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This version of the UK Core is a development copy.
This contains BREAKING CHANGES as a result of the C&TA Sprint 7 Review, and STU2 Sequence ballot reconciliation.
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StructureDefinition UKCore-Immunization

Canonical_URL	Status	Current_Version	Last_Updated	Description
https://fhir.hl7.org.uk/StructureDefinition/UKCore-Immunization	active	2.4.0	2023-12-12	This profile defines the UK constraints and extensions on the International FHIR resource Immunization.

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

Profile_Purpose

This profile is intended to cover the recording of current and historical administration of vaccines to individuals across all healthcare disciplines in all care settings and all regions.

This profile does not support the administration of non-vaccine agents, even those that may have or claim to have immunological effects. While the terms "immunisation" and "vaccination" are not clinically identical, for the purposes of the FHIR profile, the terms are used synonymously.

UKCoreImmunization (Immunization)	I		Immunization	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()` ukcore-imm-001: If the immunization was not given then Immunization.status value SHALL = 'not-done', and the Immunization.statusReason SHALL be populated `(status != 'not-done') or (status = 'not-done' and statusReason.exists())` Mappings rim: Entity. Role, or Act workflow: Event v2: VXU_V04 rim: SubstanceAdministration
id	Σ	0..1	string	There are no (further) constraints on this element Element id Immunization.id Short description Logical id of this artifact Definition The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. Comments The only time that a resource does not have an id is when it is being submitted to the server using a create operation. Data type string
meta	Σ	0..1	Meta	There are no (further) constraints on this element Element id Immunization.meta Short description Metadata about the resource Definition The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource. Data type Meta 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
implicitRules	Σ ?!	0..1	uri	There are no (further) constraints on this element Element id Immunization.implicitRules Short description A set of rules under which this content was created Definition A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc. Comments Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc. 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
language		0..1	codeBinding	There are no (further) constraints on this element Element id Immunization.language Short description Language of the resource content Definition The base language in which the resource is written. Comments Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute). Data type code Binding A human language. CommonLanguages (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
text		0..1	Narrative	There are no (further) constraints on this element Element id Immunization.text Short description Text summary of the resource, for human interpretation Alternate names narrative, html, xhtml, display Definition A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety. Comments Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later. Data type Narrative 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 rim: Act.text?
contained		0..*	Resource	There are no (further) constraints on this element Element id Immunization.contained Short description Contained, inline Resources Alternate names inline resources, anonymous resources, contained resources Definition These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope. Comments This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels. Data type Resource Mappings rim: Entity. Role, or Act rim: N/A
extension	I	0..*	Extension	There are no (further) constraints on this element 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) Extensions are always sliced by (at least) url 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
parentPresent	I	0..1	Extension(boolean)	Element id Immunization.extension:parentPresent Short description Was a parent of the patient present at an immunisation? Alternate names extensions, user content Definition Was a parent of the patient present at an immunisation? 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(boolean) Extension URL https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-ParentPresent 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	0..1	Extension(CodeableConcept)	Element id Immunization.extension:vaccinationProcedure Short description An extension to hold an immunization procedure code Alternate names extensions, user content Definition An extension to hold an immunization procedure code. 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(CodeableConcept) Extension URL https://fhir.hl7.org.uk/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
modifierExtension	?! I	0..*	Extension	There are no (further) constraints on this element Element id Immunization.modifierExtension Short description Extensions that cannot be ignored Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url 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	S 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	CodeableConceptBinding	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. UKCoreReasonImmunizationNotAdministered (preferred) 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	S Σ	1..1	CodeableConceptBinding	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. UKCoreVaccineCode (preferred) 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
patient	S 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]	S 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	S 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	S	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. UKCoreImmunizationAdministrationBodySite (preferred) 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		0..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. UKCoreSubstanceOrProductAdministrationRoute (preferred) 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	S 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]
id		0..1	string	There are no (further) constraints on this element Element id Immunization.performer.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Immunization.performer.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 element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. 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) Extensions are always sliced by (at least) url 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
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id Immunization.performer.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. 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
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(Practitioner \| PractitionerRole \| Organization)	There are no (further) constraints on this element 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(Practitioner \| PractitionerRole \| 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) 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..*	CodeableConceptBinding	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. UKCoreImmunizationExplanationReason (preferred) 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. Meaning when missing By default, a dose should be considered to be potent. 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..*	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
id		0..1	string	There are no (further) constraints on this element Element id Immunization.education.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Immunization.education.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 element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. 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) Extensions are always sliced by (at least) url 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
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id Immunization.education.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. 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
documentType		0..1	string	There are no (further) constraints on this element Element id Immunization.education.documentType Short description Educational material document identifier Definition Identifier of the material presented to the patient. 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: OBX-5 : OBX-3 = 69764-9 rim: N/A
reference		0..1	uri	There are no (further) constraints on this element Element id Immunization.education.reference Short description Educational material reference pointer Definition Reference pointer to the educational material given to the patient if the information was on line. Comments see http://en.wikipedia.org/wiki/Uniform_resource_identifier 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 rim: N/A
publicationDate		0..1	dateTime	There are no (further) constraints on this element Element id Immunization.education.publicationDate Short description Educational material publication date Definition Date the educational material was published. 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-5 : OBX-3 = 29768-9 rim: N/A
presentationDate		0..1	dateTime	There are no (further) constraints on this element Element id Immunization.education.presentationDate Short description Educational material presentation date Definition Date the educational material was given to the patient. 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-5 : OBX-3 = 29769-7 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
id		0..1	string	There are no (further) constraints on this element Element id Immunization.reaction.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Immunization.reaction.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 element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. 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) Extensions are always sliced by (at least) url 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
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id Immunization.reaction.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. 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
date		0..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	0..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
id		0..1	string	There are no (further) constraints on this element Element id Immunization.protocolApplied.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Immunization.protocolApplied.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 element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. 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) Extensions are always sliced by (at least) url 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
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id Immunization.protocolApplied.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. 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
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

