HL7 Version 2.5.1 Implementation Guide: Immunization Messaging

HL7 Version 2.5.1 Implementation Guide: Immunization Messaging (Release 1.5) 3/1/2014 Page 1

HL7 Version 2.5.1

Implementation Guide

for Immunization Messaging

Release 1.5

10/1/2014

age Intentionally Blank

HL7 Version 2.5.1 Implementation Guide: Immunization Messaging (Release 1.5) 10/1/2014 Page 2

Publication History of Previous Versions:

mplementation Guide for Immunization Data Transactions using Version 2.3.1 of the Health Level Seven

(HL7) Standard Protocol

Version Date

Version 2.0 June 1999

Version 2.1 September 2003

Version 2.2 June 2006

Publication History of HL7 Version 2.5.1 Implementation Guide for

Immunization Messaging.

evision history

Revision Date Author

Release 1.0 5/1/2010 Rob Savage

Release 1.1 8/15/2010 Rob Savage

Release 1.2 2/15/2011 Rob Savage

Release 1.3 8/15/2011 Rob Savage

Release 1.4 8/1/2012 Rob Savage

Release 1.5 for comment 3/11/2014 Rob Savage

Release 1.5 10/1/2014 Rob Savage

list of changes may be found at the end of Implementation Guide.

or information about HL7, contact:

Health Level Seven

3300 Washtenaw Avenue, Suite 227

Ann Arbor, MI 48104-4250

Phone: (734) 677-7777

Fax: (734) 677-6622

E-Ma

il: [email protected]g

Website: http://www.hl7.org

For

information about the American

Immunization Registry Association, visit

http://www.immregistries.org

For information about this Guide, contact:

Rob S

avage

rbs[email protected]

rren Williams

wxw4@cdc.gov

Imm

unization Information Systems Support

Branch, Immunization Services Division,

National Center for Immunization and

Respiratory Diseases,

Centers for Disease Control and Prevention

Phone: (404) 639-8245

Fax: (404) 639-8171

Website:

http://www.cdc.gov/vaccines/programs/iis/index.html

HL7 Version 2.5.1 Implementation Guide: Immunization Messaging (Release 1.5) 10/1/2014 Page 3

Table of Contents

TABLE OF CONTENTS

TABLE OF CONTENTS .................................................................................................................. 1

INDEX OF TABLES ......................................................................................................................... 8

TABLE OF FIGURES ...................................................................................................................... 1

1. INTRODUCTION ......................................................................................................................... 2

Intended Audience ...................................................................................................................................... 3

Scope .......................................................................................................................................................... 3

Organization and Flow ............................................................................................................................... 4

2. ACTORS, GOALS, AND MESSAGING TRANSACTIONS ........................................................ 7

Actors and Goals ........................................................................................................................................ 7

High-Level View of Use Cases..................................................................................................................10

Use Case Descriptions ............................................................................................................................... 11

Use Case 1—Send Immunization History ............................................................................................. 11

Use Case 2—Request Complete Immunization History ........................................................................12

Use Case 3—Request Evaluated History and Forecast .........................................................................12

Use Case 4—Send Demographic Data ..................................................................................................13

Use Case 5--Acknowledge Receipt .......................................................................................................13

Use Case 6—Report Error .....................................................................................................................13

Messaging in the Context of the Business Process ....................................................................................13

Core Data Elements of an Immunization History ......................................................................................15

Key Technical Decisions ...........................................................................................................................16

Pre-Adoption Of Some Features Of HL7 Version 2.7.1 ........................................................................16

Use of Vocabulary Standards .................................................................................................................16

Processing Mode ...................................................................................................................................17

Message Profiles ....................................................................................................................................17

Conventions ...........................................................................................................................................17

3. HL7 MESSAGING INFRASTRUCTURE .................................................................................. 18

Keywords ..................................................................................................................................................18

HL7 definitions ..........................................................................................................................................18

Basic Message Processing Rules ...............................................................................................................20

Message Acknowledgement ..................................................................................................................20

Encoding Rules for Sending ..................................................................................................................20

Determining Usage of Segments, Fields and Components ....................................................................22

Usage Conformance Testing Recommendations .......................................................................................22

Usage .....................................................................................................................................................23

Definition Of Conditional Usage ...........................................................................................................23

Sending And Receiving Application Conformance Requirements ........................................................23

Message Element Attributes ......................................................................................................................26

4. HL7 DATA TYPES ..................................................................................................................... 29

Data Types Used In This Implementation Guide .......................................................................................29

CE -- Coded Element (most uses) .........................................................................................................31

CE_TX -- Coded Element (text only in RXA-9) ...................................................................................32

CQ -- Composite Quantity with Units ...................................................................................................33

