Influenza Vaccination - Patient Reported

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Approval Status

  • Approval Status: Approved
  • Example Task Force: 7/28/2022
  • SDWG: 3/9/2023

C-CDA 2.1 Example:

  • 2.16.840.1.113883.10.20.22.2.2:2015-08-01
  • 2.16.840.1.113883.10.20.22.2.2.1:2015-08-01
  • Immunization Activity 2.16.840.1.113883.10.20.22.4.52:2015-08-01
  • 2.16.840.1.113883.10.20.22.4.54:2014-06-09

Reference to full CDA sample:

  • Immunizations in empty CCD

Validation location

Comments

  • This example illustrates how to structure Immunizations when it's reported by a patient

    Custodian

  • Brett Marquard, brett@riverrockassociates.com (GitHub: brettmarquard)

    Keywords

  • substance, immunzation

 

Example: download example view on GitHub 

<component>
    <section>
        <!-- Immunizations section with entries required -->
        <templateId root="2.16.840.1.113883.10.20.22.2.2.1"/>
        <templateId root="2.16.840.1.113883.10.20.22.2.2.1" extension="2015-08-01"/>
        <code code="11369-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"
            displayName="History of immunizations"/>
        <title>IMMUNIZATIONS</title>
        <text>
            <content ID="immunSect"/>
            <table border="1" width="100%">
                <thead>
                    <tr>
                        <th>Vaccine</th>
                        <th>Lot Number</th>
                        <th>Date</th>
                        <th>Status</th>
                        <th>Source</th>
                    </tr>
                </thead>
                <tbody>
                    <tr ID="immun1">
                        <td ID="ImmunizationProduct_100">Influenza Virus Vaccine</td>
                        <td>1</td>
                        <td>8/15/2010</td>
                        <td>Completed</td>
                        <td>Patient Reported</td>
                    </tr>
                </tbody>
            </table>
        </text>
        <entry typeCode="DRIV">
            <substanceAdministration classCode="SBADM" moodCode="EVN" negationInd="false">
                <!-- ** Immunization activity ** -->
                <templateId root="2.16.840.1.113883.10.20.22.4.52"/>
                <templateId root="2.16.840.1.113883.10.20.22.4.52" extension="2015-08-01"/>
                <id root="3b3e2533-46aa-4e3f-b675-12ac6749cdcd"/>
                <text>
                    <reference value="#immun1"/>
                </text>
                <!-- Indicates the status of the substanceAdministartion -->
                <statusCode code="completed"/>
                <effectiveTime value="20100815"/>
                <consumable>
                    <manufacturedProduct classCode="MANU">
                        <!-- ** Immunization medication information ** -->
                        <templateId root="2.16.840.1.113883.10.20.22.4.54"/>
                        <templateId root="2.16.840.1.113883.10.20.22.4.54" extension="2014-06-09"/>
                        <manufacturedMaterial>
                            <code code="88" codeSystem="2.16.840.1.113883.12.292"
                                displayName="influenza virus vaccine, unspecified formulation" codeSystemName="CVX">
                                <originalText>
                                    <reference value="#ImmunizationProduct_100"/>
                                </originalText>
                            </code>                                           
                            <lotNumberText>1</lotNumberText>
                        </manufacturedMaterial>
                    <!-- Optional manufacturerOrganization
                    <manufacturerOrganization>
                        <name>Health LS - Immuno Inc.</name>
                    </manufacturerOrganization>-->
                    </manufacturedProduct>  
                </consumable>
              <!-- Optional Author -->
                <author>
                    <templateId root="2.16.840.1.113883.10.20.22.4.119"/>
                    <!-- Provenance - Author Participation -->
                    <templateId root="2.16.840.1.113883.10.20.22.5.6" extension="2019-10-01"/>
                    <time value="20100815"/>
                    <assignedAuthor>
                        <!-- NPI of Author (example) -->
                        <id root="2.16.840.1.113883.4.6" extension="9911223334"/>
                        <code code="207Q00000X" codeSystem="2.16.840.1.113883.6.101" codeSystemName="Health Care Provider Taxonomy" displayName="Allopathic &amp; Osteopathic Physicians; Family Medicine" />
                        <telecom use="WP" value="tel:555-555-1002"/>
                        <assignedPerson>
                            <name>
                                <given>Henry</given>
                                <family>Seven</family>
                            </name>
                        </assignedPerson>
                        <representedOrganization>
                            <id root="2.16.840.1.113883.19.5.9999.1394"/>
                            <name>Good Health Clinic</name>
                            <telecom nullFlavor="UNK"/>
                            <addr nullFlavor="UNK"/>
                        </representedOrganization>
                    </assignedAuthor>
                </author>
                <informant>
                    <assignedEntity>
                        <!-- This is a fictional OID and identifier for the patient. This should be adapted to local implementation -->
                        <id root="2.16.840.1.113883.3.3208.101.2" extension="20130607100800-Patient2"/>
                        <addr use="HP">
                            <streetAddressLine>1111 StreetName St.</streetAddressLine>
                            <city>Silver Spring</city>
                            <state>MD</state>
                            <postalCode>20901</postalCode>
                            <country>US</country>
                        </addr>
                        <telecom value="tel:+1(301)111-1111" use="HP"/>
                        <assignedPerson>
                            <name>
                                <given>Patient</given>
                                <family>One</family>
                            </name>
                        </assignedPerson>
                    </assignedEntity>
                </informant>
            </substanceAdministration>
        </entry>
    </section>
</component>

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