Detailed Descriptions

Immunization
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.
Cardinality	0...*
Invariants	dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources `contained.contained.empty()` dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()` dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource `contained.where((('#'+id in (%resource.descendants().reference \| %resource.descendants().as(canonical) \| %resource.descendants().as(uri) \| %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()` dom-6: A resource should have narrative for robust management text.`div`.exists() dom-5: If a resource is contained in another resource, it SHALL NOT have a security label `contained.meta.security.empty()` ukcore-imm-001: If the immunization was not given then Immunization.status value SHALL = 'not-done', and the Immunization.statusReason SHALL be populated `(status != 'not-done') or (status = 'not-done' and statusReason.exists())`
Mappings	rim: Entity. Role, or Act workflow: Event v2: VXU_V04 rim: SubstanceAdministration
Immunization.id
Definition	The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Cardinality	0...1
Type	string
Summary	True
Comments	The only time that a resource does not have an id is when it is being submitted to the server using a create operation.
Immunization.meta
Definition	The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
Cardinality	0...1
Type	Meta
Summary	True
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a rim: N/A
Immunization.implicitRules
Definition	A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Cardinality	0...1
Type	uri
Modifier	True
Summary	True
Comments	Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a
Immunization.language
Definition	The base language in which the resource is written.
Cardinality	0...1
Type	code
Binding	A human language. CommonLanguages (preferred)
Comments	Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a
Immunization.text
Definition	A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
Cardinality	0...1
Type	Narrative
Alias	narrative, html, xhtml, display
Comments	Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a rim: N/A rim: Act.text?
Immunization.contained
Definition	These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
Cardinality	0...*
Type	Resource
Alias	inline resources, anonymous resources, contained resources
Comments	This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
Mappings	rim: Entity. Role, or Act rim: N/A
Immunization.extension
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.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
Comments	There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Slicing	Unordered, Open, by url(Value)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a rim: N/A
Immunization.extension:parentPresent
Definition	Was a parent of the patient present at an immunisation?
Cardinality	0...1
Type	Extension(boolean)
Alias	extensions, user content
Comments	There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a rim: N/A
Immunization.extension:vaccinationProcedure
Definition	An extension to hold an immunization procedure code.
Cardinality	0...1
Type	Extension(CodeableConcept)
Alias	extensions, user content
Comments	There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a rim: N/A
Immunization.modifierExtension
Definition	May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality	0...*
Type	Extension
Modifier	True
Alias	extensions, user content
Requirements	Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Comments	There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Slicing	Unordered, Open, by url(Value)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a rim: N/A
Immunization.identifier
Definition	A unique identifier assigned to this immunization record.
Cardinality	0...*
Type	Identifier
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: CX / EI (occasionally, more often EI maps to a resource id or a URL) rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT] servd: Identifier workflow: Event.identifier w5: FiveWs.identifier rim: .id cda: ClinicalDocument/component/StructuredBody/component/section/entry/substanceAdministration/id
Immunization.status
Definition	Indicates the current status of the immunization event.
Cardinality	1...1
Type	code
Binding	A set of codes indicating the current status of an Immunization. ImmunizationStatusCodes (required)
Must Support	True
Modifier	True
Summary	True
Comments	Will generally be set to show that the immunization has been completed or not done. This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a workflow: Event.status w5: FiveWs.status rim: statusCode
Immunization.statusReason
Definition	Indicates the reason the immunization event was not performed.
Cardinality	0...1
Type	CodeableConcept
Binding	The reason why a vaccine was not administered. UKCoreReasonImmunizationNotAdministered (preferred)
Comments	This is generally only used for the status of "not-done". The reason for performing the immunization event is captured in reasonCode, not here.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD workflow: Event.statusReason rim: .inboundRelationship[typeCode=SUBJ].source[classCode=CACT, moodCode=EVN].reasonCOde
Immunization.vaccineCode
Definition	Vaccine that was administered or was to be administered.
Cardinality	1...1
Type	CodeableConcept
Binding	The code for vaccine product administered. UKCoreVaccineCode (preferred)
Must Support	True
Summary	True
Comments	Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD workflow: Event.code w5: FiveWs.what[x] v2: RXA-5 rim: .code cda: ClinicalDocument/component/StructuredBody/component/section/entry/substanceAdministration/consumable/manfacturedProduct/manufacturedMaterial/realmCode/code
Immunization.patient
Definition	The patient who either received or did not receive the immunization.
Cardinality	1...1
Type	Reference(Patient)
Must Support	True
Summary	True
Comments	References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))`
Mappings	rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow: Event.subject w5: FiveWs.subject[x] v2: PID-3 rim: .partipication[ttypeCode=].role w5: FiveWs.subject
Immunization.encounter
Definition	The visit or admission or other contact between patient and health care provider the immunization was performed as part of.
Cardinality	0...1
Type	Reference(Encounter)
Comments	References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))`
Mappings	rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow: Event.context w5: FiveWs.context v2: PV1-19 rim: component->EncounterEvent
Immunization.occurrence[x]
Definition	Date vaccine administered or was to be administered.
Cardinality	1...1
Type	dateTime
Must Support	True
Summary	True
Comments	When immunizations are given a specific date and time should always be known. When immunizations are patient reported, a specific date might not be known. Although partial dates are allowed, an adult patient might not be able to recall the year a childhood immunization was given. An exact date is always preferable, but the use of the String data type is acceptable when an exact date is not known. A small number of vaccines (e.g. live oral typhoid vaccine) are given as a series of patient self-administered dose over a span of time. In cases like this, often, only the first dose (typically a provider supervised dose) is recorded with the occurrence indicating the date/time of the first dose.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a workflow: Event.occurrence[x] w5: FiveWs.done[x] v2: RXA-3 rim: .effectiveTime cda: ClinicalDocument/component/StructuredBody/component/section/entry/substanceAdministration/effectiveTime/value
Immunization.recorded
Definition	The date the occurrence of the immunization was first captured in the record - potentially significantly after the occurrence of the event.
Cardinality	0...1
Type	dateTime
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a w5: FiveWs.recorded rim: .participation[typeCode=AUT].time
Immunization.primarySource
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.
Cardinality	0...1
Type	boolean
Summary	True
Comments	Reflects the “reliability” of the content.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a w5: FiveWs.source v2: RXA-9 rim: immunization.uncertaintycode (if primary source=false, uncertainty=U)
Immunization.reportOrigin
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.
Cardinality	0...1
Type	CodeableConcept
Binding	The source of the data for a record which is not from a primary source. ImmunizationOriginCodes (example)
Comments	Should not be populated if primarySource = True, not required even if primarySource = False.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD w5: FiveWs.source v2: RXA-9 rim: .participation[typeCode=INF].role[classCode=PAT] (this syntax for self-reported) .participation[typeCode=INF].role[classCode=LIC] (this syntax for health care professional) .participation[typeCode=INF].role[classCode=PRS] (this syntax for family member)
Immunization.location
Definition	The service delivery location where the vaccine administration occurred.
Cardinality	0...1
Type	Reference(Location)
Comments	References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))`
Mappings	rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow: Event.location w5: FiveWs.where[x] v2: RXA-27 (or RXA-11, deprecated as of v2.7) rim: .participation[typeCode=LOC].COCT_MT240000UV
Immunization.manufacturer
Definition	Name of vaccine manufacturer.
Cardinality	0...1
Type	Reference(Organization)
Must Support	True
Comments	References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))`
Mappings	rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) v2: RXA-17 rim: .participation[typeCode=CSM].role[classCode=INST].scopedRole.scoper[classCode=ORG] cda: ClinicalDocument/component/StructuredBody/component/section/entry/substanceAdministration/consumable/manfacturedProduct/manufacuturerOrganization/name
Immunization.lotNumber
Definition	Lot number of the vaccine product.
Cardinality	0...1
Type	string
Must Support	True
Comments	Note that FHIR strings SHALL NOT exceed 1MB in size
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: RXA-15 rim: .participation[typeCode=CSM].role[classCode=INST].scopedRole.scoper[classCode=MMAT].id cda: ClinicalDocument/component/StructuredBody/component/section/entry/substanceAdministration/consumable/manfacturedProduct/manufacturedMaterial/lotNumberText
Immunization.expirationDate
Definition	Date vaccine batch expires.
Cardinality	0...1
Type	date
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: RXA-16 rim: .participation[typeCode=CSM].role[classCode=INST].scopedRole.scoper[classCode=MMAT].expirationTime
Immunization.site
Definition	Body site where vaccine was administered.
Cardinality	0...1
Type	CodeableConcept
Binding	The site at which the vaccine was administered. UKCoreImmunizationAdministrationBodySite (preferred)
Comments	Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD v2: RXR-2 rim: observation.targetSiteCode cda: ClinicalDocument/component/StructuredBody/component/section/entry/substanceAdministration/approachSiteCode/code
Immunization.route
Definition	The path by which the vaccine product is taken into the body.
Cardinality	0...1
Type	CodeableConcept
Binding	The route by which the vaccine was administered. UKCoreSubstanceOrProductAdministrationRoute (preferred)
Comments	Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD v2: RXR-1 rim: .routeCode cda: ClinicalDocument/component/StructuredBody/component/section/entry/substanceAdministration/routeCode/code
Immunization.doseQuantity
Definition	The quantity of vaccine product that was administered.
Cardinality	0...1
Type	SimpleQuantity
Must Support	True
Comments	The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` qty-3: If a code for the unit is present, the system SHALL also be present `code.empty() or system.exists()` sqty-1: The comparator is not used on a SimpleQuantity `comparator.empty()`
Mappings	rim: n/a v2: SN (see also Range) or CQ rim: PQ, IVL<PQ>, MO, CO, depending on the values v2: RXA-6 / RXA-7 rim: .doseQuantity
Immunization.performer
Definition	Indicates who performed the immunization event.
Cardinality	0...*
Type	BackboneElement
Summary	True
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a workflow: Event.performer v2: ORC-12 / RXA-10 rim: .participation[typeCode=PRF].role[scoper.determinerCode=INSTANCE]
Immunization.performer.id
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	0...1
Type	string
Mappings	rim: n/a
Immunization.performer.extension
Definition	May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
Comments	There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Slicing	Unordered, Open, by url(Value)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a rim: N/A
Immunization.performer.modifierExtension
Definition	May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality	0...*
Type	Extension
Modifier	True
Summary	True
Alias	extensions, user content, modifiers
Requirements	Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Comments	There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a rim: N/A
Immunization.performer.function
Definition	Describes the type of performance (e.g. ordering provider, administering provider, etc.).
Cardinality	0...1
Type	CodeableConcept
Binding	The role a practitioner or organization plays in the immunization event. ImmunizationFunctionCodes (extensible)
Summary	True
Comments	Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD workflow: Event.performer.function rim: .participation.functionCode
Immunization.performer.actor
Definition	The practitioner or organization who performed the action.
Cardinality	1...1
Type	Reference(Practitioner \| PractitionerRole \| Organization)
Summary	True
Comments	When the individual practitioner who performed the action is known, it is best to send.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))`
Mappings	rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow: Event.performer.actor w5: FiveWs.actor rim: .player
Immunization.note
Definition	Extra information about the immunization that is not conveyed by the other attributes.
Cardinality	0...*
Type	Annotation
Summary	True
Comments	For systems that do not have structured annotations, they can simply communicate a single annotation with no author or time. This element may need to be included in narrative because of the potential for modifying information. Annotations SHOULD NOT be used to communicate "modifying" information that could be computable. (This is a SHOULD because enforcing user behavior is nearly impossible).
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: N/A rim: Act workflow: Event.note v2: OBX-5 : OBX-3 = 48767-8 rim: note
Immunization.reasonCode
Definition	Reasons why the vaccine was administered.
Cardinality	0...*
Type	CodeableConcept
Binding	The reason why a vaccine was administered. UKCoreImmunizationExplanationReason (preferred)
Comments	Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD workflow: Event.reasonCode rim: [actionNegationInd=false].reasonCode
Immunization.reasonReference
Definition	Condition, Observation or DiagnosticReport that supports why the immunization was administered.
Cardinality	0...*
Type	Reference(Condition \| Observation \| DiagnosticReport)
Comments	References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))`
Mappings	rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow: Event.reasonReference rim: N/A
Immunization.isSubpotent
Definition	Indication if a dose is considered to be subpotent. By default, a dose should be considered to be potent.
Cardinality	0...1
Type	boolean
Modifier	True
Summary	True
Comments	Typically, the recognition of the dose being sub-potent is retrospective, after the administration (ex. notification of a manufacturer recall after administration). However, in the case of a partial administration (the patient moves unexpectedly and only some of the dose is actually administered), subpotency may be recognized immediately, but it is still important to record the event.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: RXA-20 = PA (partial administration) rim: N/A
Immunization.subpotentReason
Definition	Reason why a dose is considered to be subpotent.
Cardinality	0...*
Type	CodeableConcept
Binding	The reason why a dose is considered to be subpotent. ImmunizationSubpotentReason (example)
Comments	Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD rim: N/A
Immunization.education
Definition	Educational material presented to the patient (or guardian) at the time of vaccine administration.
Cardinality	0...*
Type	BackboneElement
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` imm-1: One of documentType or reference SHALL be present `documentType.exists() or reference.exists()`
Mappings	rim: n/a rim: N/A
Immunization.education.id
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	0...1
Type	string
Mappings	rim: n/a
Immunization.education.extension
Definition	May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
Comments	There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Slicing	Unordered, Open, by url(Value)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a rim: N/A
Immunization.education.modifierExtension
Definition	May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality	0...*
Type	Extension
Modifier	True
Summary	True
Alias	extensions, user content, modifiers
Requirements	Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Comments	There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a rim: N/A
Immunization.education.documentType
Definition	Identifier of the material presented to the patient.
Cardinality	0...1
Type	string
Comments	Note that FHIR strings SHALL NOT exceed 1MB in size
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: OBX-5 : OBX-3 = 69764-9 rim: N/A
Immunization.education.reference
Definition	Reference pointer to the educational material given to the patient if the information was on line.
Cardinality	0...1
Type	uri
Comments	see http://en.wikipedia.org/wiki/Uniform_resource_identifier
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a rim: N/A
Immunization.education.publicationDate
Definition	Date the educational material was published.
Cardinality	0...1
Type	dateTime
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: OBX-5 : OBX-3 = 29768-9 rim: N/A
Immunization.education.presentationDate
Definition	Date the educational material was given to the patient.
Cardinality	0...1
Type	dateTime
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: OBX-5 : OBX-3 = 29769-7 rim: N/A
Immunization.programEligibility
Definition	Indicates a patient's eligibility for a funding program.
Cardinality	0...*
Type	CodeableConcept
Binding	The patient's eligibility for a vaccation program. ImmunizationProgramEligibility (example)
Comments	Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD v2: OBX-5 : OBX-3 = 64994-7 rim: N/A
Immunization.fundingSource
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).
Cardinality	0...1
Type	CodeableConcept
Binding	The source of funding used to purchase the vaccine administered. ImmunizationFundingSource (example)
Comments	Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD rim: N/A
Immunization.reaction
Definition	Categorical data indicating that an adverse event is associated in time to an immunization.
Cardinality	0...*
Type	BackboneElement
Comments	A reaction may be an indication of an allergy or intolerance and, if this is determined to be the case, it should be recorded as a new AllergyIntolerance resource instance as most systems will not query against past Immunization.reaction elements.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: OBX-3 rim: Observation[classCode=obs].code
Immunization.reaction.id
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	0...1
Type	string
Mappings	rim: n/a
Immunization.reaction.extension
Definition	May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
Comments	There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Slicing	Unordered, Open, by url(Value)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a rim: N/A
Immunization.reaction.modifierExtension
Definition	May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality	0...*
Type	Extension
Modifier	True
Summary	True
Alias	extensions, user content, modifiers
Requirements	Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Comments	There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a rim: N/A
Immunization.reaction.date
Definition	Date of reaction to the immunization.
Cardinality	0...1
Type	dateTime
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: OBX-14 (ideally this would be reported in an IAM segment, but IAM is not part of the HL7 v2 VXU message - most likely would appear in OBX segments if at all) rim: .effectiveTime
Immunization.reaction.detail
Definition	Details of the reaction.
Cardinality	0...1
Type	Reference(Observation)
Comments	References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))`
Mappings	rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) v2: OBX-5 rim: .value
Immunization.reaction.reported
Definition	Self-reported indicator.
Cardinality	0...1
Type	boolean
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: (HL7 v2 doesn't seem to provide for this) rim: .participation[typeCode=INF].role[classCode=PAT] (this syntax for self-reported=true)
Immunization.protocolApplied
Definition	The protocol (set of recommendations) being followed by the provider who administered the dose.
Cardinality	0...*
Type	BackboneElement
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a rim: N/A
Immunization.protocolApplied.id
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	0...1
Type	string
Mappings	rim: n/a
Immunization.protocolApplied.extension
Definition	May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
Comments	There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Slicing	Unordered, Open, by url(Value)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a rim: N/A
Immunization.protocolApplied.modifierExtension
Definition	May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality	0...*
Type	Extension
Modifier	True
Summary	True
Alias	extensions, user content, modifiers
Requirements	Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Comments	There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a rim: N/A
Immunization.protocolApplied.series
Definition	One possible path to achieve presumed immunity against a disease - within the context of an authority.
Cardinality	0...1
Type	string
Comments	Note that FHIR strings SHALL NOT exceed 1MB in size
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a rim: N/A
Immunization.protocolApplied.authority
Definition	Indicates the authority who published the protocol (e.g. ACIP) that is being followed.
Cardinality	0...1
Type	Reference(Organization)
Comments	References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))`
Mappings	rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) rim: N/A
Immunization.protocolApplied.targetDisease
Definition	The vaccine preventable disease the dose is being administered against.
Cardinality	0...*
Type	CodeableConcept
Binding	The vaccine preventable disease the dose is being administered for. ImmunizationTargetDiseaseCodes (example)
Comments	Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD rim: N/A
Immunization.protocolApplied.doseNumber[x]
Definition	Nominal position in a series.
Cardinality	1...1
Type	positiveInt
Comments	The use of an integer is preferred if known. A string should only be used in cases where an integer is not available (such as when documenting a recurring booster dose).
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a rim: N/A
Immunization.protocolApplied.seriesDoses[x]
Definition	The recommended number of doses to achieve immunity.
Cardinality	0...1
Type	positiveInt
Comments	The use of an integer is preferred if known. A string should only be used in cases where an integer is not available (such as when documenting a recurring booster dose).
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a rim: N/A

