{ "resourceType": "StructureDefinition", "id": "nexus-emr-core-immunization", "extension": [ { "url": "https://fhir.apps.health/StructureDefinition/effective-date", "extension": [ { "url": "paths", "valueString": "occurrenceDateTime" } ] }, { "url": "https://fhir.apps.health/StructureDefinition/salient-field", "extension": [ { "url": "key", "valueCode": "vaccine_code" }, { "url": "expression", "valueString": "vaccineCode" }, { "url": "type", "valueCode": "coded" } ] }, { "url": "https://fhir.apps.health/StructureDefinition/salient-field", "extension": [ { "url": "key", "valueCode": "status" }, { "url": "expression", "valueString": "status" }, { "url": "type", "valueCode": "code" } ] }, { "url": "https://fhir.apps.health/StructureDefinition/salient-field", "extension": [ { "url": "key", "valueCode": "occurrence" }, { "url": "expression", "valueString": "occurrenceDateTime" }, { "url": "type", "valueCode": "dateTime" } ] }, { "url": "https://fhir.apps.health/StructureDefinition/salient-field", "extension": [ { "url": "key", "valueCode": "site" }, { "url": "expression", "valueString": "site" }, { "url": "type", "valueCode": "coded" } ] }, { "url": "https://fhir.apps.health/StructureDefinition/salient-field", "extension": [ { "url": "key", "valueCode": "route" }, { "url": "expression", "valueString": "route" }, { "url": "type", "valueCode": "coded" } ] }, { "url": "https://fhir.apps.health/StructureDefinition/salient-field", "extension": [ { "url": "key", "valueCode": "dose_quantity" }, { "url": "expression", "valueString": "doseQuantity" }, { "url": "type", "valueCode": "quantity" } ] }, { "url": "https://fhir.apps.health/StructureDefinition/smart-exposed", "extension": [ { "url": "read", "valueString": "immunization:read" }, { "url": "write", "valueString": "immunization:write" }, { "url": "delete", "valueString": "immunization:delete" } ] } ], "url": "https://fhir.apps.health/StructureDefinition/nexus-emr-core-immunization", "name": "NexusEmrCoreImmunization", "title": "Immunization Profile", "status": "draft", "description": "Nexus EMR profile for Immunization resources, aligned with CA-Core+ and CII requirements. Records details about vaccines administered to a patient.", "fhirVersion": "4.0.1", "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" }, { "identity": "cda", "uri": "http://hl7.org/v3/cda", "name": "CDA (R2)" } ], "kind": "resource", "abstract": false, "type": "Immunization", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Immunization", "derivation": "constraint", "snapshot": { "element": [ { "id": "Immunization", "path": "Immunization", "short": "Nexus EMR Immunization Core", "definition": "Represents vaccination records and immunization history, capturing key details\nlike vaccine product, administration date, status, and site using standard\nNexus EMR references. Uses instance-specific identifiers for tracking\nimmunization records across systems.", "min": 0, "max": "*", "base": { "path": "Immunization", "min": 0, "max": "*" }, "constraint": [ { "key": "dom-2", "severity": "error", "human": "If the resource is contained in another resource, it SHALL NOT contain nested Resources", "expression": "contained.contained.empty()", "xpath": "not(parent::f:contained and f:contained)", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" }, { "key": "dom-3", "severity": "error", "human": "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", "expression": "contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()", "xpath": "not(exists(for $id in f:contained/*/f:id/@value return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" }, { "key": "dom-4", "severity": "error", "human": "If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated", "expression": "contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()", "xpath": "not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" }, { "key": "dom-5", "severity": "error", "human": "If a resource is contained in another resource, it SHALL NOT have a security label", "expression": "contained.meta.security.empty()", "xpath": "not(exists(f:contained/*/f:meta/f:security))", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice", "valueBoolean": true }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice-explanation", "valueMarkdown": "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." } ], "key": "dom-6", "severity": "warning", "human": "A resource should have narrative for robust management", "expression": "text.`div`.exists()", "xpath": "exists(f:text/h:div)", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" }, { "key": "nexus-note-extension-not-where-native", "severity": "error", "human": "The resource-note extension is not used on a resource that has a native `note` element -- that element is the home", "expression": "extension('https://fhir.apps.health/StructureDefinition/nexus-emr-resource-note').empty()", "source": "https://fhir.apps.health/StructureDefinition/nexus-emr-core-immunization" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "Entity. Role, or Act" }, { "identity": "workflow", "map": "Event" }, { "identity": "v2", "map": "VXU_V04" }, { "identity": "rim", "map": "SubstanceAdministration" } ] }, { "id": "Immunization.id", "path": "Immunization.id", "short": "Logical id of this artifact", "definition": "The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.", "comment": "The only time that a resource does not have an id is when it is being submitted to the server using a create operation.", "min": 0, "max": "1", "base": { "path": "Resource.id", "min": 0, "max": "1" }, "type": [ { "code": "http://hl7.org/fhirpath/System.String", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ] } ], "isModifier": false, "isSummary": true }, { "id": "Immunization.meta", "path": "Immunization.meta", "short": "Metadata about the resource", "definition": "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.", "min": 0, "max": "1", "base": { "path": "Resource.meta", "min": 0, "max": "1" }, "type": [ { "code": "Meta" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true }, { "id": "Immunization.meta.id", "path": "Immunization.meta.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "code": "http://hl7.org/fhirpath/System.String", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ] } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Immunization.meta.extension", "path": "Immunization.meta.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional content defined by implementations", "definition": "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 manageable, 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.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Immunization.meta.versionId", "path": "Immunization.meta.versionId", "short": "Version specific identifier", "definition": "The version specific identifier, as it appears in the version portion of the URL. This value changes when the resource is created, updated, or deleted.", "comment": "The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes.", "min": 0, "max": "1", "base": { "path": "Meta.versionId", "min": 0, "max": "1" }, "type": [ { "code": "id" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true }, { "id": "Immunization.meta.lastUpdated", "path": "Immunization.meta.lastUpdated", "short": "When the resource version last changed", "definition": "When the resource last changed - e.g. when the version changed.", "comment": "This value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant. This is equivalent to the HTTP Last-Modified and SHOULD have the same value on a [read](http.html#read) interaction.", "min": 0, "max": "1", "base": { "path": "Meta.lastUpdated", "min": 0, "max": "1" }, "type": [ { "code": "instant" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true }, { "id": "Immunization.meta.source", "path": "Immunization.meta.source", "short": "Identifies EMR instance & pipeline version the resource came from", "definition": "A URI that identifies the EMR pipeline and version from which this resource originated. This tells you which EMR instance (recommend using the instance identifier), and the version of the pipeline code/transformations.", "comment": "In the provenance resource, this corresponds to Provenance.entity.what[x]. The exact use of the source (and the implied Provenance.entity.role) is left to implementer discretion. Only one nominated source is allowed; for additional provenance details, a full Provenance resource should be used. \n\nThis element can be used to indicate where the current master source of a resource that has a canonical URL if the resource is no longer hosted at the canonical URL.", "min": 0, "max": "1", "base": { "path": "Meta.source", "min": 0, "max": "1" }, "type": [ { "code": "uri" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": true }, { "id": "Immunization.meta.profile", "path": "Immunization.meta.profile", "short": "Profiles this resource claims to conform to", "definition": "A list of profiles (references to [StructureDefinition](structuredefinition.html#) resources) that this resource claims to conform to. The URL is a