Immunization

Defines the ID Core constraints and extensions on the Immunization resource for the minimal set of data to query and retrieve an individual’s immunisation information.

Usage

This profile is intended to cover the recording of current and historical administration of vaccines to individuals across all healthcare disciplines in all care settings and all regions. This profile does not support the administration of non-vaccine agents, even those that may have or claim to have immunological effects. While the terms "immunisation" and "vaccination" are not clinically identical, for the purposes of the FHIR profile, the terms are used synonymously.

URL

Type URL
Canonical https://fhir.kemkes.go.id/r4/StructureDefinition/Immunization

Structure

Snapshot

identifier0..*Identifier
statusΣ ?!1..1codeBinding
statusReason0..1CodeableConcept
vaccineCodeΣ1..1CodeableConcept
patientΣ I1..1Reference(Patient)
encounterI0..1Reference(Encounter)
occurrenceDateTimedateTime
occurrenceStringstring
recorded0..1dateTime
primarySourceΣ0..1boolean
reportOrigin0..1CodeableConcept
locationI0..1Reference(Location)
manufacturerI0..1Reference(Organization)
lotNumber0..1string
expirationDate0..1date
site0..1CodeableConcept
route0..1CodeableConcept
doseQuantityI0..1SimpleQuantity
functionΣ0..1CodeableConceptBinding
actorΣ I1..1Reference(Practitioner | PractitionerRole | Organization)
noteΣ0..*Annotation
reasonCode0..*CodeableConcept
reasonReferenceI0..*Reference(Condition | Observation | DiagnosticReport)
isSubpotentΣ ?!0..1boolean
subpotentReason0..*CodeableConcept
documentType0..1string
reference0..1uri
publicationDate0..1dateTime
presentationDate0..1dateTime
programEligibility0..*CodeableConcept
fundingSource0..1CodeableConcept
date0..1dateTime
detailI0..1Reference(Observation)
reported0..1boolean
series0..1string
authorityI0..1Reference(Organization)
targetDisease0..*CodeableConcept
doseNumberPositiveIntpositiveInt
doseNumberStringstring
seriesDosesPositiveIntpositiveInt
seriesDosesStringstring

Examples

Dictionary

Immunization
DefinitionDescribes the event of a patient being administered a vaccine or a record of an immunization as reported by a patient, a clinician or another party.
Cardinality0...*
Invariants
  • dom-2:If the resource is contained in another resource, it SHALL NOT contain nested Resources
    contained.contained.empty()
  • dom-4:If 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-3:If 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-6:A resource should have narrative for robust management
    text.`div`.exists()
  • dom-5:If a resource is contained in another resource, it SHALL NOT have a security label
    contained.meta.security.empty()
Mappings
  • rim:Entity. Role, or Act
  • workflow:Event
  • v2:VXU_V04
  • rim:SubstanceAdministration
Immunization.id
DefinitionThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Cardinality0...1
TypeSystem.String
SummaryTrue
Comments

The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

Immunization.meta
DefinitionThe metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
Cardinality0...1
TypeMeta
SummaryTrue
Invariants
  • ele-1:All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim:n/a
  • rim:N/A
Immunization.implicitRules
DefinitionA reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Cardinality0...1
Typeuri
ModifierTrue
SummaryTrue
Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

Invariants
  • ele-1:All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim:n/a
Immunization.language
DefinitionThe base language in which the resource is written.
Cardinality0...1
Typecode
Binding

A human language.

CommonLanguages (preferred)
Comments

Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

Invariants
  • ele-1:All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim:n/a
Immunization.text
DefinitionA human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
Cardinality0...1
TypeNarrative
Aliasnarrative, html, xhtml, display
Comments

Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.

