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draft Template  Immunization Activity (V3)

Id 2.16.840.1.113883.10.20.22.4.52
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ccda-
 		Effective Date 2015‑08‑01
Status draft Draft Version Label 2.1
Name ImmunizationActivityV3 Display Name Immunization Activity (V3)
Description
An Immunization Activity describes immunization substance administrations that have actually occurred or are intended to occur. Immunization Activities in "INT" mood are reflections of immunizations a clinician intends a patient to receive. Immunization Activities in "EVN" mood reflect immunizations actually received. An Immunization Activity is very similar to a Medication Activity with some key differentiators. The drug code system is constrained to CVX codes. Administration timing is less complex. Patient refusal reasons should be captured. All vaccines administered should be fully documented in the patient's permanent medical record. Healthcare providers who administer vaccines covered by the National Childhood Vaccine Injury Act are required to ensure that the permanent medical record of the recipient indicates: 1) Date of administration 2) Vaccine manufacturer 3) Vaccine lot number 4) Name and title of the person who administered the vaccine and the address of the clinic or facility where the permanent record will reside 5) Vaccine information statement (VIS) a. Date printed on the VIS b. Date VIS given to patient or parent/guardian. This information should be included in an Immunization Activity when available. (Reference: [URL:http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/D/vacc_admin.pdf])
Context Parent nodes of template element with id 2.16.840.1.113883.10.20.22.4.52
Classification CDA Entry Level Template
Open/Closed Open (other than defined elements are allowed)
Used by / Uses
Used by 0 transactions and 0 templates, Uses 11 templates
Uses as Name Version
2.16.840.1.113883.10.20.22.4.54 Containment draft Immunization Medication Information (V2) (2.1) 2014‑06‑09
2.16.840.1.113883.10.20.22.4.119 Containment draft Author Participation (2.1) 2015‑08‑13
2.16.840.1.113883.10.20.22.4.24 Containment draft Drug Vehicle (2.1) 2015‑08‑13
2.16.840.1.113883.10.20.22.4.19 Containment draft Indication (V2) (2.1) 2014‑06‑09
2.16.840.1.113883.10.20.22.4.20 Containment draft Instruction (V2) (2.1) 2014‑06‑09
2.16.840.1.113883.10.20.22.4.17 Containment draft Medication Supply Order (V2) (2.1) 2014‑06‑09
2.16.840.1.113883.10.20.22.4.18 Containment draft Medication Dispense (V2) (2.1) 2014‑06‑09
2.16.840.1.113883.10.20.22.4.9 Containment draft Reaction Observation (V2) (2.1) 2014‑06‑09
2.16.840.1.113883.10.20.22.4.53 Containment draft Immunization Refusal Reason (2.1) 2015‑08‑13
2.16.840.1.113883.10.20.22.4.118 Containment draft Substance Administered Act (2.1) 2015‑08‑13
2.16.840.1.113883.10.20.22.4.25 Containment draft Precondition for Substance Administration (V2) (2.1) 2014‑06‑09
Relationship Specialization: template 2.16.840.1.113883.10.12.308 CDA SubstanceAdministration (2005‑09‑07)
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ad1bbr-

Version: template 2.16.840.1.113883.10.20.22.4.52 Immunization Activity (2013‑01‑31)
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ccda-
Item DT Card Conf Description Label
cda:substanceAdministration
 		(ImmdotsyV3)
@classCode
 		cs 1 … 1 F SBADM CONFdots8826
  SHALL contain exactly one [1..1] @classCode="SBADM" (CodeSystem: HL7ActClass urn:oid:2.16.840.1.113883.5.6 STATIC) (CONF:1198-8826).
@moodCode
 		cs 1 … 1 R SHALL contain exactly one [1..1] @moodCode, which SHALL be selected from ValueSet MoodCodeEvnInt urn:oid:2.16.840.1.113883.11.20.9.18 STATIC (CONF:1198-8827). CONFdots8827
  CONF
The value of @moodCode shall be drawn from value set 2.16.840.1.113883.11.20.9.18 MoodCodeEvnInt (DYNAMIC)
@negationInd
 		bl 1 … 1 R SHALL contain exactly one [1..1] @negationInd (CONF:1198-8985). CONFdots8985
cda:templateId
 		II 1 … 1 M C-CDA R1.1 templateId root without an extension CONFdots2936
@root
 		uid 1 … 1 F 2.16.840.1.113883.10.20.22.4.52
cda:templateId
 		II 1 … 1 M SHALL contain exactly one [1..1] templateId (CONF:1198-8828) such that it CONFdots8828
@root
 		uid 1 … 1 F 2.16.840.1.113883.10.20.22.4.52 CONFdots0498
  SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.22.4.52" (CONF:1198-10498).
@extension
 		st 1 … 1 F 2015-08-01 CONFdots2528
  SHALL contain exactly one [1..1] @extension="2015-08-01" (CONF:1198-32528).
cda:id
 		II 1 … * SHALL contain at least one [1..*] id (CONF:1198-8829). CONFdots8829
cda:code
 		0 … 1 MAY contain zero or one [0..1] code (CONF:1198-8830). CONFdots8830
cda:statusCode
 		CS 1 … 1 SHALL contain exactly one [1..1] statusCode (CONF:1198-8833). CONFdots8833
@code
 		cs 1 … 1 R This statusCode  SHALL  contain exactly one [1..1]  @code , which  SHALL  be selected from ValueSet  ActStatus  urn:oid:2.16.840.1.113883.1.11.15933  DYNAMIC  (CONF:1198-32359).
CONFdots2359
  CONF
The value of @code shall be drawn from value set 2.16.840.1.113883.1.11.15933 ActStatus (DYNAMIC)
cda:effectiveTime
 		1 … 1 SHALL contain exactly one [1..1] effectiveTime (CONF:1198-8834). CONFdots8834
cda:repeatNumber
 		0 … 1 MAY contain zero or one [0..1] repeatNumber (CONF:1198-8838).