Table View

Immunization		..
Immunization.extension	Extension	..
Immunization.extension	Extension	..
Immunization.status		..
Immunization.statusReason		..
Immunization.vaccineCode		..
Immunization.patient		..
Immunization.occurrence[x]		..
Immunization.manufacturer		..
Immunization.lotNumber		..
Immunization.site		..
Immunization.route		..
Immunization.doseQuantity		..
Immunization.reasonCode		..

XML View

<StructureDefinition xmlns="http://hl7.org/fhir">
    <id value="UKCore-Immunization" />
    <url value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-Immunization" />
    <version value="2.4.0" />
    <name value="UKCoreImmunization" />
    <title value="UK Core Immunization" />
    <status value="active" />
    <date value="2023-12-12" />
    <publisher value="HL7 UK" />
    <contact>
        <name value="HL7 UK" />
        <telecom>
            <system value="email" />
            <value value="ukcore@hl7.org.uk" />
            <use value="work" />
            <rank value="1" />
        </telecom>
    </contact>
    <description value="This profile defines the UK constraints and extensions on the International FHIR resource [Immunization](https://hl7.org/fhir/R4/Immunization.html)." />
    <purpose value="This profile is intended to cover the recording of current and historical administration of vaccines to individuals across all healthcare disciplines in all care settings and all regions. \n\nThis profile does not support the administration of non-vaccine agents, even those that may have or claim to have immunological effects. While the terms &quot;immunisation&quot; and &quot;vaccination&quot; are not clinically identical, for the purposes of the FHIR profile, the terms are used synonymously." />
    <copyright value="Copyright &#169; 2021+ HL7 UK Licensed under the Apache License, Version 2.0 (the &quot;License&quot;); you may not use this file except in compliance with the License. You may obtain a copy of the License at  http://www.apache.org/licenses/LICENSE-2.0 Unless required by applicable law or agreed to in writing, software distributed under the License is distributed on an &quot;AS IS&quot; BASIS, WITHOUT WARRANTIES OR CONDITIONS OF ANY KIND, either express or implied. See the License for the specific language governing permissions and limitations under the License. HL7&#174; FHIR&#174; standard Copyright &#169; 2011+ HL7 The HL7&#174; FHIR&#174; standard is used under the FHIR license. You may obtain a copy of the FHIR license at  https://www.hl7.org/fhir/license.html." />
    <fhirVersion value="4.0.1" />
    <kind value="resource" />
    <abstract value="false" />
    <type value="Immunization" />
    <baseDefinition value="http://hl7.org/fhir/StructureDefinition/Immunization" />
    <derivation value="constraint" />
    <differential>
        <element id="Immunization">
            <path value="Immunization" />
            <constraint>
                <key value="ukcore-imm-001" />
                <severity value="error" />
                <human value="If the immunization was not given then Immunization.status value SHALL = &#39;not-done&#39;, and the Immunization.statusReason SHALL be populated" />
                <expression value="(status != &#39;not-done&#39;) or (status = &#39;not-done&#39; and statusReason.exists())" />
            </constraint>
        </element>
        <element id="Immunization.extension:parentPresent">
            <path value="Immunization.extension" />
            <sliceName value="parentPresent" />
            <type>
                <code value="Extension" />
                <profile value="https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-ParentPresent" />
            </type>
        </element>
        <element id="Immunization.extension:vaccinationProcedure">
            <path value="Immunization.extension" />
            <sliceName value="vaccinationProcedure" />
            <type>
                <code value="Extension" />
                <profile value="https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-VaccinationProcedure" />
            </type>
        </element>
        <element id="Immunization.status">
            <path value="Immunization.status" />
            <mustSupport value="true" />
        </element>
        <element id="Immunization.statusReason">
            <path value="Immunization.statusReason" />
            <binding>
                <strength value="preferred" />
                <valueSet value="https://fhir.hl7.org.uk/ValueSet/UKCore-ReasonImmunizationNotAdministered" />
            </binding>
        </element>
        <element id="Immunization.vaccineCode">
            <path value="Immunization.vaccineCode" />
            <mustSupport value="true" />
            <binding>
                <strength value="preferred" />
                <valueSet value="https://fhir.hl7.org.uk/ValueSet/UKCore-VaccineCode" />
            </binding>
        </element>
        <element id="Immunization.patient">
            <path value="Immunization.patient" />
            <mustSupport value="true" />
        </element>
        <element id="Immunization.occurrence[x]">
            <path value="Immunization.occurrence[x]" />
            <mustSupport value="true" />
        </element>
        <element id="Immunization.manufacturer">
            <path value="Immunization.manufacturer" />
            <mustSupport value="true" />
        </element>
        <element id="Immunization.lotNumber">
            <path value="Immunization.lotNumber" />
            <mustSupport value="true" />
        </element>
        <element id="Immunization.site">
            <path value="Immunization.site" />
            <binding>
                <strength value="preferred" />
                <valueSet value="https://fhir.hl7.org.uk/ValueSet/UKCore-ImmunizationAdministrationBodySite" />
            </binding>
        </element>
        <element id="Immunization.route">
            <path value="Immunization.route" />
            <binding>
                <strength value="preferred" />
                <valueSet value="https://fhir.hl7.org.uk/ValueSet/UKCore-SubstanceOrProductAdministrationRoute" />
            </binding>
        </element>
        <element id="Immunization.doseQuantity">
            <path value="Immunization.doseQuantity" />
            <mustSupport value="true" />
        </element>
        <element id="Immunization.reasonCode">
            <path value="Immunization.reasonCode" />
            <binding>
                <strength value="preferred" />
                <valueSet value="https://fhir.hl7.org.uk/ValueSet/UKCore-ImmunizationExplanationReason" />
            </binding>
        </element>
    </differential>
</StructureDefinition>

