Immunization

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.

Overview

The Immunization resource is intended to cover the recording of current and historical administration of vaccines to patients across all healthcare disciplines in all care settings and all regions. While the terms 'immunization' and 'vaccination' are not clinically identical, for the purposes of the FHIR resources, the terms are used synonymously.

This profile is used to define the content that will be returned by the API Server in response to requests to access Immunization resources. All elements described in the Definition and Detailed Definitions below are supported, which means that the API Server is capable of supplying these fields from the product database when they have been populated via the product or its APIs.

List of profiles we support:

Definition

The official URL for this profile is:

https://fhir.athena.io/StructureDefinition/ah-immunization

The base definition for this profile is:

Immunization

NameFlagsCard.TypeDescription & Constraintsdoco
.. Immunization0..*ImmunizationImmunization event information
... idΣ0..1idLogical id of this artifact
... metaΣ0..1MetaMetadata about the resource
... implicitRules?!Σ0..1uriA set of rules under which this content was created
... text0..1NarrativeText summary of the resource, for human interpretation
... contained0..*ResourceContained, inline Resources
... Slices for extension1..*ExtensionExtension
Slice: Unordered, Open by value:url
... ahChartSharingGroup0..1Reference(Organization)athenahealth Chart Sharing Group
URL: https://fhir.athena.io/StructureDefinition/ah-chart-sharing-group
... ahPractice1..1Reference(Organization)athenahealth Practice
URL: https://fhir.athena.io/StructureDefinition/ah-practice
... modifierExtension?!0..*ExtensionExtensions that cannot be ignored
... identifier0..*IdentifierBusiness identifier
... status?!Σ1..1codecompleted | entered-in-error | not-done
Binding: ImmunizationStatusCodes (required): A set of codes indicating the current status of an Immunization.

... statusReason0..1CodeableConceptReason not done
Binding: ImmunizationStatusReasonCodes (example): The reason why a vaccine was not administered.

... vaccineCodeΣ1..1CodeableConceptVaccine product administered
Binding: VaccineAdministeredValueSet (example): The code for vaccine product administered.

... patientΣ1..1Reference(Patient)Who was immunized
... encounter0..1Reference(Encounter)Encounter immunization was part of
... occurrence[x]Σ1..1dateTime (YYYY-MM-DDThh:mm:ss+zz:zz)Vaccine administration date
... primarySourceΣ0..1booleanIndicates context the data was recorded in
... lotNumber0..1stringVaccine lot number
... expirationDate0..1date (YYYY-MM-DD)Vaccine expiration date
... site0..1CodeableConceptBody site vaccine was administered
Binding: CodesForImmunizationSiteOfAdministration (example): The site at which the vaccine was administered.

... route0..1CodeableConceptHow vaccine entered body
Binding: ImmunizationRouteCodes (example): The route by which the vaccine was administered.

... doseQuantity0..1SimpleQuantityAmount of vaccine administered
... isSubpotent?!Σ0..1booleanDose potency
... subpotentReason0..*CodeableConceptReason for being subpotent
Binding: ImmunizationSubpotentReason (example): The reason why a dose is considered to be subpotent.



doco Documentation for this format

Terminology Bindings

PathConformanceValueSet
Immunization.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
Immunization.statusrequiredImmunizationStatusCodes
Immunization.statusReasonexampleImmunizationStatusReasonCodes
Immunization.vaccineCodeexampleVaccineAdministeredValueSet
Immunization.siteexampleCodesForImmunizationSiteOfAdministration
Immunization.routeexampleImmunizationRouteCodes
Immunization.performer.functionextensibleImmunizationFunctionCodes
Immunization.subpotentReasonexampleImmunizationSubpotentReason
Immunization.protocolApplied.targetDiseaseexampleImmunizationTargetDiseaseCodes

Detailed Definitions


Immunization

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..*
Type Root

Immunization.id

The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

Cardinality 0..1
Type id
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

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

Immunization.implicitRules

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
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.

Immunization.language

The base language in which the resource is written.

Cardinality 0..1
Type code Binding: 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).

Immunization.text

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
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.

Immunization.contained

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
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.

Immunization.extension

An Extension

Cardinality 1..*
Type Extension

Immunization.extension:ahChartSharingGroup

An Extension used to reference a specific athenahealth chart sharing group Organization.

Cardinality 0..1
Type Extension(AthenaChartSharingGroup)

Immunization.extension:ahPractice

An Extension used to reference a specific athenahealth practice Organization.

Cardinality 1..1
Type Extension(AthenaPractice)

Immunization.modifierExtension

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
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.
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.

Immunization.identifier

A unique identifier assigned to this immunization record.

Cardinality 0..*
Type Identifier

Immunization.status

Indicates the current status of the immunization event.

