{
  "resourceType": "StructureDefinition",
  "id": "ImmunizationRecommendation",
  "meta": {
    "lastUpdated": "2021-01-01T21:58:31.578+00:00"
  },
  "extension": [
    {
      "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-category",
      "valueString": "Clinical.Medications"
    },
    {
      "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
      "valueCode": "trial-use"
    },
    {
      "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
      "valueInteger": 1
    },
    {
      "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-security-category",
      "valueCode": "patient"
    },
    {
      "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
      "valueCode": "pher"
    },
    {
      "url": "http://hl7.org/fhir/build/StructureDefinition/entered-in-error-status",
      "valueCode": "Immunization recommendations are generated on \"just in time\" and typically are not retained by the system generating them so there isn't an expected workflow where a previous recommendation would be re-evaluated and found to be \"in error\"."
    }
  ],
  "url": "http://hl7.org/fhir/StructureDefinition/ImmunizationRecommendation",
  "version": "4.6.0",
  "name": "ImmunizationRecommendation",
  "status": "draft",
  "date": "2021-01-01T21:58:31+00:00",
  "publisher": "Health Level Seven International (Public Health and Emergency Response)",
  "contact": [
    {
      "telecom": [
        {
          "system": "url",
          "value": "http://hl7.org/fhir"
        }
      ]
    },
    {
      "telecom": [
        {
          "system": "url",
          "value": "http://www.hl7.org/Special/committees/pher/index.cfm"
        }
      ]
    }
  ],
  "description": "A patient's point-in-time set of recommendations (i.e. forecasting) according to a published schedule with optional supporting justification.",
  "fhirVersion": "4.6.0",
  "mapping": [
    {
      "identity": "workflow",
      "uri": "http://hl7.org/fhir/workflow",
      "name": "Workflow Pattern"
    },
    {
      "identity": "v2",
      "uri": "http://hl7.org/v2",
      "name": "HL7 v2 Mapping"
    },
    {
      "identity": "rim",
      "uri": "http://hl7.org/v3",
      "name": "RIM Mapping"
    },
    {
      "identity": "w5",
      "uri": "http://hl7.org/fhir/fivews",
      "name": "FiveWs Pattern Mapping"
    }
  ],
  "kind": "resource",
  "abstract": false,
  "type": "ImmunizationRecommendation",
  "baseDefinition": "http://hl7.org/fhir/StructureDefinition/DomainResource",
  "derivation": "specialization",
  "differential": {
    "element": [
      {
        "id": "ImmunizationRecommendation",
        "extension": [
          {
            "url": "http://hl7.org/fhir/build/StructureDefinition/svg",
            "valueCode": "0,0"
          }
        ],
        "path": "ImmunizationRecommendation",
        "short": "Guidance or advice relating to an immunization",
        "definition": "A patient's point-in-time set of recommendations (i.e. forecasting) according to a published schedule with optional supporting justification.",
        "min": 0,
        "max": "*",
        "mapping": [
          {
            "identity": "workflow",
            "map": "Request"
          },
          {
            "identity": "v2",
            "map": "VXU_V04"
          },
          {
            "identity": "rim",
            "map": "SubstanceAdministration[moodCode=RMD]"
          },
          {
            "identity": "w5",
            "map": "clinical.medication"
          }
        ]
      },
      {
        "id": "ImmunizationRecommendation.identifier",
        "path": "ImmunizationRecommendation.identifier",
        "short": "Business identifier",
        "definition": "A unique identifier assigned to this particular recommendation record.",
        "min": 0,
        "max": "*",
        "type": [
          {
            "code": "Identifier"
          }
        ],
        "isSummary": true,
        "mapping": [
          {
            "identity": "workflow",
            "map": "Request.identifier"
          },
          {
            "identity": "w5",
            "map": "FiveWs.identifier"
          },
          {
            "identity": "rim",
            "map": ".id"
          }
        ]
      },
      {
        "id": "ImmunizationRecommendation.instantiatesCanonical",
        "extension": [
          {
            "url": "http://hl7.org/fhir/build/StructureDefinition/committee-notes",
            "valueString": "Added - Jira 27016."