CWE -- Coded With Exceptions ............................................................................................................34

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CX -- Extended Composite ID With Check Digit .................................................................................36

DT -- Date .............................................................................................................................................38

DT_D -- Date with precision to day ......................................................................................................38

DTM -- Date/Time.................................................................................................................................39

EI -- Entity Identifier .............................................................................................................................40

ERL -- Error Location ...........................................................................................................................41

FN -- Family Name ...............................................................................................................................43

FT – Formatted Text ..............................................................................................................................43

HD -- Hierarchic Designator .................................................................................................................44

ID -- Coded Values for HL7 Tables .......................................................................................................45

IS -- Coded Values for User Defined Tables ..........................................................................................45

LA2 -- Location with Address Variation 2.............................................................................................46

MSG -- Message Type ...........................................................................................................................47

NM -- Numeric ......................................................................................................................................48

PT -- Processing Type ............................................................................................................................49

SAD -- Street Address ...........................................................................................................................49

SI -- Sequence Id ...................................................................................................................................50

ST – String .............................................................................................................................................50

TS -- Time Stamp ..................................................................................................................................51

TS_M -- Time Stamp to Month .............................................................................................................51

TS_NZ -- Time Stamp No Time Zone ...................................................................................................52

TS_Z -- Time Stamp with Time Zone ...................................................................................................53

VID -- Version Id ...................................................................................................................................54

XAD -- Extended Address .....................................................................................................................55

XCN - Extended Composite ID Number and Name for Persons ...........................................................57

XON - Extended Composite Name and ID Number and Name for Organizations ...............................60

XPN -- Extended Person Name .............................................................................................................61

XPN_M -- Extended Person Name – Maiden Name .............................................................................63

XTN - Extended Telecommunication Number ......................................................................................65

5. PROFILE Z22-SEND UNSOLICITED IMMUNIZATION UPDATE USING A VXU .................... 68

Introduction: ..............................................................................................................................................68

Interaction Definition: ...............................................................................................................................68

Dynamic Definition: ..................................................................................................................................69

Static Definition—Message Level: ...........................................................................................................71

Static Definition—Segment Level .............................................................................................................73

IN1—Insurance Segment ......................................................................................................................73

MSH—Message Header Segment .........................................................................................................78

NK1—Next of Kin Segment .................................................................................................................84

NTE—Note Segment.............................................................................................................................88

OBX—Observation Result Segment .....................................................................................................89

ORC—Order Request Segment .............................................................................................................98

PD1—Patient Demographic Segment .................................................................................................103

PID—Patient Identifier Segment .........................................................................................................107

PV1—Patient Visit Segment ............................................................................................................... 114

RXA-- Pharmacy/Treatment Administration Segment ........................................................................ 114

RXR-- Pharmacy/Treatment Route Segment.......................................................................................122

6. PROFILE Z23 RETURN AN ACKNOWLEDGEMENT ........................................................... 124

Introduction: ............................................................................................................................................124

Interaction Definition: .............................................................................................................................124

Dynamic Definition: ................................................................................................................................125

Static Definition- Message Level ............................................................................................................127

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Static Definition—Segment Level: .........................................................................................................128

ERR—Error Segment ..........................................................................................................................128

MSA—Message Acknowledgement Segment .....................................................................................131

MSH—Message Header Segment .......................................................................................................131

7. PROFILE Z34 - REQUEST A COMPLETE IMMUNIZATION HISTORY ................................ 135

Introduction: ............................................................................................................................................135

Interaction Definition: .............................................................................................................................137

Dynamic Definition: ................................................................................................................................138

Static Definition - Message Level: ..........................................................................................................141

Static Definition – Segment Level: .........................................................................................................142

MSH - Message Header Specification .................................................................................................142

QPD Input Parameter Specification ....................................................................................................145

RCP – Response Control Parameter Segment .....................................................................................150

8. PROFILE Z32 RESPONSE PROFILE – RETURN COMPLETE IMMUNIZATION HISTORY 153

Introduction: ............................................................................................................................................153

Interaction Definition ..............................................................................................................................153

Dynamic Definition .................................................................................................................................153

Static Definition – Message Level ...........................................................................................................154

Static Definition -- Segment Level ..........................................................................................................156

ERR—Error Segment ..........................................................................................................................156

IN1—Insurance Segment ....................................................................................................................158

MSA—Message Acknowledgement Segment .....................................................................................163

MSH - Message Header Specification .................................................................................................164

NK1—Next of Kin Segment ...............................................................................................................167

NTE—Note Segment...........................................................................................................................171

OBX—Observation Result Segment ...................................................................................................172

ORC—Order Request Segment ...........................................................................................................177

PD1—Patient Demographic Segment .................................................................................................181

