppliedAuthority.targetDiseasepreferredWHODDCCDiseaseTargetedCOVID19
http://smart.who.int/ddcc/ValueSet/WHODDCCDiseaseTargetedCOVID19
from this IG

Constraints

IdGradePath(s)DetailsRequirements
dom-2errorImmunizationIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorImmunizationIf 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-4errorImmunizationIf 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-5errorImmunizationIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceImmunizationA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()
imm-1errorImmunization.educationOne of documentType or reference SHALL be present
: documentType.exists() or reference.exists()

Differential View

This structure is derived from ImmunizationUvIps

NameFlagsCard.TypeDescription & Constraintsdoco
.. Immunization 0..* ImmunizationUvIps Immunization event information
... Slices for extension 2..* Extension Extension
Slice: Unordered, Open by value:url
.... vaccineBrand S 1..1 Coding DDCC Event Brand for Immunization
URL: http://smart.who.int/ddcc/StructureDefinition/DDCCEventBrand
.... vaccineMarketAuthorization S 0..1 Coding DDCC Vaccine Market Authorization for Immunization
URL: http://smart.who.int/ddcc/StructureDefinition/DDCCVaccineMarketAuthorization
.... country S 1..1 code DDCC Country Of Event for Immunization
URL: http://smart.who.int/ddcc/StructureDefinition/DDCCCountryOfEvent
Binding: Iso3166-1-3 (preferred)
.... validFrom S 0..1 date DDCC Vaccine Valid From
URL: http://smart.who.int/ddcc/StructureDefinition/DDCCVaccineValidFrom
... vaccineCode 1..1 CodeableConceptIPS Vaccine that was administered or was to be administered.Several kinds of vaccine product coding could be provided. The IPS assumes that either the type of the vaccine for particular disease or diseases (e.g. MMR vaccine) against which the patient has been immunised is provided; or the known absent / unknown code. Other coded information can be provided as well as: the IDMP Pharmaceutical Product Identifiers (PhPID), Medicinal Product Identifier (MPID), Packaged Medicinal Product Identifier (PCID), when available, or equivalent coded concepts; the WHO ATC codes; or any other kind of code that that identifies, classifies or cluster the administered product.
Binding: WHO Vaccine List (COVID-19) (preferred)
.... coding 1..1 CodingIPS A reference to a code defined by a terminology system
..... system 1..1 uri Identity of the terminology system
..... code 1..1 code Symbol in syntax defined by the system
... patient 1..1 Reference(DDCC Patient) Who was immunized
... location S 1..1 Reference(Location) Where immunization occurred
.... display S 1..1 string Text alternative for the resource
... manufacturer S 0..1 Reference(Organization) Vaccine manufacturer
... lotNumber S 0..1 string Vaccine lot number
... performer
.... actor 1..1 Reference(DDCC Practitioner | DDCC Organization) Individual or organization who was performing
... Slices for protocolApplied S 1..* BackboneElement Protocol followed by the provider
Slice: Unordered, Open by type:authority
.... protocolApplied:protocolAppliedAuthority S 1..* BackboneElement Protocol followed by the provider
..... authority 0..1 Reference(DDCC Organization) Who is responsible for publishing the recommendations
..... targetDisease 0..* CodeableConcept Vaccine preventable disease being targeted
Binding: WHO Disease or Agent Targeted (COVID-19) (preferred)
..... doseNumber[x] S 1..1 positiveInt Dose number within series
..... seriesDoses[x] 0..1 positiveInt Recommended number of doses for immunity

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSetURI
Immunization.vaccineCodepreferredWHODDCCVaccinesCOVID19
http://smart.who.int/ddcc/ValueSet/WHODDCCVaccinesCOVID19
from this IG
Immunization.protocolApplied:protocolAppliedAuthority.targetDiseasepreferredWHODDCCDiseaseTargetedCOVID19
http://smart.who.int/ddcc/ValueSet/WHODDCCDiseaseTargetedCOVID19
from this IG