Invariants
  • ele-1:All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim:n/a
  • rim:N/A
  • rim:Act.text?
Immunization.contained
DefinitionThese resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
Cardinality0...*
TypeResource
Aliasinline resources, anonymous resources, contained resources
Comments

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

Mappings
  • rim:Entity. Role, or Act
  • rim:N/A
Immunization.extension
DefinitionMay be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1:All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1:Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim:n/a
  • rim:N/A
Immunization.modifierExtension
DefinitionMay be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
Aliasextensions, user content
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1:All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1:Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim:n/a
  • rim:N/A
Immunization.identifier
DefinitionA unique identifier assigned to this immunization record.
Cardinality0...*
TypeIdentifier
Invariants
  • ele-1:All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim:n/a
  • v2:CX / EI (occasionally, more often EI maps to a resource id or a URL)
  • rim:II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
  • servd:Identifier
  • workflow:Event.identifier
  • w5:FiveWs.identifier
  • rim:.id
  • cda:ClinicalDocument/component/StructuredBody/component/section/entry/substanceAdministration/id
Immunization.status
DefinitionIndicates the current status of the immunization event.
Cardinality1...1
Typecode
Binding

A set of codes indicating the current status of an Immunization.

ImmunizationStatusCodes (required)
ModifierTrue
SummaryTrue
Comments

Will generally be set to show that the immunization has been completed or not done. This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

Invariants
  • ele-1:All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim:n/a
  • workflow:Event.status
  • w5:FiveWs.status
  • rim:statusCode
Immunization.statusReason
DefinitionIndicates the reason the immunization event was not performed.
Cardinality0...1
TypeCodeableConcept
Binding

The reason why a vaccine was not administered.

ImmunizationStatusReasonCodes (example)
Comments

This is generally only used for the status of "not-done". The reason for performing the immunization event is captured in reasonCode, not here.

Invariants
  • ele-1:All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim:n/a
  • v2:CE/CNE/CWE
  • rim:CD
  • orim:fhir:CodeableConcept rdfs:subClassOf dt:CD
  • workflow:Event.statusReason
  • rim:.inboundRelationship[typeCode=SUBJ].source[classCode=CACT, moodCode=EVN].reasonCOde
Immunization.vaccineCode
DefinitionVaccine that was administered or was to be administered.
Cardinality1...1
TypeCodeableConcept
Binding

The code for vaccine product administered.

VaccineAdministeredValueSet (example)
SummaryTrue
Comments

Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

Invariants
  • ele-1:All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim:n/a
  • v2:CE/CNE/CWE
  • rim:CD
  • orim:fhir:CodeableConcept rdfs:subClassOf dt:CD
  • workflow:Event.code
  • w5:FiveWs.what[x]
  • v2:RXA-5
  • rim:.code
  • cda:ClinicalDocument/component/StructuredBody/component/section/entry/substanceAdministration/consumable/manfacturedProduct/manufacturedMaterial/realmCode/code
Immunization.patient
DefinitionThe patient who either received or did not receive the immunization.
Cardinality1...1
TypeReference(Patient)
SummaryTrue
Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1:All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1:SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim:n/a
  • rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow:Event.subject
  • w5:FiveWs.subject[x]
  • v2:PID-3
  • rim:.partipication[ttypeCode=].role
  • w5:FiveWs.subject
Immunization.encounter
DefinitionThe visit or admission or other contact between patient and health care provider the immunization was performed as part of.
Cardinality0...1
TypeReference(Encounter)
Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1:All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1:SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim:n/a
  • rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow:Event.context
  • w5:FiveWs.context
  • v2:PV1-19
  • rim:component->EncounterEvent
Immunization.occurrence[x]
DefinitionDate vaccine administered or was to be administered.
Cardinality1...1
TypedateTime
SummaryTrue
Comments

When immunizations are given a specific date and time should always be known. When immunizations are patient reported, a specific date might not be known. Although partial dates are allowed, an adult patient might not be able to recall the year a childhood immunization was given. An exact date is always preferable, but the use of the String data type is acceptable when an exact date is not known. A small number of vaccines (e.g. live oral typhoid vaccine) are given as a series of patient self-administered dose over a span of time. In cases like this, often, only the first dose (typically a provider supervised dose) is recorded with the occurrence indicating the date/time of the first dose.

Invariants
  • ele-1:All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim:n/a
  • workflow:Event.occurrence[x]
  • w5:FiveWs.done[x]
  • v2:RXA-3
  • rim:.effectiveTime
  • cda:ClinicalDocument/component/StructuredBody/component/section/entry/substanceAdministration/effectiveTime/value
Immunization.recorded
DefinitionThe date the occurrence of the immunization was first captured in the record - potentially significantly after the occurrence of the event.
Cardinality0...1
TypedateTime
Invariants
  • ele-1:All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim:n/a
  • w5:FiveWs.recorded
  • rim:.participation[typeCode=AUT].time
Immunization.primarySource
DefinitionAn indication that the content of the record is based on information from the person who administered the vaccine. This reflects the context under which the data was originally recorded.
Cardinality0...1
Typeboolean
SummaryTrue
Comments

Reflects the “reliability” of the content.

Invariants
  • ele-1:All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim:n/a
  • w5:FiveWs.source
  • v2:RXA-9
  • rim:immunization.uncertaintycode (if primary source=false, uncertainty=U)
Immunization.reportOrigin
DefinitionThe source of the data when the report of the immunization event is not based on information from the person who administered the vaccine.
Cardinality0...1
TypeCodeableConcept
Binding

The source of the data for a record which is not from a primary source.

ImmunizationOriginCodes (example)
Comments

Should not be populated if primarySource = True, not required even if primarySource = False.

Invariants
  • ele-1:All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim:n/a
  • v2:CE/CNE/CWE
  • rim:CD
  • orim:fhir:CodeableConcept rdfs:subClassOf dt:CD
  • w5:FiveWs.source
  • v2:RXA-9
  • rim:.participation[typeCode=INF].role[classCode=PAT] (this syntax for self-reported) .participation[typeCode=INF].role[classCode=LIC] (this syntax for health care professional) .participation[typeCode=INF].role[classCode=PRS] (this syntax for family member)
Immunization.location
DefinitionThe service delivery location where the vaccine administration occurred.
Cardinality0...1
TypeReference(Location)
Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1:All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1:SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim:n/a
  • rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow:Event.location
  • w5:FiveWs.where[x]
  • v2:RXA-27 (or RXA-11, deprecated as of v2.7)
  • rim:.participation[typeCode=LOC].COCT_MT240000UV
Immunization.manufacturer
DefinitionName of vaccine manufacturer.
Cardinality0...1
TypeReference(Organization)
Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1:All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1:SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim:n/a
  • rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • v2:RXA-17
  • rim:.participation[typeCode=CSM].role[classCode=INST].scopedRole.scoper[classCode=ORG]
  • cda:ClinicalDocument/component/StructuredBody/component/section/entry/substanceAdministration/consumable/manfacturedProduct/manufacuturerOrganization/name
Immunization.lotNumber
DefinitionLot number of the vaccine product.
Cardinality0...1
Typestring
Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Invariants
  • ele-1:All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim:n/a
  • v2:RXA-15
  • rim:.participation[typeCode=CSM].role[classCode=INST].scopedRole.scoper[classCode=MMAT].id
  • cda:ClinicalDocument/component/StructuredBody/component/section/entry/substanceAdministration/consumable/manfacturedProduct/manufacturedMaterial/lotNumberText
Immunization.expirationDate
DefinitionDate vaccine batch expires.
Cardinality0...1
Typedate
Invariants
  • ele-1:All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim:n/a
  • v2:RXA-16
  • rim:.participation[typeCode=CSM].role[classCode=INST].scopedRole.scoper[classCode=MMAT].expirationTime
Immunization.site
DefinitionBody site where vaccine was administered.
Cardinality0...1
TypeCodeableConcept
Binding

The site at which the vaccine was administered.

CodesForImmunizationSiteOfAdministration (example)
Comments

Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

Invariants
  • ele-1:All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim:n/a
  • v2:CE/CNE/CWE
  • rim:CD
  • orim:fhir:CodeableConcept rdfs:subClassOf dt:CD
  • v2:RXR-2
  • rim:observation.targetSiteCode
  • cda:ClinicalDocument/component/StructuredBody/component/section/entry/substanceAdministration/approachSiteCode/code
Immunization.route
DefinitionThe path by which the vaccine product is taken into the body.
Cardinality0...1
TypeCodeableConcept
Binding

The route by which the vaccine was administered.

ImmunizationRouteCodes (example)
Comments

Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

Invariants
  • ele-1:All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim:n/a
  • v2:CE/CNE/CWE
  • rim:CD
  • orim:fhir:CodeableConcept rdfs:subClassOf dt:CD
  • v2:RXR-1
  • rim:.routeCode
  • cda:ClinicalDocument/component/StructuredBody/component/section/entry/substanceAdministration/routeCode/code
Immunization.doseQuantity
DefinitionThe quantity of vaccine product that was administered.
Cardinality0...1
TypeSimpleQuantity
Comments

The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.

Invariants
  • ele-1:All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • qty-3:If a code for the unit is present, the system SHALL also be present
    code.empty() or system.exists()
  • sqty-1:The comparator is not used on a SimpleQuantity
    comparator.empty()
Mappings
  • rim:n/a
  • v2:SN (see also Range) or CQ
  • rim:PQ, IVL<PQ>, MO, CO, depending on the values
  • v2:RXA-6 / RXA-7
  • rim:.doseQuantity
Immunization.performer
DefinitionIndicates who performed the immunization event.
Cardinality0...*
TypeBackboneElement
SummaryTrue
Invariants
  • ele-1:All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim:n/a
  • workflow:Event.performer
  • v2:ORC-12 / RXA-10
  • rim:.participation[typeCode=PRF].role[scoper.determinerCode=INSTANCE]
Immunization.performer.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
TypeSystem.String
Mappings
  • rim:n/a
Immunization.performer.extension
DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1:All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1:Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim:n/a
  • rim:N/A
Immunization.performer.modifierExtension
DefinitionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
SummaryTrue
Aliasextensions, user content, modifiers
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1:All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1:Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim:n/a
  • rim:N/A
Immunization.performer.function
DefinitionDescribes the type of performance (e.g. ordering provider, administering provider, etc.).
Cardinality0...1
TypeCodeableConcept
Binding

The role a practitioner or organization plays in the immunization event.

ImmunizationFunctionCodes (extensible)
SummaryTrue
Comments

Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

Invariants
  • ele-1:All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim:n/a
  • v2:CE/CNE/CWE
  • rim:CD
  • orim:fhir:CodeableConcept rdfs:subClassOf dt:CD
  • workflow:Event.performer.function
  • rim:.participation.functionCode
Immunization.performer.actor
DefinitionThe practitioner or organization who performed the action.
Cardinality1...1
TypeReference(Practitioner | PractitionerRole | Organization)
SummaryTrue
Comments

When the individual practitioner who performed the action is known, it is best to send.

Invariants
  • ele-1:All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1:SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim:n/a
  • rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow:Event.performer.actor
  • w5:FiveWs.actor
  • rim:.player
Immunization.note
DefinitionExtra information about the immunization that is not conveyed by the other attributes.
Cardinality0...*
TypeAnnotation
SummaryTrue
Comments

For systems that do not have structured annotations, they can simply communicate a single annotation with no author or time. This element may need to be included in narrative because of the potential for modifying information. Annotations SHOULD NOT be used to communicate "modifying" information that could be computable. (This is a SHOULD because enforcing user behavior is nearly impossible).

Invariants
  • ele-1:All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim:n/a
  • v2:N/A
  • rim:Act
  • workflow:Event.note
  • v2:OBX-5 : OBX-3 = 48767-8
  • rim:note
Immunization.reasonCode
DefinitionReasons why the vaccine was administered.
Cardinality0...*
TypeCodeableConcept
Binding

The reason why a vaccine was administered.

ImmunizationReasonCodes (example)
Comments

Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

Invariants
  • ele-1:All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim:n/a
  • v2:CE/CNE/CWE
  • rim:CD
  • orim:fhir:CodeableConcept rdfs:subClassOf dt:CD
  • workflow:Event.reasonCode
  • rim:[actionNegationInd=false].reasonCode
Immunization.reasonReference
DefinitionCondition, Observation or DiagnosticReport that supports why the immunization was administered.
Cardinality0...*
TypeReference(Condition | Observation | DiagnosticReport)
Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1:All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1:SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim:n/a
  • rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow:Event.reasonReference
  • rim:N/A
Immunization.isSubpotent
DefinitionIndication if a dose is considered to be subpotent. By default, a dose should be considered to be potent.
Cardinality0...1
Typeboolean
ModifierTrue
SummaryTrue
Comments

Typically, the recognition of the dose being sub-potent is retrospective, after the administration (ex. notification of a manufacturer recall after administration). However, in the case of a partial administration (the patient moves unexpectedly and only some of the dose is actually administered), subpotency may be recognized immediately, but it is still important to record the event.

Invariants
  • ele-1:All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim:n/a
  • v2:RXA-20 = PA (partial administration)
  • rim:N/A
Immunization.subpotentReason
DefinitionReason why a dose is considered to be subpotent.
Cardinality0...*
TypeCodeableConcept
Binding

The reason why a dose is considered to be subpotent.

ImmunizationSubpotentReason (example)
Comments

Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

Invariants
  • ele-1:All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim:n/a
  • v2:CE/CNE/CWE
  • rim:CD
  • orim:fhir:CodeableConcept rdfs:subClassOf dt:CD
  • rim:N/A
Immunization.education
DefinitionEducational material presented to the patient (or guardian) at the time of vaccine administration.
Cardinality0...*
TypeBackboneElement
Invariants
  • ele-1:All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • imm-1:One of documentType or reference SHALL be present
    documentType.exists() or reference.exists()
Mappings
  • rim:n/a
  • rim:N/A
Immunization.education.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
TypeSystem.String
Mappings
  • rim:n/a
Immunization.education.extension
DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1:All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1:Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim:n/a
  • rim:N/A
Immunization.education.modifierExtension
DefinitionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
SummaryTrue
Aliasextensions, user content, modifiers
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1:All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1:Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim:n/a
  • rim:N/A
Immunization.education.documentType
DefinitionIdentifier of the material presented to the patient.
Cardinality0...1
Typestring
Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Invariants
  • ele-1:All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim:n/a
  • v2:OBX-5 : OBX-3 = 69764-9
  • rim:N/A
Immunization.education.reference
DefinitionReference pointer to the educational material given to the patient if the information was on line.
Cardinality0...1
Typeuri
Comments

see http://en.wikipedia.org/wiki/Uniform_resource_identifier

Invariants
  • ele-1:All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim:n/a
  • rim:N/A
Immunization.education.publicationDate
DefinitionDate the educational material was published.
Cardinality0...1
TypedateTime
Invariants
  • ele-1:All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim:n/a
  • v2:OBX-5 : OBX-3 = 29768-9
  • rim:N/A
Immunization.education.presentationDate
DefinitionDate the educational material was given to the patient.
Cardinality0...1
TypedateTime
Invariants
  • ele-1:All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim:n/a
  • v2:OBX-5 : OBX-3 = 29769-7
  • rim:N/A
Immunization.programEligibility
DefinitionIndicates a patient's eligibility for a funding program.
Cardinality0...*
TypeCodeableConcept
Binding

The patient's eligibility for a vaccation program.

ImmunizationProgramEligibility (example)
Comments

Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

Invariants
  • ele-1:All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim:n/a
  • v2:CE/CNE/CWE
  • rim:CD
  • orim:fhir:CodeableConcept rdfs:subClassOf dt:CD
  • v2:OBX-5 : OBX-3 = 64994-7
  • rim:N/A
Immunization.fundingSource
DefinitionIndicates the source of the vaccine actually administered. This may be different than the patient eligibility (e.g. the patient may be eligible for a publically purchased vaccine but due to inventory issues, vaccine purchased with private funds was actually administered).
Cardinality0...1
TypeCodeableConcept
Binding

The source of funding used to purchase the vaccine administered.