PID—Patient Identifier Segment .........................................................................................................184

PV1—Patient Visit Segment ...............................................................................................................189

QAK—Query Acknowledgement Segment .........................................................................................189

QPD Input Parameter Specification ....................................................................................................190

RXA-- Pharmacy/Treatment Administration Segment ........................................................................191

RXR-- Pharmacy/Treatment Route Segment.......................................................................................195

9. PROFILE Z31 -- RETURN A LIST OF CANDIDATES PROFILE ........................................... 197

Introduction: ............................................................................................................................................197

Interaction Definition ..............................................................................................................................197

Dynamic Definition .................................................................................................................................197

Static Definition – Message Level ...........................................................................................................197

Segment Level Profile .............................................................................................................................199

ERR—Error Segment ..........................................................................................................................199

MSA—Message Acknowledgement Segment .....................................................................................201

MSH - Message Header Specification .................................................................................................202

NK1—Next of Kin Segment ...............................................................................................................205

QPD Input Parameter Specification ....................................................................................................209

PID – Patient Identification Segment .................................................................................................. 211

10. PROFILE Z33 --RETURN AN ACKNOWLEDGEMENT WITH NO PERSON RECORDS ... 215

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Introduction: ............................................................................................................................................215

Interaction Definition ..............................................................................................................................215

Dynamic Definition .................................................................................................................................216

Static Definition – Message Level ...........................................................................................................217

Static Definition -- Segment Level ..........................................................................................................218

ERR—Error Segment ..........................................................................................................................218

MSA—Message Acknowledgement Segment .....................................................................................220

MSH - Message Header Specification .................................................................................................221

QPD Input Parameter Specification ....................................................................................................223

11. PROFILE Z44--REQUEST EVALUATED IMMUNIZATION HISTORY AND FORECAST

QUERY PROFILE........................................................................................................................ 225

Introduction .............................................................................................................................................225

Interaction Definition ..............................................................................................................................228

Dynamic Definition .................................................................................................................................228

Static Definition - Message Level: ..........................................................................................................231

Static Definition—Segment Level ...........................................................................................................232

ERR—Error Segment ..........................................................................................................................232

MSA—Message Acknowledgement Segment .....................................................................................234

MSH - Message Header Specification .................................................................................................235

QPD Input Parameter Specification ....................................................................................................237

RCP Response Control Parameter Field Description and Commentary ..............................................244

12. PROFILE Z42 -- RETURN EVALUATED HISTORY AND FORECAST ............................... 245

Introduction .............................................................................................................................................245

Interaction Definition ..............................................................................................................................245

Dynamic Definition .................................................................................................................................245

Static Definition --Message Level ...........................................................................................................246

Static Definition -- Segment Level ..........................................................................................................248

MSH - Message Header Specification .................................................................................................248

OBX—Observation Result Segment ...................................................................................................250

ORC—Order Request Segment ...........................................................................................................255

PID—Patient Identifier Segment .........................................................................................................259

QAK—Query Acknowledgement Segment .........................................................................................264

QPD Input Parameter Specification ....................................................................................................265

RXA-- Pharmacy/Treatment Administration Segment ........................................................................266

RXR-- Pharmacy/Treatment Route Segment.......................................................................................270

13. BATCH FILE SPECIFICATIONS .......................................................................................... 272

Sending Messages in a Batch ..................................................................................................................272

BHS—Batch Header Segment.................................................................................................................274

Conformance Statement ......................................................................................................................275

BHS field definitions ...........................................................................................................................275

BTS—Batch Trailer Segment ..................................................................................................................276

BTS field definitions ...........................................................................................................................276

FHS—File Header Segment ....................................................................................................................277

Conformance Statement: .....................................................................................................................277

FHS field definitions ...........................................................................................................................278

FTS—File Trailer Segment .....................................................................................................................278

CHANGE HISTORY DETAILS ........................................................................................................ 1

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Release 1.1.............................................................................................................................................. 1

Release 1.2.............................................................................................................................................. 1

Release 1.3.............................................................................................................................................. 2

Release 1.4.............................................................................................................................................. 4

Release 1.5.............................................................................................................................................. 5

APPENDIX A: .................................................................................................................................. 1

CODE TABLES ............................................................................................................................... 1

User-defined Table 0001 - Sex ................................................................................................................... 1

HL7-defined Table 0003 - Event type ........................................................................................................ 2

User-defined Table 0004 - Patient class ..................................................................................................... 2

User-defined Table 0005 - Race ................................................................................................................. 2

HL7-defined Table 0008 - Acknowledgment code ..................................................................................... 2

User-defined Table 0010 - Physician ID ..................................................................................................... 3

