MyHealtheVet PHR FHIR API
0.3.9-current - ci-build United States of America flag

MyHealtheVet PHR FHIR API, published by VA Digital Services. This guide is not an authorized publication; it is the continuous build for version 0.3.9-current built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/department-of-veterans-affairs/mhv-fhir-phr-mapping/ and changes regularly. See the Directory of published versions

Resource Profile: VA MHV PHR Immunization

Official URL: https://department-of-veterans-affairs.github.io/mhv-fhir-phr-mapping/StructureDefinition/VA.MHV.PHR.immunization Version: 0.3.9-current
Standards status: Trial-use Maturity Level: 4 Computable Name: MHVimmunization

A profile on the Immunization that declares how MHV will expose PHR immunization.

  • based on US-Core Immunization Resource profile
    • US-Core already requires: status, vaccineCode, patient, occurrence[x], primarySource
  • patient is a reference to this patient
  • status is completed or entered-in-error
  • primarySource is not populated as it is unknown
  • identifier will hold the record identifier from Vista
  • vaccineCode.text and
    • vaccineCode.coding may be a CPT coding
    • do not have any other codes available
  • note.text may have comments
  • reaction.detail may be a contained Observation with reaction detail
  • occurrenceDateTime when the immunization given
  • recorded may be the date/time the immunization was recorded
  • performer.actor may be a Practitioner administering (AP) the immunization
  • performer.actor may be an Organization for the VAMC
  • protocolApplied.series may be derived from the series
  • protocolApplied.doseNumberString may be the series
  • location may be the location where the immunization was given
  • if an immunization is removed (e.g. entered-in-error) it will no longer be returned on the API
  • no other elements are populated

Should search for entries that do not have status=entered-in-error (might also work to look for only completed)

GET {path}/Immunization?patient={patient}&status:not=entered-in-error

Usage:

Formal Views of Profile Content

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

This structure is derived from USCoreImmunizationProfile

NameFlagsCard.TypeDescription & Constraintsdoco
.. Immunization 0..* USCoreImmunizationProfile Immunization event information
... Slices for identifier S 1..* Identifier Business identifier
Slice: Unordered, Open by pattern:use
.... identifier:TOid 1..1 Identifier Business identifier
..... use 1..1 code usual | official | temp | secondary | old (If known)
Required Pattern: usual
..... system C 0..1 uri urn:oid:2.16.840.1.113883.4.349.4.{stationNbr}
TOid-startswithoid: ID system must start with urn:oid:2.16.840.1.113883.4.349.4. The next would be the {stationNbr}
..... value 0..1 string `ImmunizationTO` | `.` | {ImmunizationTO.id}
... status 1..1 code May indicate entered-in-error
... statusReason 0..0
... vaccineCode
.... coding
..... code 0..1 code Symbol in syntax defined by the system
..... display 0..1 string Representation defined by the system
.... text 1..1 string Plain text representation of the concept
... patient 1..1 Reference(US Core Patient Profile) Who was immunized
... encounter 0..0
... occurrence[x] 1..1 dateTime Vaccine administration date
... recorded S 0..1 dateTime When the immunization was first captured in the subject's record
... primarySource 1..1 boolean Indicates context the data was recorded in
.... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
..... dar 1..1 (Complex) unknown | asked | temp | notasked | masked | unsupported | astext | error
URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason
...... value[x] 1..1 code Value of extension
Required Pattern: unknown
... reportOrigin 0..0
... location S 0..1 Reference(VA MHV PHR Location | Location) {c} Where immunization occurred
.... display 0..0
... manufacturer 0..0
... lotNumber 0..0
... expirationDate 0..0
... site 0..0
... route 0..0
... doseQuantity 0..0
... Slices for performer S 0..* BackboneElement Who performed event
Slice: Unordered, Closed by pattern:function
.... performer:All Slices Content/Rules for all slices
..... function S 0..1 CodeableConcept What type of performance was done
..... actor 1..1 Reference(Practitioner | PractitionerRole | Organization) {c} Individual or organization who was performing
...... display 0..0
.... performer:AP 0..* BackboneElement Who performed event
..... function S 1..1 CodeableConcept What type of performance was done
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0443
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: AP
..... actor 1..1 Reference(VA MHV PHR Practitioner | Practitioner) {c} Individual or organization who was performing
.... performer:@default 0..* BackboneElement Who performed event
..... function S 0..0
..... actor 1..1 Reference(VA MHV PHR Organization | Organization) {c} Individual or organization who was performing
... note S 0..1 Annotation Additional immunization notes
.... text 1..1 markdown The annotation - text content (as markdown)
... reasonCode 0..0
... reasonReference 0..0
... isSubpotent 0..0
... education 0..0
... programEligibility 0..0
... fundingSource 0..0
... reaction
.... date 0..0
.... detail 0..1 Reference(VA MHV PHR Immunization Reaction | Observation) {c} Additional information on reaction
..... reference 0..1 string Literal reference, Relative, internal or absolute URL
..... identifier 0..0
..... display 0..0
.... reported 0..0
... protocolApplied S 0..* BackboneElement Protocol followed by the provider
.... series S 0..1 string Name of vaccine series
.... authority 0..0
.... targetDisease 0..0
.... Slices for doseNumber[x] 1..1 positiveInt, string Dose number within series
Slice: Unordered, Open by type:$this
..... doseNumber[x]:doseNumberString S 0..1 string Dose number within series
..... doseNumber[x]:doseNumberPositiveInt 0..0
.... seriesDoses[x] 0..0

