Generated Narrative: StructureDefinition amk-core-immunization Name Flags Card. Type Description & Constraints Immunization 0..* Immunization Immunization event information #xD; status 1..1 code completed | entered-in-error | not-done Required Pattern: completed #xD; vaccineCode 1..1 CodeableConcept Vaccine administered Binding: Vaccines (SNOMED CT) (required) #xD; patient 1..1 Reference(AMK Core Patient Profile) Who was immunized #xD; Slices for occurrence[x] 1..1 dateTime Vaccine administration date Slice: Unordered, Open by type:$this #xD; occurrence[x]:occurrenceDateTime 1..1 dateTime Vaccine administration date #xD; Documentation for this format
The AMK Core Immunization Profile inherits from the FHIR [Immunization](https://hl7.org/fhir/R5/immunization.html) resource; refer to it for scope and usage definitions. This profile sets minimum expectations for the Immunization resource to record, search, and fetch basic immunization information for an individual patient within the Nepal health system. It specifies which core elements, extensions, vocabularies, and value sets SHALL be present and constrains how the elements are used. By providing a standardized foundation for capturing immunization events in Nepal
Used by permission of HL7 International, all rights reserved Creative Commons License
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.
If the resource is contained in another resource, it SHALL NOT contain nested Resources
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.trace('id') in %resource.descendants().select(reference | as(uri))) or descendants().where(reference='#' | as(uri)='#').exists()).not()).trace('unmatched', id).empty()
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()
If a resource is contained in another resource, it SHALL NOT have a security label
When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time.
A resource should have narrative for robust management
statusReason SHALL only be present if the immunization status is 'not-done'
statusReason.exists() implies status = 'not-done'
subpotentReason SHALL only be present if isSubpotent is 'true'
subpotentReason.exists() implies (isSubpotent.exists() and isSubpotent = true)
Entity, Role, or Act,SubstanceAdministration
The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Within the context of the FHIR RESTful interactions, the resource has an id except for cases like the create and conditional update. Otherwise, the use of the resource id depends on the given use case.
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.
All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
A set of rules under which this content was created
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. For DomainResources, if more than one implicitRules policy applies, additional policies may be conveyed using the [additionalImplicitRules](https://build.fhir.org/ig/HL7/fhir-extensions/StructureDefinition-additionalImplicitRules.html) extension.
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 its narrative along with other profiles, value sets, etc.
This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies its meaning or interpretation
The base language in which the resource is written.
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).
Text summary of the resource, for human interpretation
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.
Contained resources do not have a 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.
These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, nor can they have their own independent transaction scope. This is allowed to be a Parameters resource if and only if it is referenced by a resource that provides context/meaning.
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. Contained resources may be a resource type defined in the FHIR specification, or an [additional resource](http://build.fhir.org/resource.html#additional).
Extensions are always sliced by (at least) url
Additional content defined by implementations
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 managable, 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.
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.
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 managable, 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).
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](http://build.fhir.org/extensibility.html#modifierExtension).
Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
A unique identifier assigned to this immunization record.
Authority that the immunization event is based on
A plan, order or recommendation fulfilled in whole or in part by this immunization.
Allows tracing of an authorization for the Immunization.
Indicates the current status of the immunization event.
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.
This element is labeled as a modifier because it is a status element that contains statuses entered-in-error and not-done which means that the resource should not be treated as valid
Indicates the reason the immunization event was **not performed** or was **entered in error**.
This element is only used for the status of "not-done" or "entered-in-error". The reason for performing the immunization event is captured in reasonCode, not here.
.inboundRelationship[typeCode=SUBJ].source[classCode=CACT, moodCode=EVN].reasonCOde
Vaccine that was administered or was to be administered.
The code for the administered vaccine may be reported at various levels of granularity from a very generic code for a general type of vaccine (e.g. the SNOMED or CVX code for the flu vaccine) to a very discrete code for a specific product including the form and packaging (e.g. an NDC code). Because vaccineCode uses the CodeableConcept data type, multiple codes at different levels of granularity may be reported for a single immunization event provided that all codes are appropriate for the same vaccine. For example, both NDC and CVX codes may be provided for a given immunization event by repeating the coding element within vaccineCode.
An indication of which product was administered to the patient. This is typically a more detailed representation of the concept conveyed by the vaccineCode data element. If a Medication resource is referenced, it may be to a stand-alone resource or a contained resource within the Immunization resource.