HL7-defined Table 0061 - Check digit scheme .......................................................................................... 3

User-defined Table 0063 - Relationship ..................................................................................................... 3

User-defined Table 0064 - Financial class .................................................................................................. 4

HL7-defined Table 0076 - Message type .................................................................................................... 5

HL7-defined Table 0078 - Abnormal flags ................................................................................................. 5

HL7-defined Table 0085 - Observation result status codes interpretation .................................................. 6

User Defined Table 0086 - Plan Type ID .................................................................................................... 6

HL7-defined Table 0091 - Query priority ................................................................................................... 6

HL7-defined Table 0102 - Delayed acknowledgment type ........................................................................ 6

HL7-defined Table 0103 - Processing ID ................................................................................................... 6

HL7-defined Table 0104 - Version ID ........................................................................................................ 7

HL7-defined Table 0119 - Order Control Codes ........................................................................................ 7

HL7-defined Table 0125 – Value Type ....................................................................................................... 7

HL7-defined Table 0126 - Quantity limited request ................................................................................... 8

HL7-defined Table 0136 - Yes/No indicator ............................................................................................... 8

HL7-defined Table 0155 - Accept/Application acknowledgment conditions ............................................. 9

NCI Thesaurus (NCIT) – Route of Administration .................................................................................... 9

HL7-defined Table 0162 - Route of administration ................................................................................ 9

HL7-defined Table 0163 - Administrative site ..........................................................................................10

CDCREC - Ethnic Group .......................................................................................................................... 11

User-defined Table 0189 ....................................................................................................................... 11

HL7-defined Table 0190 - Address type .................................................................................................... 11

HL7-defined Table 0200 - Name type .......................................................................................................12

HL7-defined Table 0201 - Telecommunication use code ..........................................................................12

HL7-defined Table 0202 - Telecommunication equipment type ...............................................................12

User-defined Table 0203 - Identifier type ..................................................................................................13

User-defined Table 0204 - Organizational name type ...............................................................................18

HL7-defined Table 0207 - Processing mode .............................................................................................18

User-defined Table 0208 - Query response status .....................................................................................18

User-defined Table 0215 - Publicity code .................................................................................................19

User-defined Table 0220 - Living arrangement .........................................................................................19

HL7-defined Table 0227 - Manufacturers of vaccines (code = MVX) ......................................................20

User-defined Table 0288 - Census tract .....................................................................................................23

User-defined Table 0289 - County/parish ..................................................................................................23

HL7-defined Table 0292 - Codes for Vaccines administered (code=CVX) ...............................................24

CVX – Vaccines Administered ..................................................................................................................24

User-defined Table 0296 - Language.........................................................................................................38

User-defined Table 0297 - CN ID source ..................................................................................................39

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User-defined Table 0300 - Namespace ID .................................................................................................39

HL7-defined Table 0301 - Universal ID type ............................................................................................39

HL7-defined Table 0322 - Completion status ............................................................................................39

HL7-defined Table 0323 - Action code .....................................................................................................40

HL7-defined Table 0354 - Message structure ............................................................................................40

HL7-defined Table 0356 - Alternate character set handling scheme .........................................................40

HL7-defined Table 0357 - Message error status codes ..............................................................................40

User-defined Table 0360 - Degree .............................................................................................................42

User-defined Table 0361 - Application ......................................................................................................43

User-defined Table 0362 - Facility ............................................................................................................43

User-defined Table 0363 - Assigning Authority ........................................................................................43

User-defined Table 0396 - Coding system ................................................................................................45

User-defined Table 0441 - Immunization registry status ...........................................................................46

User-defined Table 0471 - Query Name ....................................................................................................47

HL7 Table 0516 - Error Severity ...............................................................................................................47

User-defined Table 0533 - Application Error Code ...................................................................................47

CDC-defined NIP001- Immunization information source ........................................................................48

CDC-defined NIP002 - Substance refusal reason......................................................................................49

CDC-defined NIP003 - Observation identifiers ........................................................................................50

CDC-defined NIP004 - Contraindications, Precautions, and Immunities .................................................53

Value Set Name – Immunization Funding Source .....................................................................................53

Value Set Name – Vaccination Contraindications .....................................................................................54

Value Set Name – Vaccination Reaction - IIS ...........................................................................................57

Value Set Name – Vaccination Special Indications - IIS ...........................................................................58

Value Set Name – Immunization Profile Identifiers - IIS ..........................................................................58

Value Set Name – Immunization Schedule Identifiers - IIS ......................................................................59

Value Set Name – History of Disease as Evidence of Immunity - IIS .......................................................60

Value Set Name – Serological

Evidence of Immunity - IIS ......................................................................61

Value Set Code – PHVS_VISBarcodes_IIS ..............................................................................................62

