description: 'An Immunization Activity describes immunization substance administrations that have actually occurred or are intended to occur. Immunization Activities in \"INT\" mood are reflections of immunizations a clinician intends a patient to receive. Immunization Activities in \"EVN\" mood reflect immunizations actually received.\n\nAn Immunization Activity is very similar to a Medication Activity with some key differentiators. The drug code system is constrained to CVX codes. Administration timing is less complex. Patient refusal reasons should be captured. All vaccines administered should be fully documented in the patient''s permanent medical record. Healthcare providers who administer vaccines covered by the National Childhood Vaccine Injury Act are required to ensure that the permanent medical record of the recipient indicates: \n\n1. Date of administration\n2. Vaccine manufacturer\n3. Vaccine lot number\n4. Name and title of the person who administered the vaccine and the address of the clinic or facility where the permanent record will reside\n5. Vaccine information statement (VIS)\n\na. Date printed on the VIS\nb. Date VIS given to patient or parent/guardian.\n\nThis information should be included in an Immunization Activity when available. (Reference: [https://www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/c/vis-instruct.pdf])'
package_name: hl7.cda.us.ccda
derivation: constraint
name: ImmunizationActivity
type: http://hl7.org/cda/stds/core/StructureDefinition/SubstanceAdministration
elements:
  administrationUnitCode:
    binding: {strength: required, valueSet: 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1021.30'}
    index: 21
  entryRelationship:
    index: 30
    slicing:
      rules: open
      discriminator:
      - {path: act, type: profile}
      - {path: observation, type: profile}
      - {path: supply, type: profile}
      min: null
      slices:
        indication:
          match: {}
          schema:
            array: true
            index: 31
            elements:
              typeCode:
                pattern: {type: Code, value: RSON}
                index: 32
              observation: {type: 'http://hl7.org/cda/stds/core/StructureDefinition/Observation', index: 33}
            required: [observation]
        instruction:
          match: {}
          schema:
            index: 34
            elements:
              typeCode:
                pattern: {type: Code, value: SUBJ}
                index: 35
              inversionInd:
                pattern: {type: Boolean, value: true}
                index: 36
              act: {type: 'http://hl7.org/cda/stds/core/StructureDefinition/Act', index: 37}
            required: [act, inversionInd]
        medSupplyOrder:
          match: {}
          schema:
            index: 38
            elements:
              typeCode:
                pattern: {type: Code, value: REFR}
                index: 39
              supply: {type: 'http://hl7.org/cda/stds/core/StructureDefinition/Supply', index: 40}
            required: [supply]
        medDispense:
          match: {}
          schema:
            index: 41
            elements:
              typeCode:
                pattern: {type: Code, value: REFR}
                index: 42
              supply: {type: 'http://hl7.org/cda/stds/core/StructureDefinition/Supply', index: 43}
            required: [supply]
        reactionObs:
          match: {}
          schema:
            index: 44
            elements:
              typeCode:
                pattern: {type: Code, value: CAUS}
                index: 45
              observation: {type: 'http://hl7.org/cda/stds/core/StructureDefinition/Observation', index: 46}
            required: [observation]
        immunizationRefusal:
          match: {}
          schema:
            index: 47
            elements:
              typeCode:
                pattern: {type: Code, value: RSON}
                index: 48
              observation: {type: 'http://hl7.org/cda/stds/core/StructureDefinition/Observation', index: 49}
            required: [observation]
        substanceAdmin:
          match: {}
          schema:
            short: The following entryRelationship is used to indicate a given immunization's order in a series. The nested Substance Administered Act identifies an administration in the series. The entryRelationship/sequenceNumber shows the order of this particular administration in that series.