doco Documentation for this format

Constraints

IdGradePath(s)DetailsRequirements
TOid-startswithoiderrorImmunization.identifier:TOid.systemID system must start with urn:oid:2.16.840.1.113883.4.349.4. The next would be the {stationNbr}
: value.startsWith('urn:oid:2.16.840.1.113883.4.349.4.')
NameFlagsCard.TypeDescription & Constraintsdoco
.. Immunization C 0..* USCoreImmunizationProfile Immunization event information
us-core-5: SHOULD have a translation to the NDC value set
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... Slices for identifier S 1..* Identifier Business identifier
Slice: Unordered, Open by pattern:use
.... identifier:TOid 1..1 Identifier Business identifier
..... use ?!Σ 1..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .


Required Pattern: usual
..... system ΣC 0..1 uri urn:oid:2.16.840.1.113883.4.349.4.{stationNbr}
TOid-startswithoid: ID system must start with urn:oid:2.16.840.1.113883.4.349.4. The next would be the {stationNbr}
Example General: http://www.acme.com/identifiers/patient
..... value Σ 0..1 string `ImmunizationTO` | `.` | {ImmunizationTO.id}
Example General: 123456
... status ?!SΣ 1..1 code May indicate entered-in-error
Binding: ImmunizationStatusCodes (required)
... vaccineCode SΣC 1..1 CodeableConcept Vaccine Product Type (bind to CVX)
Binding: CVX Vaccines Administered Vaccine Set . (extensible)
.... text Σ 1..1 string Plain text representation of the concept
... patient SΣ 1..1 Reference(US Core Patient Profile) Who was immunized
... occurrence[x] SΣ 1..1 dateTime Vaccine administration date
... recorded S 0..1 dateTime When the immunization was first captured in the subject's record
... primarySource SΣ 1..1 boolean Indicates context the data was recorded in
.... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
..... dar 1..1 (Complex) unknown | asked | temp | notasked | masked | unsupported | astext | error
URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason
...... extension 0..0
...... url 1..1 uri "http://hl7.org/fhir/StructureDefinition/data-absent-reason"
...... value[x] 1..1 code Value of extension
Binding: DataAbsentReason (required)
Required Pattern: unknown
... location S 0..1 Reference(VA MHV PHR Location | Location) {c} Where immunization occurred
... Slices for performer SΣ 0..* BackboneElement Who performed event
Slice: Unordered, Closed by pattern:function
.... performer:All Slices Content/Rules for all slices
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... function SΣ 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(Practitioner | PractitionerRole | Organization) {c} Individual or organization who was performing
.... performer:AP Σ 0..* BackboneElement Who performed event
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... function SΣ 1..1 CodeableConcept What type of performance was done
Binding: ImmunizationFunctionCodes (extensible): The role a practitioner or organization plays in the immunization event.


Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0443
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: AP
..... actor Σ 1..1 Reference(VA MHV PHR Practitioner | Practitioner) {c} Individual or organization who was performing
.... performer:@default Σ 0..* BackboneElement Who performed event
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... actor Σ 1..1 Reference(VA MHV PHR Organization | Organization) {c} Individual or organization who was performing
... note SΣ 0..1 Annotation Additional immunization notes
.... text Σ 1..1 markdown The annotation - text content (as markdown)
... protocolApplied S 0..* BackboneElement Protocol followed by the provider
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... series S 0..1 string Name of vaccine series
.... Slices for doseNumber[x] 1..1 Dose number within series
Slice: Unordered, Closed by type:$this
..... doseNumberPositiveInt positiveInt
..... doseNumberString string
..... doseNumber[x]:doseNumberString S 0..1 string Dose number within series

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
Immunization.identifier:TOid.userequiredPattern: usual
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
from the FHIR Standard
Immunization.statusrequiredImmunizationStatusCodes
http://hl7.org/fhir/ValueSet/immunization-status
from the FHIR Standard
Immunization.vaccineCodeextensibleCVX Vaccines Administered Vaccine Set .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1010.6
Immunization.primarySource.extension:dar.value[x]requiredPattern: unknown
http://hl7.org/fhir/ValueSet/data-absent-reason
from the FHIR Standard
Immunization.performer.functionextensibleImmunizationFunctionCodes
http://hl7.org/fhir/ValueSet/immunization-function
from the FHIR Standard
Immunization.performer:AP.functionextensiblePattern: AP
http://hl7.org/fhir/ValueSet/immunization-function
from the FHIR Standard

Constraints

IdGradePath(s)DetailsRequirements
TOid-startswithoiderrorImmunization.identifier:TOid.systemID system must start with urn:oid:2.16.840.1.113883.4.349.4. The next would be the {stationNbr}
: value.startsWith('urn:oid:2.16.840.1.113883.4.349.4.')
NameFlagsCard.TypeDescription & Constraintsdoco
.. Immunization C 0..* USCoreImmunizationProfile Immunization event information
us-core-5: SHOULD have a translation to the NDC value set
... 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
... extension 0..* Extension Additional content defined by implementations
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... Slices for identifier S 1..* Identifier Business identifier
Slice: Unordered, Open by pattern:use
.... identifier:TOid 1..1 Identifier Business identifier
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ 1..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .


Required Pattern: usual
..... type Σ 0..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

..... system ΣC 0..1 uri urn:oid:2.16.840.1.113883.4.349.4.{stationNbr}
TOid-startswithoid: ID system must start with urn:oid:2.16.840.1.113883.4.349.4. The next would be the {stationNbr}
Example General: http://www.acme.com/identifiers/patient
..... value Σ 0..1 string `ImmunizationTO` | `.` | {ImmunizationTO.id}
Example General: 123456
..... period Σ 0..1 Period Time period when id is/was valid for use
..... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
... status ?!SΣ 1..1 code May indicate entered-in-error
Binding: ImmunizationStatusCodes (required)
... vaccineCode SΣC 1..1 CodeableConcept Vaccine Product Type (bind to CVX)
Binding: CVX Vaccines Administered Vaccine Set . (extensible)
.... 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 Σ 0..* Coding 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 Σ 0..1 uri Identity of the terminology system
..... version Σ 0..1 string Version of the system - if relevant
..... code Σ 0..1 code Symbol in syntax defined by the system
..... display Σ 0..1 string Representation defined by the system
..... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
.... text Σ 1..1 string Plain text representation of the concept
... patient SΣ 1..1 Reference(US Core Patient Profile) Who was immunized
... occurrence[x] SΣ 1..1 dateTime S Vaccine administration date
... recorded S 0..1 dateTime When the immunization was first captured in the subject's record
... primarySource SΣ 1..1 boolean Indicates context the data was recorded in
.... id 0..1 string xml:id (or equivalent in JSON)
.... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
..... dar 1..1 (Complex) unknown | asked | temp | notasked | masked | unsupported | astext | error
URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason
...... id 0..1 id Unique id for inter-element referencing
...... extension 0..0
...... url 1..1 uri "http://hl7.org/fhir/StructureDefinition/data-absent-reason"
...... value[x] 1..1 code Value of extension
Binding: DataAbsentReason (required)
Required Pattern: unknown
.... value 0..1 boolean Primitive value for boolean
... location S 0..1 Reference(VA MHV PHR Location | Location) {c} 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
... Slices for performer SΣ 0..* BackboneElement Who performed event
Slice: Unordered, Closed by pattern:function
.... performer: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
..... function SΣ 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(Practitioner | PractitionerRole | Organization) {c} Individual or organization who was performing
...... 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
.... performer:AP 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 SΣ 1..1 CodeableConcept What type of performance was done
Binding: ImmunizationFunctionCodes (extensible): The role a practitioner or organization plays in the immunization event.


Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0443
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: AP
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... actor Σ 1..1 Reference(VA MHV PHR Practitioner | Practitioner) {c} Individual or organization who was performing
.... performer:@default 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
..... actor Σ 1..1 Reference(VA MHV PHR Organization | Organization) {c} Individual or organization who was performing
... note SΣ 0..1 Annotation Additional immunization notes
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... author[x] Σ 0..1 Individual responsible for the annotation
..... authorReference Reference(Practitioner | Patient | RelatedPerson | Organization)
..... authorString string
.... time Σ 0..1 dateTime When the annotation was made
.... text Σ 1..1 markdown The annotation - text content (as markdown)
... subpotentReason 0..* CodeableConcept Reason for being subpotent
Binding: ImmunizationSubpotentReason (example): The reason why a dose is considered to be subpotent.


... 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
.... detail 0..1 Reference(VA MHV PHR Immunization Reaction | Observation) {c} Additional information on reaction
..... 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).

... protocolApplied S 0..* 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 S 0..1 string Name of vaccine series
.... Slices for doseNumber[x] 1..1 Dose number within series
Slice: Unordered, Closed by type:$this
..... doseNumberPositiveInt positiveInt
..... doseNumberString string
..... doseNumber[x]:doseNumberString S 0..1 string Dose number within series

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
Immunization.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
http://hl7.org/fhir/ValueSet/languages
from the FHIR Standard
Immunization.identifier:TOid.userequiredPattern: usual
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
from the FHIR Standard
Immunization.identifier:TOid.typeextensibleIdentifier Type Codes
http://hl7.org/fhir/ValueSet/identifier-type
from the FHIR Standard
Immunization.statusrequiredImmunizationStatusCodes
http://hl7.org/fhir/ValueSet/immunization-status
from the FHIR Standard
Immunization.vaccineCodeextensibleCVX Vaccines Administered Vaccine Set .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1010.6
Immunization.primarySource.extension:dar.value[x]requiredPattern: unknown
http://hl7.org/fhir/ValueSet/data-absent-reason
from the FHIR Standard
Immunization.location.typeextensibleResourceType
http://hl7.org/fhir/ValueSet/resource-types
from the FHIR Standard
Immunization.performer.functionextensibleImmunizationFunctionCodes
http://hl7.org/fhir/ValueSet/immunization-function
from the FHIR Standard
Immunization.performer.actor.typeextensibleResourceType
http://hl7.org/fhir/ValueSet/resource-types
from the FHIR Standard
Immunization.performer:AP.functionextensiblePattern: AP
http://hl7.org/fhir/ValueSet/immunization-function
from the FHIR Standard
Immunization.subpotentReasonexampleImmunizationSubpotentReason
http://hl7.org/fhir/ValueSet/immunization-subpotent-reason
from the FHIR Standard
Immunization.reaction.detail.typeextensibleResourceType
http://hl7.org/fhir/ValueSet/resource-types
from the FHIR Standard

Constraints

IdGradePath(s)DetailsRequirements
TOid-startswithoiderrorImmunization.identifier:TOid.systemID system must start with urn:oid:2.16.840.1.113883.4.349.4. The next would be the {stationNbr}
: value.startsWith('urn:oid:2.16.840.1.113883.4.349.4.')

This structure is derived from USCoreImmunizationProfile

Summary

Mandatory: 6 elements(1 nested mandatory element)
Must-Support: 11 elements
Prohibited: 26 elements

Structures

This structure refers to these other structures:

Extensions

This structure refers to these extensions:

Slices

This structure defines the following Slices:

  • The element 1 is sliced based on the value of Immunization.identifier
  • The element 1 is sliced based on the value of Immunization.performer (Closed)
  • The element 1 is sliced based on the value of Immunization.protocolApplied.doseNumber[x]