Value Set Name – Funding Eligibility Observation Method (IIS) .............................................................63

Value Set Name – VIS Vaccines (IIS) .......................................................................................................63

APPENDIX B – GUIDANCE ON USAGE AND EXAMPLE MESSAGES ...................................... 1

Core Data Elements for an Immunization History ..................................................................................... 2

Send Immunization History (VXU)............................................................................................................ 5

Business Process ......................................................................................................................................... 5

Example VXU # 1-Basic message:............................................................................................................. 8

Storyboard: ............................................................................................................................................. 8

Message Example ................................................................................................................................... 8

Example VXU #2 - Indicate client eligibility status for a funding program for vaccines administered: ...10

Guidance for systems which collect eligibility at the encounter level: ..................................................10

Patient Eligibility Status: .......................................................................................................................10

Example VXU #3 - Include immunization history evaluation and forecast in VXU .................................13

Example VXU #4 - Send client specific conditions ..................................................................................13

Reaction Associated with a Previous Dose of Vaccine ..........................................................................13

Evidence of immunity: ..........................................................................................................................13

Contraindications to immunization: ......................................................................................................14

Factors which indicate the need for an immunization or a changed recommendation: .........................14

Example VXU #6 –Delete an Immunization Record ................................................................................15

VXU Example #7--Send Information About Vaccine Information Statement (VIS) .................................16

VXU Example #8—Send Information Indicating Immunization Refusal .................................................17

VXU Example #9—Send Two Lot Numbers in RXA ...............................................................................18

Two Vaccine Components Are Packaged Together And The Lot Numbers Are Inextricable Linked ....18

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Adjuvant Is Recorded Separately From Vaccine ...................................................................................18

VXU Example #10—Recording Birth Information ...................................................................................18

VXU Example #11—Recording an incompletely administered dose or a non-potent dose. .....................19

Send Acknowledgement ACK In Response To VXU ................................................................................19

Send acknowledgement of success in ACK ...........................................................................................20

Send Error in ACK ................................................................................................................................20

Example Return an Evaluated History and Forecast (RSP(Z42))..............................................................22

Indicating the Schedule that was used: ..................................................................................................26

Indicating Vaccine Group associated: ....................................................................................................27

Reporting the Ordinal Position In A Series: ..........................................................................................27

Reporting the Number of Doses in a Series: .........................................................................................28

Reporting Next Dose Recommendation Dates (forecast only): .............................................................28

Reporting Recommendation Reasons: ...................................................................................................29

Complete Example Of Evaluation And Forecasting: .............................................................................29

Important notes: .....................................................................................................................................32

Using The NTE Segment Associated With An OBX To Provide More Information: ............................32

Send Request for Complete Immunization History (QBP/RSP) ...............................................................32

Process for requesting Immunization History .......................................................................................32

Returning a list of candidate clients in response to QBP^Q11 query ....................................................33

Returning an immunization history in response to a Request for Immunization History query ............34

Acknowledging Query That Returns No Clients/Patients .........................................................................35

Acknowledging a Query that finds no candidate clients .......................................................................35

Acknowledging a query that finds more candidates than requested ......................................................36

Using a Two-step process to request an immunization history ..............................................................36

Receiving system determines that message has errors ..........................................................................38

Message Is Rejected Due to Unrecognized Message Type ....................................................................39

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Index of Tables

INDEX OF TABLES

Table 2-1 Actors and Goals for Messaging ...................................................................................... 8

Table 3-2 Receiving Application Conformance .............................................................................. 25

Table 4.1 Data Types ..................................................................................................................... 30

Table 4.2 Coded Element (CE) .......................................................................................................31

Table 4.3 Coded Element (CE) for Text Only RXA-9 ..................................................................... 33

Table 4.4 Composite Quantity with Units (CQ) .............................................................................. 33

Table 4.5 Coded with Exceptions (CWE)....................................................................................... 35

Table 4.6 Extended Composite ID with Check Digit (CX)...............................................................36

Table 4.7 Date (DT) ....................................................................................................................... 38

Table 4.8 Date With Precision to Day (DT_D) ................................................................................39

Table 4.9 Date/Time (DTM) ............................................................................................................39

Table 4.10 Entity Identifier (EI) .......................................................................................................40

Table 4.11 Error Location (ERL) .................................................................................................... 41

Table 4.12 Family Name .................................................................................................................43

Table 4.13 Formated Text ............................................................................................................. 43

Table 4.14 Hierarchical Designator (HD) .......................................................................................44

Table 4.15 ID Data Type ................................................................................................................ 45

Table 4.16 Coded Values for User Defined Tables (IS) .................................................................45

Table 4.17 Location with Address Variation 2 ................................................................................ 46

