# US Core Immunization Profile - US Core Implementation Guide v9.0.0

* [**Table of Contents**](toc.md)
* [**Artifacts Summary**](artifacts.md)
* **US Core Immunization Profile**

## Resource Profile: US Core Immunization Profile 

| | | |
| :--- | :--- | :--- |
| *Official URL*:http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization | *Version*:9.0.0 | |
| * Standards status: *[Trial-use](http://hl7.org/fhir/R4/versions.html#std-process) | [Maturity Level](changes-between-versions.md#us-core-maturity-levels): 5 | *Computable Name*:USCoreImmunizationProfile |
| *Other Identifiers:*OID:2.16.840.1.113883.4.642.40.2.42.31 | | |

 
The US Core Immunization Profile inherits from the FHIR [Immunization](https://hl7.org/fhir/R4/immunization.html) resource; refer to it for scope and usage definitions. This profile sets minimum expectations for the Immunization resource to record, search, and fetch immunization history associated with a patient. It specifies which core elements, extensions, vocabularies, and value sets **SHALL** be present and constrains how the elements are used. Providing the floor for standards development for specific use cases promotes interoperability and adoption. 

**Example Usage Scenarios:**

The following are example usage scenarios for the US Core Immunization profile:

* Query for immunizations belonging to a Patient
* [Record or update](us-core-roadmap.md#future-candidate-requirements-under-consideration) immunizations belonging to a Patient

### Mandatory and Must Support Data Elements

The following data elements must always be present ([Mandatory](must-support.md) definition) or must be supported if the data is present in the sending system ([Must Support](must-support.md) definition). They are presented below in a simple human-readable explanation. Profile specific guidance and examples are provided as well. The [Formal Views](#profile) below provides the formal summary, definitions, and terminology requirements.

**Each Immunization Must Have:**

1. a status
1. a vaccine code that identifies the kind of vaccine administered1
1. a patient
1. a date the vaccine was administered

**Each Immunization Must Support:**

1. a statusReason if the vaccine wasn't given
1. a flag to indicate whether the vaccine was reported by someone other than the person who administered the vaccine.
1. the encounter the immunization was part of
1. where the vaccine was administered
1. vaccine lot number2
1. a performer3

1,2,3 see guidance below

### Profile Specific Implementation Guidance

This section provides detailed implementation guidance for the US Core Profile to support implementation and certification.

* Servers **SHALL** use the status code: `not-done` to represent that an immunization was **not** given.[§](requirements.md#CONF-0390)
* 1Based upon the ONC U.S. Core Data for Interoperability (USCDI) requirements, [CVX vaccine codes](https://www2a.cdc.gov/vaccines/iis/iisstandards/vaccines.asp?rpt=cvx)1 are required, and the [NDC vaccine codes](http://www2a.cdc.gov/vaccines/iis/iisstandards/ndc_crosswalk.asp) **SHOULD** be supported as an additional code.[§](requirements.md#CONF-0392) 
* NDC codes are defined by the manufacturer, and CVX codes, which are much less granular, are often limited to a single product made by a single manufacturer.
* In most cases, there are separate NDCs for the Unit of Use (primary) and Unit of Sale (secondary) packaging of a vaccine, but only the Unit of Use NDC codes should be used since they represent the product that is administered.
* The code system identifiers are `http://hl7.org/fhir/sid/cvx` for CVX and `http://hl7.org/fhir/sid/ndc` for NDC vaccine codes. Note that the `vaccineCode` binding link in the formal definition and the CDC links below use the associated OID as the code system identifiers.
* Be aware that there is a **10-digit (with dashes)** NDC format displayed on drug packaging and an **11-digit (no dashes)** NDC format for billing and prescribing (for example, "49281-121-65" and "49281012165"). Normalization may be required to avoid validation errors and warnings.
* The CDC provides the [CDC National Drug Code (NDC) Directory – Vaccine NDC Linker Table](http://www2a.cdc.gov/vaccines/iis/iisstandards/ndc_crosswalk.asp) to assist implementers (note that both the Unit of Use and Unit of Sale NDC are mapped to CVX codes). The [Immunization Example 1](Immunization-imm-1.md) uses both CVX and the 11-digit NDC Unit of Use code based on this table.
 