Key Elements View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Immunization 0..* ImmunizationUvIps Immunization event information
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... Slices for extension 2..* Extension Extension
Slice: Unordered, Open by value:url
.... vaccineBrand S 1..1 Coding DDCC Event Brand for Immunization
URL: http://smart.who.int/ddcc/StructureDefinition/DDCCEventBrand
.... vaccineMarketAuthorization S 0..1 Coding DDCC Vaccine Market Authorization for Immunization
URL: http://smart.who.int/ddcc/StructureDefinition/DDCCVaccineMarketAuthorization
.... country S 1..1 code DDCC Country Of Event for Immunization
URL: http://smart.who.int/ddcc/StructureDefinition/DDCCCountryOfEvent
Binding: Iso3166-1-3 (preferred)
.... validFrom S 0..1 date DDCC Vaccine Valid From
URL: http://smart.who.int/ddcc/StructureDefinition/DDCCVaccineValidFrom
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... vaccineCode S 1..1 CodeableConceptIPS Vaccine that was administered or was to be administered.Several kinds of vaccine product coding could be provided. The IPS assumes that either the type of the vaccine for particular disease or diseases (e.g. MMR vaccine) against which the patient has been immunised is provided; or the known absent / unknown code. Other coded information can be provided as well as: the IDMP Pharmaceutical Product Identifiers (PhPID), Medicinal Product Identifier (MPID), Packaged Medicinal Product Identifier (PCID), when available, or equivalent coded concepts; the WHO ATC codes; or any other kind of code that that identifies, classifies or cluster the administered product.
Binding: WHO Vaccine List (COVID-19) (preferred)
Additional BindingsPurposeDocumentation
Vaccines - SNOMED CT IPS Free Set candidate
For when codes from the SNOMED CT IPS free set are preferred
Vaccines WHO ATC - IPS candidate
For when WHO ATC code system is preferred
Absent or Unknown Immunization - IPS candidate
"known absent" and "not known", for use with other value sets
.... coding S 1..1 CodingIPS A reference to a code defined by a terminology system
..... system SΣ 1..1 uri Identity of the terminology system
..... code SΣ 1..1 code Symbol in syntax defined by the system
..... display SΣ 0..1 string Representation defined by the system
...... Slices for extension Content/Rules for all slices
....... translation 0..* (Complex) Language Translation (Localization)
URL: http://hl7.org/fhir/StructureDefinition/translation
.... text SΣ 0..1 string Plain text representation of the concept
... patient SΣ 1..1 Reference(DDCC Patient) Who was immunized
.... reference SΣC 1..1 string Literal reference, Relative, internal or absolute URL
... occurrence[x] SΣ 1..1 dateTime Vaccine administration date
.... Slices for extension Content/Rules for all slices
..... data-absent-reason S 0..1 code occurrence[x] absence reason
URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason
Binding: DataAbsentReason (required)
... location S 1..1 Reference(Location) Where immunization occurred
.... display SΣ 1..1 string Text alternative for the resource
... manufacturer S 0..1 Reference(Organization) Vaccine manufacturer
... lotNumber S 0..1 string Vaccine lot number
... isSubpotent ?!Σ 0..1 boolean Dose potency
... Slices for protocolApplied S 1..* BackboneElement Protocol followed by the provider
Slice: Unordered, Open by type:authority
.... protocolApplied:All Slices Content/Rules for all slices
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... doseNumber[x] 1..1 Dose number within series
...... doseNumberPositiveInt positiveInt
...... doseNumberString string
.... protocolApplied:protocolAppliedAuthority S 1..* BackboneElement Protocol followed by the provider
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... authority 0..1 Reference(DDCC Organization) Who is responsible for publishing the recommendations
..... targetDisease 0..* CodeableConcept Vaccine preventable disease being targeted
Binding: WHO Disease or Agent Targeted (COVID-19) (preferred)
Additional BindingsPurpose
Vaccine Target Diseases - SNOMED CT IPS Free Set candidate

