Profile Immunization resource for COVID-19 vaccine use case

This page contains step by step exercises that are part of the 'Let's Build a FHIR specification track' at FHIR DevDays 2020 November.

These exercises teach you how to start profiling, the art of defining your FHIR data model, with Forge.

After completing this tutorial, you will be able to:

Create FHIR profiles, extensions and search parameters with Forge.
Model data properties like cardinalities and data types.
Create profile references and terminology bindings.
Slice lists of data elements.
Publish FHIR resources to Simplifier.net.

Use case: COVID-19 vaccination and adverse events report 💉🤒

In some fictional country, the medicine regulatory authority wants to monitor the uptake and safety of COVID-19 vaccines using a FHIR interface. Healthcare providers will expose COVID-19 vaccination administration and related adverse events.

The medicine regulatory authority needs to express its required data model and use cases in FHIR. They need to publish their own FHIR specification which helps the healthcare providers to implement the interface. And this is where you come in! You are asked to author these specifications.

This page zooms in on the creation of a profile on the Immunization resource for the expression of the medicine regulatory authorities' requirements.

Prerequisites

A free Simpifier.net account (sign up here)

Forge for FHIR R4 (free for non-commercial use, download here)

If you’re on Windows: Double-click the installer and follow the process

If you’re on Mac or Linux: While Forge originally wasn’t built for these platforms, you can run Forge in a virtual machine with Windows or, in some case, with Wine.

Step 1: Basic Profiling 🔥

Information on the path by which the vaccine product is taken into the body needs to be present.
The vaccine product that is administrated needs to be exchanged as a code and not solely in free text.
If a reaction follows on the vaccination administration, the reaction datetime and details needs to be captured.
The MRA cannot process information about given education material, therefore it should not be present.
If a performer is known, the information about the actor (the individual Practitioner and it's Organization) must be given through a PractitionerRole reference.

Step 1.1: Create an Immunization profile

In this step, we’ll create a profile with some high-level metadata. Start by creating a new folder on your computer for this tutorial. Open Forge and open the profile folder you just made.

Create a new profile and choose the base resource that is the best fit for vaccination administration data (the Immunization resource 😉). Add the high-level metadata in the 'Properties' tab within Forge. Of course, you can deviate from the proposed values to make it truly your profile.

Metadata	Value
URL	http://`<yourname>`.`<yourcountrycode >`/fhir/StructureDefinition/`<profile name>` for example: http://ardon.nl/fhir/StructureDefinition/ImmunizationProfile
Resource ID	immunization-profile
Name	ImmunizationProfile
Title	Immunization Profile
Description	Defines the medicine regulatory authority constraints and extensions on the Immunization resource for the minimal set of data to query and retrieve an individual’s immunization information.

From now on we will use the term ImmunizationProfile to refer to this profile.

Step 1.2: Add cardinality and reference constraints

Set the constraints according to the requirements of the medicine regulatory authority.

Step 1.3: Publish to Simplifier.net

Let's upload the patient profile to Simplifier.net and check if everything works as expected.

Create a Simplifier project (based on R4) if you haven't created one already: create one here
In Forge, go to File > Publish to Simplifier or hit Ctrl + U
- Function greyed out? Make sure you have opened and selected the profile you want to upload in Forge.
Select your Simplifier project
- Project not shown? Check that the project is configured based on the same FHIR version as your profile.
Click save and voila - your profile is now rendered online!

If all went well you should see the profile in your project. You can confirm your profile constraints in the rendering as shown in the Overview tab of your profile. Selecting diff mode helps to pin down on the made changes. The below results box