          }
        ],
        "path": "ImmunizationRecommendation.instantiatesCanonical",
        "short": "Instantiates FHIR protocol or definition for the immunization recommendation",
        "definition": "The URL pointing to a FHIR-defined protocol, guideline or other definition that is adhered to in whole or in part by this ImmunizationRecommendation.",
        "min": 0,
        "max": "*",
        "type": [
          {
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-pattern",
                "valueCanonical": "http://hl7.org/fhir/StructureDefinition/Definition"
              }
            ],
            "code": "canonical",
            "targetProfile": [
              "http://hl7.org/fhir/StructureDefinition/ActivityDefinition",
              "http://hl7.org/fhir/StructureDefinition/EventDefinition",
              "http://hl7.org/fhir/StructureDefinition/EvidenceVariable",
              "http://hl7.org/fhir/StructureDefinition/Measure",
              "http://hl7.org/fhir/StructureDefinition/OperationDefinition",
              "http://hl7.org/fhir/StructureDefinition/PlanDefinition",
              "http://hl7.org/fhir/StructureDefinition/Questionnaire",
              "http://hl7.org/fhir/StructureDefinition/SubscriptionTopic"
            ]
          }
        ],
        "isSummary": true,
        "mapping": [
          {
            "identity": "workflow",
            "map": "Request.instantiatesCanonical"
          },
          {
            "identity": "rim",
            "map": ".outboundRelationship[typeCode=DEFN].target"
          }
        ]
      },
      {
        "id": "ImmunizationRecommendation.instantiatesUri",
        "extension": [
          {
            "url": "http://hl7.org/fhir/build/StructureDefinition/committee-notes",
            "valueString": "Added - Jira 27016."
          }
        ],
        "path": "ImmunizationRecommendation.instantiatesUri",
        "short": "Instantiates external protocol or definition for the immunization recommendation",
        "definition": "The URL pointing to an externally maintained protocol, guideline or other definition that is adhered to in whole or in part by this ImmunizationRecommendation.",
        "comment": "This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier.",
        "min": 0,
        "max": "*",
        "type": [
          {
            "code": "uri"
          }
        ],
        "isSummary": true,
        "mapping": [
          {
            "identity": "workflow",
            "map": "Request.instantiatesUri"
          },
          {
            "identity": "rim",
            "map": ".outboundRelationship[typeCode=DEFN].target"
          }
        ]
      },
      {
        "id": "ImmunizationRecommendation.patient",
        "extension": [
          {
            "url": "http://hl7.org/fhir/build/StructureDefinition/committee-notes",
            "valueString": "PID, PD1, NK1 | #3706."
          }
        ],
        "path": "ImmunizationRecommendation.patient",
        "short": "Who this profile is for",
        "definition": "The patient the recommendation(s) are for.",
        "min": 1,
        "max": "1",
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "http://hl7.org/fhir/StructureDefinition/Patient"
            ]
          }
        ],
        "isSummary": true,
        "mapping": [
          {
            "identity": "workflow",
            "map": "Request.subject"
          },
          {
            "identity": "w5",
            "map": "FiveWs.subject[x]"
          },
          {
            "identity": "v2",
            "map": "PID-3"
          },
          {
            "identity": "rim",
            "map": ".partipication[typeCode=SUBJ].role"
          },
          {
            "identity": "w5",
            "map": "FiveWs.subject"
          }
        ]
      },
      {
        "id": "ImmunizationRecommendation.date",
        "path": "ImmunizationRecommendation.date",
        "short": "Date recommendation(s) created",
        "definition": "The date the immunization recommendation(s) were created.",
        "min": 1,
        "max": "1",
        "type": [
          {
            "code": "dateTime"
          }
        ],
        "isSummary": true,
        "mapping": [
          {
            "identity": "workflow",
            "map": "Request.authoredOn"
          },
          {
            "identity": "v2",
            "map": "OBX-15"
          },
          {
            "identity": "rim",
            "map": ".partipication[typeCode=AUTH].time"
          }
        ]
      },
      {
        "id": "ImmunizationRecommendation.authority",
        "path": "ImmunizationRecommendation.authority",
        "short": "Who is responsible for protocol",
        "definition": "Indicates the authority who published the protocol (e.g. ACIP).",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "http://hl7.org/fhir/StructureDefinition/Organization"
            ]
          }
        ],
        "mapping": [
          {
            "identity": "v2",
            "map": "OBX-5 : OBX-3 = 59779-9"
          },
          {
            "identity": "rim",
            "map": ".participation[typeCode=AUT]"
          }
        ]
      },
      {
        "id": "ImmunizationRecommendation.recommendation",
        "extension": [
          {
            "url": "http://hl7.org/fhir/build/StructureDefinition/committee-notes",
            "valueString": "#17773."