reference to [StructureDefinition.url](structuredefinition-definitions.html#StructureDefinition.url).", "comment": "It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set.", "min": 0, "max": "*", "base": { "path": "Meta.profile", "min": 0, "max": "*" }, "type": [ { "code": "canonical", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/StructureDefinition" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true }, { "id": "Immunization.meta.security", "path": "Immunization.meta.security", "short": "Security Labels applied to this resource", "definition": "Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure.", "comment": "The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored.", "min": 0, "max": "*", "base": { "path": "Meta.security", "min": 0, "max": "*" }, "type": [ { "code": "Coding" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "SecurityLabels" }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding", "valueBoolean": true } ], "strength": "extensible", "description": "Security Labels from the Healthcare Privacy and Security Classification System.", "valueSet": "http://hl7.org/fhir/ValueSet/security-labels" } }, { "id": "Immunization.meta.tag", "path": "Immunization.meta.tag", "short": "Tags applied to this resource", "definition": "Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource.", "comment": "The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored.", "min": 0, "max": "*", "base": { "path": "Meta.tag", "min": 0, "max": "*" }, "type": [ { "code": "Coding" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "Tags" } ], "strength": "example", "description": "Codes that represent various types of tags, commonly workflow-related; e.g. \"Needs review by Dr. Jones\".", "valueSet": "http://hl7.org/fhir/ValueSet/common-tags" } }, { "id": "Immunization.implicitRules", "path": "Immunization.implicitRules", "short": "A set of rules under which this content was created", "definition": "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.", "comment": "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.", "min": 0, "max": "1", "base": { "path": "Resource.implicitRules", "min": 0, "max": "1" }, "type": [ { "code": "uri" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": true, "isModifierReason": "This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation", "isSummary": true }, { "id": "Immunization.language", "path": "Immunization.language", "short": "Language of the resource content", "definition": "The base language in which the resource is written.", "comment": "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).", "min": 0, "max": "1", "base": { "path": "Resource.language", "min": 0, "max": "1" }, "type": [ { "code": "code" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet", "valueCanonical": "http://hl7.org/fhir/ValueSet/all-languages" }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "Language" }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding", "valueBoolean": true } ], "strength": "preferred", "description": "A human language.", "valueSet": "http://hl7.org/fhir/ValueSet/languages" } }, { "id": "Immunization.text", "path": "Immunization.text", "short": "Narrative", "definition": "A human-readable narrative summary of the NexusEmrCoreImmunization resource for human interpretation.", "comment": "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.", "alias": [ "narrative", "html", "xhtml", "display" ], "min": 0, "max": "1", "base": { "path": "DomainResource.text", "min": 0, "max": "1" }, "type": [ { "code": "Narrative" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "Act.text?" } ] }, { "id": "Immunization.contained", "path": "Immunization.contained", "short": "Contained, inline Resources", "definition": "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.", "comment": "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.", "alias": [ "inline resources", "anonymous resources", "contained resources" ], "min": 0, "max": "*", "base": { "path": "DomainResource.contained", "min": 0, "max": "*" }, "type": [ { "code": "Resource" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "N/A" } ] }, { "id": "Immunization.extension", "path": "Immunization.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "ordered": false, "rules": "open" }, "short": "Additional content defined by implementations", "definition": "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 manageable, 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.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "DomainResource.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "N/A" } ] }, { "id": "Immunization.extension:preventionInstructions", "path": "Immunization.extension", "sliceName": "preventionInstructions", "short": "Instructions given to the patient for this immunization", "definition": "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 manageable, 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.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "1", "base": { "path": "DomainResource.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension", "profile": [ "https://fhir.apps.health/StructureDefinition/nexus-prevention-instructions" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "N/A" } ] }, { "id": "Immunization.modifierExtension", "path": "Immunization.modifierExtension", "short": "Extensions that cannot be ignored", "definition": "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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "comment": "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](extensibility.html#modifierExtension).", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "DomainResource.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them", "isSummary": false, "mapping": [ { "identity": "rim", "map": "N/A" } ] }, { "id": "Immunization.identifier", "path": "Immunization.identifier", "short": "Business identifier(s) for immunization", "definition": "Unique identifiers for the immunization.\n\nA business identifier is recommended but not required (identifier is 0..*). Where available, carry the source-system identifier using the most appropriate system URI. No specific canonical system is mandated.", "comment": "A source system's own identifier SHOULD be carried alongside this one, flagged `use = secondary`. See [Carrying the raw code](https://fhir.apps.health/guide/patterns/raw-codes.html).", "min": 0, "max": "*", "base": { "path": "Immunization.identifier", "min": 0, "max": "*" }, "type": [ { "code": "Identifier" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "workflow", "map": "Event.identifier" }, { "identity": "w5", "map": "FiveWs.identifier" }, { "identity": "rim", "map": ".id" }, { "identity": "cda", "map": "ClinicalDocument/component/StructuredBody/component/section/entry/substanceAdministration/id" } ] }, { "id": "Immunization.identifier.id", "path": "Immunization.identifier.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "code": "http://hl7.org/fhirpath/System.String", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ] } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Immunization.identifier.extension", "path": "Immunization.identifier.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional content defined by implementations", "definition": "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 manageable, 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.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Immunization.identifier.use", "path": "Immunization.identifier.use", "short": "usual | official | temp | secondary | old (If known)", "definition": "The purpose of this identifier.", "comment": "Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.", "requirements": "Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.", "min": 0, "max": "1", "base": { "path": "Identifier.use", "min": 0, "max": "1" }, "type": [ { "code": "code" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": true, "isModifierReason": "This is labeled as \"Is Modifier\" because applications should not mistake a temporary id for a permanent one.", "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "IdentifierUse" } ], "strength": "required", "description": "Identifies the purpose for this identifier, if known .", "valueSet": "http://hl7.org/fhir/ValueSet/identifier-use|4.0.1" }, "mapping": [ { "identity": "v2", "map": "N/A" }, { "identity": "rim", "map": "Role.code or implied by context" } ] }, { "id": "Immunization.identifier.type", "path": "Immunization.identifier.type", "short": "Description of identifier", "definition": "A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.", "comment": "This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.", "requirements": "Allows users to make use of identifiers when the identifier system is not known.", "min": 0, "max": "1", "base": { "path": "Identifier.type", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "IdentifierType" }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding", "valueBoolean": true } ], "strength": "extensible", "description": "A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.", "valueSet": "http://hl7.org/fhir/ValueSet/identifier-type" }, "mapping": [ { "identity": "v2", "map": "CX.5" }, { "identity": "rim", "map": "Role.code or implied by context" } ] }, { "id": "Immunization.identifier.system", "path": "Immunization.identifier.system", "short": "The namespace for the identifier value", "definition": "Establishes the namespace for the value - that is, a URL that describes a set values that are unique.", "comment": "Identifier.system is always case sensitive.", "requirements": "There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.", "min": 1, "max": "1", "base": { "path": "Identifier.system", "min": 0, "max": "1" }, "type": [ { "code": "uri" } ], "example": [ { "label": "General", "valueUri": "http://www.acme.com/identifiers/patient" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "v2", "map": "CX.4 / EI-2-4" }, { "identity": "rim", "map": "II.root or Role.id.root" }, { "identity": "servd", "map": "./IdentifierType" } ] }, { "id": "Immunization.identifier.value", "path": "Immunization.identifier.value", "short": "The value that is unique", "definition": "The portion of the identifier typically relevant to the user and which is unique within the context of the system.", "comment": "If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the [Rendered Value extension](extension-rendered-value.html). Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.", "min": 1, "max": "1", "base": { "path": "Identifier.value", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "example": [ { "label": "General", "valueString": "123456" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "v2", "map": "CX.1 / EI.1" }, { "identity": "rim", "map": "II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)" }, { "identity": "servd", "map": "./Value" } ] }, { "id": "Immunization.identifier.period", "path": "Immunization.identifier.period", "short": "Time period when id is/was valid for use", "definition": "Time period during which identifier is/was valid for use.", "min": 0, "max": "1", "base": { "path": "Identifier.period", "min": 0, "max": "1" }, "type": [ { "code": "Period" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "v2", "map": "CX.7 + CX.8" }, { "identity": "rim", "map": "Role.effectiveTime or implied by context" }, { "identity": "servd", "map": "./StartDate and ./EndDate" } ] }, { "id": "Immunization.identifier.assigner", "path": "Immunization.identifier.assigner", "short": "Organization that issued id (may be just text)", "definition": "Organization that issued/manages the identifier.", "comment": "The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.", "min": 0, "max": "1", "base": { "path": "Identifier.assigner", "min": 0, "max": "1" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Organization" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "v2", "map": "CX.4 / (CX.4,CX.9,CX.10)" }, { "identity": "rim", "map": "II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper" }, { "identity": "servd", "map": "./IdentifierIssuingAuthority" } ] }, { "id": "Immunization.status", "path": "Immunization.status", "short": "completed | entered-in-error | not-done", "definition": "Indicates the current status of the immunization event.", "comment": "Will generally be 'completed' for administered vaccines.", "min": 1, "max": "1", "base": { "path": "Immunization.status", "min": 1, "max": "1" }, "type": [ { "code": "code" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": true, "isModifierReason": "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", "isSummary": true, "binding": { "strength": "required", "valueSet": "http://hl7.org/fhir/ValueSet/immunization-status" }, "mapping": [ { "identity": "workflow", "map": "Event.status" }, { "identity": "w5", "map": "FiveWs.status" }, { "identity": "rim", "map": "statusCode" } ] }, { "id": "Immunization.statusReason", "path": "Immunization.statusReason", "short": "Why the dose was not given (with status = not-done)", "definition": "Why this dose was not administered: patient objection, a contraindication, an out-of-stock product,\na deferral.\n\nRead with `status`. This element is meaningful only where `status` is `not-done`; a `completed`\nimmunization carrying a status reason is contradicting itself. Conversely, a `not-done` immunization\nSHOULD carry one -- a record that says only that a dose was not given tells a later reader nothing\nabout whether to offer it again.", "comment": "This is the element a patient refusal lands on for an Immunization, which is why `Immunization` carries no prevention-status extension: `status = not-done` plus a patient-objection status reason expresses refusal natively, where an Observation needs the extension to say the same thing. The binding is R4's own (`immunization-status-reason`, example strength) and is not narrowed here; carry the source system's own coding alongside where the value was mapped.", "min": 0, "max": "1", "base": { "path": "Immunization.statusReason", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": false, "binding": { "strength": "example", "valueSet": "http://hl7.org/fhir/ValueSet/immunization-status-reason" }, "mapping": [ { "identity": "workflow", "map": "Event.statusReason" }, { "identity": "rim", "map": ".inboundRelationship[typeCode=SUBJ].source[classCode=CACT, moodCode=EVN].reasonCOde" } ] }, { "id": "Immunization.vaccineCode", "path": "Immunization.vaccineCode", "short": "Vaccine product with raw code support", "definition": "Vaccine product administered or to be administered.\n\nREQUIRED: text element for human readability\nRECOMMENDED: a Canadian vaccine vocabulary where a coded value is available -- the National\nVaccine Catalogue (NVC), whose generic-agent, tradename and antigen value sets are published over\nSNOMED CT CA, or SNOMED CT itself\nACCEPTED: CVX on a record imported from a US source, carried as received rather than rewritten\nOPTIONAL: Raw EMR codes for source system preservation\n\nCVX is the US CDC's vaccine vocabulary and is not used in Canada's immunization stack; Ontario,\nOntarioMD and PHAC all work from NVC or SNOMED CT. A record that already carries a CVX code is\nstill valid here -- this element is unbound, and rewriting a code received from a sending system\nwould lose what that system meant.\n\nThe text element ensures human readability even when coded values are not recognized.", "comment": "Where this code was mapped from a source system's own vocabulary, carry the raw coding alongside the mapped one, flagged `userSelected = true`. See [Carrying the raw code](https://fhir.apps.health/guide/patterns/raw-codes.html).", "min": 1, "max": "1", "base": { "path": "Immunization.vaccineCode", "min": 1, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "VaccineCode" } ], "strength": "example", "description": "The code for vaccine product administered.", "valueSet": "http://hl7.org/fhir/ValueSet/vaccine-code" }, "mapping": [ { "identity": "workflow", "map": "Event.code" }, { "identity": "w5", "map": "FiveWs.what[x]" }, { "identity": "v2", "map": "RXA-5" }, { "identity": "rim", "map": ".code" }, { "identity": "cda", "map": "ClinicalDocument/component/StructuredBody/component/section/entry/substanceAdministration/consumable/manfacturedProduct/manufacturedMaterial/realmCode/code" } ] }, { "id": "Immunization.vaccineCode.id", "path": "Immunization.vaccineCode.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "code": "http://hl7.org/fhirpath/System.String", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ] } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Immunization.vaccineCode.extension", "path": "Immunization.vaccineCode.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional content defined by implementations", "definition": "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 manageable, 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.