Results after completing step 1

Differential view of ImmunizationProfile on Simplifier

Immunization	I		Immunization	There are no (further) constraints on this element Element Id Immunization Short description Immunization event information Definition Describes 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. Data Type Immunization Constraints 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
identifier		0..*	Identifier	There are no (further) constraints on this element Element Id Immunization.identifier Short description Business identifier Definition A unique identifier assigned to this immunization record. Data Type Identifier Constraints 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
status	Σ ?!	1..1	codeBinding	There are no (further) constraints on this element Element Id Immunization.status Short description completed \| entered-in-error \| not-done Definition Indicates the current status of the immunization event. 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. Data Type code Binding A set of codes indicating the current status of an Immunization. ImmunizationStatusCodes (required) Constraints 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
statusReason		0..1	CodeableConcept	There are no (further) constraints on this element Element Id Immunization.statusReason Short description Reason not done Definition Indicates the reason the immunization event was not performed. 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. Data Type CodeableConcept Binding The reason why a vaccine was not administered. ImmunizationStatusReasonCodes (example) Constraints 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
vaccineCode	Σ	1..1	CodeableConcept	There are no (further) constraints on this element Element Id Immunization.vaccineCode Short description Vaccine product administered Definition Vaccine that was administered or was to be administered. 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. Data Type CodeableConcept Binding The code for vaccine product administered. VaccineAdministeredValueSet (example) Constraints 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
coding	Σ	1..*	Coding	There are no (further) constraints on this element Element Id Immunization.vaccineCode.coding Short description Code defined by a terminology system Definition A reference to a code defined by a terminology system. Requirements Allows for alternative encodings within a code system, and translations to other code systems. Comments Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true. Data Type Coding Constraints 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 subset one of the sets of component 1-3 or 4-6 rim:CV orim:fhir:Coding rdfs:subClassOf dt:CDCoding v2:CE.1-8, CE.10-22 rim:union(., ./translation) orim:fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
system	Σ	1..1	uri	There are no (further) constraints on this element Element Id Immunization.vaccineCode.coding.system Short description Identity of the terminology system Definition The identification of the code system that defines the meaning of the symbol in the code. Requirements Need to be unambiguous about the source of the definition of the symbol. Comments The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously. Data Type uri Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE.3 rim:./codeSystem orim:*fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem
version	Σ	0..1	string	There are no (further) constraints on this element Element Id Immunization.vaccineCode.coding.version Short description Version of the system - if relevant Definition The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged. Comments Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date. Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE.7 rim:./codeSystemVersion orim:*fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion
code	Σ	1..1	code	There are no (further) constraints on this element Element Id Immunization.vaccineCode.coding.code Short description Symbol in syntax defined by the system Definition A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination). Requirements Need to refer to a particular code in the system. Comments Note that FHIR strings SHALL NOT exceed 1MB in size Data Type code Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE.1 rim:./code orim:*fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code
display	Σ	1..1	string	There are no (further) constraints on this element Element Id Immunization.vaccineCode.coding.display Short description Representation defined by the system Definition A representation of the meaning of the code in the system, following the rules of the system. Requirements Need to be able to carry a human-readable meaning of the code for readers that do not know the system. Comments Note that FHIR strings SHALL NOT exceed 1MB in size Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE.2 - but note this is not well followed rim:CV.displayName orim:*fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName
userSelected	Σ	0..1	boolean	There are no (further) constraints on this element Element Id Immunization.vaccineCode.coding.userSelected Short description If this coding was chosen directly by the user Definition Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays). Requirements This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing. Comments Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely. Data Type boolean Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:Sometimes implied by being first rim:CD.codingRationale orim:fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map; fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\#true a [ fhir:source "true"; fhir:target dt:CDCoding.codingRationale\#O ]
text	Σ	0..1	string	There are no (further) constraints on this element Element Id Immunization.vaccineCode.text Short description Plain text representation of the concept Definition A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user. Requirements The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source. Comments Very often the text is the same as a displayName of one of the codings. Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE.9. But note many systems use CE.2 for this rim:./originalText[mediaType/code="text/plain"]/data orim:fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText
patient	Σ I	1..1	Reference(Patient)	There are no (further) constraints on this element Element Id Immunization.patient Short description Who was immunized Definition The patient who either received or did not receive the immunization. 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. Data Type Reference(Patient) Constraints 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
encounter	I	0..1	Reference(Encounter)	There are no (further) constraints on this element Element Id Immunization.encounter Short description Encounter immunization was part of Definition The visit or admission or other contact between patient and health care provider the immunization was performed as part of. 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. Data Type Reference(Encounter) Constraints 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
occurrence[x]	Σ	1..1		There are no (further) constraints on this element Element Id Immunization.occurrence[x] Short description Vaccine administration date Definition Date vaccine administered or was to be administered. 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. Constraints 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
occurrenceDateTime			dateTime	There are no (further) constraints on this element Data Type dateTime
occurrenceString			string	There are no (further) constraints on this element Data Type string
recorded		0..1	dateTime	There are no (further) constraints on this element Element Id Immunization.recorded Short description When the immunization was first captured in the subject's record Definition The date the occurrence of the immunization was first captured in the record - potentially significantly after the occurrence of the event. Data Type dateTime Constraints 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
primarySource	Σ	0..1	boolean	There are no (further) constraints on this element Element Id Immunization.primarySource Short description Indicates context the data was recorded in Definition An 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. Comments Reflects the “reliability” of the content. Data Type boolean Constraints 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)
reportOrigin		0..1	CodeableConcept	There are no (further) constraints on this element Element Id Immunization.reportOrigin Short description Indicates the source of a secondarily reported record Definition The source of the data when the report of the immunization event is not based on information from the person who administered the vaccine. Comments Should not be populated if primarySource = True, not required even if primarySource = False. Data Type CodeableConcept Binding The source of the data for a record which is not from a primary source. ImmunizationOriginCodes (example) Constraints 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)
location	I	0..1	Reference(Location)	There are no (further) constraints on this element Element Id Immunization.location Short description Where immunization occurred Definition The service delivery location where the vaccine administration occurred. 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. Data Type Reference(Location) Constraints 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
manufacturer	I	0..1	Reference(Organization)	There are no (further) constraints on this element Element Id Immunization.manufacturer Short description Vaccine manufacturer Definition Name of vaccine manufacturer. 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. Data Type Reference(Organization) Constraints 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
lotNumber		0..1	string	There are no (further) constraints on this element Element Id Immunization.lotNumber Short description Vaccine lot number Definition Lot number of the vaccine product. Comments Note that FHIR strings SHALL NOT exceed 1MB in size Data Type string Constraints 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
expirationDate		0..1	date	There are no (further) constraints on this element Element Id Immunization.expirationDate Short description Vaccine expiration date Definition Date vaccine batch expires. Data Type date Constraints 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
site		0..1	CodeableConcept	There are no (further) constraints on this element Element Id Immunization.site Short description Body site vaccine was administered Definition Body site where vaccine was administered. 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. Data Type CodeableConcept Binding The site at which the vaccine was administered. CodesForImmunizationSiteOfAdministration (example) Constraints 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
route		1..1	CodeableConcept	There are no (further) constraints on this element Element Id Immunization.route Short description How vaccine entered body Definition The path by which the vaccine product is taken into the body. 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. Data Type CodeableConcept Binding The route by which the vaccine was administered. ImmunizationRouteCodes (example) Constraints 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
doseQuantity	I	0..1	SimpleQuantity	There are no (further) constraints on this element Element Id Immunization.doseQuantity Short description Amount of vaccine administered Definition The quantity of vaccine product that was administered. 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. Data Type SimpleQuantity Constraints 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
performer	Σ	0..*	BackboneElement	There are no (further) constraints on this element Element Id Immunization.performer Short description Who performed event Definition Indicates who performed the immunization event. Data Type BackboneElement Constraints 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]
function	Σ	0..1	CodeableConceptBinding	There are no (further) constraints on this element Element Id Immunization.performer.function Short description What type of performance was done Definition Describes the type of performance (e.g. ordering provider, administering provider, etc.). 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. Data Type CodeableConcept Binding The role a practitioner or organization plays in the immunization event. ImmunizationFunctionCodes (extensible) Constraints 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
actor	Σ I	1..1	Reference(PractitionerRole)	Element Id Immunization.performer.actor Short description Individual or organization who was performing Definition The practitioner or organization who performed the action. Comments When the individual practitioner who performed the action is known, it is best to send. Data Type Reference(PractitionerRole) Constraints 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
note	Σ	0..*	Annotation	There are no (further) constraints on this element Element Id Immunization.note Short description Additional immunization notes Definition Extra information about the immunization that is not conveyed by the other attributes. 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). Data Type Annotation Constraints 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
reasonCode		0..*	CodeableConcept	There are no (further) constraints on this element Element Id Immunization.reasonCode Short description Why immunization occurred Definition Reasons why the vaccine was administered. 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. Data Type CodeableConcept Binding The reason why a vaccine was administered. ImmunizationReasonCodes (example) Constraints 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
reasonReference	I	0..*	Reference(Condition \| Observation \| DiagnosticReport)	There are no (further) constraints on this element Element Id Immunization.reasonReference Short description Why immunization occurred Definition Condition, Observation or DiagnosticReport that supports why the immunization was administered. 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. Data Type Reference(Condition \| Observation \| DiagnosticReport) Constraints 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
isSubpotent	Σ ?!	0..1	boolean	There are no (further) constraints on this element Element Id Immunization.isSubpotent Short description Dose potency Definition Indication if a dose is considered to be subpotent. By default, a dose should be considered to be potent. 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. Data Type boolean Constraints 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
subpotentReason		0..*	CodeableConcept	There are no (further) constraints on this element Element Id Immunization.subpotentReason Short description Reason for being subpotent Definition Reason why a dose is considered to be subpotent. 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. Data Type CodeableConcept Binding The reason why a dose is considered to be subpotent. ImmunizationSubpotentReason (example) Constraints 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
education	I	0..0	BackboneElement	There are no (further) constraints on this element Element Id Immunization.education Short description Educational material presented to patient Definition Educational material presented to the patient (or guardian) at the time of vaccine administration. Data Type BackboneElement Constraints 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
programEligibility		0..*	CodeableConcept	There are no (further) constraints on this element Element Id Immunization.programEligibility Short description Patient eligibility for a vaccination program Definition Indicates a patient's eligibility for a funding program. 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. Data Type CodeableConcept Binding The patient's eligibility for a vaccation program. ImmunizationProgramEligibility (example) Constraints 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
fundingSource		0..1	CodeableConcept	There are no (further) constraints on this element Element Id Immunization.fundingSource Short description Funding source for the vaccine Definition Indicates 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). 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. Data Type CodeableConcept Binding The source of funding used to purchase the vaccine administered. ImmunizationFundingSource (example) Constraints 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
reaction		0..*	BackboneElement	There are no (further) constraints on this element Element Id Immunization.reaction Short description Details of a reaction that follows immunization Definition Categorical data indicating that an adverse event is associated in time to an immunization. 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. Data Type BackboneElement Constraints 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
date		1..1	dateTime	There are no (further) constraints on this element Element Id Immunization.reaction.date Short description When reaction started Definition Date of reaction to the immunization. Data Type dateTime Constraints 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
detail	I	1..1	Reference(Observation)	There are no (further) constraints on this element Element Id Immunization.reaction.detail Short description Additional information on reaction Definition Details of the reaction. 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. Data Type Reference(Observation) Constraints 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
reported		0..1	boolean	There are no (further) constraints on this element Element Id Immunization.reaction.reported Short description Indicates self-reported reaction Definition Self-reported indicator. Data Type boolean Constraints 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)
protocolApplied		0..*	BackboneElement	There are no (further) constraints on this element Element Id Immunization.protocolApplied Short description Protocol followed by the provider Definition The protocol (set of recommendations) being followed by the provider who administered the dose. Data Type BackboneElement Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a rim:N/A
series		0..1	string	There are no (further) constraints on this element Element Id Immunization.protocolApplied.series Short description Name of vaccine series Definition One possible path to achieve presumed immunity against a disease - within the context of an authority. Comments Note that FHIR strings SHALL NOT exceed 1MB in size Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a rim:N/A
authority	I	0..1	Reference(Organization)	There are no (further) constraints on this element Element Id Immunization.protocolApplied.authority Short description Who is responsible for publishing the recommendations Definition Indicates the authority who published the protocol (e.g. ACIP) that is being followed. 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. Data Type Reference(Organization) Constraints 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
targetDisease		0..*	CodeableConcept	There are no (further) constraints on this element Element Id Immunization.protocolApplied.targetDisease Short description Vaccine preventatable disease being targetted Definition The vaccine preventable disease the dose is being administered against. 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. Data Type CodeableConcept Binding The vaccine preventable disease the dose is being administered for. ImmunizationTargetDiseaseCodes (example) Constraints 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
doseNumber[x]		1..1		There are no (further) constraints on this element Element Id Immunization.protocolApplied.doseNumber[x] Short description Dose number within series Definition Nominal position in a series. 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). Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a rim:N/A
doseNumberPositiveInt			positiveInt	There are no (further) constraints on this element Data Type positiveInt
doseNumberString			string	There are no (further) constraints on this element Data Type string
seriesDoses[x]		0..1		There are no (further) constraints on this element Element Id Immunization.protocolApplied.seriesDoses[x] Short description Recommended number of doses for immunity Definition The recommended number of doses to achieve immunity. 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). Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a rim:N/A
seriesDosesPositiveInt			positiveInt	There are no (further) constraints on this element Data Type positiveInt
seriesDosesString			string	There are no (further) constraints on this element Data Type string

Step 2: Add extensions to ImmunizationProfile ➕

Not all required information is present in the core Immunization resource. The following addition requirments are made.

The medicine regulatory authority (MRA) needs to know the performed vaccination procedure.
The MRA needs to have all the specific details of the administrated vaccine product. Although the vaccineCode and other relevant elements of Immunization provide essential information the Medication resource is more suitable for all the requirements.

Step 2.1: Reuse an extension: ExtensionUKCoreVaccinationProcedure

A search in the FHIR Registry and Simplifier.net revealed that HL7 UK published an extension to capture information about the vaccination procedure in a coded way. It is named ExtensionUKCoreVaccinationProcedure. We are going to reuse that extension.

HL7 UK published the ExtensionUKCoreVaccinationProcedure in a FHIR package. That makes it even easier for us to include the extension.

Examine the extension and see where the extension is allowed to be used to see if it fits.
In Forge, select your profiling folder and go to the dependencies tab
Hit the Simplifier icon
Search for Uk.Core.r4
Install version 1.3.0 by selecting it and clicking on ‘Add’

Nice! You have downloaded all the published HL7 UK profiles and it's dependencies (in this case also the HL7 FHIR R4 core resources) to your local package cache folder. The profiling folder now contains a package.json file with references to the package. In short, all those profiles are now ready to be used in Forge!

Add the extension to the ImmunizationProfile. Select your profile, go to the Element Tree view and select the Immunization root element. Click the extend button and find the extension.
Give the extension a proper (slice)name, like 'vaccinationProcedure'.
Make the extension mandatory.

Step: 2.2: Create a simple extension and add it to ImmunizationProfile

The Immunization resource does not contain a reference to the Medication resource. We are going to create our own extension to add this reference.

In Forge, select the profiling folder and click on New Extension. In the new screen that pops up, select 'Extension definition' in the left menu and use the 'profiles-types.xml'.
Similiar to the ImmunizationProfile, the extension needs at least some basic metadata such as a canonical URL, a name and description. See the table below for example values.
It is mandatory to provide the extension context. This element indicates where the extension is allowed to be used. You can set this in the 'Properties' tab of the extension. (Tip: the Context element is at the bottom.)