Table 4.18 Message Type (MSG) .................................................................................................. 47

Table 4.19 Numeric (NM) ............................................................................................................... 48

Table 4.20 Processing Type (PT) .................................................................................................. 49

Table 4.21 Street Address (SAD) ....................................................................................................49

Table 4.22 Sequence Id (SI) ...........................................................................................................50

Table 4-22 String (ST) ................................................................................................................... 50

Table 4.23 Time Stamp (TS) ...........................................................................................................51

Table 4.24 Time Stamp Precision to Month (TS) ............................................................................52

Table 4.25 Time Stamp No Time Zone (TS_NZ) ........................................................................... 52

Table 4.26 Time Stamp with Time Zone (TS_Z) ............................................................................ 53

Table 4.27 Version ID (VID) ........................................................................................................... 54

Table 4.28 Extended Address (XAD) ..............................................................................................55

Table 4.29 Extended Composite ID Number and Name (XCN) .....................................................57

Table 4.30 Extended Composite ID Number and Name for Organizations (XON) ........................60

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Index of Tables

Table 4.31 Extended Person Name (XPN) .....................................................................................61

Table 4.32 Extended Person Name (XPN_M) ................................................................................63

Table 4.33 XTN Extended Telecommunication Number (XTN) ......................................................65

Table 5.1 VXU Segment Usage .................................................................................................... 71

Table 5-2 Insurance Segment (IN1)............................................................................................... 74

Table 5-4 Message Header Segment (MSH) ................................................................................ 79

Table 5-5 Next of Kin Segment (NK1) ........................................................................................... 85

Table 5-6 Note Segment (NTE) ..................................................................................................... 89

Table 5-7 Observation Segment (OBX) ......................................................................................... 90

Table 5-8 Application Conformance Statements ........................................................................... 95

Table 5-9 Common Order Segment (ORC) ................................................................................... 99

Table 5-10 Patient Demographic Segment (PD1) ........................................................................104

Table 5-11 Patient Identifier Segment (PID) ................................................................................ 108

Table 5-12 Pharmacy/Treatment Administration (RXA) ................................................................ 115

Table 5-13 Pharmacy

/Treatment Route (RXR) ............................................................................ 122

Table 6-1 Message Acknowledgement Segment (ACK) ............................................................. 127

Table 6-2 Error Segment (ERR) .................................................................................................. 128

Table 6-3 Message Acknowledgement Segment (MSA) ............................................................. 131

Table 6-4 Message Header Segment (MSH) .............................................................................. 132

Table 7-5 QPD Input Parameter Specification ............................................................................. 145

Table 7-7 Response Control Parameter ...................................................................................... 151

Table 8-1 Return Complete Immunization History Response GrammarSP^K11 ........................ 154

Table 8-3 Insurance Segment (IN1)............................................................................................. 159

Table 8-4 Message Acknowledgement Segment (MSA) ............................................................. 163

Table 8-5 MSH for Request Complete Immunization History Query ........................................... 164

Table 8-6 Next of Kin Segment (NK1) ......................................................................................... 168

Table 8-7 Note Segment (NTE) ................................................................................................... 171

Table 8-8 Observation Segment (OBX) ....................................................................................... 173

Table 8-10 Common Order Segment (ORC) ................................................................................178

Table 8-11 Patient Demographic Segment (PD1) ....................................................................... 182

Table 8-12 Patient Identifier Segment (PID) ................................................................................ 185

Table 8-13 Query Acknowledgement Segment (QAK) ................................................................ 189

Table 8-14 QPD Input Parameter Specification (QPD) ............................................................... 190

Table 8-15 Pharmacy/Treatment Administration (RXA) ...............................................................192

Table 8-16 Pharmacy/Treatment Route (RXR) ............................................................................ 196

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Index of Tables

Table 9-1 Base Response Grammar RSP^K11 ......................................................................... 198

Table 9-2 Error Segment (ERR) .................................................................................................. 199

Table 9-3 Message Acknowledgement Segment (MSA) ............................................................. 201

Table 9-4 MSH for Request Complete Immunization History Query ........................................... 202

Table 9-5 Next of Kin Segment (NK1) ......................................................................................... 206

Table 10-2 Error Segment (ERR) ................................................................................................ 218

Table 10-4 Message Acknowledgement Segment (MSA) ........................................................... 220

Table 11-4 Error Segment (ERR) ................................................................................................. 232

Table 11-5 Message Acknowledgement Segment (MSA) ........................................................... 234

Table 12-3 Observation Segment (OBX) ..................................................................................... 251

Table 12-5 Common Order Segment (ORC) ............................................................................... 256

Table 12-6 Patient Identifier Segment (PID) ................................................................................ 260