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Immunization.vaccineCode.coding", "path": "Immunization.vaccineCode.coding", "short": "Code defined by a terminology system", "definition": "A reference to a code defined by a terminology system.", "comment": "Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.", "requirements": "Allows for alternative encodings within a code system, and translations to other code systems.", "min": 0, "max": "*", "base": { "path": "CodeableConcept.coding", "min": 0, "max": "*" }, "type": [ { "code": "Coding" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "v2", "map": "C*E.1-8, C*E.10-22" }, { "identity": "rim", "map": "union(., ./translation)" }, { "identity": "orim", "map": "fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding" } ] }, { "id": "Immunization.vaccineCode.text", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean": true } ], "path": "Immunization.vaccineCode.text", "short": "The vaccine as written, in human-readable form", "definition": "Plain text representation of the vaccine product, required for all entries", "comment": "Required.", "requirements": "The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.", "min": 1, "max": "1", "base": { "path": "CodeableConcept.text", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "v2", "map": "C*E.9. But note many systems use C*E.2 for this" }, { "identity": "rim", "map": "./originalText[mediaType/code=\"text/plain\"]/data" }, { "identity": "orim", "map": "fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText" } ] }, { "id": "Immunization.patient", "path": "Immunization.patient", "short": "Who was immunized", "definition": "The patient who received or is to receive the immunization. Must reference using Nexus EMR patient identifier.", "comment": "References should use identifier-based references following Nexus EMR patterns.", "min": 1, "max": "1", "base": { "path": "Immunization.patient", "min": 1, "max": "1" }, "type": [ { "code": "Reference", "targetProfile": [ "https://fhir.apps.health/StructureDefinition/nexus-emr-core-patient" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "workflow", "map": "Event.subject" }, { "identity": "w5", "map": "FiveWs.subject[x]" }, { "identity": "v2", "map": "PID-3" }, { "identity": "rim", "map": ".partipication[ttypeCode=].role" }, { "identity": "w5", "map": "FiveWs.subject" } ] }, { "id": "Immunization.encounter", "path": "Immunization.encounter", "short": "Encounter when immunization was given", "definition": "The encounter during which this immunization was administered. Optional but provides important clinical context.", "comment": "Linking to encounter helps establish the clinical context of the immunization.", "min": 0, "max": "1", "base": { "path": "Immunization.encounter", "min": 0, "max": "1" }, "type": [ { "code": "Reference", "targetProfile": [ "https://fhir.apps.health/StructureDefinition/nexus-emr-core-encounter" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "workflow", "map": "Event.context" }, { "identity": "w5", "map": "FiveWs.context" }, { "identity": "v2", "map": "PV1-19" }, { "identity": "rim", "map": "component->EncounterEvent" } ] }, { "id": "Immunization.occurrence[x]", "path": "Immunization.occurrence[x]", "short": "When vaccine was administered", "definition": "The date/time when the vaccine was administered to the patient.", "comment": "This is the administration date, not when the immunization was recorded.", "min": 1, "max": "1", "base": { "path": "Immunization.occurrence[x]", "min": 1, "max": "1" }, "type": [ { "code": "dateTime" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "workflow", "map": "Event.occurrence[x]" }, { "identity": "w5", "map": "FiveWs.done[x]" }, { "identity": "v2", "map": "RXA-3" }, { "identity": "rim", "map": ".effectiveTime" }, { "identity": "cda", "map": "ClinicalDocument/component/StructuredBody/component/section/entry/substanceAdministration/effectiveTime/value" } ] }, { "id": "Immunization.occurrence[x].id", "path": "Immunization.occurrence[x].id", "representation": [ "xmlAttr" ], "short": "xml:id (or equivalent in JSON)", "definition": "unique id for the element within a resource (for internal references)", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "code": "http://hl7.org/fhirpath/System.String", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ] } ], "isModifier": false, "isSummary": false }, { "id": "Immunization.occurrence[x].extension", "path": "Immunization.occurrence[x].extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "ordered": false, "rules": "open" }, "short": "Additional content defined by implementations", "definition": "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 manageable, 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.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": false, "isSummary": false }, { "id": "Immunization.occurrence[x].extension:dataAbsentReason", "path": "Immunization.occurrence[x].extension", "sliceName": "dataAbsentReason", "short": "Additional content defined by implementations", "definition": "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 manageable, 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.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "1", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension", "profile": [ "http://hl7.org/fhir/StructureDefinition/data-absent-reason|4.0.1" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mustSupport": true, "isModifier": false, "isSummary": false }, { "id": "Immunization.occurrence[x].value", "path": "Immunization.occurrence[x].value", "representation": [ "xmlAttr" ], "short": "Primitive value for dateTime", "definition": "The actual value", "min": 0, "max": "1", "base": { "path": "dateTime.value", "min": 0, "max": "1" }, "type": [ { "code": "http://hl7.org/fhirpath/System.DateTime", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "dateTime" }, { "url": "http://hl7.org/fhir/StructureDefinition/regex", "valueString": "([0-9]([0-9]([0-9][1-9]|[1-9]0)|[1-9]00)|[1-9]000)(-(0[1-9]|1[0-2])(-(0[1-9]|[1-2][0-9]|3[0-1])(T([01][0-9]|2[0-3]):[0-5][0-9]:([0-5][0-9]|60)(\\.[0-9]+)?(Z|(\\+|-)((0[0-9]|1[0-3]):[0-5][0-9]|14:00)))?)?)?" } ] } ], "isModifier": false, "isSummary": false }, { "id": "Immunization.recorded", "path": "Immunization.recorded", "short": "When the immunization was first captured in the subject's record", "definition": "The date the occurrence of the immunization was first captured in the record - potentially significantly after the occurrence of the event.", "min": 0, "max": "1", "base": { "path": "Immunization.recorded", "min": 0, "max": "1" }, "type": [ { "code": "dateTime" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "w5", "map": "FiveWs.recorded" }, { "identity": "rim", "map": ".participation[typeCode=AUT].time" } ] }, { "id": "Immunization.primarySource", "path": "Immunization.primarySource", "short": "Indicates context the data was recorded in", "definition": "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.", "comment": "Reflects the “reliability” of the content.", "min": 0, "max": "1", "base": { "path": "Immunization.primarySource", "min": 0, "max": "1" }, "type": [ { "code": "boolean" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "mapping": [ { "identity": "w5", "map": "FiveWs.source" }, { "identity": "v2", "map": "RXA-9" }, { "identity": "rim", "map": "immunization.uncertaintycode (if primary source=false, uncertainty=U)" } ] }, { "id": "Immunization.reportOrigin", "path": "Immunization.reportOrigin", "short": "Indicates the source of a secondarily reported record", "definition": "The source of the data when the report of the immunization event is not based on information from the person who administered the vaccine.", "comment": "Should not be populated if primarySource = True, not required even if primarySource = False.", "min": 0, "max": "1", "base": { "path": "Immunization.reportOrigin", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ImmunizationReportOrigin" } ], "strength": "example", "description": "The source of the data for a record which is not from a primary source.", "valueSet": "http://hl7.org/fhir/ValueSet/immunization-origin" }, "mapping": [ { "identity": "w5", "map": "FiveWs.source" }, { "identity": "v2", "map": "RXA-9" }, { "identity": "rim", "map": ".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)" } ] }, { "id": "Immunization.location", "path": "Immunization.location", "short": "Where immunization occurred", "definition": "The service delivery location where the vaccine administration occurred.", "min": 0, "max": "1", "base": { "path": "Immunization.location", "min": 0, "max": "1" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Location" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "workflow", "map": "Event.location" }, { "identity": "w5", "map": "FiveWs.where[x]" }, { "identity": "v2", "map": "RXA-27 (or RXA-11, deprecated as of v2.7)" }, { "identity": "rim", "map": ".participation[typeCode=LOC].COCT_MT240000UV" } ] }, { "id": "Immunization.manufacturer", "path": "Immunization.manufacturer", "short": "Vaccine manufacturer", "definition": "Name of vaccine manufacturer.", "min": 0, "max": "1", "base": { "path": "Immunization.manufacturer", "min": 0, "max": "1" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Organization" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "v2", "map": "RXA-17" }, { "identity": "rim", "map": ".participation[typeCode=CSM].role[classCode=INST].scopedRole.scoper[classCode=ORG]" }, { "identity": "cda", "map": "ClinicalDocument/component/StructuredBody/component/section/entry/substanceAdministration/consumable/manfacturedProduct/manufacuturerOrganization/name" } ] }, { "id": "Immunization.lotNumber", "path": "Immunization.lotNumber", "short": "Vaccine lot number", "definition": "Lot number of the vaccine product.", "min": 0, "max": "1", "base": { "path": "Immunization.lotNumber", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "v2", "map": "RXA-15" }, { "identity": "rim", "map": ".participation[typeCode=CSM].role[classCode=INST].scopedRole.scoper[classCode=MMAT].id" }, { "identity": "cda", "map": "ClinicalDocument/component/StructuredBody/component/section/entry/substanceAdministration/consumable/manfacturedProduct/manufacturedMaterial/lotNumberText" } ] }, { "id": "Immunization.expirationDate", "path": "Immunization.expirationDate", "short": "Vaccine expiration date", "definition": "Date vaccine batch expires.", "min": 0, "max": "1", "base": { "path": "Immunization.expirationDate", "min": 0, "max": "1" }, "type": [ { "code": "date" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "v2", "map": "RXA-16" }, { "identity": "rim", "map": ".participation[typeCode=CSM].role[classCode=INST].scopedRole.scoper[classCode=MMAT].expirationTime" } ] }, { "id": "Immunization.site", "path": "Immunization.site", "short": "Body site with raw code support", "definition": "Body site where vaccine was administered.