Metadata	value
URL	http://`<yourname>`.`<yourcountrycode >`/fhir/StructureDefinition/`<profile name>`
Resource ID	extension-administeredproduct
Name	ExtensionAdministeredProduct
Title	Vaccination Product Administered
Description	A reference to the Medication resouce to provide details about the product administered during a vaccination event.
Context	`Type` = 'element' and `Expression` = 'Immunization'

Profile the extension so that provides a reference element to a Medication resource.
Step by step: click value[x], uncheck all data types, check the Reference datatype and expand it. Here you can provide the Medication URL ('http://hl7.org/fhir/StructureDefinition/Medication') in the Target Profiles.
Add the extension to ImmunizationProfile, on a similar basis as with step 2.1

Step 2.3: Publish the extension and the updated ImmunizationProfile to Simplifier.net

Let's upload the extension and the updated ImmunizationProfile to Simplifier.net and check if everything works as expected.

Likely Simplifier will complain that it cannot resolve ExtensionUKCoreVaccinationProcedure. For this, you should add a project dependency to the Uk.Core.r4 package. Go to the dependency tab, hit the green manage button, find and add the package.

Results after completing step 2

Differential view of ImmunizationProfile

Immunization	I		Immunization	There are no (further) constraints on this element Element Id Immunization Short description Immunization event information Definition Describes 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. Data Type Immunization Constraints 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
extension	I	0..*	Extension	Element Id Immunization.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May 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. 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. Data Type Extension Sliced: Unordered, Open, by url(Value) Constraints 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
vaccinationProcedure	I	1..*	Extension	Element Id Immunization.extension:vaccinationProcedure Short description Additional content defined by implementations Alternate names extensions, user content Definition May 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. 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. Data Type Extension Extension URL https://fhir.nhs.uk/R4/StructureDefinition/Extension-UKCore-VaccinationProcedure Constraints 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
administeredProduct	I	1..1	Extension(Reference(Medication))	Element Id Immunization.extension:administeredProduct Short description Optional Extensions Element Alternate names extensions, user content Definition Optional Extension Element - found in all resources. 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. Data Type Extension(Reference(Medication)) Extension URL https://fhir.devdays.com/R4/StructureDefinition/Extension-AdministeredProduct Constraints 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
identifier		0..*	Identifier	There are no (further) constraints on this element Element Id Immunization.identifier Short description Business identifier Definition A unique identifier assigned to this immunization record. Data Type Identifier Constraints 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
status	Σ ?!	1..1	codeBinding	There are no (further) constraints on this element Element Id Immunization.status Short description completed \| entered-in-error \| not-done Definition Indicates the current status of the immunization event. 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. Data Type code Binding A set of codes indicating the current status of an Immunization. ImmunizationStatusCodes (required) Constraints 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
statusReason		0..1	CodeableConcept	There are no (further) constraints on this element Element Id Immunization.statusReason Short description Reason not done Definition Indicates the reason the immunization event was not performed. 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. Data Type CodeableConcept Binding The reason why a vaccine was not administered. ImmunizationStatusReasonCodes (example) Constraints 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
vaccineCode	Σ	1..1	CodeableConcept	There are no (further) constraints on this element Element Id Immunization.vaccineCode Short description Vaccine product administered Definition Vaccine that was administered or was to be administered. 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. Data Type CodeableConcept Binding The code for vaccine product administered. VaccineAdministeredValueSet (example) Constraints 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
coding	Σ	1..*	Coding	There are no (further) constraints on this element Element Id Immunization.vaccineCode.coding Short description Code defined by a terminology system Definition A reference to a code defined by a terminology system. Requirements Allows for alternative encodings within a code system, and translations to other code systems. Comments Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true. Data Type Coding Constraints 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 subset one of the sets of component 1-3 or 4-6 rim:CV orim:fhir:Coding rdfs:subClassOf dt:CDCoding v2:CE.1-8, CE.10-22 rim:union(., ./translation) orim:fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
system	Σ	1..1	uri	There are no (further) constraints on this element Element Id Immunization.vaccineCode.coding.system Short description Identity of the terminology system Definition The identification of the code system that defines the meaning of the symbol in the code. Requirements Need to be unambiguous about the source of the definition of the symbol. Comments The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously. Data Type uri Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE.3 rim:./codeSystem orim:*fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem
version	Σ	0..1	string	There are no (further) constraints on this element Element Id Immunization.vaccineCode.coding.version Short description Version of the system - if relevant Definition The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged. Comments Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date. Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE.7 rim:./codeSystemVersion orim:*fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion
code	Σ	1..1	code	There are no (further) constraints on this element Element Id Immunization.vaccineCode.coding.code Short description Symbol in syntax defined by the system Definition A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination). Requirements Need to refer to a particular code in the system. Comments Note that FHIR strings SHALL NOT exceed 1MB in size Data Type code Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE.1 rim:./code orim:*fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code
display	Σ	0..1	string	There are no (further) constraints on this element Element Id Immunization.vaccineCode.coding.display Short description Representation defined by the system Definition A representation of the meaning of the code in the system, following the rules of the system. Requirements Need to be able to carry a human-readable meaning of the code for readers that do not know the system. Comments Note that FHIR strings SHALL NOT exceed 1MB in size Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE.2 - but note this is not well followed rim:CV.displayName orim:*fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName
userSelected	Σ	0..1	boolean	There are no (further) constraints on this element Element Id Immunization.vaccineCode.coding.userSelected Short description If this coding was chosen directly by the user Definition Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays). Requirements This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing. Comments Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely. Data Type boolean Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:Sometimes implied by being first rim:CD.codingRationale orim:fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map; fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\#true a [ fhir:source "true"; fhir:target dt:CDCoding.codingRationale\#O ]
text	Σ	0..1	string	There are no (further) constraints on this element Element Id Immunization.vaccineCode.text Short description Plain text representation of the concept Definition A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user. Requirements The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source. Comments Very often the text is the same as a displayName of one of the codings. Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE.9. But note many systems use CE.2 for this rim:./originalText[mediaType/code="text/plain"]/data orim:fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText
patient	Σ I	1..1	Reference(Patient)	There are no (further) constraints on this element Element Id Immunization.patient Short description Who was immunized Definition The patient who either received or did not receive the immunization. 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. Data Type Reference(Patient) Constraints 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
encounter	I	0..1	Reference(Encounter)	There are no (further) constraints on this element Element Id Immunization.encounter Short description Encounter immunization was part of Definition The visit or admission or other contact between patient and health care provider the immunization was performed as part of. 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. Data Type Reference(Encounter) Constraints 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
occurrence[x]	Σ	1..1		There are no (further) constraints on this element Element Id Immunization.occurrence[x] Short description Vaccine administration date Definition Date vaccine administered or was to be administered. 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. Constraints 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
occurrenceDateTime			dateTime	There are no (further) constraints on this element Data Type dateTime
occurrenceString			string	There are no (further) constraints on this element Data Type string
recorded		0..1	dateTime	There are no (further) constraints on this element Element Id Immunization.recorded Short description When the immunization was first captured in the subject's record Definition The date the occurrence of the immunization was first captured in the record - potentially significantly after the occurrence of the event. Data Type dateTime Constraints 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
primarySource	Σ	0..1	boolean	There are no (further) constraints on this element Element Id Immunization.primarySource Short description Indicates context the data was recorded in Definition An 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. Comments Reflects the “reliability” of the content. Data Type boolean Constraints 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)
reportOrigin		0..1	CodeableConcept	There are no (further) constraints on this element Element Id Immunization.reportOrigin Short description Indicates the source of a secondarily reported record Definition The source of the data when the report of the immunization event is not based on information from the person who administered the vaccine. Comments Should not be populated if primarySource = True, not required even if primarySource = False. Data Type CodeableConcept Binding The source of the data for a record which is not from a primary source. ImmunizationOriginCodes (example) Constraints 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)
location	I	0..1	Reference(Location)	There are no (further) constraints on this element Element Id Immunization.location Short description Where immunization occurred Definition The service delivery location where the vaccine administration occurred. 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. Data Type Reference(Location) Constraints 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
manufacturer	I	0..1	Reference(Organization)	There are no (further) constraints on this element Element Id Immunization.manufacturer Short description Vaccine manufacturer Definition Name of vaccine manufacturer. 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. Data Type Reference(Organization) Constraints 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
lotNumber		0..1	string	There are no (further) constraints on this element Element Id Immunization.lotNumber Short description Vaccine lot number Definition Lot number of the vaccine product. Comments Note that FHIR strings SHALL NOT exceed 1MB in size Data Type string Constraints 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
expirationDate		0..1	date	There are no (further) constraints on this element Element Id Immunization.expirationDate Short description Vaccine expiration date Definition Date vaccine batch expires. Data Type date Constraints 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
site		0..1	CodeableConcept	There are no (further) constraints on this element Element Id Immunization.site Short description Body site vaccine was administered Definition Body site where vaccine was administered. 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. Data Type CodeableConcept Binding The site at which the vaccine was administered. CodesForImmunizationSiteOfAdministration (example) Constraints 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
route		1..1	CodeableConcept	There are no (further) constraints on this element Element Id Immunization.route Short description How vaccine entered body Definition The path by which the vaccine product is taken into the body. 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. Data Type CodeableConcept Binding The route by which the vaccine was administered. ImmunizationRouteCodes (example) Constraints 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
doseQuantity	I	0..1	SimpleQuantity	There are no (further) constraints on this element Element Id Immunization.doseQuantity Short description Amount of vaccine administered Definition The quantity of vaccine product that was administered. 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. Data Type SimpleQuantity Constraints 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
performer	Σ	0..*	BackboneElement	There are no (further) constraints on this element Element Id Immunization.performer Short description Who performed event Definition Indicates who performed the immunization event. Data Type BackboneElement Constraints 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]
function	Σ	0..1	CodeableConceptBinding	There are no (further) constraints on this element Element Id Immunization.performer.function Short description What type of performance was done Definition Describes the type of performance (e.g. ordering provider, administering provider, etc.). 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. Data Type CodeableConcept Binding The role a practitioner or organization plays in the immunization event. ImmunizationFunctionCodes (extensible) Constraints 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
actor	Σ I	1..1	Reference(PractitionerRole)	Element Id Immunization.performer.actor Short description Individual or organization who was performing Definition The practitioner or organization who performed the action. Comments When the individual practitioner who performed the action is known, it is best to send. Data Type Reference(PractitionerRole) Constraints 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
note	Σ	0..*	Annotation	There are no (further) constraints on this element Element Id Immunization.note Short description Additional immunization notes Definition Extra information about the immunization that is not conveyed by the other attributes. 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). Data Type Annotation Constraints 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
reasonCode		0..*	CodeableConcept	There are no (further) constraints on this element Element Id Immunization.reasonCode Short description Why immunization occurred Definition Reasons why the vaccine was administered. 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. Data Type CodeableConcept Binding The reason why a vaccine was administered. ImmunizationReasonCodes (example) Constraints 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
reasonReference	I	0..*	Reference(Condition \| Observation \| DiagnosticReport)	There are no (further) constraints on this element Element Id Immunization.reasonReference Short description Why immunization occurred Definition Condition, Observation or DiagnosticReport that supports why the immunization was administered. 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. Data Type Reference(Condition \| Observation \| DiagnosticReport) Constraints 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
isSubpotent	Σ ?!	0..1	boolean	There are no (further) constraints on this element Element Id Immunization.isSubpotent Short description Dose potency Definition Indication if a dose is considered to be subpotent. By default, a dose should be considered to be potent. 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. Data Type boolean Constraints 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
subpotentReason		0..*	CodeableConcept	There are no (further) constraints on this element Element Id Immunization.subpotentReason Short description Reason for being subpotent Definition Reason why a dose is considered to be subpotent. 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. Data Type CodeableConcept Binding The reason why a dose is considered to be subpotent. ImmunizationSubpotentReason (example) Constraints 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
education	I	0..0	BackboneElement	There are no (further) constraints on this element Element Id Immunization.education Short description Educational material presented to patient Definition Educational material presented to the patient (or guardian) at the time of vaccine administration. Data Type BackboneElement Constraints 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
programEligibility		0..*	CodeableConcept	There are no (further) constraints on this element Element Id Immunization.programEligibility Short description Patient eligibility for a vaccination program Definition Indicates a patient's eligibility for a funding program. 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. Data Type CodeableConcept Binding The patient's eligibility for a vaccation program. ImmunizationProgramEligibility (example) Constraints 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
fundingSource		0..1	CodeableConcept	There are no (further) constraints on this element Element Id Immunization.fundingSource Short description Funding source for the vaccine Definition Indicates 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). 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. Data Type CodeableConcept Binding The source of funding used to purchase the vaccine administered. ImmunizationFundingSource (example) Constraints 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
reaction		0..*	BackboneElement	There are no (further) constraints on this element Element Id Immunization.reaction Short description Details of a reaction that follows immunization Definition Categorical data indicating that an adverse event is associated in time to an immunization. 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. Data Type BackboneElement Constraints 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
date		1..1	dateTime	There are no (further) constraints on this element Element Id Immunization.reaction.date Short description When reaction started Definition Date of reaction to the immunization. Data Type dateTime Constraints 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
detail	I	1..1	Reference(Observation)	There are no (further) constraints on this element Element Id Immunization.reaction.detail Short description Additional information on reaction Definition Details of the reaction. 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. Data Type Reference(Observation) Constraints 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
reported		0..1	boolean	There are no (further) constraints on this element Element Id Immunization.reaction.reported Short description Indicates self-reported reaction Definition Self-reported indicator. Data Type boolean Constraints 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)
protocolApplied		0..*	BackboneElement	There are no (further) constraints on this element Element Id Immunization.protocolApplied Short description Protocol followed by the provider Definition The protocol (set of recommendations) being followed by the provider who administered the dose. Data Type BackboneElement Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a rim:N/A
series		0..1	string	There are no (further) constraints on this element Element Id Immunization.protocolApplied.series Short description Name of vaccine series Definition One possible path to achieve presumed immunity against a disease - within the context of an authority. Comments Note that FHIR strings SHALL NOT exceed 1MB in size Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a rim:N/A
authority	I	0..1	Reference(Organization)	There are no (further) constraints on this element Element Id Immunization.protocolApplied.authority Short description Who is responsible for publishing the recommendations Definition Indicates the authority who published the protocol (e.g. ACIP) that is being followed. 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. Data Type Reference(Organization) Constraints 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
targetDisease		0..*	CodeableConcept	There are no (further) constraints on this element Element Id Immunization.protocolApplied.targetDisease Short description Vaccine preventatable disease being targetted Definition The vaccine preventable disease the dose is being administered against. 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. Data Type CodeableConcept Binding The vaccine preventable disease the dose is being administered for. ImmunizationTargetDiseaseCodes (example) Constraints 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
doseNumber[x]		1..1		There are no (further) constraints on this element Element Id Immunization.protocolApplied.doseNumber[x] Short description Dose number within series Definition Nominal position in a series. 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). Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a rim:N/A
doseNumberPositiveInt			positiveInt	There are no (further) constraints on this element Data Type positiveInt
doseNumberString			string	There are no (further) constraints on this element Data Type string
seriesDoses[x]		0..1		There are no (further) constraints on this element Element Id Immunization.protocolApplied.seriesDoses[x] Short description Recommended number of doses for immunity Definition The recommended number of doses to achieve immunity. 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). Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a rim:N/A
seriesDosesPositiveInt			positiveInt	There are no (further) constraints on this element Data Type positiveInt
seriesDosesString			string	There are no (further) constraints on this element Data Type string