            array: true
            index: 50
            elements:
              typeCode:
                pattern: {type: Code, value: COMP}
                index: 51
              inversionInd:
                pattern: {type: Boolean, value: true}
                index: 52
              sequenceNumber: {index: 53}
              act: {type: 'http://hl7.org/cda/stds/core/StructureDefinition/Act', index: 54}
            required: [act, inversionInd]
  consumable:
    index: 22
    elements:
      manufacturedProduct: {type: 'http://hl7.org/cda/stds/core/StructureDefinition/ManufacturedProduct', index: 23}
  doseQuantity:
    constraint:
      should-unit: {human: SHOULD contain @unit, source: 'http://hl7.org/cda/us/ccda/StructureDefinition/ImmunizationActivity', severity: warning, expression: nullFlavor.exists() or unit.exists()}
    index: 19
    elements:
      unit:
        short: 'NOTE: The base CDA R2.0 standard requires @unit to be drawn from UCUM, and best practice is to use case sensitive UCUM units'
        binding: {strength: required, valueSet: 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.1.11.12839'}
        index: 20
  routeCode:
    binding: {strength: required, valueSet: 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.88.12.3221.8.7'}
    constraint:
      should-translation: {human: SHOULD contain translation, source: 'http://hl7.org/cda/us/ccda/StructureDefinition/ImmunizationActivity', severity: warning, expression: translation.exists()}
    index: 16
    elements:
      translation:
        binding: {strength: required, valueSet: 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1099.12'}
        index: 17
  participant:
    index: 26
    slicing:
      rules: open
      discriminator:
      - {path: typeCode, type: value}
      min: null
      slices:
        drugVehicle:
          match: {typeCode: CSM}
          schema:
            array: true
            index: 27
            elements:
              typeCode:
                pattern: {type: Code, value: CSM}
                index: 28
              participantRole: {type: 'http://hl7.org/cda/stds/core/StructureDefinition/ParticipantRole', index: 29}
  classCode: {index: 4}
  author: {type: 'http://hl7.org/cda/stds/core/StructureDefinition/Author', index: 25}
  repeatNumber:
    short: In "INT" (intent) mood, the repeatNumber defines the number of allowed administrations. For example, a repeatNumber of "3" means that the substance can be administered up to 3 times. In "EVN" (event) mood, the repeatNumber is the number of occurrences. For example, a repeatNumber of "3" in a substance administration event means that the current administration is the 3rd in a series.
    constraint:
      value-only: {human: Interval fields SHALL not be present, source: 'http://hl7.org/cda/us/ccda/StructureDefinition/ImmunizationActivity', severity: error, expression: (low | high | width | center).empty()}
    index: 14
    elements:
      value: {short: value should be used instead of low/high, index: 15}
  id: {index: 6}
  approachSiteCode:
    binding: {strength: required, valueSet: 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.88.12.3221.8.9'}
    index: 18
  code: {short: 'SubstanceAdministration.code is an optional field. Per HL7 Pharmacy Committee, "this is intended to further specify the nature of the substance administration act. To date the committee has made no use of this attribute". Because the type of substance administration is generally implicit in the routeCode, in the consumable participant, etc., the field is generally not used and there is no defined value set.', index: 7}
  moodCode:
    binding: {strength: required, valueSet: 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.18'}
    index: 5
  effectiveTime: {index: 13}
  templateId:
    index: 0
    slicing:
      rules: open
      discriminator:
      - {path: root, type: value}
      - {path: extension, type: value}
      min: 1
      slices:
        immunization-activity:
          match: {root: 2.16.840.1.113883.10.20.22.4.52, extension: '2015-08-01'}
          schema:
            _required: true
            index: 1
            elements:
              root:
                pattern: {type: String, value: 2.16.840.1.113883.10.20.22.4.52}
                index: 2
              extension:
                pattern: {type: String, value: '2015-08-01'}
                index: 3
            required: [root, extension]
            extensions: {}
  statusCode:
    index: 11
    elements:
      code:
        binding: {strength: required, valueSet: 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.1.11.15933'}
        index: 12
    required: [code]
  performer: {index: 24}
  text:
    short: SHOULD reference the portion of section narrative text corresponding to this entry
    index: 9
    elements:
      reference:
        constraint:
          value-starts-octothorpe: {human: 'If reference/@value is present, it SHALL begin with a ''#'' and SHALL point to its corresponding narrative', source: 'http://hl7.org/cda/us/ccda/StructureDefinition/ImmunizationActivity', severity: error, expression: value.exists() implies value.startsWith('#')}
        index: 10
  precondition:
    index: 55
    slicing:
      rules: open
      discriminator:
      - {path: criterion, type: profile}
      min: null
      slices:
        substanceAdmin:
          match: {}
          schema:
            array: true
            index: 56
            elements:
              typeCode: {index: 57}
              criterion: {type: 'http://hl7.org/cda/stds/core/StructureDefinition/Criterion', index: 58}
            required: [typeCode]
  negationInd: {short: Use negationInd="true" to indicate that the immunization was not given., index: 8}
package_version: 3.0.0-ballot
class: logical
kind: logical
url: http://hl7.org/cda/us/ccda/StructureDefinition/ImmunizationActivity
base: http://hl7.org/cda/stds/core/StructureDefinition/SubstanceAdministration
version: 3.0.0-ballot
required: [id, negationInd, effectiveTime, statusCode, templateId]