\n\nRECOMMENDED: SNOMED CT or other standard terminology when available\nOPTIONAL: Raw EMR codes for source system preservation", "comment": "Useful for tracking injection site reactions and following protocols.", "min": 0, "max": "1", "base": { "path": "Immunization.site", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ImmunizationSite" } ], "strength": "example", "description": "The site at which the vaccine was administered.", "valueSet": "http://hl7.org/fhir/ValueSet/immunization-site" }, "mapping": [ { "identity": "v2", "map": "RXR-2" }, { "identity": "rim", "map": "observation.targetSiteCode" }, { "identity": "cda", "map": "ClinicalDocument/component/StructuredBody/component/section/entry/substanceAdministration/approachSiteCode/code" } ] }, { "id": "Immunization.route", "path": "Immunization.route", "short": "Administration route with raw code support", "definition": "The path by which the vaccine product is taken into the body.\n\nRECOMMENDED: SNOMED CT or other standard terminology when available\nOPTIONAL: Raw EMR codes for source system preservation", "comment": "The route affects absorption and effectiveness of the vaccine.", "min": 0, "max": "1", "base": { "path": "Immunization.route", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ImmunizationRoute" } ], "strength": "example", "description": "The route by which the vaccine was administered.", "valueSet": "http://hl7.org/fhir/ValueSet/immunization-route" }, "mapping": [ { "identity": "v2", "map": "RXR-1" }, { "identity": "rim", "map": ".routeCode" }, { "identity": "cda", "map": "ClinicalDocument/component/StructuredBody/component/section/entry/substanceAdministration/routeCode/code" } ] }, { "id": "Immunization.doseQuantity", "path": "Immunization.doseQuantity", "short": "Amount of vaccine administered", "definition": "The quantity of vaccine product that was administered.", "min": 0, "max": "1", "base": { "path": "Immunization.doseQuantity", "min": 0, "max": "1" }, "type": [ { "code": "Quantity", "profile": [ "http://hl7.org/fhir/StructureDefinition/SimpleQuantity" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "v2", "map": "RXA-6 / RXA-7" }, { "identity": "rim", "map": ".doseQuantity" } ] }, { "id": "Immunization.performer", "path": "Immunization.performer", "short": "Who performed the immunization; repeat for an outside performer", "definition": "Who administered the vaccine.\n\nA performer this system holds a record for is referenced normally, with `actor.reference` and an\n`actor.display` carrying the readable name. A performer it does NOT hold a record for -- a clinician\nat an outside clinic whose administration is being recorded here -- is a **display-only** reference:\n`actor.display` carries the name as recorded and `actor.reference` is absent.\n\nThe element repeats, so a record may name both. A consumer distinguishes them by whether\n`actor.reference` is present, never by position.", "comment": "A display-only performer has no `actor.reference` to resolve and therefore does not conform to the referenced profiles below -- that is intended, and is the R4 shape for naming a party that has no resource. `function` is available to say in what capacity each performer acted and is not constrained here.", "min": 0, "max": "*", "base": { "path": "Immunization.performer", "min": 0, "max": "*" }, "type": [ { "code": "BackboneElement" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "workflow", "map": "Event.performer" }, { "identity": "v2", "map": "ORC-12 / RXA-10" }, { "identity": "rim", "map": ".participation[typeCode=PRF].role[scoper.determinerCode=INSTANCE]" } ] }, { "id": "Immunization.performer.id", "path": "Immunization.performer.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "code": "http://hl7.org/fhirpath/System.String", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ] } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Immunization.performer.extension", "path": "Immunization.performer.extension", "short": "Additional content defined by implementations", "definition": "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 manageable, 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.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Immunization.performer.modifierExtension", "path": "Immunization.performer.modifierExtension", "short": "Extensions that cannot be ignored even if unrecognized", "definition": "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 manageable, 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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "comment": "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](extensibility.html#modifierExtension).", "alias": [ "extensions", "user content", "modifiers" ], "min": 0, "max": "*", "base": { "path": "BackboneElement.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary": true, "mapping": [ { "identity": "rim", "map": "N/A" } ] }, { "id": "Immunization.performer.function", "path": "Immunization.performer.function", "short": "What type of performance was done", "definition": "Describes the type of performance (e.g. ordering provider, administering provider, etc.).", "min": 0, "max": "1", "base": { "path": "Immunization.performer.function", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ImmunizationFunction" } ], "strength": "extensible", "description": "The role a practitioner or organization plays in the immunization event.", "valueSet": "http://hl7.org/fhir/ValueSet/immunization-function" }, "mapping": [ { "identity": "workflow", "map": "Event.performer.function" }, { "identity": "rim", "map": ".participation.functionCode" } ] }, { "id": "Immunization.performer.actor", "path": "Immunization.performer.actor", "short": "Individual who administered the vaccine (display-only when outside this system)", "definition": "The practitioner or organization who performed the immunization. Display-only -- `display` set, `reference` absent -- where the performer has no record in this system.", "comment": "When the individual practitioner who performed the action is known, it is best to send.", "min": 1, "max": "1", "base": { "path": "Immunization.performer.actor", "min": 1, "max": "1" }, "type": [ { "code": "Reference", "targetProfile": [ "https://fhir.apps.health/StructureDefinition/nexus-emr-core-practitionerrole", "https://fhir.apps.health/StructureDefinition/nexus-emr-core-practitioner" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "workflow", "map": "Event.performer.actor" }, { "identity": "w5", "map": "FiveWs.actor" }, { "identity": "rim", "map": ".player" } ] }, { "id": "Immunization.note", "path": "Immunization.note", "short": "Clinical comments on the immunization -- one whole comment per repeat", "definition": "Free-text clinical comment about this immunization: what a person wanted to say about it that no\nother element carries.\n\n**One whole comment per repeat.** `note.text` is the comment in full, and a consumer renders it\nverbatim.\n\n**`note.text` is not a carrier for other fields.** A consumer MUST NOT parse it for prefixes,\nmarkers, keys or any other in-band convention, and a producer MUST NOT encode in it a value that\nbelongs to an element or an extension of its own. Anything with its own editing lifecycle gets its\nown address: the instructions given to the patient are the\n[prevention instructions](https://fhir.apps.health/fhir/StructureDefinition-nexus-prevention-instructions.html)\nextension, an outside administering provider is a display-only `performer`, and the reason a dose\nwas not given is `statusReason`.", "comment": "Attribution is OPTIONAL here, unlike on a task. `author[x]` and `time` keep their base R4 cardinality: a producer that has them SHOULD write them, a consumer displays them when present, and no consumer may require them -- comments reaching this element from a source system routinely carry neither. This is why the element is a plain `Annotation` rather than the [Task Note](https://fhir.apps.health/fhir/StructureDefinition-nexus-emr-task-note.html) profile, which requires both because a task's turns must each say who said it.", "min": 0, "max": "*", "base": { "path": "Immunization.note", "min": 0, "max": "*" }, "type": [ { "code": "Annotation" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "workflow", "map": "Event.note" }, { "identity": "v2", "map": "OBX-5 : OBX-3 = 48767-8" }, { "identity": "rim", "map": "note" } ] }, { "id": "Immunization.reasonCode", "path": "Immunization.reasonCode", "short": "Why