Differential view of ExtensionAdministeredProduct

Extension	I		Extension	There are no (further) constraints on this element Element Id Extension Short description Optional Extensions Element Definition Optional Extension Element - found in all resources. Data Type Extension Constraints 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
url		1..1	System.StringFixed Value	Element Id Extension.url Short description identifies the meaning of the extension Definition Source of the definition for the extension code - a logical name or a URL. Comments The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension. Data Type System.String Fixed Value https://fhir.devdays.com/R4/StructureDefinition/Extension-AdministeredProduct Mappings rim:N/A
value[x]		1..1		There are no (further) constraints on this element Element Id Extension.value[x] Short description Value of extension Definition Value of extension - must be one of a constrained set of the data types (see Extensibility for a list). Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a rim:N/A
valueReference			Reference(Medication)	Data Type Reference(Medication)

Step 3: Terminology bindings 💎

The medicine regulatory authority (MRA) can only capture specific data on the certain elements. The following requirements are specified:

For the vaccine administration route, the MRA uses the codes in the bound ValueSet by the FHIR core Immunization resource. A code from this ValuSet is exected.
The FHIR ValueSet bound to site is not sufficiently detailed. The MRA can handle SNOMED codes and expects codes as defined by the International Patient Summary for target site.

Step 3.1: Adjust the ValueSet binding strength in ImmunizationProfile

Adjust the ValueSet binding strength of the route element. Tip! The FHIR specification provides a thorough description of the meaning of the binding strenghts.

Step 3.2: Find the right ValueSet and add it to ImmunizationProfile

The International Patient Summary has defined a ValueSet for site named TargetSiteCodeUvIps.

Examine the ValueSet.
Copy the ValuSet canonical URL into the ValueSet binding in Forge.
Adjust the binding strength.

You can download the ValueSet to include it in your profile folder or download it through the International Patient Summary package hl7.fhir.uv.ips in a similar way as step 2.4.

Step 3.3: Publish the updated ImmunizationProfile to Simplifier.net

Upload the updated ImmunizationProfile to Simplifier.net and check if everything works as expected. Remember, pressing CTRL + U pops up the publish screen. Then just select your project e voila!

Optionally, you can add a project dependency to a specific version of the hl7.fhir.uv.ips package to let the ValueSet reference of step 3.2 resolve to a versioned version of the ValueSet.