In "INT" (intent) mood, the repeatNumber defines the number of allowed administrations. For example, a repeatNumber of "3" means that the substance can be administered up to 3 times. In "EVN" (event) mood, the repeatNumber is the number of occurrences. For example, a repeatNumber of "3" in a substance administration event means that the current administration is the 3rd in a series.

CONFdots8838
cda:routeCode
 		CD 0 … 1 MAY contain zero or one [0..1] routeCode, which SHALL be selected from ValueSet SPL Drug Route of Administration Terminology urn:oid:2.16.840.1.113883.3.88.12.3221.8.7 DYNAMIC (CONF:1198-8839).

Value Set: SPL Drug Route of Administration Terminology urn:oid:2.16.840.1.113883.3.88.12.3221.8.7 (Clinical Focus: The set of route of administration concepts that may be used in structured product labeling.),(Data Element Scope: Ordered, administered, medication route),(Inclusion Criteria: Selected concepts that are descendent of C38114 as determined by the FDA. These concepts are linked to "SPL Drug Route of Administration Terminology (Code C54455)" by Concept_In_Subset.),(Exclusion Criteria: As determined by the FDA those routes not to be used in SPL (navigational concepts, etc.))

This value set was imported on 7/25/2018 with a version of 20180521.

Value Set Source: https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.88.12.3221.8.7/expansion 		CONFdots8839
  CONF
The value of @code shall be drawn from value set 2.16.840.1.113883.3.88.12.3221.8.7 Medication Route FDA (DYNAMIC)
hl7:translation
 		CD 0 … * If the routeCode is present,  SHOULD  contain zero or more [0..*]  translation , which  SHALL  be selected from ValueSet  Medication Route  urn:oid:2.16.840.1.113762.1.4.1099.12   DYNAMIC  (   CONF:1198-32960 ).
CONFdots2960
  CONF
The value of @code shall be drawn from value set 2.16.840.1.113762.1.4.1099.12 Medication Route (DYNAMIC)
cda:approachSiteCode
 		CD 0 … 1 MAY contain zero or one [0..1] approachSiteCode, where the code SHALL be selected from ValueSet Body Site urn:oid:2.16.840.1.113883.3.88.12.3221.8.9 DYNAMIC (CONF:1198-8840). CONFdots8840
  CONF
The value of @code shall be drawn from value set 2.16.840.1.113883.3.88.12.3221.8.9 Body Site (DYNAMIC)
cda:doseQuantity
 		0 … 1 R SHOULD contain zero or one [0..1] doseQuantity (CONF:1198-8841). CONFdots8841
@unit
 		cs 0 … 1   The doseQuantity, if present, SHOULD contain zero or one [0..1] @unit, which SHALL be selected from ValueSet UnitsOfMeasureCaseSensitive urn:oid:2.16.840.1.113883.1.11.12839 DYNAMIC (CONF:1198-8842). CONFdots8842
  CONF
The value of @unit shall be drawn from value set 2.16.840.1.113883.1.11.12839 UnitsOfMeasureCaseSensitive (DYNAMIC)
cda:administrationUnitCode
 		CE 0 … 1 MAY contain zero or one [0..1] administrationUnitCode, which SHALL be selected from ValueSet AdministrationUnitDoseForm urn:oid:2.16.840.1.113762.1.4.1021.30 DYNAMIC (CONF:1198-8846). CONFdots8846
  CONF
The value of @code shall be drawn from value set 2.16.840.1.113762.1.4.1021.30 Administration Unit Dose Form (DYNAMIC)
cda:consumable
 		1 … 1 Contains 2.16.840.1.113883.10.20.22.4.54 Immunization Medication Information (V2) (2014‑06‑09) CONFdots8847
cda:performer
 		0 … 1 R SHOULD contain zero or one [0..1] performer (CONF:1198-8849). CONFdots8849
cda:author
 		0 … * R SHOULD contain zero or more [0..*] Author Participation (identifier: urn:oid:2.16.840.1.113883.10.20.22.4.119) (CONF:1198-31151).
Contains 2.16.840.1.113883.10.20.22.4.119 Author Participation (2015‑08‑13) 		CONFdots1151
cda:participant
 		0 … * Contains 2.16.840.1.113883.10.20.22.4.24 Drug Vehicle (2015‑08‑13) CONFdots8850
@typeCode
 		cs 1 … 1 F CSM CONFdots8851
  SHALL contain exactly one [1..1] @typeCode="CSM" (CodeSystem: HL7ParticipationType urn:oid:2.16.840.1.113883.5.90 STATIC) (CONF:1198-8851).
cda:entryRelationship
 		0 … * Contains 2.16.840.1.113883.10.20.22.4.19 Indication (V2) (2014‑06‑09) CONFdots8853
@typeCode
 		cs 1 … 1 F RSON CONFdots8854
  SHALL contain exactly one [1..1] @typeCode="RSON" (CodeSystem: HL7ActRelationshipType urn:oid:2.16.840.1.113883.5.1002 STATIC) (CONF:1198-8854).
cda:entryRelationship
 		0 … 1 Contains 2.16.840.1.113883.10.20.22.4.20 Instruction (V2) (2014‑06‑09) CONFdots8856
@typeCode
 		cs 1 … 1 F SUBJ CONFdots8857
  SHALL contain exactly one [1..1] @typeCode="SUBJ" (CodeSystem: HL7ActRelationshipType urn:oid:2.16.840.1.113883.5.1002 STATIC) (CONF:1198-8857).
@inversionInd
 		bl 1 … 1 F true CONFdots8858
  SHALL contain exactly one [1..1] @inversionInd="true" True (CONF:1198-8858).
cda:entryRelationship
 		0 … 1 Contains 2.16.840.1.113883.10.20.22.4.17 Medication Supply Order (V2) (2014‑06‑09) CONFdots8860
@typeCode
 		cs 1 … 1 F REFR CONFdots8861
  SHALL contain exactly one [1..1] @typeCode="REFR" (CodeSystem: HL7ActRelationshipType urn:oid:2.16.840.1.113883.5.1002 STATIC) (CONF:1198-8861).
cda:entryRelationship
 		0 … 1 Contains 2.16.840.1.113883.10.20.22.4.18 Medication Dispense (V2) (2014‑06‑09) CONFdots8863
@typeCode
 		cs 1 … 1 F REFR CONFdots8864
  SHALL contain exactly one [1..1] @typeCode="REFR" (CodeSystem: HL7ActRelationshipType urn:oid:2.16.840.1.113883.5.1002 STATIC) (CONF:1198-8864).
cda:entryRelationship
 		0 … 1 Contains 2.16.840.1.113883.10.20.22.4.9 Reaction Observation (V2) (2014‑06‑09) CONFdots8866
@typeCode
 		cs 1 … 1 F CAUS CONFdots8867
  SHALL contain exactly one [1..1] @typeCode="CAUS" (CodeSystem: HL7ActRelationshipType urn:oid:2.16.840.1.113883.5.1002 STATIC) (CONF:1198-8867).
cda:entryRelationship
 		0 … 1 Contains 2.16.840.1.113883.10.20.22.4.53 Immunization Refusal Reason (2015‑08‑13) CONFdots8988
@typeCode
 		cs 1 … 1 F RSON CONFdots8989
  SHALL contain exactly one [1..1] @typeCode="RSON" (CodeSystem: HL7ActRelationshipType urn:oid:2.16.840.1.113883.5.1002 STATIC) (CONF:1198-8989).
cda:entryRelationship
 		0 … * R The following entryRelationship is used to indicate a given immunization's order in a series. The nested Substance Administered Act identifies an administration in the series. The entryRelationship/sequenceNumber shows the order of this particular administration in that series.
Contains 2.16.840.1.113883.10.20.22.4.118 Substance Administered Act (2015‑08‑13) 		CONFdots1510
@typeCode
 		cs 1 … 1 F COMP CONFdots1511
  SHALL contain exactly one [1..1] @typeCode="COMP" Component (CodeSystem: HL7ActRelationshipType urn:oid:2.16.840.1.113883.5.1002) (CONF:1198-31511).
@inversionInd
 		bl 1 … 1 F true CONFdots1512
  SHALL contain exactly one [1..1] @inversionInd="true" (CONF:1198-31512).
cda:sequenceNumber
 		0 … 1 MAY contain zero or one [0..1] sequenceNumber (CONF:1198-31513). CONFdots1513
cda:precondition
 		0 … * Contains 2.16.840.1.113883.10.20.22.4.25 Precondition for Substance Administration (V2) (2014‑06‑09) CONFdots8869
@typeCode
 		cs 1 … 1 F PRCN CONFdots8870
  SHALL contain exactly one [1..1] @typeCode="PRCN" (CodeSystem: HL7ActRelationshipType urn:oid:2.16.840.1.113883.5.1002 STATIC) (CONF:1198-8870).