JSON View

{
    "resourceType": "StructureDefinition",
    "id": "UKCore-Immunization",
    "url": "https://fhir.hl7.org.uk/StructureDefinition/UKCore-Immunization",
    "version": "2.4.0",
    "name": "UKCoreImmunization",
    "title": "UK Core Immunization",
    "status": "active",
    "date": "2023-12-12",
    "publisher": "HL7 UK",
    "contact":  [
        {
            "name": "HL7 UK",
            "telecom":  [
                {
                    "system": "email",
                    "value": "ukcore@hl7.org.uk",
                    "use": "work",
                    "rank": 1
                }
            ]
        }
    ],
    "description": "This profile defines the UK constraints and extensions on the International FHIR resource [Immunization](https://hl7.org/fhir/R4/Immunization.html).",
    "purpose": "This profile is intended to cover the recording of current and historical administration of vaccines to individuals across all healthcare disciplines in all care settings and all regions. \n\nThis profile does not support the administration of non-vaccine agents, even those that may have or claim to have immunological effects. While the terms \"immunisation\" and \"vaccination\" are not clinically identical, for the purposes of the FHIR profile, the terms are used synonymously.",
    "copyright": "Copyright © 2021+ HL7 UK Licensed under the Apache License, Version 2.0 (the \"License\"); you may not use this file except in compliance with the License. You may obtain a copy of the License at  http://www.apache.org/licenses/LICENSE-2.0 Unless required by applicable law or agreed to in writing, software distributed under the License is distributed on an \"AS IS\" BASIS, WITHOUT WARRANTIES OR CONDITIONS OF ANY KIND, either express or implied. See the License for the specific language governing permissions and limitations under the License. HL7® FHIR® standard Copyright © 2011+ HL7 The HL7® FHIR® standard is used under the FHIR license. You may obtain a copy of the FHIR license at  https://www.hl7.org/fhir/license.html.",
    "fhirVersion": "4.0.1",
    "kind": "resource",
    "abstract": false,
    "type": "Immunization",
    "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Immunization",
    "derivation": "constraint",
    "differential": {
        "element":  [
            {
                "id": "Immunization",
                "path": "Immunization",
                "constraint":  [
                    {
                        "key": "ukcore-imm-001",
                        "severity": "error",
                        "human": "If the immunization was not given then Immunization.status value SHALL = 'not-done', and the Immunization.statusReason SHALL be populated",
                        "expression": "(status != 'not-done') or (status = 'not-done' and statusReason.exists())"
                    }
                ]
            },
            {
                "id": "Immunization.extension:parentPresent",
                "path": "Immunization.extension",
                "sliceName": "parentPresent",
                "type":  [
                    {
                        "code": "Extension",
                        "profile":  [
                            "https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-ParentPresent"
                        ]
                    }
                ]
            },
            {
                "id": "Immunization.extension:vaccinationProcedure",
                "path": "Immunization.extension",
                "sliceName": "vaccinationProcedure",
                "type":  [
                    {
                        "code": "Extension",
                        "profile":  [
                            "https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-VaccinationProcedure"
                        ]
                    }
                ]
            },
            {
                "id": "Immunization.status",
                "path": "Immunization.status",
                "mustSupport": true
            },
            {
                "id": "Immunization.statusReason",
                "path": "Immunization.statusReason",
                "binding": {
                    "strength": "preferred",
                    "valueSet": "https://fhir.hl7.org.uk/ValueSet/UKCore-ReasonImmunizationNotAdministered"
                }
            },
            {
                "id": "Immunization.vaccineCode",
                "path": "Immunization.vaccineCode",
                "mustSupport": true,
                "binding": {
                    "strength": "preferred",
                    "valueSet": "https://fhir.hl7.org.uk/ValueSet/UKCore-VaccineCode"
                }
            },
            {
                "id": "Immunization.patient",
                "path": "Immunization.patient",
                "mustSupport": true
            },
            {
                "id": "Immunization.occurrence[x]",
                "path": "Immunization.occurrence[x]",
                "mustSupport": true
            },
            {
                "id": "Immunization.manufacturer",
                "path": "Immunization.manufacturer",
                "mustSupport": true
            },
            {
                "id": "Immunization.lotNumber",
                "path": "Immunization.lotNumber",
                "mustSupport": true
            },
            {
                "id": "Immunization.site",
                "path": "Immunization.site",
                "binding": {
                    "strength": "preferred",
                    "valueSet": "https://fhir.hl7.org.uk/ValueSet/UKCore-ImmunizationAdministrationBodySite"
                }
            },
            {
                "id": "Immunization.route",
                "path": "Immunization.route",
                "binding": {
                    "strength": "preferred",
                    "valueSet": "https://fhir.hl7.org.uk/ValueSet/UKCore-SubstanceOrProductAdministrationRoute"
                }
            },
            {
                "id": "Immunization.doseQuantity",
                "path": "Immunization.doseQuantity",
                "mustSupport": true
            },
            {
                "id": "Immunization.reasonCode",
                "path": "Immunization.reasonCode",
                "binding": {
                    "strength": "preferred",
                    "valueSet": "https://fhir.hl7.org.uk/ValueSet/UKCore-ImmunizationExplanationReason"
                }
            }
        ]
    }
}

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Examples

Influenza virus vaccine - An example to illustrate an Influenza virus vaccine.
Example UKCore-Immunization-InfluenzaVaccine

Parent Present - An example to illustrate the ParentPresent extension.
Example UKCore-Extension-ParentPresent

Vaccination Procedure - An example to illustrate the VaccinationProcedure extension, with a vaccination procedure for an administered Influenza virus vaccine.
Example UKCore-Extension-VaccinationProcedure

Vaccination Procedure Covid - An example to illustrate the VaccinationProcedureCovid extension, with a vaccination procedure for the COVID-19 Vaccine Vaxzevria.
Example UKCore-Extension-VaccinationProcedure-COVID

Example Usage Scenarios

The following are example usage scenarios for the UK Core Immunization profile:

Query and retrieve an individual’s immunisations (vaccinations)
Record or update an individual’s immunisations (vaccinations).

Profile Specific Implementation Guidance:

Mandatory and Must Support Data Elements

The following elements are identified as MustSupport, and it is expected that consumers and suppliers SHALL support these as per the MustSupport Guidance.

Element
`Immunization.status`
`Immunization.vaccineCode`
`Immunization.patient`
`Immunization.occurrence[x]`
`Immunization.manufacturer`
`Immunization.lotNumber`
`Immunization.doseQuantity`

Extensions

More information about the extensions on the UKCore-Immunization profile can be found using the links below.

Extension	Context	Link
parentPresent	Immunization.extension	https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-ParentPresent
vaccinationProcedure	Immunization.extension	https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-VaccinationProcedure

Bindings (differential)

More information about the bindings to UK Core ValueSets can be found below.

Context	Strength	Link
Immunization.statusReason	preferred	https://fhir.hl7.org.uk/ValueSet/UKCore-ReasonImmunizationNotAdministered
Immunization.vaccineCode	preferred	https://fhir.hl7.org.uk/ValueSet/UKCore-VaccineCode
Immunization.site	preferred	https://fhir.hl7.org.uk/ValueSet/UKCore-ImmunizationAdministrationBodySite
Immunization.route	preferred	https://fhir.hl7.org.uk/ValueSet/UKCore-SubstanceOrProductAdministrationRoute
Immunization.reasonCode	preferred	https://fhir.hl7.org.uk/ValueSet/UKCore-ImmunizationExplanationReason

Immunization.extension:vaccinationProcedure

preferred

ValueSet UKCore-VaccinationProcedure

Constraints (differential)

More information about the constraints on the UKCore-Immunization profile can be found below.