Results after completing step 3

Differential view of ImmunizationProfile

Immunization	I		Immunization	There are no (further) constraints on this element Element Id Immunization Short description Immunization event information Definition Describes 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. Data Type Immunization Constraints 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
extension	I	0..*	Extension	Element Id Immunization.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May 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. 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. Data Type Extension Sliced: Unordered, Open, by url(Value) Constraints 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
vaccinationProcedure	I	1..*	Extension	Element Id Immunization.extension:vaccinationProcedure Short description Additional content defined by implementations Alternate names extensions, user content Definition May 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. 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. Data Type Extension Extension URL https://fhir.nhs.uk/R4/StructureDefinition/Extension-UKCore-VaccinationProcedure Constraints 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
administeredProduct	I	1..1	Extension(Reference(Medication))	Element Id Immunization.extension:administeredProduct Short description Optional Extensions Element Alternate names extensions, user content Definition Optional Extension Element - found in all resources. 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. Data Type Extension(Reference(Medication)) Extension URL https://fhir.devdays.com/R4/StructureDefinition/Extension-AdministeredProduct Constraints 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
identifier		0..*	Identifier	There are no (further) constraints on this element Element Id Immunization.identifier Short description Business identifier Definition A unique identifier assigned to this immunization record. Data Type Identifier Constraints 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
status	Σ ?!	1..1	codeBinding	There are no (further) constraints on this element Element Id Immunization.status Short description completed \| entered-in-error \| not-done Definition Indicates the current status of the immunization event. 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. Data Type code Binding A set of codes indicating the current status of an Immunization. ImmunizationStatusCodes (required) Constraints 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
statusReason		0..1	CodeableConcept	There are no (further) constraints on this element Element Id Immunization.statusReason Short description Reason not done Definition Indicates the reason the immunization event was not performed. 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. Data Type CodeableConcept Binding The reason why a vaccine was not administered. ImmunizationStatusReasonCodes (example) Constraints 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
vaccineCode	Σ	1..1	CodeableConcept	There are no (further) constraints on this element Element Id Immunization.vaccineCode Short description Vaccine product administered Definition Vaccine that was administered or was to be administered. 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. Data Type CodeableConcept Binding The code for vaccine product administered. VaccineAdministeredValueSet (example) Constraints 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
coding	Σ	1..*	Coding	There are no (further) constraints on this element Element Id Immunization.vaccineCode.coding Short description Code defined by a terminology system Definition A reference to a code defined by a terminology system. Requirements Allows for alternative encodings within a code system, and translations to other code systems. Comments Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true. Data Type Coding Constraints 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 subset one of the sets of component 1-3 or 4-6 rim:CV orim:fhir:Coding rdfs:subClassOf dt:CDCoding v2:CE.1-8, CE.10-22 rim:union(., ./translation) orim:fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
system	Σ	1..1	uri	There are no (further) constraints on this element Element Id Immunization.vaccineCode.coding.system Short description Identity of the terminology system Definition The identification of the code system that defines the meaning of the symbol in the code. Requirements Need to be unambiguous about the source of the definition of the symbol. Comments The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously. Data Type uri Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE.3 rim:./codeSystem orim:*fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem
version	Σ	0..1	string	There are no (further) constraints on this element Element Id Immunization.vaccineCode.coding.version Short description Version of the system - if relevant Definition The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged. Comments Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date. Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE.7 rim:./codeSystemVersion orim:*fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion
code	Σ	1..1	code	There are no (further) constraints on this element Element Id Immunization.vaccineCode.coding.code Short description Symbol in syntax defined by the system Definition A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination). Requirements Need to refer to a particular code in the system. Comments Note that FHIR strings SHALL NOT exceed 1MB in size Data Type code Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE.1 rim:./code orim:*fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code
display	Σ	0..1	string	There are no (further) constraints on this element Element Id Immunization.vaccineCode.coding.display Short description Representation defined by the system Definition A representation of the meaning of the code in the system, following the rules of the system. Requirements Need to be able to carry a human-readable meaning of the code for readers that do not know the system. Comments Note that FHIR strings SHALL NOT exceed 1MB in size Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE.2 - but note this is not well followed rim:CV.displayName orim:*fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName
userSelected	Σ	0..1	boolean	There are no (further) constraints on this element Element Id Immunization.vaccineCode.coding.userSelected Short description If this coding was chosen directly by the user Definition Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays). Requirements This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing. Comments Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely. Data Type boolean Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:Sometimes implied by being first rim:CD.codingRationale orim:fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map; fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\#true a [ fhir:source "true"; fhir:target dt:CDCoding.codingRationale\#O ]
text	Σ	0..1	string	There are no (further) constraints on this element Element Id Immunization.vaccineCode.text Short description Plain text representation of the concept Definition A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user. Requirements The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source. Comments Very often the text is the same as a displayName of one of the codings. Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE.9. But note many systems use CE.2 for this rim:./originalText[mediaType/code="text/plain"]/data orim:fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText
patient	Σ I	1..1	Reference(Patient)	There are no (further) constraints on this element Element Id Immunization.patient Short description Who was immunized Definition The patient who either received or did not receive the immunization. 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. Data Type Reference(Patient) Constraints 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
encounter	I	0..1	Reference(Encounter)	There are no (further) constraints on this element Element Id Immunization.encounter Short description Encounter immunization was part of Definition The visit or admission or other contact between patient and health care provider the immunization was performed as part of. 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. Data Type Reference(Encounter) Constraints 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
occurrence[x]	Σ	1..1		There are no (further) constraints on this element Element Id Immunization.occurrence[x] Short description Vaccine administration date Definition Date vaccine administered or was to be administered. 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. Constraints 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
occurrenceDateTime			dateTime	There are no (further) constraints on this element Data Type dateTime
occurrenceString			string	There are no (further) constraints on this element Data Type string
recorded		0..1	dateTime	There are no (further) constraints on this element Element Id Immunization.recorded Short description When the immunization was first captured in the subject's record Definition The date the occurrence of the immunization was first captured in the record - potentially significantly after the occurrence of the event. Data Type dateTime Constraints 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
primarySource	Σ	0..1	boolean	There are no (further) constraints on this element Element Id Immunization.primarySource Short description Indicates context the data was recorded in Definition An 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. Comments Reflects the “reliability” of the content. Data Type boolean Constraints 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)
reportOrigin		0..1	CodeableConcept	There are no (further) constraints on this element Element Id Immunization.reportOrigin Short description Indicates the source of a secondarily reported record Definition The source of the data when the report of the immunization event is not based on information from the person who administered the vaccine. Comments Should not be populated if primarySource = True, not required even if primarySource = False. Data Type CodeableConcept Binding The source of the data for a record which is not from a primary source. ImmunizationOriginCodes (example) Constraints 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)
location	I	0..1	Reference(Location)	There are no (further) constraints on this element Element Id Immunization.location Short description Where immunization occurred Definition The service delivery location where the vaccine administration occurred. 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. Data Type Reference(Location) Constraints 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
manufacturer	I	0..1	Reference(Organization)	There are no (further) constraints on this element Element Id Immunization.manufacturer Short description Vaccine manufacturer Definition Name of vaccine manufacturer. 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. Data Type Reference(Organization) Constraints 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
lotNumber		0..1	string	There are no (further) constraints on this element Element Id Immunization.lotNumber Short description Vaccine lot number Definition Lot number of the vaccine product. Comments Note that FHIR strings SHALL NOT exceed 1MB in size Data Type string Constraints 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
expirationDate		0..1	date	There are no (further) constraints on this element Element Id Immunization.expirationDate Short description Vaccine expiration date Definition Date vaccine batch expires. Data Type date Constraints 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
site		0..1	CodeableConceptBinding	Element Id Immunization.site Short description Body site vaccine was administered Definition Body site where vaccine was administered. 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. Data Type CodeableConcept Binding The site at which the vaccine was administered. TargetSiteCodeUvIps (required) Constraints 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
route		1..1	CodeableConceptBinding	Element Id Immunization.route Short description How vaccine entered body Definition The path by which the vaccine product is taken into the body. 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. Data Type CodeableConcept Binding The route by which the vaccine was administered. ImmunizationRouteCodes (required) Constraints 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
doseQuantity	I	0..1	SimpleQuantity	There are no (further) constraints on this element Element Id Immunization.doseQuantity Short description Amount of vaccine administered Definition The quantity of vaccine product that was administered. 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. Data Type SimpleQuantity Constraints 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
performer	Σ	0..*	BackboneElement	There are no (further) constraints on this element Element Id Immunization.performer Short description Who performed event Definition Indicates who performed the immunization event. Data Type BackboneElement Constraints 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]
function	Σ	0..1	CodeableConceptBinding	There are no (further) constraints on this element Element Id Immunization.performer.function Short description What type of performance was done Definition Describes the type of performance (e.g. ordering provider, administering provider, etc.). 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. Data Type CodeableConcept Binding The role a practitioner or organization plays in the immunization event. ImmunizationFunctionCodes (extensible) Constraints 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
actor	Σ I	1..1	Reference(PractitionerRole)	Element Id Immunization.performer.actor Short description Individual or organization who was performing Definition The practitioner or organization who performed the action. Comments When the individual practitioner who performed the action is known, it is best to send. Data Type Reference(PractitionerRole) Constraints 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
note	Σ	0..*	Annotation	There are no (further) constraints on this element Element Id Immunization.note Short description Additional immunization notes Definition Extra information about the immunization that is not conveyed by the other attributes. 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). Data Type Annotation Constraints 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
reasonCode		0..*	CodeableConcept	There are no (further) constraints on this element Element Id Immunization.reasonCode Short description Why immunization occurred Definition Reasons why the vaccine was administered. 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. Data Type CodeableConcept Binding The reason why a vaccine was administered. ImmunizationReasonCodes (example) Constraints 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
reasonReference	I	0..*	Reference(Condition \| Observation \| DiagnosticReport)	There are no (further) constraints on this element Element Id Immunization.reasonReference Short description Why immunization occurred Definition Condition, Observation or DiagnosticReport that supports why the immunization was administered. 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. Data Type Reference(Condition \| Observation \| DiagnosticReport) Constraints 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
isSubpotent	Σ ?!	0..1	boolean	There are no (further) constraints on this element Element Id Immunization.isSubpotent Short description Dose potency Definition Indication if a dose is considered to be subpotent. By default, a dose should be considered to be potent. 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. Data Type boolean Constraints 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
subpotentReason		0..*	CodeableConcept	There are no (further) constraints on this element Element Id Immunization.subpotentReason Short description Reason for being subpotent Definition Reason why a dose is considered to be subpotent. 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. Data Type CodeableConcept Binding The reason why a dose is considered to be subpotent. ImmunizationSubpotentReason (example) Constraints 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
education	I	0..0	BackboneElement	There are no (further) constraints on this element Element Id Immunization.education Short description Educational material presented to patient Definition Educational material presented to the patient (or guardian) at the time of vaccine administration. Data Type BackboneElement Constraints 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
programEligibility		0..*	CodeableConcept	There are no (further) constraints on this element Element Id Immunization.programEligibility Short description Patient eligibility for a vaccination program Definition Indicates a patient's eligibility for a funding program. 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. Data Type CodeableConcept Binding The patient's eligibility for a vaccation program. ImmunizationProgramEligibility (example) Constraints 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
fundingSource		0..1	CodeableConcept	There are no (further) constraints on this element Element Id Immunization.fundingSource Short description Funding source for the vaccine Definition Indicates 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). 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. Data Type CodeableConcept Binding The source of funding used to purchase the vaccine administered. ImmunizationFundingSource (example) Constraints 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
reaction		0..*	BackboneElement	There are no (further) constraints on this element Element Id Immunization.reaction Short description Details of a reaction that follows immunization Definition Categorical data indicating that an adverse event is associated in time to an immunization. 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. Data Type BackboneElement Constraints 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
date		1..1	dateTime	There are no (further) constraints on this element Element Id Immunization.reaction.date Short description When reaction started Definition Date of reaction to the immunization. Data Type dateTime Constraints 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
detail	I	1..1	Reference(Observation)	There are no (further) constraints on this element Element Id Immunization.reaction.detail Short description Additional information on reaction Definition Details of the reaction. 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. Data Type Reference(Observation) Constraints 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
reported		0..1	boolean	There are no (further) constraints on this element Element Id Immunization.reaction.reported Short description Indicates self-reported reaction Definition Self-reported indicator. Data Type boolean Constraints 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)
protocolApplied		0..*	BackboneElement	There are no (further) constraints on this element Element Id Immunization.protocolApplied Short description Protocol followed by the provider Definition The protocol (set of recommendations) being followed by the provider who administered the dose. Data Type BackboneElement Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a rim:N/A
series		0..1	string	There are no (further) constraints on this element Element Id Immunization.protocolApplied.series Short description Name of vaccine series Definition One possible path to achieve presumed immunity against a disease - within the context of an authority. Comments Note that FHIR strings SHALL NOT exceed 1MB in size Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a rim:N/A
authority	I	0..1	Reference(Organization)	There are no (further) constraints on this element Element Id Immunization.protocolApplied.authority Short description Who is responsible for publishing the recommendations Definition Indicates the authority who published the protocol (e.g. ACIP) that is being followed. 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. Data Type Reference(Organization) Constraints 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
targetDisease		0..*	CodeableConcept	There are no (further) constraints on this element Element Id Immunization.protocolApplied.targetDisease Short description Vaccine preventatable disease being targetted Definition The vaccine preventable disease the dose is being administered against. 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. Data Type CodeableConcept Binding The vaccine preventable disease the dose is being administered for. ImmunizationTargetDiseaseCodes (example) Constraints 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
doseNumber[x]		1..1		There are no (further) constraints on this element Element Id Immunization.protocolApplied.doseNumber[x] Short description Dose number within series Definition Nominal position in a series. 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). Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a rim:N/A
doseNumberPositiveInt			positiveInt	There are no (further) constraints on this element Data Type positiveInt
doseNumberString			string	There are no (further) constraints on this element Data Type string
seriesDoses[x]		0..1		There are no (further) constraints on this element Element Id Immunization.protocolApplied.seriesDoses[x] Short description Recommended number of doses for immunity Definition The recommended number of doses to achieve immunity. 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). Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a rim:N/A
seriesDosesPositiveInt			positiveInt	There are no (further) constraints on this element Data Type positiveInt
seriesDosesString			string	There are no (further) constraints on this element Data Type string