..... doseNumber[x] S 1..1 positiveInt Dose number within series
..... seriesDoses[x] 0..1 positiveInt Recommended number of doses for immunity

doco Documentation for this format

Terminology Bindings

PathConformanceValueSetURI
Immunization.statusrequiredImmunizationStatusCodes
http://hl7.org/fhir/ValueSet/immunization-status|4.0.1
from the FHIR Standard
Immunization.vaccineCodepreferredWHODDCCVaccinesCOVID19
http://smart.who.int/ddcc/ValueSet/WHODDCCVaccinesCOVID19
from this IG
Immunization.protocolApplied:protocolAppliedAuthority.targetDiseasepreferredWHODDCCDiseaseTargetedCOVID19
http://smart.who.int/ddcc/ValueSet/WHODDCCDiseaseTargetedCOVID19
from this IG

Constraints

IdGradePath(s)DetailsRequirements
dom-2errorImmunizationIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorImmunizationIf 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-4errorImmunizationIf 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-5errorImmunizationIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceImmunizationA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Immunization 0..* ImmunizationUvIps Immunization event information
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): A human language.

Additional BindingsPurpose
AllLanguages Max Binding
... text 0..1 Narrative Text summary of the resource, for human interpretation
... contained 0..* Resource Contained, inline Resources
... Slices for extension 2..* Extension Extension
Slice: Unordered, Open by value:url
.... vaccineBrand S 1..1 Coding DDCC Event Brand for Immunization
URL: http://smart.who.int/ddcc/StructureDefinition/DDCCEventBrand
.... vaccineMarketAuthorization S 0..1 Coding DDCC Vaccine Market Authorization for Immunization
URL: http://smart.who.int/ddcc/StructureDefinition/DDCCVaccineMarketAuthorization
.... country S 1..1 code DDCC Country Of Event for Immunization
URL: http://smart.who.int/ddcc/StructureDefinition/DDCCCountryOfEvent
Binding: Iso3166-1-3 (preferred)
.... validFrom S 0..1 date DDCC Vaccine Valid From
URL: http://smart.who.int/ddcc/StructureDefinition/DDCCVaccineValidFrom
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier 0..* Identifier Business identifier
... status ?!SΣ 1..1 code completed | entered-in-error | not-done
Binding: ImmunizationStatusCodes (required): A set of codes indicating the current status of an Immunization.

... statusReason 0..1 CodeableConcept Reason not done
Binding: ImmunizationStatusReasonCodes (example): The reason why a vaccine was not administered.

... vaccineCode S 1..1 CodeableConceptIPS Vaccine that was administered or was to be administered.Several kinds of vaccine product coding could be provided. The IPS assumes that either the type of the vaccine for particular disease or diseases (e.g. MMR vaccine) against which the patient has been immunised is provided; or the known absent / unknown code. Other coded information can be provided as well as: the IDMP Pharmaceutical Product Identifiers (PhPID), Medicinal Product Identifier (MPID), Packaged Medicinal Product Identifier (PCID), when available, or equivalent coded concepts; the WHO ATC codes; or any other kind of code that that identifies, classifies or cluster the administered product.
Binding: WHO Vaccine List (COVID-19) (preferred)
Additional BindingsPurposeDocumentation
Vaccines - SNOMED CT IPS Free Set candidate
For when codes from the SNOMED CT IPS free set are preferred
Vaccines WHO ATC - IPS candidate
For when WHO ATC code system is preferred
Absent or Unknown Immunization - IPS candidate
"known absent" and "not known", for use with other value sets
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... coding S 1..1 CodingIPS A reference to a code defined by a terminology system
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... system SΣ 1..1 uri Identity of the terminology system
..... version Σ 0..1 string Version of the system - if relevant
..... code SΣ 1..1 code Symbol in syntax defined by the system
..... display SΣ 0..1 string Representation defined by the system
...... id 0..1 string xml:id (or equivalent in JSON)
...... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
....... translation 0..* (Complex) Language Translation (Localization)
URL: http://hl7.org/fhir/StructureDefinition/translation
...... value 0..1 string Primitive value for string
Max Length: 1048576
..... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
.... text SΣ 0..1 string Plain text representation of the concept
... patient SΣ 1..1 Reference(DDCC Patient) Who was immunized
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... reference SΣC 1..1 string Literal reference, Relative, internal or absolute URL
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).

.... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
.... display Σ 0..1 string Text alternative for the resource
... encounter 0..1 Reference(Encounter) Encounter immunization was part of
... occurrence[x] SΣ 1..1 dateTime Vaccine administration date
.... id 0..1 string Unique id for inter-element referencing
.... Slices for extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... data-absent-reason S 0..1 code occurrence[x] absence reason
URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason
Binding: DataAbsentReason (required)
... recorded 0..1 dateTime When the immunization was first captured in the subject's record
... primarySource Σ 0..1 boolean Indicates context the data was recorded in
... reportOrigin 0..1 CodeableConcept Indicates the source of a secondarily reported record
Binding: ImmunizationOriginCodes (example): The source of the data for a record which is not from a primary source.

... location S 1..1 Reference(Location) Where immunization occurred
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... reference ΣC 0..1 string Literal reference, Relative, internal or absolute URL
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).

.... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
.... display SΣ 1..1 string Text alternative for the resource
... manufacturer S 0..1 Reference(Organization) Vaccine manufacturer
... lotNumber S 0..1 string Vaccine lot number
... expirationDate 0..1 date Vaccine expiration date
... site 0..1 CodeableConceptIPS Concept - reference to a terminology or just text
Binding: SNOMEDCTBodyStructures (preferred)
... route 0..1 CodeableConceptIPS Concept - reference to a terminology or just text
Binding: Medicine Route of Administration - IPS (preferred)
... doseQuantity 0..1 SimpleQuantity Amount of vaccine administered
... performer Σ 0..* BackboneElement Who performed event
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... function Σ 0..1 CodeableConcept What type of performance was done
Binding: ImmunizationFunctionCodes (extensible): The role a practitioner or organization plays in the immunization event.

.... actor Σ 1..1 Reference(DDCC Practitioner | DDCC Organization) Individual or organization who was performing
... note Σ 0..* Annotation Additional immunization notes
... reasonCode 0..* CodeableConcept Why immunization occurred
Binding: ImmunizationReasonCodes (example): The reason why a vaccine was administered.


... reasonReference 0..* Reference(Condition | Observation | DiagnosticReport) Why immunization occurred
... isSubpotent ?!Σ 0..1 boolean Dose potency
... subpotentReason 0..* CodeableConcept Reason for being subpotent
Binding: ImmunizationSubpotentReason (example): The reason why a dose is considered to be subpotent.


... education C 0..* BackboneElement Educational material presented to patient
imm-1: One of documentType or reference SHALL be present
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... documentType 0..1 string Educational material document identifier
.... reference 0..1 uri Educational material reference pointer
.... publicationDate 0..1 dateTime Educational material publication date
.... presentationDate 0..1 dateTime Educational material presentation date
... programEligibility 0..* CodeableConcept Patient eligibility for a vaccination program
Binding: ImmunizationProgramEligibility (example): The patient's eligibility for a vaccation program.


... fundingSource 0..1 CodeableConcept Funding source for the vaccine
Binding: ImmunizationFundingSource (example): The source of funding used to purchase the vaccine administered.

... reaction 0..* BackboneElement Details of a reaction that follows immunization
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... date 0..1 dateTime When reaction started
.... detail 0..1 Reference(Observation) Additional information on reaction
.... reported 0..1 boolean Indicates self-reported reaction
... Slices for protocolApplied S 1..* BackboneElement Protocol followed by the provider
Slice: Unordered, Open by type:authority
.... protocolApplied:All Slices Content/Rules for all slices
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... series 0..1 string Name of vaccine series
..... authority 0..1 Reference(Organization) Who is responsible for publishing the recommendations
..... targetDisease 0..* CodeableConcept Vaccine preventable disease being targeted
Binding: Vaccine Target Diseases - IPS (preferred): The particular disease or diseases against which the patient has been immunized.