Table 12-7 Query Acknowledgement Segment............................................................................ 264

Table 12-8 QPD Input Parameter Specification............................................................................265

Table 12-9 Pharmacy/Treatment Administration (RXA) ...............................................................267

Table 12-10 Pharmacy/Treatment Route (RXR) ...........................................................................271

Table 13-1 Batch Header Segment (BHS) .................................................................................. 274

Table 13-2 Batch Trailer Segment (BTS) ..................................................................................... 276

Table 13-3 File Header Segment (FHS) ...................................................................................... 277

Table 13-4 File Trailer Segment (FTS) ........................................................................................ 278

Release 1.1 Changes ...................................................................................................................... 1

Release 1.2 Changes ...................................................................................................................... 1

Release 1.3 Changes ...................................................................................................................... 2

Release 1.4. Changes ..................................................................................................................... 4

Release 1.5 Changes ...................................................................................................................... 5

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Introduction

TABLE OF FIGURES

Figure 1 Immunization Messaging Use Cases ............................................................................... 11

Figure 2 VXU Process Model ........................................................................................................ 15

Table 3-1 Receiving System Processing Rules ............................................................................. 21

Table 3-2 Sending Application Conformance ................................................................................ 23

Table 3-3 Message Element Attributes .......................................................................................... 26

Table 4-3 Coded Element (CE) for Text Only RXA-9 ..................................................................... 33

Figure 36 Send Immunization History Sequence Diagram .......................................................... 69

Figure 37 Send VXU Activity Diagram ........................................................................................... 70

Figure 38 Send Immunization History Sequence Diagram ........................................................ 125

Figure 39 Activity Diagram-Return Acknowledgement ................................................................ 126

Table 7-1 Request Complete Immunization History Query Profile .............................................. 136

Figure 40 Sequence Diagram-Return Complete Immunization History ...................................... 138

Figure 41 Request Complete History and Responses Activity Diagram ..................................... 139

Table 7-3 Z34 Request Complete Immunization History ............................................................. 141

Table 7-4 MSH Specification for Request Complete Immunization History Query ..................... 142

Table 7-6 QPD Input Parameter Field Description and Commentary ......................................... 146

Table 8-2 Error Segment (ERR) .................................................................................................. 156

Table 9-1 Base Response Grammar RSPAK11...........................................................................198

Table 9-6 QPD Input Parameter Specification ............................................................................. 209

Table 9-7 PID Patient Identification Segment ............................................................................... 211

Figure 42 Return Acknowledgement .......................................................................................... 216

Table 10-1 Base Response Grammar RSP^K11 ......................................................................... 217

Table 10-3 Query Response Possibilities .................................................................................... 219

Table 10-5 MSH Specification for Request Complete Immunization History Query ................... 221

Table 10-6 QPD Input Parameter Specification ........................................................................... 223

Table 11-1 Request Evaluated Immunization History and Forecast Query Profile ..................... 226

Table 11-2 Response Grammar to Different Outcomes .............................................................. 227

Figure 43 Return Immunization Evaluated History Sequence Diagram ...................................... 228

Figure 44 Activity Diagram -Response to Different Outcomes .................................................... 229

Table 11-3 Response to Different Outcomes ............................................................................... 230

Table 11-4 Z44 Request Complete Immunization History ........................................................... 231

Table 11-6 MSH Specification for Request Complete Immunization History Query .................... 235

Table 11-7 QPD Input Parameter Specification ........................................................................... 237

Table 11-8 QPD Input Parameter Field Description and Commentary ........................................ 239

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Table 11-10 RCP Response Control Parameter Field Description and Commentary ................. 244

Table 12-1 Return Evaluated Immunization History and Forecast Response Grammar RSP^K11

............................................................................................................................................ 246

Table 12-2 MSH Specification for Return Evaluated Immunization History and Forecast Response

............................................................................................................................................ 248

Table A-1 Appendix A Revision History ............................................................................................ 1

Table B-1 Appendix B Revision History ........................................................................................... 1

Table B-2--Immunization History Core Data Elements .................................................................... 2

Figure B-45-VXU Business Process................................................................................................ 6

Table B-2 -- Eligibility Outcomes ..................................................................................................... 11

Figure B-46 Sequence Diagram-Deleting an Immunization Record ............................................. 15

Table B-3--Birth Information Fields ................................................................................................ 18

Table B-3--Codes Supporting Messaging Evaluation and Forecasting ......................................... 23

Table B-4--Due Date Definitions .................................................................................................... 28

Figure B-3--Sequence Diagram Acknowledging Response Indicating No Matchesa ................... 35

Figure B-3-- Sequence Diagram -Two Step Request .................................................................... 37

1. Introduction

Immunization Information Systems (IIS) are centralized population based repositories of immunization

related information. They receive and share data on individual clients/patients

with a number of other

systems, including Electronic Health Record systems (EHR-S). Health Level Seven (HL7) is a nationally

recognized standard for electronic data exchange between systems housing health care data. The HL7

standard is a key factor that supports this two-way exchange of information because it defines a syntax or

grammar for formulating the messages that carry this information. It further describes a standard

vocabulary that is used in these messages. It does not depend on specific software, that is, it is platform

independent.