Step 4: Slicing ✂️🍕

The medicine regulatory authority (MRA) has additinoal requirments that require a little bit more advance profiling. The following requirements are made:

The MRA has specific implementation comments for the use of the String and DateTime datatypes of the vaccine administration date.
Only coded values from SNOMED as defined in the International Patient Summery VaccinesGpsUvIpsv ValueSet or WHO ATC codes can be used to indicate the administrated vaccine product.

Slicing is useful when constraints need to be made that do not necessarily apply to the whole element. In this case, it would be best to slice the element first and then apply constraints to the slices individually. This allows you to define different constraints to each slice of a single element, thereby further customizing your profile.

Step 4.1: Create a type slice for `occurrence[x]`

A common form of slicing is so-called type slices. FHIR resources often contain polymorphic elements which are indicated with the [x] at the end (i.e. Observation.value[X] and the Immunization.occurcence[X]).

In this step, we are going to place a comment in both the slice for DateTime and the slice for String. You could consider other constraints as well, such as indicating a maximum string length for String or a minimum date for DateTime.

First, we have to slice the occurrence[x] element by selecting it and clicking the Slice button on top.
Add two slices with the button next to it.
Forge throws errors at you now because the slices don't have a name and it's own type. Let's solve that by specializing each slice with a specific type. Forge will then automatically assign the slice names occurrenceDateTime en occurrenceString to the slice.
Note that Forge reconizes that this is a type slice and prefils the slicing details in the occurrence[x] element with Type = 'type' and Path = '$this'.
Finally, add implementation comments for the slices. For example, the String data type should only be used in the rare event that the DateTime is not known with of patient self-administered dose. Or you can be creative and add other constraints.

Note: this isn't the best example of a type slice because the implementation comments we are adding could have been made clear on the occurrence[x] element without slicing. It does however simulate how to profile an element in multiple ways.

Step 4.2: Bind multiple ValueSets to `vaccineCode`

The International Patient Summary defines the following two ValueSets that we will reuse in the ImmunizationProfile: VaccinesGpsUvIps and WhoAtcUvIps. As slicing can only be done on repeating elements (or polymorphic elements), we will slice the vaccineCode.coding because coding is 0..*.

Remove the previous made cardinality constraints so the pencil icon disappears.
Perform the same procedure as in step 4.1 (create two slices).
Provide the slices with the names of ValueSets
Let's get rid of the error by providing the right slicing details at vaccineCode.coding. This time we are creating a slicing definition based on the binding ValueSets. In other words, the slices are discriminated by the codes inside bound ValueSets. We should let the validator logic know how it can discriminate between the slices by providing the slicing details: Type = 'value' and Path = '$this'. Forge does not show the $this option in the dropdown, but you can type it in. The equivalent for $this is the element you are in, this case coding. The FHIR spec provides a lot of information on slice discriminators.
Next, we will add the ValueSet bindings to the sliced elements. Provide the ValueSet's URL in the ValueSet reference box.
Set the binding strength to 'required'. This is important for slices based on bound ValueSets. Without the required strength, the validator cannot validate the instance because it cannot confirm if the provided code belongs to one of the bound ValueSets.
Lastly, set the cardinality of vaccineCode.coding to 1..* so at least a coded value of one of these ValueSets needs to be given.

Step 4.3: Publish the updated ImmunizationProfile to Simplifier.net

This step should be familiar by now! 😊 Update your profile and compare it with the results here below.