          },
          {
            "url": "http://hl7.org/fhir/build/StructureDefinition/svg",
            "valueCode": "300,120"
          }
        ],
        "path": "ImmunizationRecommendation.recommendation",
        "short": "Vaccine administration recommendations",
        "definition": "Vaccine administration recommendations.",
        "comment": "A given instance of the .recommendation backbone element should correspond to a single recommended administration.",
        "min": 1,
        "max": "*",
        "type": [
          {
            "code": "BackboneElement"
          }
        ],
        "constraint": [
          {
            "key": "imr-1",
            "severity": "error",
            "human": "One of vaccineCode or targetDisease SHALL be present",
            "expression": "vaccineCode.exists() or targetDisease.exists()",
            "xpath": "exists(f:vaccineCode) or exists(f:targetDisease)",
            "source": "http://hl7.org/fhir/StructureDefinition/ImmunizationRecommendation"
          }
        ],
        "isSummary": true,
        "mapping": [
          {
            "identity": "rim",
            "map": ".outboundRelationship[typeCode='COMP'].target[classCode=SBADM, moodCode=RMD]"
          }
        ]
      },
      {
        "id": "ImmunizationRecommendation.recommendation.vaccineCode",
        "extension": [
          {
            "url": "http://hl7.org/fhir/build/StructureDefinition/committee-notes",
            "valueString": "#12484."
          }
        ],
        "path": "ImmunizationRecommendation.recommendation.vaccineCode",
        "short": "Vaccine  or vaccine group recommendation applies to",
        "definition": "Vaccine(s) or vaccine group that pertain to the recommendation.",
        "min": 0,
        "max": "*",
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "isSummary": true,
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "VaccineCode"
            }
          ],
          "strength": "example",
          "description": "The type of vaccine administered.",
          "valueSet": "http://hl7.org/fhir/ValueSet/vaccine-code"
        },
        "mapping": [
          {
            "identity": "workflow",
            "map": "Request.code"
          },
          {
            "identity": "v2",
            "map": "OBX-5 : OBX-3 = ( 30956-7 | 38890-0 )"
          },
          {
            "identity": "rim",
            "map": ".partipication[typeCode=CSM].role[classCode=ADMM].code"
          }
        ]
      },
      {
        "id": "ImmunizationRecommendation.recommendation.targetDisease",
        "extension": [
          {
            "url": "http://hl7.org/fhir/build/StructureDefinition/committee-notes",
            "valueString": "#12484, #17773."
          }
        ],
        "path": "ImmunizationRecommendation.recommendation.targetDisease",
        "short": "Disease to be immunized against",
        "definition": "The targeted disease for the recommendation.",
        "comment": "A given instance of the .recommendation backbone element should correspond to a single recommended administration but sometimes that administration (eg. MMR) will encompass multiple diseases, thus the targetDisease element is allowed to repeat.",
        "min": 0,
        "max": "*",
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "isSummary": true,
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "TargetDisease"
            }
          ],
          "strength": "example",
          "description": "The disease that the recommended vaccination targets.",
          "valueSet": "http://hl7.org/fhir/ValueSet/immunization-target-disease"
        },
        "mapping": [
          {
            "identity": "v2",
            "map": "OBX-5 : OBX-3 = ( 30956-7 | 38890-0 )"
          },
          {
            "identity": "rim",
            "map": ".partipication[typeCode=CSM].role[classCode=ADMM].code"
          }
        ]
      },
      {
        "id": "ImmunizationRecommendation.recommendation.contraindicatedVaccineCode",
        "path": "ImmunizationRecommendation.recommendation.contraindicatedVaccineCode",
        "short": "Vaccine which is contraindicated to fulfill the recommendation",
        "definition": "Vaccine(s) which should not be used to fulfill the recommendation.",
        "min": 0,
        "max": "*",
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "isSummary": true,
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "VaccineCode"
            }
          ],
          "strength": "example",
          "description": "The type of vaccine administered.",
          "valueSet": "http://hl7.org/fhir/ValueSet/vaccine-code"
        }
      },
      {
        "id": "ImmunizationRecommendation.recommendation.forecastStatus",
        "path": "ImmunizationRecommendation.recommendation.forecastStatus",
        "short": "Vaccine recommendation status",
        "definition": "Indicates the patient status with respect to the path to immunity for the target disease.",
        "min": 1,
        "max": "1",
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "isModifier": true,
        "isModifierReason": "This element is labeled as a modifier because the forecastStatus indicates whether a patient needs additional doses (due, overdue, etc) or not  (contraindicated, complete, etc).",
        "isSummary": true,
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "ImmunizationRecommendationStatus"
            }
          ],
          "strength": "example",
          "description": "The patient's status with respect to a vaccination protocol.",
          "valueSet": "http://hl7.org/fhir/ValueSet/immunization-recommendation-status"