Key	Severity	Expression	Human_Description
ukcore-imm-001	error	(status != 'not-done') or (status = 'not-done' and statusReason.exists())	If the immunization was not given then Immunization.status value SHALL = 'not-done', and the Immunization.statusReason SHALL be populated

Breaking Change

The key for this constraint was changed from ukcore-imm-1 in UK Core STU1 Sequence, to ukcore-imm-001 in this release, as a result of the UK Core STU2 Sequence ballot reconciliation actions.

`status`

Indicates the current status of the immunisation event.

For a vaccination that has been administered, the status will be completed. This status does not indicate a vaccination course has been completed. When the vaccination has not been administered, the status will be not-done and a Immunization.statusReason SHALL be populated.

`vaccineCode`

Vaccine that was administered or was to be administered.

This indicates vaccine product administered. This SHOULD be a dm+d code from ValueSet UKCore-VaccineCode. AMPP codes SHOULD NOT be used.

Example of `Immunization.vaccineCode` usage:

Table View

Immunization.id[0]	UKCore-Immunization-Sn-AstraZenecaVaccine-Example
Immunization.status[0]	completed
Immunization.vaccineCode[0].coding[0].system[0]	https://dmd.nhs.uk
Immunization.vaccineCode[0].coding[0].code[0]	39114911000001105
Immunization.vaccineCode[0].coding[0].display[0]	COVID-19 Vaccine Vaxzevria (ChAdOx1 S [recombinant]) not less than 2.5x100,000,000 infectious units/0.5ml dose suspension for injection multidose vials (AstraZeneca UK Ltd)
Immunization.patient[0].reference[0]	Patient/UKCore-Patient-RichardSmith-Example
Immunization.occurrence[0]	2021-07-20

Tree View

Immunization

id : UKCore-Immunization-Sn-AstraZenecaVaccine-Example

status : completed

vaccineCode

coding

system : https://dmd.nhs.uk

code : 39114911000001105

display : COVID-19 Vaccine Vaxzevria (ChAdOx1 S [recombinant]) not less than 2.5x100,000,000 infectious units/0.5ml dose suspension for injection multidose vials (AstraZeneca UK Ltd)

patient

reference : Patient/UKCore-Patient-RichardSmith-Example

occurrence : 2021-07-20

XML View

<Immunization xmlns="http://hl7.org/fhir">
    <id value="UKCore-Immunization-Sn-AstraZenecaVaccine-Example" />
    <status value="completed" />
    <!--  **************snippet start**************  -->
    <vaccineCode>
        <coding>
            <system value="https://dmd.nhs.uk" />
            <code value="39114911000001105" />
            <display value="COVID-19 Vaccine Vaxzevria (ChAdOx1 S [recombinant]) not less than 2.5x100,000,000 infectious units/0.5ml dose suspension for injection multidose vials (AstraZeneca UK Ltd)" />
        </coding>
    </vaccineCode>
    <!--  **************snippet end**************  -->
    <patient>
        <reference value="Patient/UKCore-Patient-RichardSmith-Example" />
    </patient>
    <occurrenceDateTime value="2021-07-20" />
</Immunization>

JSON View

{
    "resourceType": "Immunization",
    "id": "UKCore-Immunization-Sn-AstraZenecaVaccine-Example",
    "status": "completed",
    "vaccineCode": {
        "coding":  [
            {
                "system": "https://dmd.nhs.uk",
                "code": "39114911000001105",
                "display": "COVID-19 Vaccine Vaxzevria (ChAdOx1 S [recombinant]) not less than 2.5x100,000,000 infectious units/0.5ml dose suspension for injection multidose vials (AstraZeneca UK Ltd)"
            }
        ]
    },
    "patient": {
        "reference": "Patient/UKCore-Patient-RichardSmith-Example"
    },
    "occurrenceDateTime": "2021-07-20"
}

`patient`

A reference to the patient who either received or did not receive the immunisation. Where possible, it is expected that the resource being referenced SHOULD conform to Profile UKCore-Patient.

Example of `Immunization.patient` usage:

Table View

Immunization.id[0]	UKCore-Immunization-Sn-PatientConformVaccination-Example
Immunization.status[0]	completed
Immunization.vaccineCode[0].coding[0].system[0]	https://dmd.nhs.uk
Immunization.vaccineCode[0].coding[0].code[0]	39114911000001105
Immunization.vaccineCode[0].coding[0].display[0]	COVID-19 Vaccine Vaxzevria (ChAdOx1 S [recombinant]) not less than 2.5x100,000,000 infectious units/0.5ml dose suspension for injection multidose vials (AstraZeneca UK Ltd)
Immunization.patient[0].reference[0]	Patient/UKCore-Patient-RichardSmith-Example
Immunization.patient[0].type[0]	Patient
Immunization.patient[0].identifier[0].system[0]	https://fhir.nhs.uk/Id/nhs-number
Immunization.patient[0].identifier[0].value[0]	9912003888
Immunization.occurrence[0]	2021-07-20

Tree View

Immunization

id : UKCore-Immunization-Sn-PatientConformVaccination-Example

status : completed

vaccineCode

coding

system : https://dmd.nhs.uk

code : 39114911000001105

display : COVID-19 Vaccine Vaxzevria (ChAdOx1 S [recombinant]) not less than 2.5x100,000,000 infectious units/0.5ml dose suspension for injection multidose vials (AstraZeneca UK Ltd)

patient

reference : Patient/UKCore-Patient-RichardSmith-Example

type : Patient

identifier

system : https://fhir.nhs.uk/Id/nhs-number

value : 9912003888

occurrence : 2021-07-20

XML View

<Immunization xmlns="http://hl7.org/fhir">
    <id value="UKCore-Immunization-Sn-PatientConformVaccination-Example" />
    <status value="completed" />
    <vaccineCode>
        <coding>
            <system value="https://dmd.nhs.uk" />
            <code value="39114911000001105" />
            <display value="COVID-19 Vaccine Vaxzevria (ChAdOx1 S [recombinant]) not less than 2.5x100,000,000 infectious units/0.5ml dose suspension for injection multidose vials (AstraZeneca UK Ltd)" />
        </coding>
    </vaccineCode>
    <!--   **************snippet start**************   -->
    <patient>
        <reference value="Patient/UKCore-Patient-RichardSmith-Example" />
        <type value="Patient" />
        <identifier>
            <system value="https://fhir.nhs.uk/Id/nhs-number" />
            <value value="9912003888" />
        </identifier>
    </patient>
    <!--   **************snippet end**************   -->
    <occurrenceDateTime value="2021-07-20" />
</Immunization>

JSON View

{
    "resourceType": "Immunization",
    "id": "UKCore-Immunization-Sn-PatientConformVaccination-Example",
    "status": "completed",
    "vaccineCode": {
        "coding":  [
            {
                "system": "https://dmd.nhs.uk",
                "code": "39114911000001105",
                "display": "COVID-19 Vaccine Vaxzevria (ChAdOx1 S [recombinant]) not less than 2.5x100,000,000 infectious units/0.5ml dose suspension for injection multidose vials (AstraZeneca UK Ltd)"
            }
        ]
    },
    "patient": {
        "reference": "Patient/UKCore-Patient-RichardSmith-Example",
        "type": "Patient",
        "identifier": {
            "system": "https://fhir.nhs.uk/Id/nhs-number",
            "value": "9912003888"
        }
    },
    "occurrenceDateTime": "2021-07-20"
}

`encounter`

Where possible, it is expected that the resource being referenced SHOULD conform to Profile UKCore-Encounter.

`primarySource`

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.

Set as true when the content of the record is based on information from the person performing the vaccine or who has clinical responsibility for the vaccination, and the system can be considered a primary source of the vaccination event. Set as false when the information has not come directly from people performing the vaccine (e.g. a patient or patient’s carer), and the system should not be treated as a primary source for this record. This is used to help identify and eliminate duplicate records held centrally.

`location`

The service delivery location where the vaccine administration occurred by reference to the location.

Where possible, it is expected that the resource being referenced SHOULD conform to Profile UKCore-Location.

`manufacturer`

Name of vaccine manufacturer by reference to the organisation. Where possible, it is expected that the resource being referenced SHOULD conform to Profile UKCore-Organization.