Results after completing step 4

Differential view of ImmunizationProfile

Immunization	I		Immunization	There are no (further) constraints on this element Element Id Immunization Short description Immunization event information Definition Describes 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. Data Type Immunization Constraints 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
extension	I	0..*	Extension	Element Id Immunization.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May 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. 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. Data Type Extension Sliced: Unordered, Open, by url(Value) Constraints 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
vaccinationProcedure	I	1..*	Extension	Element Id Immunization.extension:vaccinationProcedure Short description Additional content defined by implementations Alternate names extensions, user content Definition May 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. 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. Data Type Extension Extension URL https://fhir.nhs.uk/R4/StructureDefinition/Extension-UKCore-VaccinationProcedure Constraints 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
administeredProduct	I	1..1	Extension(Reference(Medication))	Element Id Immunization.extension:administeredProduct Short description Optional Extensions Element Alternate names extensions, user content Definition Optional Extension Element - found in all resources. 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. Data Type Extension(Reference(Medication)) Extension URL https://fhir.devdays.com/R4/StructureDefinition/Extension-AdministeredProduct Constraints 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
identifier		0..*	Identifier	There are no (further) constraints on this element Element Id Immunization.identifier Short description Business identifier Definition A unique identifier assigned to this immunization record. Data Type Identifier Constraints 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
status	Σ ?!	1..1	codeBinding	There are no (further) constraints on this element Element Id Immunization.status Short description completed \| entered-in-error \| not-done Definition Indicates the current status of the immunization event. 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. Data Type code Binding A set of codes indicating the current status of an Immunization. ImmunizationStatusCodes (required) Constraints 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
statusReason		0..1	CodeableConcept	There are no (further) constraints on this element Element Id Immunization.statusReason Short description Reason not done Definition Indicates the reason the immunization event was not performed. 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. Data Type CodeableConcept Binding The reason why a vaccine was not administered. ImmunizationStatusReasonCodes (example) Constraints 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
vaccineCode	Σ	1..1	CodeableConcept	There are no (further) constraints on this element Element Id Immunization.vaccineCode Short description Vaccine product administered Definition Vaccine that was administered or was to be administered. 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. Data Type CodeableConcept Binding The code for vaccine product administered. VaccineAdministeredValueSet (example) Constraints 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
coding	Σ	1..*	Coding	Element Id Immunization.vaccineCode.coding Short description Code defined by a terminology system Definition A reference to a code defined by a terminology system. Requirements Allows for alternative encodings within a code system, and translations to other code systems. Comments Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true. Data Type Coding Sliced: Unordered, Open, by $this(Value) Constraints 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 subset one of the sets of component 1-3 or 4-6 rim:CV orim:fhir:Coding rdfs:subClassOf dt:CDCoding v2:CE.1-8, CE.10-22 rim:union(., ./translation) orim:fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
vaccinesGpsUvIps	Σ	0..*	CodingBinding	Element Id Immunization.vaccineCode.coding:vaccinesGpsUvIps Short description Vaccines (GPS) - IPS Definition This value set includes the codes from the SNOMED International Global Patient Set (GPS) subset of SNOMED CT that are included in: all descendants of 71181003 \|Product containing vaccine (product)\|. The concepts currently included in the value set are from the September 2019 release of the GPS, which is based on the July 2019 SNOMED CT International Edition release. Requirements Allows for alternative encodings within a code system, and translations to other code systems. Comments Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true. Data Type Coding Binding VaccinesGpsUvIps VaccinesGpsUvIps (required) Constraints 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 subset one of the sets of component 1-3 or 4-6 rim:CV orim:fhir:Coding rdfs:subClassOf dt:CDCoding v2:CE.1-8, CE.10-22 rim:union(., ./translation) orim:fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
system	Σ	1..1	uri	There are no (further) constraints on this element Element Id Immunization.vaccineCode.coding:vaccinesGpsUvIps.system Short description Identity of the terminology system Definition The identification of the code system that defines the meaning of the symbol in the code. Requirements Need to be unambiguous about the source of the definition of the symbol. Comments The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously. Data Type uri Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE.3 rim:./codeSystem orim:*fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem
version	Σ	0..1	string	There are no (further) constraints on this element Element Id Immunization.vaccineCode.coding:vaccinesGpsUvIps.version Short description Version of the system - if relevant Definition The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged. Comments Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date. Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE.7 rim:./codeSystemVersion orim:*fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion
code	Σ	1..1	code	There are no (further) constraints on this element Element Id Immunization.vaccineCode.coding:vaccinesGpsUvIps.code Short description Symbol in syntax defined by the system Definition A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination). Requirements Need to refer to a particular code in the system. Comments Note that FHIR strings SHALL NOT exceed 1MB in size Data Type code Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE.1 rim:./code orim:*fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code
display	Σ	0..1	string	There are no (further) constraints on this element Element Id Immunization.vaccineCode.coding:vaccinesGpsUvIps.display Short description Representation defined by the system Definition A representation of the meaning of the code in the system, following the rules of the system. Requirements Need to be able to carry a human-readable meaning of the code for readers that do not know the system. Comments Note that FHIR strings SHALL NOT exceed 1MB in size Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE.2 - but note this is not well followed rim:CV.displayName orim:*fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName
userSelected	Σ	0..1	boolean	There are no (further) constraints on this element Element Id Immunization.vaccineCode.coding:vaccinesGpsUvIps.userSelected Short description If this coding was chosen directly by the user Definition Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays). Requirements This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing. Comments Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely. Data Type boolean Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:Sometimes implied by being first rim:CD.codingRationale orim:fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map; fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\#true a [ fhir:source "true"; fhir:target dt:CDCoding.codingRationale\#O ]
atcClass	Σ	0..*	CodingBinding	Element Id Immunization.vaccineCode.coding:atcClass Short description WHO ATC - IPS Definition World Health Organization Anatomical Therapeutic Chemical (ATC) classification system. Note: The currently implemented code system and the value set expansion contain only a set of example ATC codes, not the complete code system content. Requirements Allows for alternative encodings within a code system, and translations to other code systems. Comments Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true. Data Type Coding Binding WhoAtcUvIps WhoAtcUvIps (required) Constraints 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 subset one of the sets of component 1-3 or 4-6 rim:CV orim:fhir:Coding rdfs:subClassOf dt:CDCoding v2:CE.1-8, CE.10-22 rim:union(., ./translation) orim:fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
system	Σ	1..1	uri	There are no (further) constraints on this element Element Id Immunization.vaccineCode.coding:atcClass.system Short description Identity of the terminology system Definition The identification of the code system that defines the meaning of the symbol in the code. Requirements Need to be unambiguous about the source of the definition of the symbol. Comments The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously. Data Type uri Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE.3 rim:./codeSystem orim:*fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem
version	Σ	0..1	string	There are no (further) constraints on this element Element Id Immunization.vaccineCode.coding:atcClass.version Short description Version of the system - if relevant Definition The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged. Comments Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date. Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE.7 rim:./codeSystemVersion orim:*fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion
code	Σ	1..1	code	There are no (further) constraints on this element Element Id Immunization.vaccineCode.coding:atcClass.code Short description Symbol in syntax defined by the system Definition A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination). Requirements Need to refer to a particular code in the system. Comments Note that FHIR strings SHALL NOT exceed 1MB in size Data Type code Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE.1 rim:./code orim:*fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code
display	Σ	0..1	string	There are no (further) constraints on this element Element Id Immunization.vaccineCode.coding:atcClass.display Short description Representation defined by the system Definition A representation of the meaning of the code in the system, following the rules of the system. Requirements Need to be able to carry a human-readable meaning of the code for readers that do not know the system. Comments Note that FHIR strings SHALL NOT exceed 1MB in size Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE.2 - but note this is not well followed rim:CV.displayName orim:*fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName
userSelected	Σ	0..1	boolean	There are no (further) constraints on this element Element Id Immunization.vaccineCode.coding:atcClass.userSelected Short description If this coding was chosen directly by the user Definition Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays). Requirements This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing. Comments Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely. Data Type boolean Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:Sometimes implied by being first rim:CD.codingRationale orim:fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map; fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\#true a [ fhir:source "true"; fhir:target dt:CDCoding.codingRationale\#O ]
text	Σ	0..1	string	There are no (further) constraints on this element Element Id Immunization.vaccineCode.text Short description Plain text representation of the concept Definition A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user. Requirements The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source. Comments Very often the text is the same as a displayName of one of the codings. Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE.9. But note many systems use CE.2 for this rim:./originalText[mediaType/code="text/plain"]/data orim:fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText
patient	Σ I	1..1	Reference(Patient)	There are no (further) constraints on this element Element Id Immunization.patient Short description Who was immunized Definition The patient who either received or did not receive the immunization. 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. Data Type Reference(Patient) Constraints 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
encounter	I	0..1	Reference(Encounter)	There are no (further) constraints on this element Element Id Immunization.encounter Short description Encounter immunization was part of Definition The visit or admission or other contact between patient and health care provider the immunization was performed as part of. 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. Data Type Reference(Encounter) Constraints 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
occurrence[x]	Σ	1..1		Element Id Immunization.occurrence[x] Short description Vaccine administration date Definition Date vaccine administered or was to be administered. 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. Sliced: Unordered, Open, by $this(Type) Constraints 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
occurrenceDateTime	Σ	0..1	dateTime	Element Id Immunization.occurrence[x]:occurrenceDateTime Short description Vaccine administration date Definition Date vaccine administered or was to be administered. Comments The use of the DateTime data type is required when immunizations are given by the healthcare provide as a specific date and time should then always be known. Data Type dateTime Constraints 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
occurrenceString	Σ	0..1	string	Element Id Immunization.occurrence[x]:occurrenceString Short description Vaccine administration date Definition Date vaccine administered or was to be administered. Comments The use of the String data type is only acceptable when an exact date is not known in the case of patient self-administered dose. Data Type string Constraints 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
recorded		0..1	dateTime	There are no (further) constraints on this element Element Id Immunization.recorded Short description When the immunization was first captured in the subject's record Definition The date the occurrence of the immunization was first captured in the record - potentially significantly after the occurrence of the event. Data Type dateTime Constraints 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
primarySource	Σ	0..1	boolean	There are no (further) constraints on this element Element Id Immunization.primarySource Short description Indicates context the data was recorded in Definition An 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. Comments Reflects the “reliability” of the content. Data Type boolean Constraints 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)
reportOrigin		0..1	CodeableConcept	There are no (further) constraints on this element Element Id Immunization.reportOrigin Short description Indicates the source of a secondarily reported record Definition The source of the data when the report of the immunization event is not based on information from the person who administered the vaccine. Comments Should not be populated if primarySource = True, not required even if primarySource = False. Data Type CodeableConcept Binding The source of the data for a record which is not from a primary source. ImmunizationOriginCodes (example) Constraints 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)
location	I	0..1	Reference(Location)	There are no (further) constraints on this element Element Id Immunization.location Short description Where immunization occurred Definition The service delivery location where the vaccine administration occurred. 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. Data Type Reference(Location) Constraints 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
manufacturer	I	0..1	Reference(Organization)	There are no (further) constraints on this element Element Id Immunization.manufacturer Short description Vaccine manufacturer Definition Name of vaccine manufacturer. 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. Data Type Reference(Organization) Constraints 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
lotNumber		0..1	string	There are no (further) constraints on this element Element Id Immunization.lotNumber Short description Vaccine lot number Definition Lot number of the vaccine product. Comments Note that FHIR strings SHALL NOT exceed 1MB in size Data Type string Constraints 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
expirationDate		0..1	date	There are no (further) constraints on this element Element Id Immunization.expirationDate Short description Vaccine expiration date Definition Date vaccine batch expires. Data Type date Constraints 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
site		0..1	CodeableConceptBinding	Element Id Immunization.site Short description Body site vaccine was administered Definition Body site where vaccine was administered. 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. Data Type CodeableConcept Binding The site at which the vaccine was administered. TargetSiteCodeUvIps (required) Constraints 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
route		1..1	CodeableConceptBinding	Element Id Immunization.route Short description How vaccine entered body Definition The path by which the vaccine product is taken into the body. 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. Data Type CodeableConcept Binding The route by which the vaccine was administered. ImmunizationRouteCodes (required) Constraints 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
doseQuantity	I	0..1	SimpleQuantity	There are no (further) constraints on this element Element Id Immunization.doseQuantity Short description Amount of vaccine administered Definition The quantity of vaccine product that was administered. 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. Data Type SimpleQuantity Constraints 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
performer	Σ	0..*	BackboneElement	There are no (further) constraints on this element Element Id Immunization.performer Short description Who performed event Definition Indicates who performed the immunization event. Data Type BackboneElement Constraints 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]
function	Σ	0..1	CodeableConceptBinding	There are no (further) constraints on this element Element Id Immunization.performer.function Short description What type of performance was done Definition Describes the type of performance (e.g. ordering provider, administering provider, etc.). 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. Data Type CodeableConcept Binding The role a practitioner or organization plays in the immunization event. ImmunizationFunctionCodes (extensible) Constraints 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
actor	Σ I	1..1	Reference(PractitionerRole)	Element Id Immunization.performer.actor Short description Individual or organization who was performing Definition The practitioner or organization who performed the action. Comments When the individual practitioner who performed the action is known, it is best to send. Data Type Reference(PractitionerRole) Constraints 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
note	Σ	0..*	Annotation	There are no (further) constraints on this element Element Id Immunization.note Short description Additional immunization notes Definition Extra information about the immunization that is not conveyed by the other attributes. 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). Data Type Annotation Constraints 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
reasonCode		0..*	CodeableConcept	There are no (further) constraints on this element Element Id Immunization.reasonCode Short description Why immunization occurred Definition Reasons why the vaccine was administered. 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. Data Type CodeableConcept Binding The reason why a vaccine was administered. ImmunizationReasonCodes (example) Constraints 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
reasonReference	I	0..*	Reference(Condition \| Observation \| DiagnosticReport)	There are no (further) constraints on this element Element Id Immunization.reasonReference Short description Why immunization occurred Definition Condition, Observation or DiagnosticReport that supports why the immunization was administered. 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. Data Type Reference(Condition \| Observation \| DiagnosticReport) Constraints 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
isSubpotent	Σ ?!	0..1	boolean	There are no (further) constraints on this element Element Id Immunization.isSubpotent Short description Dose potency Definition Indication if a dose is considered to be subpotent. By default, a dose should be considered to be potent. 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. Data Type boolean Constraints 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
subpotentReason		0..*	CodeableConcept	There are no (further) constraints on this element Element Id Immunization.subpotentReason Short description Reason for being subpotent Definition Reason why a dose is considered to be subpotent. 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. Data Type CodeableConcept Binding The reason why a dose is considered to be subpotent. ImmunizationSubpotentReason (example) Constraints 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
education	I	0..0	BackboneElement	There are no (further) constraints on this element Element Id Immunization.education Short description Educational material presented to patient Definition Educational material presented to the patient (or guardian) at the time of vaccine administration. Data Type BackboneElement Constraints 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
programEligibility		0..*	CodeableConcept	There are no (further) constraints on this element Element Id Immunization.programEligibility Short description Patient eligibility for a vaccination program Definition Indicates a patient's eligibility for a funding program. 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. Data Type CodeableConcept Binding The patient's eligibility for a vaccation program. ImmunizationProgramEligibility (example) Constraints 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
fundingSource		0..1	CodeableConcept	There are no (further) constraints on this element Element Id Immunization.fundingSource Short description Funding source for the vaccine Definition Indicates 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). 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. Data Type CodeableConcept Binding The source of funding used to purchase the vaccine administered. ImmunizationFundingSource (example) Constraints 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
reaction		0..*	BackboneElement	There are no (further) constraints on this element Element Id Immunization.reaction Short description Details of a reaction that follows immunization Definition Categorical data indicating that an adverse event is associated in time to an immunization. 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. Data Type BackboneElement Constraints 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
date		1..1	dateTime	There are no (further) constraints on this element Element Id Immunization.reaction.date Short description When reaction started Definition Date of reaction to the immunization. Data Type dateTime Constraints 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
detail	I	1..1	Reference(Observation)	There are no (further) constraints on this element Element Id Immunization.reaction.detail Short description Additional information on reaction Definition Details of the reaction. 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. Data Type Reference(Observation) Constraints 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
reported		0..1	boolean	There are no (further) constraints on this element Element Id Immunization.reaction.reported Short description Indicates self-reported reaction Definition Self-reported indicator. Data Type boolean Constraints 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)
protocolApplied		0..*	BackboneElement	There are no (further) constraints on this element Element Id Immunization.protocolApplied Short description Protocol followed by the provider Definition The protocol (set of recommendations) being followed by the provider who administered the dose. Data Type BackboneElement Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a rim:N/A
series		0..1	string	There are no (further) constraints on this element Element Id Immunization.protocolApplied.series Short description Name of vaccine series Definition One possible path to achieve presumed immunity against a disease - within the context of an authority. Comments Note that FHIR strings SHALL NOT exceed 1MB in size Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a rim:N/A
authority	I	0..1	Reference(Organization)	There are no (further) constraints on this element Element Id Immunization.protocolApplied.authority Short description Who is responsible for publishing the recommendations Definition Indicates the authority who published the protocol (e.g. ACIP) that is being followed. 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. Data Type Reference(Organization) Constraints 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
targetDisease		0..*	CodeableConcept	There are no (further) constraints on this element Element Id Immunization.protocolApplied.targetDisease Short description Vaccine preventatable disease being targetted Definition The vaccine preventable disease the dose is being administered against. 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. Data Type CodeableConcept Binding The vaccine preventable disease the dose is being administered for. ImmunizationTargetDiseaseCodes (example) Constraints 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
doseNumber[x]		1..1		There are no (further) constraints on this element Element Id Immunization.protocolApplied.doseNumber[x] Short description Dose number within series Definition Nominal position in a series. 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). Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a rim:N/A
doseNumberPositiveInt			positiveInt	There are no (further) constraints on this element Data Type positiveInt
doseNumberString			string	There are no (further) constraints on this element Data Type string
seriesDoses[x]		0..1		There are no (further) constraints on this element Element Id Immunization.protocolApplied.seriesDoses[x] Short description Recommended number of doses for immunity Definition The recommended number of doses to achieve immunity. 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). Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a rim:N/A
seriesDosesPositiveInt			positiveInt	There are no (further) constraints on this element Data Type positiveInt
seriesDosesString			string	There are no (further) constraints on this element Data Type string

Step 5: Create a SearchParameter definition 🔎

In the current design, the medicine regulatory authority (MRA) retrieves the vaccination information from the healthcare provider's system. The MRA wants to search administered vaccinations resources based on the detailed information of the administered product. Additionally, this allows to include the administered product in the search results without the need to perform an additional read request.

Step 5.1: Create a SearchParameter resource with basic metadata

We created an extension named 'ExtensionAdministeredProduct' in step 2.2. The FHIR specification defines SearchParameter resources for elements that are included in common use cases. These search parameters are listed at the bottom of every resource page. Here is the list of SearchParameters for Immunization.

Because we added an extension, there is no SearchParameter available in the FHIR core specification. That's not a problem as we can create it ourselves with Forge! Almost all FHIR reference servers can incorporate SearchParameters, some even on the fly.

Select your profile folder in Forge, hit the little dropdown button next to New and select New Search Parameter.
Forge throws a lot of warnings. Don't worry, we will get rit of them all. Start with filling in basic metadata in the properties tab:

Metadata	Value
URL	http://`<yourname>`.`<yourcountrycode >`/fhir/SearchParameter/`<searchparameter name>`
Resource ID	searchparameter-administeredproduct
Name	SearchParameterAdministeredProduct
Description	To search (and _include) Medication resources that are referenced from the AdministeredProduct extension in Immunization.

Step 5.2: Provide the SearchParameter details

Continue with the required information in the SearchParameter tab.

Provide a Code. This code is used in the API Search URLs and should not overlap one of the existing SearchParamater codes for Immunization.
Click on the blue plus sign at Base to indicate the base resources this parameter applies.
State the data type of SearchParameter value in the dropdown at Type.
Last but certainly not least: Expression. The SearchParameter needs precisely states what to search on. Provide the following FHIRPath expression to search on the previously created extension:
```
Immunization.extension('[extension URL]')
```

That's it! You have created your own SearchParameter to extend the core FHIR API. You can test if it works by creating instances of the FHIR profiles, import all the conformance resources and play around with a HTTP tool such as Postman. This is however out of scope for this exercise. There is only one step left!

Step 5.3: Publish the SearchParameter to Simplifier.net

This is the last step! Well done. Compare your results with the SearchParameter here below.

Results after completing step 5

JSON view of SearchParameter AdministeredProduct

{
    "resourceType": "SearchParameter",
    "id": "searchparameter-administeredproduct",
    "meta": {
        "lastUpdated": "2020-11-15T20:48:14.822+00:00"
    },
    "url": "https://fhir.devdays.com/R4/SearchParameter/AdministeredProduct",
    "name": "SearchParameterAdministeredProduct",
    "status": "draft",
    "date": "2020-11-15T20:48:14.6108237+00:00",
    "description": "To search (and _include) Medication resources that are referenced from the AdministeredProduct extension in Immunization.",
    "purpose": "To allow to search on Medication resource, referenced from a Immunization.extension.administeredProduct extension. Main purpose is to use this search parameter for including related Medication resources in the result for a search on Immunization.",
    "code": "administered-product",
    "base":  [
        "Immunization"
    ],
    "type": "reference",
    "expression": "Immunization.extension('https://fhir.devdays.com/R4/StructureDefinition/Extension-AdministeredProduct')"
}

Profile Immunization resource for COVID-19 vaccine use case

Use case: COVID-19 vaccination and adverse events report 💉🤒

Prerequisites

Step 1: Basic Profiling 🔥

Step 1.1: Create an Immunization profile

Step 1.2: Add cardinality and reference constraints

Step 1.3: Publish to Simplifier.net

Results after completing step 1

Differential view of ImmunizationProfile on Simplifier

Step 2: Add extensions to ImmunizationProfile ➕

Step 2.1: Reuse an extension: ExtensionUKCoreVaccinationProcedure

Step: 2.2: Create a simple extension and add it to ImmunizationProfile

Step 2.3: Publish the extension and the updated ImmunizationProfile to Simplifier.net

Results after completing step 2

Differential view of ImmunizationProfile

Differential view of ExtensionAdministeredProduct

Step 3: Terminology bindings 💎

Step 3.1: Adjust the ValueSet binding strength in ImmunizationProfile

Step 3.2: Find the right ValueSet and add it to ImmunizationProfile

Step 3.3: Publish the updated ImmunizationProfile to Simplifier.net

Results after completing step 3

Differential view of ImmunizationProfile

Step 4: Slicing ✂️🍕

Step 4.1: Create a type slice for occurrence[x]

Step 4.2: Bind multiple ValueSets to vaccineCode

Step 4.3: Publish the updated ImmunizationProfile to Simplifier.net

Results after completing step 4

Differential view of ImmunizationProfile

Step 5: Create a SearchParameter definition 🔎

Step 5.1: Create a SearchParameter resource with basic metadata

Step 5.2: Provide the SearchParameter details

Step 5.3: Publish the SearchParameter to Simplifier.net

Results after completing step 5

JSON view of SearchParameter AdministeredProduct

Step 4.1: Create a type slice for `occurrence[x]`

Step 4.2: Bind multiple ValueSets to `vaccineCode`