Maturity: 4

Differential View

This structure is derived from USCoreImmunizationProfile

NameFlagsCard.TypeDescription & Constraintsdoco
.. Immunization 0..* USCoreImmunizationProfile Immunization event information
... Slices for identifier S 1..* Identifier Business identifier
Slice: Unordered, Open by pattern:use
.... identifier:TOid 1..1 Identifier Business identifier
..... use 1..1 code usual | official | temp | secondary | old (If known)
Required Pattern: usual
..... system C 0..1 uri urn:oid:2.16.840.1.113883.4.349.4.{stationNbr}
TOid-startswithoid: ID system must start with urn:oid:2.16.840.1.113883.4.349.4. The next would be the {stationNbr}
..... value 0..1 string `ImmunizationTO` | `.` | {ImmunizationTO.id}
... status 1..1 code May indicate entered-in-error
... statusReason 0..0
... vaccineCode
.... coding
..... code 0..1 code Symbol in syntax defined by the system
..... display 0..1 string Representation defined by the system
.... text 1..1 string Plain text representation of the concept
... patient 1..1 Reference(US Core Patient Profile) Who was immunized
... encounter 0..0
... occurrence[x] 1..1 dateTime Vaccine administration date
... recorded S 0..1 dateTime When the immunization was first captured in the subject's record
... primarySource 1..1 boolean Indicates context the data was recorded in
.... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
..... dar 1..1 (Complex) unknown | asked | temp | notasked | masked | unsupported | astext | error
URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason
...... value[x] 1..1 code Value of extension
Required Pattern: unknown
... reportOrigin 0..0
... location S 0..1 Reference(VA MHV PHR Location | Location) {c} Where immunization occurred
.... display 0..0
... manufacturer 0..0
... lotNumber 0..0
... expirationDate 0..0
... site 0..0
... route 0..0
... doseQuantity 0..0
... Slices for performer S 0..* BackboneElement Who performed event
Slice: Unordered, Closed by pattern:function
.... performer:All Slices Content/Rules for all slices
..... function S 0..1 CodeableConcept What type of performance was done
..... actor 1..1 Reference(Practitioner | PractitionerRole | Organization) {c} Individual or organization who was performing
...... display 0..0
.... performer:AP 0..* BackboneElement Who performed event
..... function S 1..1 CodeableConcept What type of performance was done
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0443
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: AP
..... actor 1..1 Reference(VA MHV PHR Practitioner | Practitioner) {c} Individual or organization who was performing
.... performer:@default 0..* BackboneElement Who performed event
..... function S 0..0
..... actor 1..1 Reference(VA MHV PHR Organization | Organization) {c} Individual or organization who was performing
... note S 0..1 Annotation Additional immunization notes
.... text 1..1 markdown The annotation - text content (as markdown)
... reasonCode 0..0
... reasonReference 0..0
... isSubpotent 0..0
... education 0..0
... programEligibility 0..0
... fundingSource 0..0
... reaction
.... date 0..0
.... detail 0..1 Reference(VA MHV PHR Immunization Reaction | Observation) {c} Additional information on reaction
..... reference 0..1 string Literal reference, Relative, internal or absolute URL
..... identifier 0..0
..... display 0..0
.... reported 0..0
... protocolApplied S 0..* BackboneElement Protocol followed by the provider
.... series S 0..1 string Name of vaccine series
.... authority 0..0
.... targetDisease 0..0
.... Slices for doseNumber[x] 1..1 positiveInt, string Dose number within series
Slice: Unordered, Open by type:$this
..... doseNumber[x]:doseNumberString S 0..1 string Dose number within series
..... doseNumber[x]:doseNumberPositiveInt 0..0
.... seriesDoses[x] 0..0

doco Documentation for this format

Constraints

IdGradePath(s)DetailsRequirements
TOid-startswithoiderrorImmunization.identifier:TOid.systemID system must start with urn:oid:2.16.840.1.113883.4.349.4. The next would be the {stationNbr}
: value.startsWith('urn:oid:2.16.840.1.113883.4.349.4.')

Key Elements View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Immunization C 0..* USCoreImmunizationProfile Immunization event information
us-core-5: SHOULD have a translation to the NDC value set
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... Slices for identifier S 1..* Identifier Business identifier
Slice: Unordered, Open by pattern:use
.... identifier:TOid 1..1 Identifier Business identifier
..... use ?!Σ 1..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .


Required Pattern: usual
..... system ΣC 0..1 uri urn:oid:2.16.840.1.113883.4.349.4.{stationNbr}
TOid-startswithoid: ID system must start with urn:oid:2.16.840.1.113883.4.349.4. The next would be the {stationNbr}
Example General: http://www.acme.com/identifiers/patient
..... value Σ 0..1 string `ImmunizationTO` | `.` | {ImmunizationTO.id}
Example General: 123456
... status ?!SΣ 1..1 code May indicate entered-in-error
Binding: ImmunizationStatusCodes (required)
... vaccineCode SΣC 1..1 CodeableConcept Vaccine Product Type (bind to CVX)
Binding: CVX Vaccines Administered Vaccine Set . (extensible)
.... text Σ 1..1 string Plain text representation of the concept
... patient SΣ 1..1 Reference(US Core Patient Profile) Who was immunized
... occurrence[x] SΣ 1..1 dateTime Vaccine administration date
... recorded S 0..1 dateTime When the immunization was first captured in the subject's record
... primarySource SΣ 1..1 boolean Indicates context the data was recorded in
.... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
..... dar 1..1 (Complex) unknown | asked | temp | notasked | masked | unsupported | astext | error
URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason
...... extension 0..0
...... url 1..1 uri "http://hl7.org/fhir/StructureDefinition/data-absent-reason"
...... value[x] 1..1 code Value of extension
Binding: DataAbsentReason (required)
Required Pattern: unknown
... location S 0..1 Reference(VA MHV PHR Location | Location) {c} Where immunization occurred
... Slices for performer SΣ 0..* BackboneElement Who performed event
Slice: Unordered, Closed by pattern:function
.... performer:All Slices Content/Rules for all slices
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... function SΣ 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(Practitioner | PractitionerRole | Organization) {c} Individual or organization who was performing
.... performer:AP Σ 0..* BackboneElement Who performed event
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... function SΣ 1..1 CodeableConcept What type of performance was done
Binding: ImmunizationFunctionCodes (extensible): The role a practitioner or organization plays in the immunization event.


Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0443
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: AP
..... actor Σ 1..1 Reference(VA MHV PHR Practitioner | Practitioner) {c} Individual or organization who was performing
.... performer:@default Σ 0..* BackboneElement Who performed event
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... actor Σ 1..1 Reference(VA MHV PHR Organization | Organization) {c} Individual or organization who was performing
... note SΣ 0..1 Annotation Additional immunization notes
.... text Σ 1..1 markdown The annotation - text content (as markdown)
... protocolApplied S 0..* BackboneElement Protocol followed by the provider
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... series S 0..1 string Name of vaccine series
.... Slices for doseNumber[x] 1..1 Dose number within series
Slice: Unordered, Closed by type:$this
..... doseNumberPositiveInt positiveInt
..... doseNumberString string
..... doseNumber[x]:doseNumberString S 0..1 string Dose number within series

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
Immunization.identifier:TOid.userequiredPattern: usual
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
from the FHIR Standard
Immunization.statusrequiredImmunizationStatusCodes
http://hl7.org/fhir/ValueSet/immunization-status
from the FHIR Standard
Immunization.vaccineCodeextensibleCVX Vaccines Administered Vaccine Set .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1010.6
Immunization.primarySource.extension:dar.value[x]requiredPattern: unknown
http://hl7.org/fhir/ValueSet/data-absent-reason
from the FHIR Standard
Immunization.performer.functionextensibleImmunizationFunctionCodes
http://hl7.org/fhir/ValueSet/immunization-function
from the FHIR Standard
Immunization.performer:AP.functionextensiblePattern: AP
http://hl7.org/fhir/ValueSet/immunization-function
from the FHIR Standard

Constraints

IdGradePath(s)DetailsRequirements
TOid-startswithoiderrorImmunization.identifier:TOid.systemID system must start with urn:oid:2.16.840.1.113883.4.349.4. The next would be the {stationNbr}
: value.startsWith('urn:oid:2.16.840.1.113883.4.349.4.')

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Immunization C 0..* USCoreImmunizationProfile Immunization event information
us-core-5: SHOULD have a translation to the NDC value set
... 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
... extension 0..* Extension Additional content defined by implementations
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... Slices for identifier S 1..* Identifier Business identifier
Slice: Unordered, Open by pattern:use
.... identifier:TOid 1..1 Identifier Business identifier
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ 1..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .


Required Pattern: usual
..... type Σ 0..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

