# Health Journey Immunization - Amakomaya Nepal FHIR Implementation Guide v2.0.0

* [**Table of Contents**](toc.md)
* **Health Journey Immunization**

## Health Journey Immunization

This story describes how immunization services are recorded and shared using FHIR resources in the context of Nepal’s Electronic Health Management Information System (EHMIS).

### Objective

To document and exchange data about childhood and routine immunizations to support continuity of care, reduce missed vaccinations, and improve national reporting.

-------

### Actors

* Child (Patient)
* Caregiver/Parent (RelatedPerson)
* Health Worker (e.g., ANM, HA)
* Outreach Worker (e.g., FCHV during EPI clinics)

-------

### Workflow Steps

1. **Child Registration**
* Capture child’s demographic info
* FHIR Resource: `Patient`
* Link to mother/caregiver using `RelatedPerson`
* Assign EPI ID if applicable

1. **Immunization Encounter**
* Record immunization session
* FHIR Resource: `Encounter` (optional but useful for grouping)

1. **Vaccine Administration**
* FHIR Resource: `Immunization`
* Include: 
* Vaccine code (e.g., BCG, Penta, MR)
* Date administered
* Lot number
* Expiration date
* Body site
* Route
* Performer (Health Worker)
* Location (Facility, Outreach Clinic)
 

1. **Adverse Events (if any)**
* FHIR Resource: `AdverseEvent` (optional)
* Used to record any AEFI (Adverse Events Following Immunization)

1. **Follow-up or Reminders**
* Track missed doses or next appointments
* FHIR Resource: `CarePlan` or `Task` (optional)

-------

### FHIR Resources Used

| | |
| :--- | :--- |
| `Patient` | Identification of child |
| `RelatedPerson` | Linking to parent/caregiver |
| `Encounter` | Grouping vaccinations on a single day |
| `Immunization` | Vaccine dose administration |
| `Location` | Immunization session site |
| `Practitioner` | Health worker administering vaccine |
| `AdverseEvent` | Recording post-vaccine reactions |

-------

### Example: BCG and OPV0 for a Newborn

* **Patient**: Male newborn, 3 days old
* **Encounter**: Immunization session on 2025-08-08 at Outreach Clinic
* **Immunization**: 
* BCG vaccine: Given on left upper arm
* OPV0: Oral drops
* Lot number: BCG-2025-01
* Performer: ANM at Rural Health Post
 
* **RelatedPerson**: Linked to mother

-------

### Reporting Considerations

* Coverage by antigen (e.g., Penta1, MR1)
* Dropout rates (e.g., Penta1 → Penta3)
* Age at vaccination (timeliness)
* Disaggregation by: 
* Age group
* Sex
* Geographic area (palika/district)
 
* Integration with national EPI reporting via DHIS2 Tracker or aggregate datasets