Example of `Immunization.manufacturer` usage:

Table View

Immunization.id[0]	UKCore-Immunization-Sn-Manufacturer-Example
Immunization.status[0]	completed
Immunization.vaccineCode[0].coding[0].system[0]	https://dmd.nhs.uk
Immunization.vaccineCode[0].coding[0].code[0]	39114911000001105
Immunization.vaccineCode[0].coding[0].display[0]	COVID-19 Vaccine Vaxzevria (ChAdOx1 S [recombinant]) not less than 2.5x100,000,000 infectious units/0.5ml dose suspension for injection multidose vials (AstraZeneca UK Ltd)
Immunization.patient[0].reference[0]	Patient/UKCore-Patient-RichardSmith-Example
Immunization.occurrence[0]	2021-07-20
Immunization.manufacturer[0].display[0]	DREAMLAND Pharmaceuticals Ltd

Tree View

Immunization

id : UKCore-Immunization-Sn-Manufacturer-Example

status : completed

vaccineCode

coding

system : https://dmd.nhs.uk

code : 39114911000001105

display : COVID-19 Vaccine Vaxzevria (ChAdOx1 S [recombinant]) not less than 2.5x100,000,000 infectious units/0.5ml dose suspension for injection multidose vials (AstraZeneca UK Ltd)

patient

reference : Patient/UKCore-Patient-RichardSmith-Example

occurrence : 2021-07-20

manufacturer

display : DREAMLAND Pharmaceuticals Ltd

XML View

<Immunization xmlns="http://hl7.org/fhir">
    <id value="UKCore-Immunization-Sn-Manufacturer-Example" />
    <status value="completed" />
    <vaccineCode>
        <coding>
            <system value="https://dmd.nhs.uk" />
            <code value="39114911000001105" />
            <display value="COVID-19 Vaccine Vaxzevria (ChAdOx1 S [recombinant]) not less than 2.5x100,000,000 infectious units/0.5ml dose suspension for injection multidose vials (AstraZeneca UK Ltd)" />
        </coding>
    </vaccineCode>
    <patient>
        <reference value="Patient/UKCore-Patient-RichardSmith-Example" />
    </patient>
    <occurrenceDateTime value="2021-07-20" />
    <!--  **************snippet start**************  -->
    <manufacturer>
        <display value="DREAMLAND Pharmaceuticals Ltd" />
    </manufacturer>
    <!--  **************snippet end**************  -->
</Immunization>

JSON View

{
    "resourceType": "Immunization",
    "id": "UKCore-Immunization-Sn-Manufacturer-Example",
    "status": "completed",
    "vaccineCode": {
        "coding":  [
            {
                "system": "https://dmd.nhs.uk",
                "code": "39114911000001105",
                "display": "COVID-19 Vaccine Vaxzevria (ChAdOx1 S [recombinant]) not less than 2.5x100,000,000 infectious units/0.5ml dose suspension for injection multidose vials (AstraZeneca UK Ltd)"
            }
        ]
    },
    "patient": {
        "reference": "Patient/UKCore-Patient-RichardSmith-Example"
    },
    "occurrenceDateTime": "2021-07-20",
    "manufacturer": {
        "display": "DREAMLAND Pharmaceuticals Ltd"
    }
}

`lotNumber`

Lot number of the vaccine product.

Where Immunization.status=completed this SHOULD be present.

This should be captured at source ideally via use of automated scanning technology (GS1 GTIN / NTIN standard).

Example of `Immunization.lotNumber` usage:

Table View

Immunization.id[0]	UKCore-Immunization-Sn-LotNumber-Example
Immunization.status[0]	completed
Immunization.vaccineCode[0].coding[0].system[0]	https://dmd.nhs.uk
Immunization.vaccineCode[0].coding[0].code[0]	39114911000001105
Immunization.vaccineCode[0].coding[0].display[0]	COVID-19 Vaccine Vaxzevria (ChAdOx1 S [recombinant]) not less than 2.5x100,000,000 infectious units/0.5ml dose suspension for injection multidose vials (AstraZeneca UK Ltd)
Immunization.patient[0].reference[0]	Patient/UKCore-Patient-RichardSmith-Example
Immunization.occurrence[0]	2021-07-20
Immunization.lotNumber[0]	R04X

Tree View

Immunization

id : UKCore-Immunization-Sn-LotNumber-Example

status : completed

vaccineCode

coding

system : https://dmd.nhs.uk

code : 39114911000001105

display : COVID-19 Vaccine Vaxzevria (ChAdOx1 S [recombinant]) not less than 2.5x100,000,000 infectious units/0.5ml dose suspension for injection multidose vials (AstraZeneca UK Ltd)

patient

reference : Patient/UKCore-Patient-RichardSmith-Example

occurrence : 2021-07-20

lotNumber : R04X

XML View

<Immunization xmlns="http://hl7.org/fhir">
    <id value="UKCore-Immunization-Sn-LotNumber-Example" />
    <status value="completed" />
    <vaccineCode>
        <coding>
            <system value="https://dmd.nhs.uk" />
            <code value="39114911000001105" />
            <display value="COVID-19 Vaccine Vaxzevria (ChAdOx1 S [recombinant]) not less than 2.5x100,000,000 infectious units/0.5ml dose suspension for injection multidose vials (AstraZeneca UK Ltd)" />
        </coding>
    </vaccineCode>
    <patient>
        <reference value="Patient/UKCore-Patient-RichardSmith-Example" />
    </patient>
    <occurrenceDateTime value="2021-07-20" />
    <!--  **************snippet start**************  -->
    <lotNumber value="R04X" />
    <!--  **************snippet end**************  -->
</Immunization>

JSON View

{
    "resourceType": "Immunization",
    "id": "UKCore-Immunization-Sn-LotNumber-Example",
    "status": "completed",
    "vaccineCode": {
        "coding":  [
            {
                "system": "https://dmd.nhs.uk",
                "code": "39114911000001105",
                "display": "COVID-19 Vaccine Vaxzevria (ChAdOx1 S [recombinant]) not less than 2.5x100,000,000 infectious units/0.5ml dose suspension for injection multidose vials (AstraZeneca UK Ltd)"
            }
        ]
    },
    "patient": {
        "reference": "Patient/UKCore-Patient-RichardSmith-Example"
    },
    "occurrenceDateTime": "2021-07-20",
    "lotNumber": "R04X"
}

`site`

Body site where vaccine was administered.

A SNOMED CT concept ID value from UK published reference set “Vaccine body site of administration simple reference set” (1127941000000100) SHOULD be used ValueSet UKCore-ImmunizationAdministrationBodySite.

Example of `Immunization.site` usage:

Table View

Immunization.id[0]	UKCore-Immunization-Sn-LeftUpperArmStructure-Example
Immunization.status[0]	completed
Immunization.vaccineCode[0].coding[0].system[0]	https://dmd.nhs.uk
Immunization.vaccineCode[0].coding[0].code[0]	39114911000001105
Immunization.vaccineCode[0].coding[0].display[0]	COVID-19 Vaccine Vaxzevria (ChAdOx1 S [recombinant]) not less than 2.5x100,000,000 infectious units/0.5ml dose suspension for injection multidose vials (AstraZeneca UK Ltd)
Immunization.patient[0].reference[0]	Patient/UKCore-Patient-RichardSmith-Example
Immunization.occurrence[0]	2021-07-20
Immunization.site[0].coding[0].system[0]	http://snomed.info/sct
Immunization.site[0].coding[0].code[0]	368208006
Immunization.site[0].coding[0].display[0]	Left upper arm structure (body structure)

Tree View

Immunization

id : UKCore-Immunization-Sn-LeftUpperArmStructure-Example

status : completed

vaccineCode

coding

system : https://dmd.nhs.uk

code : 39114911000001105

display : COVID-19 Vaccine Vaxzevria (ChAdOx1 S [recombinant]) not less than 2.5x100,000,000 infectious units/0.5ml dose suspension for injection multidose vials (AstraZeneca UK Ltd)

patient

reference : Patient/UKCore-Patient-RichardSmith-Example

occurrence : 2021-07-20

site

coding

system : http://snomed.info/sct

code : 368208006

display : Left upper arm structure (body structure)

XML View

<Immunization xmlns="http://hl7.org/fhir">
    <id value="UKCore-Immunization-Sn-LeftUpperArmStructure-Example" />
    <status value="completed" />
    <vaccineCode>
        <coding>
            <system value="https://dmd.nhs.uk" />
            <code value="39114911000001105" />
            <display value="COVID-19 Vaccine Vaxzevria (ChAdOx1 S [recombinant]) not less than 2.5x100,000,000 infectious units/0.5ml dose suspension for injection multidose vials (AstraZeneca UK Ltd)" />
        </coding>
    </vaccineCode>
    <patient>
        <reference value="Patient/UKCore-Patient-RichardSmith-Example" />
    </patient>
    <occurrenceDateTime value="2021-07-20" />
    <!--  **************snippet start**************  -->
    <site>
        <coding>
            <system value="http://snomed.info/sct" />
            <code value="368208006" />
            <display value="Left upper arm structure (body structure)" />
        </coding>
    </site>
    <!--  **************snippet end**************  -->
</Immunization>

JSON View

{
    "resourceType": "Immunization",
    "id": "UKCore-Immunization-Sn-LeftUpperArmStructure-Example",
    "status": "completed",
    "vaccineCode": {
        "coding":  [
            {
                "system": "https://dmd.nhs.uk",
                "code": "39114911000001105",
                "display": "COVID-19 Vaccine Vaxzevria (ChAdOx1 S [recombinant]) not less than 2.5x100,000,000 infectious units/0.5ml dose suspension for injection multidose vials (AstraZeneca UK Ltd)"
            }
        ]
    },
    "patient": {
        "reference": "Patient/UKCore-Patient-RichardSmith-Example"
    },
    "occurrenceDateTime": "2021-07-20",
    "site": {
        "coding":  [
            {
                "system": "http://snomed.info/sct",
                "code": "368208006",
                "display": "Left upper arm structure (body structure)"
            }
        ]
    }
}

`route`

The path by which the vaccine product is taken into the body.

A SNOMED CT concept ID value from either of the following SHOULD be used:
UK “ePrescribing route of administration simple reference set (foundation metadata concept)” (999000051000001100) ValueSet UKCore-SubstanceOrProductAdministrationRoute
or:
UK published reference set “Vaccine route of administration simple reference set” (115231000001104).