        },
        "mapping": [
          {
            "identity": "v2",
            "map": "OBX-5 : OBX-3 = 59783-1"
          },
          {
            "identity": "rim",
            "map": ".inboundRelationship[typeCode=SUBJ] .source[classCode=OBS, moodCode=EVN, code=\"Immunization Forecast Status\"].value"
          }
        ]
      },
      {
        "id": "ImmunizationRecommendation.recommendation.forecastReason",
        "path": "ImmunizationRecommendation.recommendation.forecastReason",
        "short": "Vaccine administration status reason",
        "definition": "The reason for the assigned forecast status.",
        "min": 0,
        "max": "*",
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "isSummary": true,
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "ImmunizationRecommendationReason"
            }
          ],
          "strength": "example",
          "description": "The reason for the patient's status with respect to a vaccination protocol.",
          "valueSet": "http://hl7.org/fhir/ValueSet/immunization-recommendation-reason"
        },
        "mapping": [
          {
            "identity": "v2",
            "map": "OBX-5 : OBX-3 = 30982-3"
          },
          {
            "identity": "rim",
            "map": "N/A"
          }
        ]
      },
      {
        "id": "ImmunizationRecommendation.recommendation.dateCriterion",
        "extension": [
          {
            "url": "http://hl7.org/fhir/build/StructureDefinition/svg",
            "valueCode": "350,0"
          }
        ],
        "path": "ImmunizationRecommendation.recommendation.dateCriterion",
        "short": "Dates governing proposed immunization",
        "definition": "Vaccine date recommendations.  For example, earliest date to administer, latest date to administer, etc.",
        "min": 0,
        "max": "*",
        "type": [
          {
            "code": "BackboneElement"
          }
        ],
        "mapping": [
          {
            "identity": "workflow",
            "map": "Request.occurrence[x]"
          },
          {
            "identity": "v2",
            "map": "OBX-3: 30980-7 = Next dose recommended, 59777-3 = Latest next dose should be given, 59778-1 = Dose is overdue"
          },
          {
            "identity": "rim",
            "map": ".outboundRelationship[typeCode='LIMIT'].target[classCode=OBS, moodCode=EVN, isCriterionInd=true]"
          }
        ]
      },
      {
        "id": "ImmunizationRecommendation.recommendation.dateCriterion.code",
        "path": "ImmunizationRecommendation.recommendation.dateCriterion.code",
        "short": "Type of date",
        "definition": "Date classification of recommendation.  For example, earliest date to give, latest date to give, etc.",
        "min": 1,
        "max": "1",
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "ImmunizationRecommendationDateCriterion"
            }
          ],
          "strength": "example",
          "description": "Classifies date criterion with respect to conveying information about a patient's vaccination status (e.g. due date, latest to give date, etc.).",
          "valueSet": "http://hl7.org/fhir/ValueSet/immunization-recommendation-date-criterion"
        },
        "mapping": [
          {
            "identity": "v2",
            "map": "OBX-3"
          },
          {
            "identity": "rim",
            "map": ".code"
          }
        ]
      },
      {
        "id": "ImmunizationRecommendation.recommendation.dateCriterion.value",
        "path": "ImmunizationRecommendation.recommendation.dateCriterion.value",
        "short": "Recommended date",
        "definition": "The date whose meaning is specified by dateCriterion.code.",
        "min": 1,
        "max": "1",
        "type": [
          {
            "code": "dateTime"
          }
        ],
        "mapping": [
          {
            "identity": "v2",
            "map": "OBX-5"
          },
          {
            "identity": "rim",
            "map": ".value"
          }
        ]
      },
      {
        "id": "ImmunizationRecommendation.recommendation.description",
        "path": "ImmunizationRecommendation.recommendation.description",
        "short": "Protocol details",
        "definition": "Contains the description about the protocol under which the vaccine was administered.",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "string"
          }
        ],
        "mapping": [
          {
            "identity": "v2",
            "map": "OBX-5 : OBX-3 = 30956-7"
          },
          {
            "identity": "rim",
            "map": ".text"
          }
        ]
      },
      {
        "id": "ImmunizationRecommendation.recommendation.series",
        "path": "ImmunizationRecommendation.recommendation.series",
        "short": "Name of vaccination series",
        "definition": "One possible path to achieve presumed immunity against a disease - within the context of an authority.",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "string"
          }
        ],
        "mapping": [
          {
            "identity": "v2",
            "map": "RXA-5-administered code"
          },
          {
            "identity": "rim",
            "map": ".title"
          }
        ]
      },
      {
        "id": "ImmunizationRecommendation.recommendation.doseNumber",
        "extension": [
          {
            "url": "http://hl7.org/fhir/build/StructureDefinition/committee-notes",
            "valueString": "#13185 (add option for string), #25277 (restrict to string data type)."
