Immunization not given Patient refused

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Approval Status

  • Approval Status: Approved
  • Example Task Force: 10/29/2015
  • SDWG: 11/12/2015

  • SDWG C-CDA R2.1 Upgrade: 12/1/2016

C-CDA 2.1 Example:

  • 2.16.840.1.113883.

  • 2.16.840.1.113883.

  • Immunization Activity 2.16.840.1.113883.

  • 2.16.840.1.113883.

    Reference to full CDA sample:

  • Immunizations in empty CCD

Validation location


  • This is an example of how an author can record a patient refused an immunization.


  • Brett Marquard, (GitHub: brettmarquard)


  • substance, immunzation




Example: download example view on GitHub

        <!-- conforms to Immunizations section with entries optional -->
        <templateId root="2.16.840.1.113883."/>
        <templateId root="2.16.840.1.113883." extension="2015-08-01"/>
        <!-- Immunizations section with entries required -->
        <templateId root="2.16.840.1.113883."/>
        <templateId root="2.16.840.1.113883." extension="2015-08-01"/>
        <code code="11369-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"
            displayName="History of Immunizations"/>
        <text><paragraph ID="immun1">Patient objected to <content ID="ImmunizationProduct_1">influenza, intradermal, quadrivalent</content> on 11/15/2015</paragraph></text>
        <entry typeCode="COMP">
            <!-- negationInd=true indicates substance was NOT given at this date-->
            <substanceAdministration classCode="SBADM" moodCode="EVN"
                <!-- ** Immunization activity ** -->
                <templateId root="2.16.840.1.113883."/>
                <templateId root="2.16.840.1.113883." extension="2015-08-01"/>
                <id root="e6f1ba43-c0ed-4b9b-9f12-f435d8ad8f92"/>
                    <reference value="#immun1"/>
                <!-- Indicates the status of the substanceAdministartion -->
                <statusCode code="completed"/>
                <effectiveTime value="20151115"/>
                    <manufacturedProduct classCode="MANU">
                        <!-- ** Immunization medication information ** -->
                        <templateId root="2.16.840.1.113883."/>
                        <templateId root="2.16.840.1.113883." extension="2014-06-09"/>
                            <code code="166" codeSystem="2.16.840.1.113883.12.292"
                                displayName="influenza, intradermal, quadrivalent, preservative free, injectable"
                                    <reference value="#ImmunizationProduct_1"/>
                            <!-- DSTU comment relaxing lotNumber requirement -->
                            <!-- -->
                            <!-- <lotNumberText>1</lotNumberText> -->
                    	<!-- Optional manufacturerOrganization
                     				   <name>Health LS - Immuno Inc.</name>
                <entryRelationship typeCode="RSON">
                    <observation classCode="OBS" moodCode="EVN">
                        <!-- Immunization Refusal Reason  -->
                        <!-- Included the reason since it may be relevant to a future clinician or quality measurement -->
                        <templateId root="2.16.840.1.113883."/>
                        <id root="c1296315-9a6d-45a2-aac0-ee225d375409"/>
                        <code displayName="patient objection" code="PATOBJ"
                            codeSystemName="HL7 ActNoImmunizationReason" codeSystem="2.16.840.1.113883.5.8"/>
                        <statusCode code="completed"/>
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