Cardinality 1..1
Type code Binding: ImmunizationStatusCodes (required)
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.

Immunization.statusReason

Indicates the reason the immunization event was not performed.

Cardinality 0..1
Type CodeableConcept Binding: ImmunizationStatusReasonCodes (example)
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.

Immunization.vaccineCode

Vaccine that was administered or was to be administered.

Cardinality 1..1
Type CodeableConcept Binding: VaccineAdministeredValueSet (example)

Immunization.patient

The patient who either received or did not receive the immunization.

Cardinality 1..1
Type Reference(Patient)

Immunization.encounter

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)

Immunization.occurrence[x]

Date vaccine administered or was to be administered.

Cardinality 1..1
Type dateTime (YYYY-MM-DDThh:mm:ss+zz:zz)
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.

Immunization.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.

Cardinality 0..1
Type boolean
Comments Reflects the "reliability" of the content.

Immunization.lotNumber

Lot number of the vaccine product.

Cardinality 0..1
Type string

Immunization.expirationDate

Date vaccine batch expires.

Cardinality 0..1
Type date (YYYY-MM-DD)

Immunization.site

Body site where vaccine was administered.

Cardinality 0..1
Type CodeableConcept Binding: CodesForImmunizationSiteOfAdministration (example)

Immunization.route

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

Cardinality 0..1
Type CodeableConcept Binding: ImmunizationRouteCodes (example)

Immunization.doseQuantity

The quantity of vaccine product that was administered.

Cardinality 0..1
Type Quantity

Immunization.isSubpotent

Indication if a dose is considered to be subpotent. By default, a dose should be considered to be potent.

Cardinality 0..1
Type boolean
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.

Immunization.subpotentReason

Reason why a dose is considered to be subpotent.

Cardinality 0..*
Type CodeableConcept Binding: ImmunizationSubpotentReason (example)

Interactions

READ

Read interactions are executed as specified in the HL7 FHIR RESTful API read specification. To read Immunization resources, an application will perform an HTTP GET specifying the logical ID of the Immunization being retrieved.

The [patient|user|system]/Immunization.read authorization scope is required.

GET
/fhir/r4/Immunization/{logicalId}
Try in Postman

Parameters

required

conditional required

Name Type Description
logicalId string (REQUIRED) The logical ID of the resource (alias: Resource.id). It is specified in the URL path and not as a query parameter.

Response Codes

Response code Description
200 OK The requested Immunization resource was found and is contained within the body of the HTTP response.
400 Bad Request The server could not understand the request due to invalid syntax. The body of the HTTP response will contain an OperationOutcome resource that indicates the invalid request could not be processed.
404 Not Found The requested resource does not exist. The body of the HTTP response will contain an OperationOutcome resource that indicates the resource could not be found.
410 Gone The requested resource has been permanently deleted from server with no forwarding address. The body of the HTTP response will contain an OperationOutcome resource that indicates the resource could not be found.
500 Internal Server Error The server has encountered a situation it doesn't know how to handle. The body of the HTTP response will contain an OperationOutcome resource that indicates the nature of the error.
5xx Server Error The server may return other error codes to indicate other error conditions. The body of the HTTP response will contain an OperationOutcome resource that indicates the nature of the error.

GET SEARCH

Search interactions are executed as specified in the HL7 FHIR RESTful API search specification. To search for Immunization resources using the HTTP GET method, an application will perform the HTTP GET specifying the query parameters associated with the Immunization in the URL.

The [patient|user|system]/Immunization.read authorization scope is required.

The following additional authorization scopes might be required depending on _include and/or _revinclude search parameters used:

  • [patient|user|system]/Encounter.read
  • [patient|user|system]/Organization.read
  • [patient|user|system]/Patient.read
  • [patient|user|system]/Provenance.read

GET
/fhir/r4/Immunization
Try in Postman

Parameters

Immunization search requests conditionally require one of the following search parameters or search parameter combinations in order to match and return a result set:
  • patient
  • _id

