<status value="draft" /> <experimental value="false" /> <date value="2024-04-09T00:00:00-08:00" /> <description value="This profile represents the constraints applied to the Immunization resource by the PS-CA project to represent a record of immunization in the patient summary. It allows for cross-border and cross-jurisdiction sharing of Medication Summary information. It describes the event of a patient being administered a vaccination or a record of a vaccination as reported by a patient, a clinician or another party." /> <copyright value="Copyright © 2024+ Canada Health Infoway. All rights reserved. [Terms of Use and License Agreements](https://ic.infoway-inforoute.ca/en/about/tou). [Privacy Policy](https://www.infoway-inforoute.ca/en/legal/privacy-policy)." /> <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.status"> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:populate" /> </extension> <extension url="actor"> <valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/producer" /> </extension> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:no-error" /> </extension> <extension url="actor"> <valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer" /> </extension> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:handle" /> </extension> <extension url="actor"> <valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer" /> </extension> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHOULD:display" /> </extension> <extension url="actor"> <valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer" /> </extension> </extension> <path value="Immunization.status" /> <mustSupport value="true" /> </element> <element id="Immunization.vaccineCode"> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:populate" /> </extension> <extension url="actor"> <valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/producer" /> </extension> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:no-error" /> </extension> <extension url="actor"> <valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer" /> </extension> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:handle" /> </extension> <extension url="actor"> <valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer" /> </extension> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHOULD:display" /> </extension> <extension url="actor"> <valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer" /> </extension> </extension> <path value="Immunization.vaccineCode" /> <short value="Vaccine that was administered or was to be administered. IPS-UV Note: Several kinds of vaccine product coding could be provided. The IPS assumes that either the type of the vaccine for particular disease or diseases (e.g. MMR vaccine) against which the patient has been immunised is provided; or the known absent/unknown code. Other coded information can be provided as well as: the Pharmaceutical and medicinal product identifiers, when available, or equivalent coded concepts; the WHO ATC codes; or any other kind of code that that identifies, classifies or cluster the administered product. The IPS-UV vaccine concepts are not used in Canadian implementations as they do not include Canadian trade or brand names. Implementers should use the following pan-Canadian value sets, depending on context: "VaccineHistoricalNameCode", "PassiveAdministeredImmunizingAgentCode", and "PassiveHistoricalImmunizingAgentCode", which are equivalently preferred alongside the primary binding." /> <comment value="See additionalBinding extension. Future releases of PS-CA may require use of coded entries. In this release, however, implementations that support codings are encouraged to send the codings for codeable concepts if they are available. Consistent with FHIR best practice, receivers should not produce failures or rejections if codings are received. Vendors should expect that some jurisdictions may further constrain support of this element within the context of their own jurisdictional content." /> <mustSupport value="true" /> <binding> <extension url="http://hl7.org/fhir/tools/StructureDefinition/additional-binding"> <extension url="purpose"> <valueCode value="preferred" /> </extension> <extension url="valueSet"> <valueCanonical value="https://fhir.infoway-inforoute.ca/ValueSet/vaccinehistoricalnamecode" /> </extension> <extension url="documentation"> <valueMarkdown value="This refset is intended to capture the immunization history and includes concepts represented by a generic description for a vaccine that was previously administered to the client." /> </extension> </extension> <extension url="http://hl7.org/fhir/tools/StructureDefinition/additional-binding"> <extension url="purpose"> <valueCode value="preferred" /> </extension> <extension url="valueSet"> <valueCanonical value="https://fhir.infoway-inforoute.ca/ValueSet/passiveadministeredimmunizingagentcode" /> </extension> <extension url="documentation"> <valueMarkdown value="This refset is intended to capture the product administered at the point of immunization and includes the passive immunizing agent tradenames that are currently licensed for use in Canada, those obtained through special access programs for use in Canada, and those that were never licensed in Canada." /> </extension> </extension> <extension url="http://hl7.org/fhir/tools/StructureDefinition/additional-binding"> <extension url="purpose"> <valueCode value="preferred" /> </extension> <extension url="valueSet"> <valueCanonical value="https://fhir.infoway-inforoute.ca/ValueSet/passivehistoricalimmunizingagentcode" /> </extension> <extension url="documentation"> <valueMarkdown value="This refset is intended to capture the immunization history and includes concepts represented by a generic description for a passive immunizing agent that was previously administered to the client." /> </extension> </extension> <extension url="http://hl7.org/fhir/tools/StructureDefinition/additional-binding"> <extension url="purpose"> <valueCode value="candidate" /> </extension> <extension url="valueSet"> <valueCanonical value="http://hl7.org/fhir/uv/ips/ValueSet/vaccines-uv-ips" /> </extension> <extension url="documentation"> <valueMarkdown value="IPS Vaccine codes value set. This value set includes codes from SNOMED CT." /> </extension> </extension> <extension url="http://hl7.org/fhir/tools/StructureDefinition/additional-binding"> <extension url="purpose"> <valueCode value="candidate" /> </extension> <extension url="valueSet"> <valueCanonical value="http://hl7.org/fhir/uv/ips/ValueSet/whoatc-uv-ips" /> </extension> <extension url="documentation"> <valueMarkdown value="Code that is selected from the WHO ATC classification." /> </extension> </extension> <extension url="http://hl7.org/fhir/tools/StructureDefinition/additional-binding"> <extension url="purpose"> <valueCode value="candidate" /> </extension> <extension url="valueSet"> <valueCanonical value="http://hl7.org/fhir/uv/ips/ValueSet/absent-or-unknown-immunizations-uv-ips" /> </extension> <extension url="documentation"> <valueMarkdown value="Code to identify absent or unknown immunizations." /> </extension> </extension> <strength value="preferred" /> <description value="Codes from the Vaccine Administered Trade Name Code ValueSet. Equivalently preferred to the Vaccine Historical Name Code ValueSet, Passive Administered Immunizing Agent Code ValueSet, or Passive Historical Immunizing Agent Code ValueSet found in additionalBinding extension" /> <valueSet value="https://fhir.infoway-inforoute.ca/ValueSet/vaccineadministeredtradenamecode" /> </binding> </element> <element id="Immunization.patient"> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:populate" /> </extension> <extension url="actor"> <valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/producer" /> </extension> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:no-error" /> </extension> <extension url="actor"> <valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer" /> </extension> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:handle" /> </extension> <extension url="actor"> <valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer" /> </extension> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHOULD:display" /> </extension> <extension url="actor"> <valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer" /> </extension> </extension> <path value="Immunization.patient" /> <type> <code value="Reference" /> <targetProfile value="http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/patient-ca-ps" /> </type> <mustSupport value="true" /> </element> <element id="Immunization.patient.reference"> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:populate" /> </extension> <extension url="actor"> <valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/producer" /> </extension> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:no-error" /> </extension> <extension url="actor"> <valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer" /> </extension> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:handle" /> </extension> <extension url="actor"> <valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer" /> </extension> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHOULD:display" /> </extension> <extension url="actor"> <valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer" /> </extension> </extension> <path value="Immunization.patient.reference" /> <min value="1" /> <mustSupport value="true" /> </element> <element id="Immunization.occurrence[x]"> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:populate" /> </extension> <extension url="actor"> <valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/producer" /> </extension> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:no-error" /> </extension> <extension url="actor"> <valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer" /> </extension> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHALL:handle" /> </extension> <extension url="actor"> <valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer" /> </extension> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/obligation"> <extension url="code"> <valueCode value="SHOULD:display" /> </extension> <extension url="actor"> <valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ActorDefinition/consumer" /> </extension> </extension> <path value="Immunization.occurrence[x]" /> <mustSupport value="true" /> </element> <element id="Immunization.site"> <path value="Immunization.site" /> <type> <code value="CodeableConcept" /> <profile value="http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/CodeableConcept-ca-ps" /> </type> <binding> <strength value="preferred" /> <valueSet value="https://fhir.infoway-inforoute.ca/ValueSet/immunizationadministrationanatomicalsitecode" /> </binding> </element> <element id="Immunization.route"> <path value="Immunization.route" /> <comment value="See additionalBinding extension. Future releases of PS-CA may require use of coded entries. In this release, however, implementations that support codings are encouraged to send the codings for codeable concepts if they are available. Consistent with FHIR best practice, receivers should not produce failures or rejections if codings are received." /> <type> <code value="CodeableConcept" /> <profile value="http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/CodeableConcept-ca-ps" /> </type> <binding> <extension url="http://hl7.org/fhir/tools/StructureDefinition/additional-binding"> <extension url="purpose"> <valueCode value="candidate" /> </extension> <extension url="valueSet"> <valueCanonical value="http://hl7.org/fhir/uv/ips/ValueSet/medicine-route-of-administration" /> </extension> <extension url="documentation"> <valueMarkdown value="Route of immunization administration includes content from EDQM Standard Terms. While this additional binding is not primarily used in the Canadian healthcare context, it is retained to support potential use of PS-CA internationally and IPS within Canada. Implementers should be aware that this binding may not comprehensively represent all Canadian route of administration codes." /> </extension> </extension> <extension url="http://hl7.org/fhir/tools/StructureDefinition/additional-binding"> <extension url="purpose"> <valueCode value="candidate" /> </extension> <extension url="valueSet"> <valueCanonical value="http://terminology.hl7.org/ValueSet/v3-RouteOfAdministration" /> </extension> <extension url="documentation"> <valueMarkdown value="The path the administered medication takes to get into the body or into contact with the body. While not the preferred terminology for broader pan-Canadian exchange use cases, this additional binding is surfaced to socialize the value sets that may be more commonly in use. Where multiple codings can be supplied, it is encouraged to supply the original coding alongside the pan-Canadian preferred terminology." /> </extension> </extension> <strength value="preferred" /> <description value="The path or route by which the vaccine was administered." /> <valueSet value="https://fhir.infoway-inforoute.ca/ValueSet/immunizationrouteofadministrationcode" /> </binding> </element> <element id="Immunization.protocolApplied.targetDisease"> <path value="Immunization.protocolApplied.targetDisease" /> <comment value="See additionalBinding extension. IPS-UV no longer flags this as a Must Support element. It is not currently flagged as Must Support in PS-CA, as stakeholders have indicated the element may not be supported by the majority of systems today. Systems that do support the element are encouraged to include it in generated Patient Summary documents, and support it when received." /> <binding> <extension url="http://hl7.org/fhir/tools/StructureDefinition/additional-binding"> <extension url="purpose"> <valueCode value="candidate" /> </extension> <extension url="valueSet"> <valueCanonical value="http://hl7.org/fhir/uv/ips/ValueSet/target-diseases-uv-ips" /> </extension> <extension url="documentation"> <valueMarkdown value="IPS Vaccine target disease codes value set. This value set includes codes from SNOMED CT" /> </extension> </extension> <strength value="preferred" /> <valueSet value="https://fhir.infoway-inforoute.ca/ValueSet/vaccinepreventablediseasecode" /> </binding> </element> </differential> </StructureDefinition>