ImmunizationFundingSource (example)
Comments

Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

Invariants
  • ele-1:All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim:n/a
  • v2:CE/CNE/CWE
  • rim:CD
  • orim:fhir:CodeableConcept rdfs:subClassOf dt:CD
  • rim:N/A
Immunization.reaction
DefinitionCategorical data indicating that an adverse event is associated in time to an immunization.
Cardinality0...*
TypeBackboneElement
Comments

A reaction may be an indication of an allergy or intolerance and, if this is determined to be the case, it should be recorded as a new AllergyIntolerance resource instance as most systems will not query against past Immunization.reaction elements.

Invariants
  • ele-1:All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim:n/a
  • v2:OBX-3
  • rim:Observation[classCode=obs].code
Immunization.reaction.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
TypeSystem.String
Mappings
  • rim:n/a
Immunization.reaction.extension
DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1:All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1:Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim:n/a
  • rim:N/A
Immunization.reaction.modifierExtension
DefinitionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
SummaryTrue
Aliasextensions, user content, modifiers
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1:All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1:Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim:n/a
  • rim:N/A
Immunization.reaction.date
DefinitionDate of reaction to the immunization.
Cardinality0...1
TypedateTime
Invariants
  • ele-1:All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim:n/a
  • v2:OBX-14 (ideally this would be reported in an IAM segment, but IAM is not part of the HL7 v2 VXU message - most likely would appear in OBX segments if at all)
  • rim:.effectiveTime
Immunization.reaction.detail
DefinitionDetails of the reaction.
Cardinality0...1
TypeReference(Observation)
Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1:All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1:SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim:n/a
  • rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • v2:OBX-5
  • rim:.value
Immunization.reaction.reported
DefinitionSelf-reported indicator.
Cardinality0...1
Typeboolean
Invariants
  • ele-1:All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim:n/a
  • v2:(HL7 v2 doesn't seem to provide for this)
  • rim:.participation[typeCode=INF].role[classCode=PAT] (this syntax for self-reported=true)
Immunization.protocolApplied
DefinitionThe protocol (set of recommendations) being followed by the provider who administered the dose.
Cardinality0...*
TypeBackboneElement
Invariants
  • ele-1:All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim:n/a
  • rim:N/A
Immunization.protocolApplied.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
TypeSystem.String
Mappings
  • rim:n/a
Immunization.protocolApplied.extension
DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1:All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1:Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim:n/a
  • rim:N/A
Immunization.protocolApplied.modifierExtension
DefinitionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
SummaryTrue
Aliasextensions, user content, modifiers
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1:All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1:Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim:n/a
  • rim:N/A
Immunization.protocolApplied.series
DefinitionOne possible path to achieve presumed immunity against a disease - within the context of an authority.
Cardinality0...1
Typestring
Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Invariants
  • ele-1:All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim:n/a
  • rim:N/A
Immunization.protocolApplied.authority
DefinitionIndicates the authority who published the protocol (e.g. ACIP) that is being followed.
Cardinality0...1
TypeReference(Organization)
Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1:All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1:SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim:n/a
  • rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • rim:N/A
Immunization.protocolApplied.targetDisease
DefinitionThe vaccine preventable disease the dose is being administered against.
Cardinality0...*
TypeCodeableConcept
Binding

The vaccine preventable disease the dose is being administered for.

ImmunizationTargetDiseaseCodes (example)
Comments

Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

Invariants
  • ele-1:All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim:n/a
  • v2:CE/CNE/CWE
  • rim:CD
  • orim:fhir:CodeableConcept rdfs:subClassOf dt:CD
  • rim:N/A
Immunization.protocolApplied.doseNumber[x]
DefinitionNominal position in a series.
Cardinality1...1
TypepositiveInt
Comments

The use of an integer is preferred if known. A string should only be used in cases where an integer is not available (such as when documenting a recurring booster dose).

Invariants
  • ele-1:All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim:n/a
  • rim:N/A
Immunization.protocolApplied.seriesDoses[x]
DefinitionThe recommended number of doses to achieve immunity.
Cardinality0...1
TypepositiveInt
Comments

The use of an integer is preferred if known. A string should only be used in cases where an integer is not available (such as when documenting a recurring booster dose).

Invariants
  • ele-1:All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim:n/a
  • rim:N/A