          }
        ],
        "path": "ImmunizationRecommendation.recommendation.doseNumber",
        "short": "Recommended dose number within series",
        "definition": "Nominal position of the recommended dose in a series as determined by the evaluation and forecasting process (e.g. dose 2 is the next recommended dose).",
        "comment": "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).",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "string"
          }
        ],
        "isSummary": true,
        "mapping": [
          {
            "identity": "v2",
            "map": "OBX-5 : OBX-3 = 30973-2"
          },
          {
            "identity": "rim",
            "map": ".inboundRelationship[typeCode=COMP, .source[classCode=SBADM, moodCode=INT]].sequenceNumber"
          }
        ]
      },
      {
        "id": "ImmunizationRecommendation.recommendation.seriesDoses",
        "extension": [
          {
            "url": "http://hl7.org/fhir/build/StructureDefinition/committee-notes",
            "valueString": "#13185 (add option for string), #25277 (restrict to string data type)."
          }
        ],
        "path": "ImmunizationRecommendation.recommendation.seriesDoses",
        "short": "Recommended number of doses for immunity",
        "definition": "The recommended number of doses to achieve immunity as determined by the evaluation and forecasting process.",
        "comment": "The use of an integer is preferred if known.",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "string"
          }
        ],
        "mapping": [
          {
            "identity": "v2",
            "map": "OBX-5 : OBX-3 = 59782-3"
          },
          {
            "identity": "rim",
            "map": ".inboundRelationship[typeCode=COMP, .source[classCode=SBADM, moodCode=DEF]].sequenceNumber"
          }
        ]
      },
      {
        "id": "ImmunizationRecommendation.recommendation.supportingImmunization",
        "path": "ImmunizationRecommendation.recommendation.supportingImmunization",
        "short": "Past immunizations supporting recommendation",
        "definition": "Immunization event history and/or evaluation that supports the status and recommendation.",
        "min": 0,
        "max": "*",
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "http://hl7.org/fhir/StructureDefinition/Immunization",
              "http://hl7.org/fhir/StructureDefinition/ImmunizationEvaluation"
            ]
          }
        ],
        "mapping": [
          {
            "identity": "v2",
            "map": "? No clear way to associate in HL7 v2 or IG"
          },
          {
            "identity": "rim",
            "map": ".outboundRelationship[typeCode=RSON].target[classCode=SBADM, moodCode=EVN, code=\"immunization\"]"
          }
        ]
      },
      {
        "id": "ImmunizationRecommendation.recommendation.supportingPatientInformation",
        "path": "ImmunizationRecommendation.recommendation.supportingPatientInformation",
        "short": "Patient observations supporting recommendation",
        "definition": "Patient Information that supports the status and recommendation.  This includes patient observations, adverse reactions and allergy/intolerance information.",
        "min": 0,
        "max": "*",
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "http://hl7.org/fhir/StructureDefinition/Resource"
            ]
          }
        ],
        "mapping": [
          {
            "identity": "workflow",
            "map": "Request.supportingInfo"
          },
          {
            "identity": "v2",
            "map": "OBX If OBX is associated with ( RXA : RXA-5-administered code = '998^No vaccine administered^CVX'), could contain the reason the vaccine was not administered"
          },
          {
            "identity": "rim",
            "map": ".outboundRelationship[typeCode=RSON].target[classCode=OBS, moodCode=EVN]"
          }
        ]
      }
    ]
  }
}