Example of `Immunization.route` usage:

Table View

Immunization.id[0]	UKCore-Immunization-Sn-IntramuscularRoute-Example
Immunization.status[0]	completed
Immunization.vaccineCode[0].coding[0].system[0]	https://dmd.nhs.uk
Immunization.vaccineCode[0].coding[0].code[0]	39114911000001105
Immunization.vaccineCode[0].coding[0].display[0]	COVID-19 Vaccine Vaxzevria (ChAdOx1 S [recombinant]) not less than 2.5x100,000,000 infectious units/0.5ml dose suspension for injection multidose vials (AstraZeneca UK Ltd)
Immunization.patient[0].reference[0]	Patient/UKCore-Patient-RichardSmith-Example
Immunization.occurrence[0]	2021-07-20
Immunization.route[0].coding[0].system[0]	http://snomed.info/sct
Immunization.route[0].coding[0].code[0]	78421000
Immunization.route[0].coding[0].display[0]	Intramuscular route (qualifier value)

Tree View

Immunization

id : UKCore-Immunization-Sn-IntramuscularRoute-Example

status : completed

vaccineCode

coding

system : https://dmd.nhs.uk

code : 39114911000001105

display : COVID-19 Vaccine Vaxzevria (ChAdOx1 S [recombinant]) not less than 2.5x100,000,000 infectious units/0.5ml dose suspension for injection multidose vials (AstraZeneca UK Ltd)

patient

reference : Patient/UKCore-Patient-RichardSmith-Example

occurrence : 2021-07-20

route

coding

system : http://snomed.info/sct

code : 78421000

display : Intramuscular route (qualifier value)

XML View

<Immunization xmlns="http://hl7.org/fhir">
    <id value="UKCore-Immunization-Sn-IntramuscularRoute-Example" />
    <status value="completed" />
    <vaccineCode>
        <coding>
            <system value="https://dmd.nhs.uk" />
            <code value="39114911000001105" />
            <display value="COVID-19 Vaccine Vaxzevria (ChAdOx1 S [recombinant]) not less than 2.5x100,000,000 infectious units/0.5ml dose suspension for injection multidose vials (AstraZeneca UK Ltd)" />
        </coding>
    </vaccineCode>
    <patient>
        <reference value="Patient/UKCore-Patient-RichardSmith-Example" />
    </patient>
    <occurrenceDateTime value="2021-07-20" />
    <!--  **************snippet start**************  -->
    <route>
        <coding>
            <system value="http://snomed.info/sct" />
            <code value="78421000" />
            <display value="Intramuscular route (qualifier value)" />
        </coding>
    </route>
    <!--  **************snippet end**************  -->
</Immunization>

JSON View

{
    "resourceType": "Immunization",
    "id": "UKCore-Immunization-Sn-IntramuscularRoute-Example",
    "status": "completed",
    "vaccineCode": {
        "coding":  [
            {
                "system": "https://dmd.nhs.uk",
                "code": "39114911000001105",
                "display": "COVID-19 Vaccine Vaxzevria (ChAdOx1 S [recombinant]) not less than 2.5x100,000,000 infectious units/0.5ml dose suspension for injection multidose vials (AstraZeneca UK Ltd)"
            }
        ]
    },
    "patient": {
        "reference": "Patient/UKCore-Patient-RichardSmith-Example"
    },
    "occurrenceDateTime": "2021-07-20",
    "route": {
        "coding":  [
            {
                "system": "http://snomed.info/sct",
                "code": "78421000",
                "display": "Intramuscular route (qualifier value)"
            }
        ]
    }
}

`doseQuantity`

The quantity of vaccine product that was administered.

By preference, use UCUM units of measure. Examples of when a UCUM unit of measure would be used are “gram” or “milliliter” or “percent”.

Where a UCUM unit of measure is not defined, use a SNOMED CT unit of measure. Examples of when a SNOMED CT unit of measure would typically be used are “tablet”, “capsule” or “ampule”.

Example of `Immunization.doseQuantity` usage:

Table View

Immunization.id[0]	UKCore-Immunization-Sn-UnitsOfMeasure-Example
Immunization.status[0]	completed
Immunization.vaccineCode[0].coding[0].system[0]	https://dmd.nhs.uk
Immunization.vaccineCode[0].coding[0].code[0]	39114911000001105
Immunization.vaccineCode[0].coding[0].display[0]	COVID-19 Vaccine Vaxzevria (ChAdOx1 S [recombinant]) not less than 2.5x100,000,000 infectious units/0.5ml dose suspension for injection multidose vials (AstraZeneca UK Ltd)
Immunization.patient[0].reference[0]	Patient/UKCore-Patient-RichardSmith-Example
Immunization.occurrence[0]	2021-07-20
Immunization.doseQuantity[0].value[0]	0.5
Immunization.doseQuantity[0].unit[0]	milliliter
Immunization.doseQuantity[0].system[0]	http://unitsofmeasure.org
Immunization.doseQuantity[0].code[0]	ml

Tree View

Immunization

id : UKCore-Immunization-Sn-UnitsOfMeasure-Example

status : completed

vaccineCode

coding

system : https://dmd.nhs.uk

code : 39114911000001105

display : COVID-19 Vaccine Vaxzevria (ChAdOx1 S [recombinant]) not less than 2.5x100,000,000 infectious units/0.5ml dose suspension for injection multidose vials (AstraZeneca UK Ltd)

patient

reference : Patient/UKCore-Patient-RichardSmith-Example

occurrence : 2021-07-20

doseQuantity

value : 0.5

unit : milliliter

system : http://unitsofmeasure.org

code : ml

XML View

<Immunization xmlns="http://hl7.org/fhir">
    <id value="UKCore-Immunization-Sn-UnitsOfMeasure-Example" />
    <status value="completed" />
    <vaccineCode>
        <coding>
            <system value="https://dmd.nhs.uk" />
            <code value="39114911000001105" />
            <display value="COVID-19 Vaccine Vaxzevria (ChAdOx1 S [recombinant]) not less than 2.5x100,000,000 infectious units/0.5ml dose suspension for injection multidose vials (AstraZeneca UK Ltd)" />
        </coding>
    </vaccineCode>
    <patient>
        <reference value="Patient/UKCore-Patient-RichardSmith-Example" />
    </patient>
    <occurrenceDateTime value="2021-07-20" />
    <!--  **************snippet start**************  -->
    <doseQuantity>
        <value value="0.5" />
        <unit value="milliliter" />
        <system value="http://unitsofmeasure.org" />
        <code value="ml" />
    </doseQuantity>
    <!--  **************snippet end**************  -->
</Immunization>

JSON View

{
    "resourceType": "Immunization",
    "id": "UKCore-Immunization-Sn-UnitsOfMeasure-Example",
    "status": "completed",
    "vaccineCode": {
        "coding":  [
            {
                "system": "https://dmd.nhs.uk",
                "code": "39114911000001105",
                "display": "COVID-19 Vaccine Vaxzevria (ChAdOx1 S [recombinant]) not less than 2.5x100,000,000 infectious units/0.5ml dose suspension for injection multidose vials (AstraZeneca UK Ltd)"
            }
        ]
    },
    "patient": {
        "reference": "Patient/UKCore-Patient-RichardSmith-Example"
    },
    "occurrenceDateTime": "2021-07-20",
    "doseQuantity": {
        "value": 0.5,
        "unit": "milliliter",
        "system": "http://unitsofmeasure.org",
        "code": "ml"
    }
}

`performer`

Indicates who performed the immunisation event by reference. Where possible, it is expected that the resource being referenced SHOULD conform to one of the following UK Core profiles:

Example of `Immunization.performer` usage:

Table View

Immunization.id[0]	UKCore-Immunization-Sn-Performer-Example
Immunization.status[0]	completed
Immunization.vaccineCode[0].coding[0].system[0]	https://dmd.nhs.uk
Immunization.vaccineCode[0].coding[0].code[0]	39114911000001105
Immunization.vaccineCode[0].coding[0].display[0]	COVID-19 Vaccine Vaxzevria (ChAdOx1 S [recombinant]) not less than 2.5x100,000,000 infectious units/0.5ml dose suspension for injection multidose vials (AstraZeneca UK Ltd)
Immunization.patient[0].reference[0]	Patient/UKCore-Patient-RichardSmith-Example
Immunization.occurrence[0]	2021-07-20
Immunization.performer[0].actor[0].type[0]	Practitioner
Immunization.performer[0].actor[0].identifier[0].system[0]	https://fhir.hl7.org.uk/Id/nmc-number
Immunization.performer[0].actor[0].identifier[0].value[0]	5566789
Immunization.performer[0].actor[0].display[0]	HOLDING, Rafferty
Immunization.performer[1].actor[0].type[0]	Organization
Immunization.performer[1].actor[0].identifier[0].system[0]	https://fhir.nhs.uk/Id/ods-organization-code
Immunization.performer[1].actor[0].identifier[0].value[0]	C4B2A
Immunization.performer[1].actor[0].display[0]	ELLAND ROAD STADIUM - COVID VACCINATION CENTRE