immunization occurred", "definition": "Reasons why the vaccine was administered.", "min": 0, "max": "*", "base": { "path": "Immunization.reasonCode", "min": 0, "max": "*" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ImmunizationReason" } ], "strength": "example", "description": "The reason why a vaccine was administered.", "valueSet": "http://hl7.org/fhir/ValueSet/immunization-reason" }, "mapping": [ { "identity": "workflow", "map": "Event.reasonCode" }, { "identity": "rim", "map": "[actionNegationInd=false].reasonCode" } ] }, { "id": "Immunization.reasonReference", "path": "Immunization.reasonReference", "short": "Why immunization occurred", "definition": "Condition, Observation or DiagnosticReport that supports why the immunization was administered.", "min": 0, "max": "*", "base": { "path": "Immunization.reasonReference", "min": 0, "max": "*" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Condition", "http://hl7.org/fhir/StructureDefinition/Observation", "http://hl7.org/fhir/StructureDefinition/DiagnosticReport" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "workflow", "map": "Event.reasonReference" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Immunization.isSubpotent", "path": "Immunization.isSubpotent", "short": "Dose potency", "definition": "Indication if a dose is considered to be subpotent. By default, a dose should be considered to be potent.", "comment": "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.", "min": 0, "max": "1", "base": { "path": "Immunization.isSubpotent", "min": 0, "max": "1" }, "type": [ { "code": "boolean" } ], "meaningWhenMissing": "By default, a dose should be considered to be potent.", "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": true, "isModifierReason": "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.", "isSummary": true, "mapping": [ { "identity": "v2", "map": "RXA-20 = PA (partial administration)" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Immunization.subpotentReason", "path": "Immunization.subpotentReason", "short": "Reason for being subpotent", "definition": "Reason why a dose is considered to be subpotent.", "min": 0, "max": "*", "base": { "path": "Immunization.subpotentReason", "min": 0, "max": "*" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "SubpotentReason" } ], "strength": "example", "description": "The reason why a dose is considered to be subpotent.", "valueSet": "http://hl7.org/fhir/ValueSet/immunization-subpotent-reason" }, "mapping": [ { "identity": "rim", "map": "N/A" } ] }, { "id": "Immunization.education", "path": "Immunization.education", "short": "Educational material presented to patient", "definition": "Educational material presented to the patient (or guardian) at the time of vaccine administration.", "min": 0, "max": "*", "base": { "path": "Immunization.education", "min": 0, "max": "*" }, "type": [ { "code": "BackboneElement" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "imm-1", "severity": "error", "human": "One of documentType or reference SHALL be present", "expression": "documentType.exists() or reference.exists()", "xpath": "exists(f:documentType) or exists(f:reference)" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "N/A" } ] }, { "id": "Immunization.education.id", "path": "Immunization.education.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "code": "http://hl7.org/fhirpath/System.String", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ] } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Immunization.education.extension", "path": "Immunization.education.extension", "short": "Additional content defined by implementations", "definition": "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 manageable, 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.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Immunization.education.modifierExtension", "path": "Immunization.education.modifierExtension", "short": "Extensions that cannot be ignored even if unrecognized", "definition": "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 manageable, 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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "comment": "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](extensibility.html#modifierExtension).", "alias": [ "extensions", "user content", "modifiers" ], "min": 0, "max": "*", "base": { "path": "BackboneElement.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary": true, "mapping": [ { "identity": "rim", "map": "N/A" } ] }, { "id": "Immunization.education.documentType", "path": "Immunization.education.documentType", "short": "Educational material document identifier", "definition": "Identifier of the material presented to the patient.", "min": 0, "max": "1", "base": { "path": "Immunization.education.documentType", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "v2", "map": "OBX-5 : OBX-3 = 69764-9" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Immunization.education.reference", "path": "Immunization.education.reference", "short": "Educational material reference pointer", "definition": "Reference pointer to the educational material given to the patient if the information was on line.", "min": 0, "max": "1", "base": { "path": "Immunization.education.reference", "min": 0, "max": "1" }, "type": [ { "code": "uri" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "N/A" } ] }, { "id": "Immunization.education.publicationDate", "path": "Immunization.education.publicationDate", "short": "Educational material publication date", "definition": "Date the educational material was published.", "min": 0, "max": "1", "base": { "path": "Immunization.education.publicationDate", "min": 0, "max": "1" }, "type": [ { "code": "dateTime" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "v2", "map": "OBX-5 : OBX-3 = 29768-9" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Immunization.education.presentationDate", "path": "Immunization.education.presentationDate", "short": "Educational material presentation date", "definition": "Date the educational material was given to the patient.", "min": 0, "max": "1", "base": { "path": "Immunization.education.presentationDate", "min": 0, "max": "1" }, "type": [ { "code": "dateTime" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "v2", "map": "OBX-5 : OBX-3 = 29769-7" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Immunization.programEligibility", "path": "Immunization.programEligibility", "short": "Patient eligibility for a vaccination program", "definition": "Indicates a patient's eligibility for a funding program.", "min": 0, "max": "*", "base": { "path": "Immunization.programEligibility", "min": 0, "max": "*" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ProgramEligibility" } ], "strength": "example", "description": "The patient's eligibility for a vaccation program.", "valueSet": "http://hl7.org/fhir/ValueSet/immunization-program-eligibility" }, "mapping": [ { "identity": "v2", "map": "OBX-5 : OBX-3 = 64994-7" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "Immunization.fundingSource", "path": "Immunization.fundingSource", "short": "Funding source for the vaccine", "definition": "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 publically purchased vaccine but due to inventory issues, vaccine purchased with private funds was actually administered).", "min": 0, "max": "1", "base": { "path": "Immunization.fundingSource", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "FundingSource" } ], "strength": "example", "description": "The source of funding used to purchase the vaccine administered.", "valueSet": "http://hl7.org/fhir/ValueSet/immunization-funding-source" }, "mapping": [ { "identity": "rim", "map": "N/A" } ] }, { "id": "Immunization.reaction", "path": "Immunization.reaction", "short": "Details of a reaction that follows immunization", "definition": "Categorical data indicating that an adverse event is associated in time to an immunization.", "comment": "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.", "min": 0, "max": "*", "base": { "path": "Immunization.reaction", "min": 0, "max": "*" }, "type": [ { "code": "BackboneElement" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "v2", "map": "OBX-3" }, { "identity": "rim", "map": "Observation[classCode=obs].code" } ] }, { "id": "Immunization.reaction.id", "path": "Immunization.reaction.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "code": "http://hl7.org/fhirpath/System.String", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ] } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Immunization.reaction.extension", "path": "Immunization.reaction.extension", "short": "Additional content defined by implementations", "definition": "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 manageable, 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.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Immunization.reaction.modifierExtension", "path": "Immunization.reaction.modifierExtension", "short": "Extensions that cannot be ignored even if unrecognized", "definition": "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 manageable, 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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "comment": "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](extensibility.html#modifierExtension).", "alias": [ "extensions", "user content", "modifiers" ], "min": 0, "max": "*", "base": { "path": "BackboneElement.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary": true, "mapping": [ { "identity": "rim", "map": "N/A" } ] }, { "id": "Immunization.reaction.date", "path": "Immunization.reaction.date", "short": "When reaction started", "definition": "Date of reaction to the immunization.", "min": 0, "max": "1", "base": { "path": "Immunization.reaction.date", "min": 0, "max": "1" }, "type": [ { "code": "dateTime" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "v2", "map": "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)" }, { "identity": "rim", "map": ".effectiveTime" } ] }, { "id": "Immunization.reaction.detail", "path": "Immunization.reaction.detail", "short": "Additional information on reaction", "definition": "Details of the reaction.", "min": 0, "max": "1", "base": { "path": "Immunization.reaction.detail", "min": 0, "max": "1" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Observation" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "v2", "map": "OBX-5" }, { "identity": "rim", "map": ".value" } ] }, { "id": "Immunization.reaction.reported", "path": "Immunization.reaction.reported", "short": "Indicates self-reported reaction", "definition": "Self-reported indicator.", "min": 0, "max": "1", "base": { "path": "Immunization.reaction.reported", "min": 0, "max": "1" }, "type": [ { "code": "boolean" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "v2", "map": "(HL7 v2 doesn't seem to provide for this)" }, { "identity": "rim", "map": ".participation[typeCode=INF].role[classCode=PAT] (this syntax for self-reported=true)" } ] }, { "id": "Immunization.protocolApplied", "path": "Immunization.protocolApplied", "short": "Protocol followed by the provider", "definition": "The protocol (set of recommendations) being followed by the provider who administered the dose.", "min": 0, "max": "*", "base": { "path": "Immunization.protocolApplied", "min": 0, "max": "*" }, "type": [ { "code": "BackboneElement" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "N/A" } ] }, { "id": "Immunization.protocolApplied.id", "path": "Immunization.protocolApplied.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "code": "http://hl7.org/fhirpath/System.String", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ] } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Immunization.protocolApplied.extension", "path": "Immunization.protocolApplied.extension", "short": "Additional content defined by implementations", "definition": "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 manageable, 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.", "comment": "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.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "Immunization.protocolApplied.modifierExtension", "path": "Immunization.protocolApplied.modifierExtension", "short": "Extensions that cannot be ignored even if unrecognized", "definition": "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 manageable, 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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "comment": "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](extensibility.html#modifierExtension).", "alias": [ "extensions", "user content", "modifiers" ], "min": 0, "max": "*", "base": { "path": "BackboneElement.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary": true, "mapping": [ { "identity": "rim", "map": "N/A" } ] }, { "id": "Immunization.protocolApplied.series", "path": "Immunization.protocolApplied.series", "short": "Name of vaccine series", "definition": "One possible path to achieve presumed immunity against a disease - within the context of an authority.", "min": 0, "max": "1", "base": { "path": "Immunization.protocolApplied.series", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "N/A" } ] }, { "id": "Immunization.protocolApplied.authority", "path": "Immunization.protocolApplied.authority", "short": "Who is responsible for publishing the recommendations", "definition": "Indicates the authority who published the protocol (e.g. ACIP) that is being followed.", "min": 0, "max": "1", "base": { "path": "Immunization.protocolApplied.authority", "min": 0, "max": "1" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Organization" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "N/A" } ] }, { "id": "Immunization.protocolApplied.targetDisease", "path": "Immunization.protocolApplied.targetDisease", "short": "Vaccine preventatable disease being targetted", "definition": "The vaccine preventable disease the dose is being administered against.", "min": 0, "max": "*", "base": { "path": "Immunization.protocolApplied.targetDisease", "min": 0, "max": "*" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "TargetDisease" } ], "strength": "example", "description": "The vaccine preventable disease the dose is being administered for.", "valueSet": "http://hl7.org/fhir/ValueSet/immunization-target-disease" }, "mapping": [ { "identity": "rim", "map": "N/A" } ] }, { "id": "Immunization.protocolApplied.doseNumber[x]", "path": "Immunization.protocolApplied.doseNumber[x]", "short": "Dose number within series", "definition": "Nominal position in a series.", "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": 1, "max": "1", "base": { "path": "Immunization.protocolApplied.doseNumber[x]", "min": 1, "max": "1" }, "type": [ { "code": "positiveInt" }, { "code": "string" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "N/A" } ] }, { "id": "Immunization.protocolApplied.seriesDoses[x]", "path": "Immunization.protocolApplied.seriesDoses[x]", "short": "Recommended number of doses for immunity", "definition": "The recommended number of doses to achieve immunity.", "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", "base": { "path": "Immunization.protocolApplied.seriesDoses[x]", "min": 0, "max": "1" }, "type": [ { "code": "positiveInt" }, { "code": "string" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "N/A" } ] } ] }, "differential": { "element": [ { "id": "Immunization", "path": "Immunization", "short": "Nexus EMR Immunization Core", "definition": "Represents vaccination records and immunization history, capturing key details\nlike vaccine product, administration date, status, and site using standard\nNexus EMR references. Uses instance-specific identifiers for tracking\nimmunization records across systems.", "constraint": [ { "key": "nexus-note-extension-not-where-native", "severity": "error", "human": "The resource-note extension is not used on a resource that has a native `note` element -- that element is the home", "expression": "extension('https://fhir.apps.health/StructureDefinition/nexus-emr-resource-note').empty()", "source": "https://fhir.apps.health/StructureDefinition/nexus-emr-core-immunization" } ] }, { "id": "Immunization.meta.source", "path": "Immunization.meta.source", "short": "Identifies EMR instance & pipeline version the resource came from", "definition": "A URI that identifies the EMR pipeline and version from which this resource originated. This tells you which EMR instance (recommend using the instance identifier), and the version of the pipeline code/transformations.", "mustSupport": true }, { "id": "Immunization.text", "path": "Immunization.text", "short": "Narrative", "definition": "A human-readable narrative summary of the NexusEmrCoreImmunization resource for human interpretation.", "mustSupport": true }, { "id": "Immunization.extension", "path": "Immunization.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "ordered": false, "rules": "open" } }, { "id": "Immunization.extension:preventionInstructions", "path": "Immunization.extension", "sliceName": "preventionInstructions", "short": "Instructions given to the patient for this immunization", "min": 0, "max": "1", "type": [ { "code": "Extension", "profile": [ "https://fhir.apps.health/StructureDefinition/nexus-prevention-instructions" ] } ] }, { "id": "Immunization.identifier", "path": "Immunization.identifier", "short": "Business identifier(s) for immunization", "definition": "Unique identifiers for the immunization.\n\nA business identifier is recommended but not required (identifier is 0..*). Where available, carry the source-system identifier using the most appropriate system URI. No specific canonical system is mandated.", "comment": "A source system's own identifier SHOULD be carried alongside this one, flagged `use = secondary`. See [Carrying the raw code](https://fhir.apps.health/guide/patterns/raw-codes.html).", "mustSupport": true }, { "id": "Immunization.identifier.system", "path": "Immunization.identifier.system", "min": 1 }, { "id": "Immunization.identifier.value", "path": "Immunization.identifier.value", "min": 1 }, { "id": "Immunization.status", "path": "Immunization.status", "comment": "Will generally be 'completed' for administered vaccines.", "mustSupport": true, "binding": { "strength": "required", "valueSet": "http://hl7.org/fhir/ValueSet/immunization-status" } }, { "id": "Immunization.statusReason", "path": "Immunization.statusReason", "short": "Why the dose was not given (with status = not-done)", "definition": "Why this dose was not administered: patient objection, a contraindication, an out-of-stock product,\na deferral.\n\nRead with `status`. This element is meaningful only where `status` is `not-done`; a `completed`\nimmunization carrying a status reason is contradicting itself. Conversely, a `not-done` immunization\nSHOULD carry one -- a record that says only that a dose was not given tells a later reader nothing\nabout whether to offer it again.", "comment": "This is the element a patient refusal lands on for an Immunization, which is why `Immunization` carries no prevention-status extension: `status = not-done` plus a patient-objection status reason expresses refusal natively, where an Observation needs the extension to say the same thing. The binding is R4's own (`immunization-status-reason`, example strength) and is not narrowed here; carry the source system's own coding alongside where the value was mapped.", "mustSupport": true, "binding": { "strength": "example", "valueSet": "http://hl7.org/fhir/ValueSet/immunization-status-reason" } }, { "id": "Immunization.vaccineCode", "path": "Immunization.vaccineCode", "short": "Vaccine product with raw code support", "definition": "Vaccine product administered or to be administered.\n\nREQUIRED: text element for human readability\nRECOMMENDED: a Canadian vaccine vocabulary where a coded value is available -- the National\nVaccine Catalogue (NVC), whose generic-agent, tradename and antigen value sets are published over\nSNOMED CT CA, or SNOMED CT itself\nACCEPTED: CVX on a record imported from a US source, carried as received rather than rewritten\nOPTIONAL: Raw EMR codes for source system preservation\n\nCVX is the US CDC's vaccine vocabulary and is not used in Canada's immunization stack; Ontario,\nOntarioMD and PHAC all work from NVC or SNOMED CT. A record that already carries a CVX code is\nstill valid here -- this element is unbound, and rewriting a code received from a sending system\nwould lose what that system meant.\n\nThe text element ensures human readability even when coded values are not recognized.", "comment": "Where this code was mapped from a source system's own vocabulary, carry the raw coding alongside the mapped one, flagged `userSelected = true`. See [Carrying the raw code](https://fhir.apps.health/guide/patterns/raw-codes.html).", "mustSupport": true }, { "id": "Immunization.vaccineCode.text", "path": "Immunization.vaccineCode.text", "short": "The vaccine as written, in human-readable form", "definition": "Plain text representation of the vaccine product, required for all entries", "comment": "Required.", "min": 1, "mustSupport": true }, { "id": "Immunization.patient", "path": "Immunization.patient", "definition": "The patient who received or is to receive the immunization. Must reference using Nexus EMR patient identifier.", "comment": "References should use identifier-based references following Nexus EMR patterns.", "type": [ { "code": "Reference", "targetProfile": [ "https://fhir.apps.health/StructureDefinition/nexus-emr-core-patient" ] } ], "mustSupport": true }, { "id": "Immunization.encounter", "path": "Immunization.encounter", "short": "Encounter when immunization was given", "definition": "The encounter during which this immunization was administered. Optional but provides important clinical context.", "comment": "Linking to encounter helps establish the clinical context of the immunization.", "type": [ { "code": "Reference", "targetProfile": [ "https://fhir.apps.health/StructureDefinition/nexus-emr-core-encounter" ] } ], "mustSupport": true }, { "id": "Immunization.occurrence[x]", "path": "Immunization.occurrence[x]", "short": "When vaccine was administered", "definition": "The date/time when the vaccine was administered to the patient.", "comment": "This is the administration date, not when the immunization was recorded.", "type": [ { "code": "dateTime" } ], "mustSupport": true }, { "id": "Immunization.occurrence[x].extension", "path": "Immunization.occurrence[x].extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "ordered": false, "rules": "open" } }, { "id": "Immunization.occurrence[x].extension:dataAbsentReason", "path": "Immunization.occurrence[x].extension", "sliceName": "dataAbsentReason", "min": 0, "max": "1", "type": [ { "code": "Extension", "profile": [ "http://hl7.org/fhir/StructureDefinition/data-absent-reason|4.0.1" ] } ], "mustSupport": true }, { "id": "Immunization.lotNumber", "path": "Immunization.lotNumber", "mustSupport": true }, { "id": "Immunization.expirationDate", "path": "Immunization.expirationDate", "mustSupport": true }, { "id": "Immunization.site", "path": "Immunization.site", "short": "Body site with raw code support", "definition": "Body site where vaccine was administered.\n\nRECOMMENDED: SNOMED CT or other standard terminology when available\nOPTIONAL: Raw EMR codes for source system preservation", "comment": "Useful for tracking injection site reactions and following protocols.", "mustSupport": true }, { "id": "Immunization.route", "path": "Immunization.route", "short": "Administration route with raw code support", "definition": "The path by which the vaccine product is taken into the body.\n\nRECOMMENDED: SNOMED CT or other standard terminology when available\nOPTIONAL: Raw EMR codes for source system preservation", "comment": "The route affects absorption and effectiveness of the vaccine.", "mustSupport": true }, { "id": "Immunization.doseQuantity", "path": "Immunization.doseQuantity", "mustSupport": true }, { "id": "Immunization.performer", "path": "Immunization.performer", "short": "Who performed the immunization; repeat for an outside performer", "definition": "Who administered the vaccine.\n\nA performer this system holds a record for is referenced normally, with `actor.reference` and an\n`actor.display` carrying the readable name. A performer it does NOT hold a record for -- a clinician\nat an outside clinic whose administration is being recorded here -- is a **display-only** reference:\n`actor.display` carries the name as recorded and `actor.reference` is absent.\n\nThe element repeats, so a record may name both. A consumer distinguishes them by whether\n`actor.reference` is present, never by position.", "comment": "A display-only performer has no `actor.reference` to resolve and therefore does not conform to the referenced profiles below -- that is intended, and is the R4 shape for naming a party that has no resource. `function` is available to say in what capacity each performer acted and is not constrained here.", "mustSupport": true }, { "id": "Immunization.performer.actor", "path": "Immunization.performer.actor", "short": "Individual who administered the vaccine (display-only when outside this system)", "definition": "The practitioner or organization who performed the immunization. Display-only -- `display` set, `reference` absent -- where the performer has no record in this system.", "type": [ { "code": "Reference", "targetProfile": [ "https://fhir.apps.health/StructureDefinition/nexus-emr-core-practitionerrole", "https://fhir.apps.health/StructureDefinition/nexus-emr-core-practitioner" ] } ], "mustSupport": true }, { "id": "Immunization.note", "path": "Immunization.note", "short": "Clinical comments on the immunization -- one whole comment per repeat", "definition": "Free-text clinical comment about this immunization: what a person wanted to say about it that no\nother element carries.\n\n**One whole comment per repeat.** `note.text` is the comment in full, and a consumer renders it\nverbatim.\n\n**`note.text` is not a carrier for other fields.** A consumer MUST NOT parse it for prefixes,\nmarkers, keys or any other in-band convention, and a producer MUST NOT encode in it a value that\nbelongs to an element or an extension of its own. Anything with its own editing lifecycle gets its\nown address: the instructions given to the patient are the\n[prevention instructions](https://fhir.apps.health/fhir/StructureDefinition-nexus-prevention-instructions.html)\nextension, an outside administering provider is a display-only `performer`, and the reason a dose\nwas not given is `statusReason`.", "comment": "Attribution is OPTIONAL here, unlike on a task. `author[x]` and `time` keep their base R4 cardinality: a producer that has them SHOULD write them, a consumer displays them when present, and no consumer may require them -- comments reaching this element from a source system routinely carry neither. This is why the element is a plain `Annotation` rather than the [Task Note](https://fhir.apps.health/fhir/StructureDefinition-nexus-emr-task-note.html) profile, which requires both because a task's turns must each say who said it.", "mustSupport": true } ] } }