..... system ΣC 0..1 uri urn:oid:2.16.840.1.113883.4.349.4.{stationNbr}
TOid-startswithoid: ID system must start with urn:oid:2.16.840.1.113883.4.349.4. The next would be the {stationNbr}
Example General: http://www.acme.com/identifiers/patient
..... value Σ 0..1 string `ImmunizationTO` | `.` | {ImmunizationTO.id}
Example General: 123456
..... period Σ 0..1 Period Time period when id is/was valid for use
..... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
... status ?!SΣ 1..1 code May indicate entered-in-error
Binding: ImmunizationStatusCodes (required)
... vaccineCode SΣC 1..1 CodeableConcept Vaccine Product Type (bind to CVX)
Binding: CVX Vaccines Administered Vaccine Set . (extensible)
.... 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 Σ 0..* Coding 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 Σ 0..1 uri Identity of the terminology system
..... version Σ 0..1 string Version of the system - if relevant
..... code Σ 0..1 code Symbol in syntax defined by the system
..... display Σ 0..1 string Representation defined by the system
..... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
.... text Σ 1..1 string Plain text representation of the concept
... patient SΣ 1..1 Reference(US Core Patient Profile) Who was immunized
... occurrence[x] SΣ 1..1 dateTime S Vaccine administration date
... recorded S 0..1 dateTime When the immunization was first captured in the subject's record
... primarySource SΣ 1..1 boolean Indicates context the data was recorded in
.... id 0..1 string xml:id (or equivalent in JSON)
.... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
..... dar 1..1 (Complex) unknown | asked | temp | notasked | masked | unsupported | astext | error
URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason
...... id 0..1 id Unique id for inter-element referencing
...... extension 0..0
...... url 1..1 uri "http://hl7.org/fhir/StructureDefinition/data-absent-reason"
...... value[x] 1..1 code Value of extension
Binding: DataAbsentReason (required)
Required Pattern: unknown
.... value 0..1 boolean Primitive value for boolean
... location S 0..1 Reference(VA MHV PHR Location | Location) {c} 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
... Slices for performer SΣ 0..* BackboneElement Who performed event
Slice: Unordered, Closed by pattern:function
.... performer: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
..... function SΣ 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(Practitioner | PractitionerRole | Organization) {c} Individual or organization who was performing
...... 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
.... performer:AP 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 SΣ 1..1 CodeableConcept What type of performance was done
Binding: ImmunizationFunctionCodes (extensible): The role a practitioner or organization plays in the immunization event.


Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0443
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: AP
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... actor Σ 1..1 Reference(VA MHV PHR Practitioner | Practitioner) {c} Individual or organization who was performing
.... performer:@default 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
..... actor Σ 1..1 Reference(VA MHV PHR Organization | Organization) {c} Individual or organization who was performing
... note SΣ 0..1 Annotation Additional immunization notes
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... author[x] Σ 0..1 Individual responsible for the annotation
..... authorReference Reference(Practitioner | Patient | RelatedPerson | Organization)
..... authorString string
.... time Σ 0..1 dateTime When the annotation was made
.... text Σ 1..1 markdown The annotation - text content (as markdown)
... subpotentReason 0..* CodeableConcept Reason for being subpotent
Binding: ImmunizationSubpotentReason (example): The reason why a dose is considered to be subpotent.


... 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
.... detail 0..1 Reference(VA MHV PHR Immunization Reaction | Observation) {c} Additional information on reaction
..... 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).

... protocolApplied S 0..* 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 S 0..1 string Name of vaccine series
.... Slices for doseNumber[x] 1..1 Dose number within series
Slice: Unordered, Closed by type:$this
..... doseNumberPositiveInt positiveInt
..... doseNumberString string
..... doseNumber[x]:doseNumberString S 0..1 string Dose number within series

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
Immunization.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
http://hl7.org/fhir/ValueSet/languages
from the FHIR Standard
Immunization.identifier:TOid.userequiredPattern: usual
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
from the FHIR Standard
Immunization.identifier:TOid.typeextensibleIdentifier Type Codes
http://hl7.org/fhir/ValueSet/identifier-type
from the FHIR Standard
Immunization.statusrequiredImmunizationStatusCodes
http://hl7.org/fhir/ValueSet/immunization-status
from the FHIR Standard
Immunization.vaccineCodeextensibleCVX Vaccines Administered Vaccine Set .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1010.6
Immunization.primarySource.extension:dar.value[x]requiredPattern: unknown
http://hl7.org/fhir/ValueSet/data-absent-reason
from the FHIR Standard
Immunization.location.typeextensibleResourceType
http://hl7.org/fhir/ValueSet/resource-types
from the FHIR Standard
Immunization.performer.functionextensibleImmunizationFunctionCodes
http://hl7.org/fhir/ValueSet/immunization-function
from the FHIR Standard
Immunization.performer.actor.typeextensibleResourceType
http://hl7.org/fhir/ValueSet/resource-types
from the FHIR Standard
Immunization.performer:AP.functionextensiblePattern: AP
http://hl7.org/fhir/ValueSet/immunization-function
from the FHIR Standard
Immunization.subpotentReasonexampleImmunizationSubpotentReason
http://hl7.org/fhir/ValueSet/immunization-subpotent-reason
from the FHIR Standard
Immunization.reaction.detail.typeextensibleResourceType
http://hl7.org/fhir/ValueSet/resource-types
from the FHIR Standard

Constraints

IdGradePath(s)DetailsRequirements
TOid-startswithoiderrorImmunization.identifier:TOid.systemID system must start with urn:oid:2.16.840.1.113883.4.349.4. The next would be the {stationNbr}
: value.startsWith('urn:oid:2.16.840.1.113883.4.349.4.')