Tree View

Immunization

id : UKCore-Immunization-Sn-Performer-Example

status : completed

vaccineCode

coding

system : https://dmd.nhs.uk

code : 39114911000001105

display : COVID-19 Vaccine Vaxzevria (ChAdOx1 S [recombinant]) not less than 2.5x100,000,000 infectious units/0.5ml dose suspension for injection multidose vials (AstraZeneca UK Ltd)

patient

reference : Patient/UKCore-Patient-RichardSmith-Example

occurrence : 2021-07-20

performer

actor

type : Practitioner

identifier

system : https://fhir.hl7.org.uk/Id/nmc-number

value : 5566789

display : HOLDING, Rafferty

performer

actor

type : Organization

identifier

system : https://fhir.nhs.uk/Id/ods-organization-code

value : C4B2A

display : ELLAND ROAD STADIUM - COVID VACCINATION CENTRE

XML View

<Immunization xmlns="http://hl7.org/fhir">
    <id value="UKCore-Immunization-Sn-Performer-Example" />
    <status value="completed" />
    <vaccineCode>
        <coding>
            <system value="https://dmd.nhs.uk" />
            <code value="39114911000001105" />
            <display value="COVID-19 Vaccine Vaxzevria (ChAdOx1 S [recombinant]) not less than 2.5x100,000,000 infectious units/0.5ml dose suspension for injection multidose vials (AstraZeneca UK Ltd)" />
        </coding>
    </vaccineCode>
    <patient>
        <reference value="Patient/UKCore-Patient-RichardSmith-Example" />
    </patient>
    <occurrenceDateTime value="2021-07-20" />
    <!--  **************snippet start**************  -->
    <performer>
        <actor>
            <type value="Practitioner" />
            <identifier>
                <system value="https://fhir.hl7.org.uk/Id/nmc-number" />
                <value value="5566789" />
            </identifier>
            <display value="HOLDING, Rafferty" />
        </actor>
    </performer>
    <performer>
        <actor>
            <type value="Organization" />
            <identifier>
                <system value="https://fhir.nhs.uk/Id/ods-organization-code" />
                <value value="C4B2A" />
            </identifier>
            <display value="ELLAND ROAD STADIUM - COVID VACCINATION CENTRE" />
        </actor>
    </performer>
    <!--  **************snippet end**************  -->
</Immunization>

JSON View

{
    "resourceType": "Immunization",
    "id": "UKCore-Immunization-Sn-Performer-Example",
    "status": "completed",
    "vaccineCode": {
        "coding":  [
            {
                "system": "https://dmd.nhs.uk",
                "code": "39114911000001105",
                "display": "COVID-19 Vaccine Vaxzevria (ChAdOx1 S [recombinant]) not less than 2.5x100,000,000 infectious units/0.5ml dose suspension for injection multidose vials (AstraZeneca UK Ltd)"
            }
        ]
    },
    "patient": {
        "reference": "Patient/UKCore-Patient-RichardSmith-Example"
    },
    "occurrenceDateTime": "2021-07-20",
    "performer":  [
        {
            "actor": {
                "type": "Practitioner",
                "identifier": {
                    "system": "https://fhir.hl7.org.uk/Id/nmc-number",
                    "value": "5566789"
                },
                "display": "HOLDING, Rafferty"
            }
        },
        {
            "actor": {
                "type": "Organization",
                "identifier": {
                    "system": "https://fhir.nhs.uk/Id/ods-organization-code",
                    "value": "C4B2A"
                },
                "display": "ELLAND ROAD STADIUM - COVID VACCINATION CENTRE"
            }
        }
    ]
}

`reasonReference`

Why immunisation occurred by reference to Condition, Observation or DiagnosticReport.

Where possible, it is expected that the resource being referenced SHOULD conform to one of the following UK Core profiles:

`protocolApplied`

The protocol (set of recommendations) being followed by the provider who administered the dose.

`protocolApplied.targetDisease`

It is recommended for international/EU interoperability that Immunization.protocolApplied.targetDisease is populated. The SNOMED CT concept SHOULD be from EU COVID-19 Diseases or Vaccine Target Diseases (GPS) - IPS

Disease	UK SNOMED self
COVID-19	840539006
Others	See "Vaccine Target Diseases (GPS) - IPS"

`protocolApplied.doseNumberPositiveInt`

Nominal position in a series of vaccines, N.B. This field will not always be reliable, therefore for Covid vaccinations, the vaccination procedure code or situation code SHOULD be used as that includes the dose number.

Example of `Immunization.protocolApplied` usage:

Table View

Immunization.id[0]	UKCore-Immunization-Sn-ProtocolApplied-Example
Immunization.status[0]	completed
Immunization.vaccineCode[0].coding[0].system[0]	https://dmd.nhs.uk
Immunization.vaccineCode[0].coding[0].code[0]	39114911000001105
Immunization.vaccineCode[0].coding[0].display[0]	COVID-19 Vaccine Vaxzevria (ChAdOx1 S [recombinant]) not less than 2.5x100,000,000 infectious units/0.5ml dose suspension for injection multidose vials (AstraZeneca UK Ltd)
Immunization.patient[0].reference[0]	Patient/UKCore-Patient-RichardSmith-Example
Immunization.occurrence[0]	2021-07-20
Immunization.protocolApplied[0].targetDisease[0].coding[0].system[0]	http://snomed.info/sct
Immunization.protocolApplied[0].targetDisease[0].coding[0].code[0]	840539006
Immunization.protocolApplied[0].targetDisease[0].coding[0].display[0]	COVID-19
Immunization.protocolApplied[0].doseNumber[0]	1

Tree View

Immunization

id : UKCore-Immunization-Sn-ProtocolApplied-Example

status : completed

vaccineCode

coding

system : https://dmd.nhs.uk

code : 39114911000001105

display : COVID-19 Vaccine Vaxzevria (ChAdOx1 S [recombinant]) not less than 2.5x100,000,000 infectious units/0.5ml dose suspension for injection multidose vials (AstraZeneca UK Ltd)

patient

reference : Patient/UKCore-Patient-RichardSmith-Example

occurrence : 2021-07-20

protocolApplied

targetDisease

coding

system : http://snomed.info/sct

code : 840539006

display : COVID-19

doseNumber : 1

XML View

<Immunization xmlns="http://hl7.org/fhir">
    <id value="UKCore-Immunization-Sn-ProtocolApplied-Example" />
    <status value="completed" />
    <vaccineCode>
        <coding>
            <system value="https://dmd.nhs.uk" />
            <code value="39114911000001105" />
            <display value="COVID-19 Vaccine Vaxzevria (ChAdOx1 S [recombinant]) not less than 2.5x100,000,000 infectious units/0.5ml dose suspension for injection multidose vials (AstraZeneca UK Ltd)" />
        </coding>
    </vaccineCode>
    <patient>
        <reference value="Patient/UKCore-Patient-RichardSmith-Example" />
    </patient>
    <occurrenceDateTime value="2021-07-20" />
    <!--  **************snippet start**************  -->
    <protocolApplied>
        <targetDisease>
            <coding>
                <system value="http://snomed.info/sct" />
                <code value="840539006" />
                <display value="COVID-19" />
            </coding>
        </targetDisease>
        <doseNumberPositiveInt value="1" />
    </protocolApplied>
    <!--  **************snippet end**************  -->
</Immunization>

JSON View

{
    "resourceType": "Immunization",
    "id": "UKCore-Immunization-Sn-ProtocolApplied-Example",
    "status": "completed",
    "vaccineCode": {
        "coding":  [
            {
                "system": "https://dmd.nhs.uk",
                "code": "39114911000001105",
                "display": "COVID-19 Vaccine Vaxzevria (ChAdOx1 S [recombinant]) not less than 2.5x100,000,000 infectious units/0.5ml dose suspension for injection multidose vials (AstraZeneca UK Ltd)"
            }
        ]
    },
    "patient": {
        "reference": "Patient/UKCore-Patient-RichardSmith-Example"
    },
    "occurrenceDateTime": "2021-07-20",
    "protocolApplied":  [
        {
            "targetDisease":  [
                {
                    "coding":  [
                        {
                            "system": "http://snomed.info/sct",
                            "code": "840539006",
                            "display": "COVID-19"
                        }
                    ]
                }
            ],
            "doseNumberPositiveInt": 1
        }
    ]
}

StructureDefinition UKCore-Immunization

Detailed Descriptions

Table View

XML View

JSON View

Feedback

Examples

Example Usage Scenarios

Profile Specific Implementation Guidance:

Mandatory and Must Support Data Elements

Extensions

Bindings (differential)

Constraints (differential)

Breaking Change

status

vaccineCode

Example of Immunization.vaccineCode usage:

Table View

Tree View

XML View

JSON View

patient

Example of Immunization.patient usage:

Table View

Tree View

XML View

JSON View

encounter

primarySource

location

manufacturer

Example of Immunization.manufacturer usage:

Table View

Tree View

XML View

JSON View

lotNumber

Example of Immunization.lotNumber usage:

Table View

Tree View

XML View

JSON View

site

Example of Immunization.site usage:

Table View

Tree View

XML View

JSON View

route

Example of Immunization.route usage:

Table View

Tree View

XML View

JSON View

doseQuantity

Example of Immunization.doseQuantity usage:

Table View

Tree View

XML View

JSON View

performer

Example of Immunization.performer usage:

Table View

Tree View

XML View

JSON View

reasonReference

protocolApplied

protocolApplied.targetDisease

protocolApplied.doseNumberPositiveInt

Example of Immunization.protocolApplied usage:

Table View

Tree View

XML View

JSON View

`status`

`vaccineCode`

Example of `Immunization.vaccineCode` usage:

`patient`

Example of `Immunization.patient` usage:

`encounter`

`primarySource`

`location`

`manufacturer`

Example of `Immunization.manufacturer` usage:

`lotNumber`

Example of `Immunization.lotNumber` usage:

`site`

Example of `Immunization.site` usage:

`route`

Example of `Immunization.route` usage:

`doseQuantity`

Example of `Immunization.doseQuantity` usage:

`performer`

Example of `Immunization.performer` usage:

`reasonReference`

`protocolApplied`

`protocolApplied.targetDisease`

`protocolApplied.doseNumberPositiveInt`

Example of `Immunization.protocolApplied` usage: