Template ID |
1.3.6.1.4.1.19376.1.5.3.1.1.18.1.2 |
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Reference(s) |
IHE PCC Technical Framework Vol. 2 : 6.3.1.10 |
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Base Template (IS-A) |
Medical Summary |
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Document Code |
LOINC: 11369-6 (HISTORY OF IMMUNIZATIONS) |
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XDS Format Code |
IHE Format Code: urn:ihe:pcc:xds-ms:2007 |
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XDS Type Code |
LOINC: 11369-6 |
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Description |
The immunization content document type is used to record the history of immunizations related to a patient. The immunization content document is a "living document" meaning it may change over the lifetime of the patient's care. |
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Expected Sections |
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Section |
Template ID |
Reference |
Vital Signs |
1.3.6.1.4.1.19376.1.5.3.1.3.25 or 1.3.6.1.4.1.19376.1.5.3.1.1.5.3.2 |
3.3.2.17 |
Pregnancy History |
1.3.6.1.4.1.19376.1.5.3.1.1.5.3.4 |
3.3.2.14 |
Allergies and Other Adverse Reactions |
1.3.6.1.4.1.19376.1.5.3.1.3.13 |
3.3.2.3 |
Medications |
1.3.6.1.4.1.19376.1.5.3.1.3.19 |
3.3.2.12 |
Immunizations |
1.3.6.1.4.1.19376.1.5.3.1.3.23 |
3.3.2.11 |
Results |
1.3.6.1.4.1.19376.1.5.3.1.3.27 or 1.3.6.1.4.1.19376.1.5.3.1.3.28 |
3.3.2.7 |
Advance Directives |
1.3.6.1.4.1.19376.1.5.3.1.3.34 or 1.3.6.1.4.1.19376.1.5.3.1.3.35 |
3.3.2.2 |
Problems |
1.3.6.1.4.1.19376.1.5.3.1.3.6 |
3.3.2.1 |
History of Past Illness |
1.3.6.1.4.1.19376.1.5.3.1.3.8 |
3.3.2.10 |
OpenSHR Implementation Notes |
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Additional Constraints |
- OpenSHR does not support the "Immunization Recommendations" section at level 3 conformance, IC content containing this section will be imported at level 2.
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Notes |
- This document type is currently only supported for import.
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Specification |
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<ClinicalDocument xmlns="urn:hl7-org:v3" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" classCode="DOCCLIN" moodCode="EVN">
<realmCode code="UV"/>
<typeId root="2.16.840.1.113883.1.3" extension="POCD_HD000040"/>
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.1.18.1.2"/>
<id root="1.2.3.4.5.6.9.100.2" extension="2-20141027135823"/>
<code code="11369-6" codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC" displayName="HISTORY OF IMMUNIZATIONS"/>
<title language="en-US">HISTORY OF PATIENT IMMUNIZATIONS</title>
<effectiveTime value=""/>
<confidentialityCode code="" codeSystem="2.16.840.1.113883.5.25" codeSystemName="x_BasicConfidentialityKind"/>
<languageCode code=""/>
<!-- 1..1 Authors -->
<recordTarget typeCode="RCT" contextControlCode="OP">
<patientRole classCode="PAT">
...
</patientRole>
</recordTarget>
<!-- 1..n Authors -->
<author typeCode="AUT" contextControlCode="OP">
<time value=""/>
<assignedAuthor classCode="ASSIGNED">
...
</assignedAuthor>
</author>
<!-- 1..1 Custodial Organization -->
<custodian typeCode="CST">
<assignedCustodian classCode="ASSIGNED">
<representedCustodianOrganization classCode="ORG" determinerCode="INSTANCE">
...
</representedCustodianOrganization>
</assignedCustodian>
</custodian>
<!-- 0..n Participants -->
<participant typeCode="IND">
<time value=""/>
<associatedEntity classCode="PRS">
...
</associatedEntity>
</participant>
<!-- 1..n Documentation Of -->
<documentationOf typeCode="DOC">
<serviceEvent classCode="PCPR" moodCode="EVN">
<effectiveTime>
<low value=""/>
<high value=""/>
</effectiveTime>
</serviceEvent>
</documentationOf>
<!-- 1..1 Component -->
<component typeCode="COMP" contextConductionInd="true">
<!-- Must be structured body -->
<structuredBody classCode="DOCBODY" moodCode="EVN">
<!-- 1..n Components -->
<component typeCode="COMP" contextConductionInd="true">
<!-- 1..1 Section -->
<section classCode="DOCSECT" moodCode="EVN">
...
</section>
</component>
</structuredBody>
</component>
</ClinicalDocument> |
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Example |
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The following example illustrates an IC document indicating that a patient has received BCG and OPV vaccines.
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<?xml version="1.0" encoding="utf-8"?>
<ClinicalDocument xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" classCode="DOCCLIN" moodCode="EVN" xmlns="urn:hl7-org:v3">
<realmCode code="UV" />
<typeId root="2.16.840.1.113883.1.3" extension="POCD_HD000040" />
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.1.18.1.2" />
<id root="5858AEDB-05AD-4BDD-9018-6AD317F87955" />
<code code="11369-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="HISTORY OF IMMUNIZATIONS" />
<title language="en-US">Immunization History</title>
<effectiveTime value="20150105090657.170-0500" />
<confidentialityCode code="N" codeSystem="2.16.840.1.113883.5.25" displayName="normal" />
<languageCode code="en-US" />
<recordTarget typeCode="RCT" contextControlCode="OP">
<patientRole classCode="PAT">
<id root="8.48.3.2.3.4.5.6.7.5.4" extension="635560492116819361" />
<id root="9.1.2.3.4.5.0" extension="2022" />
<addr use="H">
<country>CA</country>
</addr>
<patient classCode="PSN" determinerCode="INSTANCE">
<name use="L">
<family>Morris</family>
<given>Lyssa</given>
</name>
<administrativeGenderCode code="F" />
<birthTime value="20150105" />
</patient>
</patientRole>
</recordTarget>
<author typeCode="AUT" contextControlCode="AP">
<time value="20150105090657.170-0500" />
<assignedAuthor classCode="ASSIGNED">
<id root="8.48.3.2.3.4.5.6.7.5.4.6" extension="24" />
<addr use="PHYS">
<streetAddressLine>4500 King St. E</streetAddressLine>
<city>Lincoln</city>
<state>ON</state>
<country>CA</country>
<postalCode>L0R 1B4</postalCode>
</addr>
<assignedPerson classCode="PSN" determinerCode="INSTANCE">
<name use="L">
<family>General</family>
<given>Gerald</given>
</name>
</assignedPerson>
<representedOrganization classCode="ORG" determinerCode="INSTANCE">
<id root="8.48.3.2.3.4.5.6.7.5.4.9" extension="1305" />
<name>General Medical Associates</name>
</representedOrganization>
</assignedAuthor>
</author>
<custodian typeCode="CST">
<assignedCustodian classCode="ASSIGNED">
<representedCustodianOrganization classCode="ORG" determinerCode="INSTANCE">
<id root="8.48.3.2.3.4.5.6.7.5.4.9" extension="1305" />
<name>General Medical Associates</name>
<addr use="PHYS">
<streetAddressLine>4500 King St. E</streetAddressLine>
<city>Lincoln</city>
<state>ON</state>
<country>CA</country>
<postalCode>L0R 1B4</postalCode>
</addr>
</representedCustodianOrganization>
</assignedCustodian>
</custodian>
<participant typeCode="IND" contextControlCode="ON">
<time value="2015" />
<associatedEntity classCode="NOK">
<id root="8.48.3.2.3.4.5.6.7.5.4" extension="635560492116818824" />
<id root="9.2.5.6.5.2.1.2.3.5" extension="391f094b-c6f3-4eec-b9ed-24d7c3cfde84" />
<id root="9.1.2.3.4.5.0" extension="2020" />
<code code="MTH" codeSystem="2.16.840.1.113883.5.111" displayName="Mother" />
<addr use="H">
<streetAddressLine>West 5th</streetAddressLine>
<city>Grimsby</city>
<state>ON</state>
<country>CA</country>
</addr>
<telecom nullFlavor="NI" />
<associatedPerson classCode="PSN" determinerCode="INSTANCE">
<name use="L">
<family>Morris</family>
<given>Madeline</given>
</name>
</associatedPerson>
</associatedEntity>
</participant>
<participant typeCode="IND" contextControlCode="ON">
<time value="2015" />
<associatedEntity classCode="NOK">
<id root="8.48.3.2.3.4.5.6.7.5.4" extension="635560492116818824" />
<id root="9.2.5.6.5.2.1.2.3.5" extension="391f094b-c6f3-4eec-b9ed-24d7c3cfde84" />
<id root="9.1.2.3.4.5.0" extension="2020" />
<code code="FTH" codeSystem="2.16.840.1.113883.5.111" displayName="Father" />
<addr use="H">
<streetAddressLine>West 5th</streetAddressLine>
<city>Grimsby</city>
<state>ON</state>
<country>CA</country>
</addr>
<telecom nullFlavor="NI" />
<associatedPerson classCode="PSN" determinerCode="INSTANCE">
<name use="L">
<family>Morris</family>
<given>Benjamin</given>
</name>
</associatedPerson>
</associatedEntity>
</participant>
<component typeCode="COMP" contextConductionInd="true">
<structuredBody classCode="DOCBODY" moodCode="EVN">
<component typeCode="COMP" contextConductionInd="true">
<section classCode="DOCSECT" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.1.6" />
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.3.23" />
<id root="07E142AC-974C-42B9-A3A3-C7F11303196A" />
<code code="11369-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="HISTORY OF IMMUNIZATIONS" />
<title language="en-US">Immunizations</title>
<text language="en-US">
<list>
<item ID="id4db85">2015-Jan-05 - Oral Polio Vaccine via Swallow, Oral</item>
<item ID="idffda6">2015-Jan-05 - BCG via injection, subcutaneous</item>
</list>
</text>
<entry typeCode="COMP" contextConductionInd="true">
<substanceAdministration classCode="SBADM" moodCode="EVN">
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.12" />
<templateId root="2.16.840.1.113883.10.20.1.24" />
<id root="FB5E112D-CC17-43EB-B43F-B90850B34B28" />
<code code="IMMUNIZ" codeSystem="2.16.840.1.113883.5.4" codeSystemName="ActCode" displayName="Immunization" />
<text mediaType="text/plain">
<reference value="#id4db85" />
</text>
<statusCode code="completed" />
<effectiveTime xsi:type="IVL_TS" value="20150105090657.154-0500" />
<routeCode code="PO" codeSystem="2.16.840.1.113883.5.112" codeSystemName="Route Of Administration" displayName="Swallow, Oral" />
<doseQuantity value="1" />
<consumable typeCode="CSM">
<manufacturedProduct classCode="MANU">
<manufacturedMaterial classCode="MMAT" determinerCode="KIND">
<code code="02" codeSystem="2.16.840.1.113883.6.59" codeSystemName="HL7CVX" displayName="Oral Polio Vaccine" />
<name>Oral Polio Vaccine</name>
</manufacturedMaterial>
</manufacturedProduct>
</consumable>
</substanceAdministration>
</entry>
<entry typeCode="COMP" contextConductionInd="true">
<substanceAdministration classCode="SBADM" moodCode="EVN">
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.12" />
<templateId root="2.16.840.1.113883.10.20.1.24" />
<id root="37EA3A9A-48E2-4293-866E-18D1CD96FC13" />
<code code="IMMUNIZ" codeSystem="2.16.840.1.113883.5.4" codeSystemName="ActCode" displayName="Immunization" />
<text mediaType="text/plain">
<reference value="#idffda6" />
</text>
<statusCode code="completed" />
<effectiveTime xsi:type="IVL_TS" value="20150105090657.170-0500" />
<routeCode code="SQ" codeSystem="2.16.840.1.113883.5.112" codeSystemName="Route Of Administration" displayName="injection, subcutaneous" />
<doseQuantity value="1" />
<consumable typeCode="CSM">
<manufacturedProduct classCode="MANU">
<manufacturedMaterial classCode="MMAT" determinerCode="KIND">
<code code="19" codeSystem="2.16.840.1.113883.6.59" codeSystemName="HL7CVX" displayName="BCG" />
<name>BCG</name>
</manufacturedMaterial>
</manufacturedProduct>
</consumable>
</substanceAdministration>
</entry>
</section>
</component>
</structuredBody>
</component>
</ClinicalDocument>
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