Additional BindingsPurpose
Vaccine Target Diseases - SNOMED CT IPS Free Set candidate

..... doseNumber[x] 1..1 Dose number within series
...... doseNumberPositiveInt positiveInt
...... doseNumberString string
..... seriesDoses[x] 0..1 Recommended number of doses for immunity
...... seriesDosesPositiveInt positiveInt
...... seriesDosesString string
.... protocolApplied:protocolAppliedAuthority S 1..* BackboneElement Protocol followed by the provider
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... series 0..1 string Name of vaccine series
..... authority 0..1 Reference(DDCC Organization) Who is responsible for publishing the recommendations
..... targetDisease 0..* CodeableConcept Vaccine preventable disease being targeted
Binding: WHO Disease or Agent Targeted (COVID-19) (preferred)
Additional BindingsPurpose
Vaccine Target Diseases - SNOMED CT IPS Free Set candidate

..... doseNumber[x] S 1..1 positiveInt Dose number within series
..... seriesDoses[x] 0..1 positiveInt Recommended number of doses for immunity

doco Documentation for this format

Terminology Bindings

PathConformanceValueSetURI
Immunization.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
http://hl7.org/fhir/ValueSet/languages
from the FHIR Standard
Immunization.statusrequiredImmunizationStatusCodes
http://hl7.org/fhir/ValueSet/immunization-status|4.0.1
from the FHIR Standard
Immunization.statusReasonexampleImmunizationStatusReasonCodes
http://hl7.org/fhir/ValueSet/immunization-status-reason
from the FHIR Standard
Immunization.vaccineCodepreferredWHODDCCVaccinesCOVID19
http://smart.who.int/ddcc/ValueSet/WHODDCCVaccinesCOVID19
from this IG
Immunization.patient.typeextensibleResourceType
http://hl7.org/fhir/ValueSet/resource-types
from the FHIR Standard
Immunization.reportOriginexampleImmunizationOriginCodes
http://hl7.org/fhir/ValueSet/immunization-origin
from the FHIR Standard
Immunization.location.typeextensibleResourceType
http://hl7.org/fhir/ValueSet/resource-types
from the FHIR Standard
Immunization.sitepreferredSNOMEDCTBodyStructures
http://hl7.org/fhir/ValueSet/body-site
from the FHIR Standard
Immunization.routepreferredMedicineRouteOfAdministrationUvIps
http://hl7.org/fhir/uv/ips/ValueSet/medicine-route-of-administration
Immunization.performer.functionextensibleImmunizationFunctionCodes
http://hl7.org/fhir/ValueSet/immunization-function
from the FHIR Standard
Immunization.reasonCodeexampleImmunizationReasonCodes
http://hl7.org/fhir/ValueSet/immunization-reason
from the FHIR Standard
Immunization.subpotentReasonexampleImmunizationSubpotentReason
http://hl7.org/fhir/ValueSet/immunization-subpotent-reason
from the FHIR Standard
Immunization.programEligibilityexampleImmunizationProgramEligibility
http://hl7.org/fhir/ValueSet/immunization-program-eligibility
from the FHIR Standard
Immunization.fundingSourceexampleImmunizationFundingSource
http://hl7.org/fhir/ValueSet/immunization-funding-source
from the FHIR Standard
Immunization.protocolApplied.targetDiseasepreferredVaccineTargetDiseasesUvIps
http://hl7.org/fhir/uv/ips/ValueSet/target-diseases-uv-ips
Immunization.protocolApplied:protocolAppliedAuthority.targetDiseasepreferredWHODDCCDiseaseTargetedCOVID19
http://smart.who.int/ddcc/ValueSet/WHODDCCDiseaseTargetedCOVID19
from this IG

Constraints

IdGradePath(s)DetailsRequirements
dom-2errorImmunizationIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorImmunizationIf 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-4errorImmunizationIf 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-5errorImmunizationIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceImmunizationA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()
imm-1errorImmunization.educationOne of documentType or reference SHALL be present
: documentType.exists() or reference.exists()

 

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