The patient who either received or did not receive the immunization.
The visit or admission or other contact between patient and health care provider the immunization was performed as part of.
Additional information in support of the immunization
Additional information that is relevant to the immunization (e.g. for a vaccine recipient who is pregnant, the gestational age of the fetus). The reason why a vaccine was given (e.g. occupation, underlying medical condition) should be conveyed in Immunization.reason, not as supporting information. The reason why a vaccine was not given (e.g. contraindication) should be conveyed in Immunization.statusReason, not as supporting information.
Date vaccine administered or was to be administered.
When immunizations are given, a specific date and time should always be recorded if known. If the time is not known, it should not be included. However, systems primarily rely on the date component of the immunization record for determining dose validity and future dose forecasting. For this reason, immunization records should preserve the immunization date as recorded for the time zone where the dose was administered. Care should be taken when recording and transmitting time and time zone information, as adjustments based on time zone can shift the recorded date. Additionally, because Patient.birthDate does not include a time component, systems should ensure that comparisons between occurrence date and birth date do not introduce inconsistencies in determining patient age at vaccination. 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.
Indicates context the data was captured in
Indicates whether the data contained in the resource was captured by the individual/organization which was responsible for the administration of the vaccine rather than as 'secondary reported' data documented by a third party. A value of 'true' means this data originated with the individual/organization which was responsible for the administration of the vaccine.
Reflects the “reliability” of the content.
immunization.uncertaintycode (if primary source=false, uncertainty=U)
Indicates the source of a reported record
Typically the source of the data when the report of the immunization event is not based on information from the person who administered the vaccine.
Typically will not be populated if primarySource = True, not required even if primarySource = False.
.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)
The service delivery location where the vaccine administration occurred.
RXA-27 (or RXA-11, deprecated as of v2.7)
Body site where vaccine was administered.
The path by which the vaccine product is taken into the body.
The quantity of vaccine product that was administered.
Indicates who performed the immunization event.
All FHIR elements must have a @value or children or both
Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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 managable, 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.
Extensions that cannot be ignored even if unrecognized
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 managable, 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).
Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Describes the function played by the performer in the immunization event (e.g. ordering provider, administering provider, etc.).
Individual or organization who performed the event
The practitioner or organization who performed the action.
When the individual practitioner who performed the action is known, it is best to send.
Extra information about the immunization that is not conveyed by the other attributes.
Describes why the immunization occurred in coded or textual form, or indicates another resource (Condition, Observation or DiagnosticReport) whose existence justifies this immunization.
Indication if a dose is considered to be subpotent. By default, a dose should be considered to be potent.
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.
By default, a dose should be considered to be potent.
This element is labeled as a modifier because an immunization event with a subpotent vaccine doesn't protect the patient the same way as a potent dose.
Reason why a dose is considered to be subpotent.
The reason why a dose is considered to be subpotent.
Patient eligibility for a specific vaccination program
Indicates a patient's eligibility for a funding program.
The program that eligibility is declared for
Indicates which program the patient had their eligibility evaluated for.
The patient's eligibility status for the program
Indicates the patient's eligibility status for a specific payment program.
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 publicly purchased vaccine but due to inventory issues, vaccine purchased with private funds was actually administered).
Details of a reaction that followed the immunization
Categorical data indicating that an adverse event is associated in time to an immunization.
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.
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)
(HL7 V2 doesn't seem to provide for this)
.participation[typeCode=INF].role[classCode=PAT] (this syntax for self-reported=true)
The protocol (set of recommendations) being followed by the provider who administered the dose.
One possible path to achieve presumed immunity against a disease - within the context of an authority.
Who is responsible for publishing the recommendations
Indicates the authority who published the protocol (e.g. ACIP) that is being followed.
Vaccine preventable disease being targeted
The vaccine preventable disease the dose is being administered against.
Nominal position in a series as intended by the practitioner administering the dose.
The dose number may be communicated as either a coded concept (for example Dose 1, Dose 2 or Booster) or as free text as needed by the use case.
A code expressing the vaccine dose number - several coding schemes exist or will be defined for each jurisdiction.
Recommended number of doses for immunity
The recommended number of doses to achieve immunity as intended by the practitioner administering the dose.
The number of doses in a series may be communicated as either a coded concept or as free text as needed by the use case.
A code expressing the doses recommended or expected - several coding schemes exist or will be defined for each jurisdiction.