* 2 There is no guarantee that vaccine lot numbers are globally unique, and they are not recommended for matching or de-duplication across systems unless used with other data elements such as a vaccine product code, manufacturer code, or date of administration. Implementers **MAY** communicate the `Immunization.manufacturer` to ensure global uniqueness to lot numbers.[§](requirements.md#CONF-0841)

* 3The profile element `Immunization.performer.actor` communicates the [individual level provenance](basic-provenance.md#individual-level-provenance) author data corresponding to the U.S. Core Data for Interoperability (USCDI) Provenance Author Data Elements.

**Usages:**

* Examples for this Profile: [Immunization/imm-1](Immunization-imm-1.md)
* CapabilityStatements using this Profile: [US Core Client CapabilityStatement](CapabilityStatement-us-core-client.md) and [US Core Server CapabilityStatement](CapabilityStatement-us-core-server.md)

You can also check for [usages in the FHIR IG Statistics](https://packages2.fhir.org/xig/resource/hl7.fhir.us.core|current/StructureDefinition/StructureDefinition-us-core-immunization.json)

**Changes since version 8.0.1:**

* The resource metadata has changed (copyright)

### Formal Views of Profile Content

 [Description of Profiles, Differentials, Snapshots and how the different presentations work](http://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#structure-definitions). 

 

Other representations of profile: [CSV](StructureDefinition-us-core-immunization.csv), [Excel](StructureDefinition-us-core-immunization.xlsx), [Schematron](StructureDefinition-us-core-immunization.sch) 

### Notes:

-------

**Quick Start**  

-------

Below is an overview of the required Server RESTful FHIR interactions for this profile - for example, search and read operations - when supporting the US Core interactions to access this profile's information (Profile Support + Interaction Support). Note that systems that support only US Core Profiles (Profile Only Support) are not required to support these interactions. See the [US Core Server CapabilityStatement](CapabilityStatement-us-core-server.md) for a complete list of supported RESTful interactions for this IG.

* See the [Scopes Format](scopes.md#scopes-format) section for a description of the SMART scopes syntax.
* See the [Search Syntax](general-guidance.md#search-syntax) section for a description of the US Core search syntax.
* See the [General Requirements](general-requirements.md) section for additional rules and expectations when a Server requires status parameters.
* See the [General Guidance](general-guidance.md) section for additional guidance on searching for multiple patients.

#### US Core Scopes

Servers providing access to immunization data **SHALL** support these [US Core SMART Scopes](scopes.md#smart-scopes):

* [resource level scopes](http://hl7.org/fhir/smart-app-launch/STU2.2/scopes-and-launch-context.html#scopes-for-requesting-clinical-data): `<patient|user|system>/Immunization.rs` [§](requirements.md#CONF-0142)

-------

#### Mandatory Search Parameters:

The following search parameters and search parameter combinations **SHALL** be supported:

1. **SHALL** support searching for all immunizations for a patient using the [patient](SearchParameter-us-core-immunization-patient.md) search parameter`GET [base]/Immunization?patient={Patient/}[id]`Example:
> 
1. GET [base]/Immunization?patient=Patient/1137192

**Implementation Notes**: Fetches a bundle of all US Core Immunization Profile resources for the specified patient ( see [how to search by reference](http://hl7.org/fhir/R4/search.html#reference)).