required

conditional required

Name Type Description
ah-practice reference Identify the athenahealth Practice Organization (e.g., 'ah-practice=Organization/a-1.Practice-[practiceId]')
encounter reference Resource reference to FHIR Encounter resource - use with patient
patient reference (CONDITIONAL REQUIRED) Reference to patient related to the resource
date date occurence date - use with patient
status token Vaccine status - use with patient
_id token (CONDITIONAL REQUIRED) Immunization.id resource reference to FHIR Immunization resource
_count number The number of Immunization resources to return per page for paged search results. - use with patient
cursor token Search by cursor token for first resource to return in a paged search result
ah-chart-sharing-group reference Search by athenahealth Chart Sharing Group (e.g., 'ah-chart-sharing-group=Organization/a-[practiceId].CSG-[csgId]') for resources containing the 'Athena Chart Sharing Group' Extension
_include string Requests the server to include the referenced resource(s) in the search results according to the specified search parameter. Additional authorization scope(s) will be required. The supported _include parameter values are:
  • Immunization:encounter - Included resource(s) Encounter and required scope(s) [patient|user|system]/Encounter.read
  • Immunization:patient - Included resource(s) Patient and required scope(s) [patient|user|system]/Patient.read
  • Immunization:ah-chart-sharing-group - Included resource(s) Organization and required scope(s) [patient|user|system]/Organization.read
  • Immunization:ah-practice - Included resource(s) Organization and required scope(s) [patient|user|system]/Organization.read
_revinclude string Requests the server to include the associated resource(s) in the search results according to the specified search parameter. Additional authorization scope(s) will be required. The supported _revinclude parameter values are:
  • Provenance:target - Associated resource(s) Provenance and required scope(s) [patient|user|system]/Provenance.read

Response Codes

Response code Description
200 OK The search request succeeded. The body of the HTTP response will contain a Bundle resource containing the results of the search.
403 Forbidden The server refused to perform the search due to a missing required search parameter. The body of the HTTP response will contain an OperationOutcome resource that includes the required search parameters.
500 Internal Server Error The server has encountered a situation it doesn't know how to handle. The body of the HTTP response will contain an OperationOutcome resource that indicates the nature of the error.
5xx Server Error The server may return other error codes to indicate other error conditions. The body of the HTTP response will contain an OperationOutcome resource that indicates the nature of the error.

POST SEARCH

Search interactions are executed as specified in the HL7 FHIR RESTful API search specification. To search for Immunization resources using the HTTP POST method, an application will perform the HTTP POST specifying the query parameters associated with the Immunization in the request body.

The [patient|user|system]/Immunization.read authorization scope is required.

The following additional authorization scopes might be required depending on _include and/or _revinclude search parameters used:

  • [patient|user|system]/Encounter.read
  • [patient|user|system]/Organization.read
  • [patient|user|system]/Patient.read
  • [patient|user|system]/Provenance.read

POST
/fhir/r4/Immunization/_search
Try in Postman

Request Header

Content-Type: application/x-www-form-urlencoded

Request Body

param1=value1&param2=value2...

Parameters

Immunization search requests conditionally require one of the following search parameters or search parameter combinations in order to match and return a result set:
  • patient
  • _id

required

conditional required

Name Type Description
ah-practice reference Identify the athenahealth Practice Organization (e.g., 'ah-practice=Organization/a-1.Practice-[practiceId]')
encounter reference Resource reference to FHIR Encounter resource - use with patient
patient reference (CONDITIONAL REQUIRED) Reference to patient related to the resource
date date occurence date - use with patient
status token Vaccine status - use with patient
_id token (CONDITIONAL REQUIRED) Immunization.id resource reference to FHIR Immunization resource
_count number The number of Immunization resources to return per page for paged search results. - use with patient
cursor token Search by cursor token for first resource to return in a paged search result
ah-chart-sharing-group reference Search by athenahealth Chart Sharing Group (e.g., 'ah-chart-sharing-group=Organization/a-[practiceId].CSG-[csgId]') for resources containing the 'Athena Chart Sharing Group' Extension
_include string Requests the server to include the referenced resource(s) in the search results according to the specified search parameter. Additional authorization scope(s) will be required. The supported _include parameter values are:
  • Immunization:encounter - Included resource(s) Encounter and required scope(s) [patient|user|system]/Encounter.read
  • Immunization:patient - Included resource(s) Patient and required scope(s) [patient|user|system]/Patient.read
  • Immunization:ah-chart-sharing-group - Included resource(s) Organization and required scope(s) [patient|user|system]/Organization.read
  • Immunization:ah-practice - Included resource(s) Organization and required scope(s) [patient|user|system]/Organization.read
_revinclude string Requests the server to include the associated resource(s) in the search results according to the specified search parameter. Additional authorization scope(s) will be required. The supported _revinclude parameter values are:
  • Provenance:target - Associated resource(s) Provenance and required scope(s) [patient|user|system]/Provenance.read

Response Codes

Response code Description
200 OK The search request succeeded. The body of the HTTP response will contain a Bundle resource containing the results of the search.
403 Forbidden The server refused to perform the search due to a missing required search parameter. The body of the HTTP response will contain an OperationOutcome resource that includes the required search parameters.
500 Internal Server Error The server has encountered a situation it doesn't know how to handle. The body of the HTTP response will contain an OperationOutcome resource that indicates the nature of the error.
5xx Server Error The server may return other error codes to indicate other error conditions. The body of the HTTP response will contain an OperationOutcome resource that indicates the nature of the error.
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