This structure is derived from USCoreImmunizationProfile

Summary

Mandatory: 6 elements(1 nested mandatory element)
Must-Support: 11 elements
Prohibited: 26 elements

Structures

This structure refers to these other structures:

Extensions

This structure refers to these extensions:

Slices

This structure defines the following Slices:

  • The element 1 is sliced based on the value of Immunization.identifier
  • The element 1 is sliced based on the value of Immunization.performer (Closed)
  • The element 1 is sliced based on the value of Immunization.protocolApplied.doseNumber[x]

Maturity: 4

 

Other representations of profile: CSV, Excel, Schematron

Notes:

  • The mock example
  • maps to ImmunizationTO schema.
  • Mapping from ImmunizationTO
  • Vivian Immunization
  • Derived off of US-Core Immunization
    • US-Core already requires: status, vaccineCode, patient, occurrence[x], primarySource
  • should have meta.profile set to https://department-of-veterans-affairs.github.io/mhv-fhir-phr-mapping/StructureDefinition/VA.MHV.PHR.immunization to indicate the intent to be compliant with this profile
  • must have identifier as cross reference to original source
  • US-Core requires that this be populated, but we don't get this details
    • Given that the field is not used by UX, it does not matter what the value is
    • do not populate, but add to the element the Data Absent Reason extension
  • any reaction is recorded as a contained Observation. This Observation is simply
    • status of final
    • code.text from ImmunizationTo.reaction
    • valueCodeableConcept of SNOMED#401515003 Known present
    • see Immunization Reaction Profile of Observation
    • note that va.gov has been directed to now show reaction. The reason is that this is not available in Vista for clinician use anymore.
  • status will be completed for those we receive from VIA,
  • contraindicated - '1' for Yes (do not repeat this vaccine), '0' for no (okay to use in the future)
    • KBS indicates that there is a very small fragment that have this set.
    • KBS discussion, we will follow the definition of the element. Meaning we presume tha the immunization was given. This could be recorded as a FHIR Immunization with .status=not-done.
      • Thus we ignore this element.
    • Some in KBS discussion were pointing out that medically something contraindicated would not be executed. But this understanding does not seem to align with recording an Immunization and indicating contraindicated, but would be recorded as a stopping of the order to give immunization.
  • Not mapped due to lack of clarity on what the value is and if it will ever be populated
    • shortName
    • encounterProvider
    • orderingProvider
  • Based on experimentation, VIA does not provide the following even if they are populated in vista
    • site
    • lotNumber
    • administrator
    • orderedBy
    • manufacture
  • Updates
    • VIA hides deleted, or removed immunizations (proven with experimentation)
    • Thus we will be using Update-and-Expunge
  • series - series of the immunization type was given to the patient
    • see table below for how to set .protocolApplied.series
    • single character series into .protocolApplied.doseNumberString
    • note not using doseNumberPositiveInt as this element is removed in future versions of FHIR so it seems string is more future proof

Table: series, VIA converts the series code to the string defined in Vista

code text
P PARTIALLY COMPLETE
C COMPLETE
B BOOSTER
1 SERIES 1
2 SERIES 2
3 SERIES 3
4 SERIES 4
5 SERIES 5
6 SERIES 6
7 SERIES 7
8 SERIES 8

Table: reaction VIA converts the reaction number found in Vista to the text string defined Vista:

num text potential SNOMED
1 FEVER 38666106
2 IRRITABILITY 55929007
3 LOCAL REACTION OR SWELLING  
4 VOMITING 422400008
5 RASH OR ITCHING  
6 LETHARGY 214264003
7 CONVULSIONS 91175000
8 ARTHRITIS OR ARTHRALGIAS  
9 ANAPHYLAXIS OR COLLAPSE  
10 RESPIRATORY DISTRESS 271825005
11 OTHER  
0 NONE  

Note will NOT be using the SNOMED conversion as it is only partial and may not be perfect. So just using text.

Mapping Concerns

  • codes for protocolApplied.series and translation of series to a code for protocolApplied – TODO Leaf 62
    • not a priority as current text is sufficient for now.
  • codes for reaction – TODO Leaf 60
    • not a priority as current text is sufficient for now.
    • some of the codes can be mapped, but others are multiple things in an OR relationship
    • If the reaction is "NONE", then we should record a contained Observation indicating no reaction. MHV-54039 – TODO Leaf 59

changes needed

none known