#### Optional Search Parameters:

The following search parameters and search parameter combinations **SHOULD** be supported

1. **SHOULD** support searching for all immunizations for a patient for a specified time period using the combination of the [patient](SearchParameter-us-core-immunization-patient.md) and [date](SearchParameter-us-core-immunization-date.md) search parameters
* Including optional support for **AND** search on `date` (e.g.`date=[date]&date=[date]&...`)
* Including support for these `date` comparators: "gt", "lt", "ge", "le"
`GET [base]/Immunization?patient={Patient/}[id]&date={gt|lt|ge|le}[dateTime]{&date={gt|lt|ge|le}[dateTime]&...}`Example:
> 
1. GET [base]/Immunization?patient=Patient/1137192&date=ge2019-01-14T00:00:00Z

**Implementation Notes**: Fetches a bundle of all US Core Immunization Profile resources for the specified patient and date ( see [how to search by reference](http://hl7.org/fhir/R4/search.html#reference) and [how to search by date](http://hl7.org/fhir/R4/search.html#date)).
1. **SHOULD** support searching for all administered immunizations for a patient using the combination of the [patient](SearchParameter-us-core-immunization-patient.md) and [status](SearchParameter-us-core-immunization-status.md) search parameters`GET [base]/Immunization?patient={Patient/}[id]&status={system|}[search_code]`Example:
> 
1. GET [base]/Immunization?patient=Patient/1137192&status=completed

**Implementation Notes**: Fetches a bundle of all US Core Immunization Profile resources for the specified patient and status ( see [how to search by reference](http://hl7.org/fhir/R4/search.html#reference) and [how to search by token](http://hl7.org/fhir/R4/search.html#token)).

-------

1 Although the CVX code system contains some concepts that are procedures, medications, or substances rather than immunizations, the value set defined in VSAC has removed those and retained only the vaccine codes (see the exclusion definition in VSAC for more detail)



## Resource Content

```json
{
  "resourceType" : "StructureDefinition",
  "id" : "us-core-immunization",
  "extension" : [{
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
    "valueInteger" : 5
  },
  {
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
    "valueCode" : "cgp"
  },
  {
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
    "valueCode" : "trial-use",
    "_valueCode" : {
      "extension" : [{
        "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
        "valueCanonical" : "http://hl7.org/fhir/us/core/ImplementationGuide/hl7.fhir.us.core"
      }]
    }
  }],
  "url" : "http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization",
  "identifier" : [{
    "system" : "urn:ietf:rfc:3986",
    "value" : "urn:oid:2.16.840.1.113883.4.642.40.2.42.31"
  }],
  "version" : "9.0.0",
  "name" : "USCoreImmunizationProfile",
  "title" : "US Core Immunization Profile",
  "status" : "active",
  "experimental" : false,
  "date" : "2023-10-17",
  "publisher" : "HL7 International / Cross-Group Projects",
  "contact" : [{
    "name" : "HL7 International / Cross-Group Projects",
    "telecom" : [{
      "system" : "url",
      "value" : "http://www.hl7.org/Special/committees/cgp"
    },
    {
      "system" : "email",
      "value" : "cgp@lists.HL7.org"
    }]
  }],
  "description" : "The US Core Immunization Profile inherits from the FHIR [Immunization](https://hl7.org/fhir/R4/immunization.html) resource; refer to it for scope and usage definitions. This profile sets minimum expectations for the Immunization resource to record, search, and fetch immunization history associated with a patient. It specifies which core elements, extensions, vocabularies, and value sets **SHALL** be present and constrains how the elements are used. Providing the floor for standards development for specific use cases promotes interoperability and adoption.",
  "jurisdiction" : [{
    "coding" : [{
      "system" : "urn:iso:std:iso:3166",
      "code" : "US"
    }]
  }],
  "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",
  "differential" : {
    "element" : [{
      "id" : "Immunization",
      "path" : "Immunization",
      "constraint" : [{
        "extension" : [{
          "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice",
          "valueBoolean" : true
        }],
        "key" : "us-core-5",
        "severity" : "warning",
        "human" : "SHOULD have an additional coding to the NDC value set",
        "expression" : "vaccineCode.coding.where(system='http://hl7.org/fhir/sid/cvx').exists() implies vaccineCode.coding.where(system='http://hl7.org/fhir/sid/ndc').exists()",
        "xpath" : "(exists(f:vaccineCode/f:coding/f:system[@value='http://hl7.org/fhir/sid/ndc']) and exists(f:vaccineCode/f:coding/f:system[@value='http://hl7.org/fhir/sid/cvx'])) or exists(f:vaccineCode/f:coding/f:system[@value='http://hl7.org/fhir/sid/cvx'])not()"
      }],
      "mustSupport" : false
    },
    {
      "id" : "Immunization.status",
      "path" : "Immunization.status",
      "mustSupport" : true,
      "binding" : {
        "strength" : "required",
        "valueSet" : "http://hl7.org/fhir/ValueSet/immunization-status"
      }
    },
    {
      "id" : "Immunization.statusReason",
      "path" : "Immunization.statusReason",
      "mustSupport" : true,
      "binding" : {
        "strength" : "example",
        "valueSet" : "http://hl7.org/fhir/ValueSet/immunization-status-reason"
      }
    },
    {
      "id" : "Immunization.vaccineCode",
      "path" : "Immunization.vaccineCode",
      "short" : "Vaccine Product Type (bind to CVX)",
      "condition" : ["us-core-5"],
      "mustSupport" : true,
      "binding" : {
        "strength" : "extensible",
        "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1010.6"
      }
    },
    {
      "id" : "Immunization.patient",
      "path" : "Immunization.patient",
      "alias" : ["Patient"],
      "type" : [{
        "code" : "Reference",
        "targetProfile" : ["http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient"]
      }],
      "mustSupport" : true
    },
    {
      "id" : "Immunization.encounter",
      "path" : "Immunization.encounter",
      "short" : "Encounter the immunization was part of",
      "type" : [{
        "code" : "Reference",
        "targetProfile" : ["http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter"]
      }],
      "mustSupport" : true
    },
    {
      "id" : "Immunization.occurrence[x]",
      "path" : "Immunization.occurrence[x]",
      "type" : [{
        "extension" : [{
          "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
          "valueBoolean" : true
        }],
        "code" : "dateTime"
      },
      {
        "code" : "string"
      }],
      "mustSupport" : true
    },
    {
      "id" : "Immunization.primarySource",
      "path" : "Immunization.primarySource",
      "definition" : "Indicates whether the data contained in the resource was captured by the individual/organization which was responsible for the administration of the vaccine rather than as 'secondary reported' data  documented by a third party. A value of 'true' means this data originated with the individual/organization which was responsible for the administration of the vaccine.",
      "comment" : "This updated definition is adopted from the FHIR R5 Immunization resource.",
      "mustSupport" : true
    },
    {
      "id" : "Immunization.location",
      "path" : "Immunization.location",
      "short" : "Where the vaccine was administered",
      "type" : [{
        "code" : "Reference",
        "targetProfile" : ["http://hl7.org/fhir/us/core/StructureDefinition/us-core-location"]
      }],
      "mustSupport" : true
    },
    {
      "id" : "Immunization.lotNumber",
      "path" : "Immunization.lotNumber",
      "mustSupport" : true
    },
    {
      "id" : "Immunization.performer",
      "path" : "Immunization.performer",
      "mustSupport" : true
    },
    {
      "id" : "Immunization.performer.actor",
      "path" : "Immunization.performer.actor",
      "type" : [{
        "code" : "Reference",
        "targetProfile" : ["http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner",
        "http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitionerrole",
        "http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization"],
        "_targetProfile" : [{
          "extension" : [{
            "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
            "valueBoolean" : true
          }]
        },
        {
          "extension" : [{
            "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
            "valueBoolean" : false
          }]
        },
        {
          "extension" : [{
            "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
            "valueBoolean" : false
          }]
        }]
      }],
      "mustSupport" : true
    }]
  }
}

```