This document represents the collaborative effort of the American Immunization Registry Association

(AIRA) and the Centers for Disease Control and Prevention (CDC) to improve inter-system communication

of immunization records. The effort has received input from the National Institute of Standards and

Technology (NIST) to improve the capacity to test conformance with this Implementation Guide. In

addition, this Guide addresses a need to specify usage requirements for data elements that are not included

in the standard HL7 usage designations. This implementation guide replaces the Implementation Guide for

Immunization Data Transaction Using Version 2.3.1 of the HL7 Standard Protocol, and previous versions

of this Guide. It is based on HL7 Version 2.5.1, as published by the HL7 organization (www.hl7.org). In

addition, it pre-adopts a number of features of HL7 Version 2.7.1, such as data types and the conformance

model (defined in Chapter 2B).

As HL7 has developed and published new versions of the standard, it has sought to maximize the ability of

implementations, based on newer versions to be able to accept messages from earlier versions. Based on

this, we anticipate that faithful implementations of this Guide will be able to accept most immunization

Note that client, patient and recipient are terms which we interchangeably in this document.

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Introduction

messages based on the 2.3.1 Guide. Note that variations in current 2.3.1 interfaces increase the risk that

faithful 2.5.1 implementations will encounter problems with 2.3.1 messages.

Implementations that are supporting Version 2.3.1 messages should continue to follow the specifications of

2.3.1 messages described in the Implementation Guide Version 2.2, June 2006.

Intended Audience

This Guide has two audiences. The first is the system managers that must understand this process at a high

level. The second is the technical group from IIS and EHR-S that must implement these guidelines. For

them we strive for an unambiguous specification for creating and interpreting messages. Our goal is for this

Guide to be a bridge between the two.

It is important to note that HL7 specifies the interface between 2 systems. It does not specify how any

given system is implemented to accomplish the goals of messaging.

Scope

This Guide is intended to facilitate the exchange of immunization records between different systems

. This

includes

• sending and receiving immunization histories for individuals

• requesting immunization histories for individuals

• requesting an evaluated history and forecast for individuals

• responding to requests for immunization histories by returning immunization histories

• responding to requests for evaluated history and forecast

• acknowledging receipt of immunization histories and requests for immunization histories

• reporting errors in the messaging process

• sending observations about an immunization event (this may include patient eligibility for a

funding program, reactions, forecasts and evaluations).

The Guide is not intended to specify other issues such as

• business rules, which are not implicit in HL7, applied when creating a message

• business rules, which are not implicit in HL7, applied when processing a received message

• a standard transport layer

• search process used when responding to a query

• business rules used to deduplicate clients or events

• management of vaccine inventory

• maintenance of Master Person Index (MPI).

The exchange partners could be IIS, EHR-S. or other health data systems.

Note that requesting an immunization history may require interaction with an MPI or other identity source. Those using these

services should consult with profiles or implementation guides that support this. Integrating the Healthcare Enterprise (IHE) has

profiles that support MPI maintenance and identity resolution.

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Introduction

Local implementations are responsible for the important issues described above. One way to insure success

is to publish a local profile or implementation guide that outlines the local business rules and processes.

These guides may further constrain this Guide, but may not contradict it. This Guide will identify some of

the key issues that should be addressed in local profiles.

This Guide makes the following assumptions:

• Infrastructure is in place to allow accurate and secure information exchange between information

systems.

• Providers access immunization information through either an EHR-S or immunization information

system (IIS).

• Privacy and security has been implemented at an appropriate level.

• Legal and governance issues regarding data access authorizations, data ownership and data use are

outside the scope of this document.

• The immunization record and demographic record for each patient contains sufficient information

for the sending system to construct the immunization and demographic message properly.

• External business rules are assumed to be documented locally.

It is important to be able to accept complete immunization histories from different sources and have a

method for integrating them. This implies that a system should not assume that any record sent is “new”. If

the system makes this assumption and receives a complete history that has overlapping immunization

records, there is a risk for duplicate records.

There is “best practice” guidance on handling this from the American Immunization Registry Association

(AIRA) in the Modeling Immunization Registry Operations Workgroup (MIROW) documents available the

AIRA website. (immregistries.org)

Organization and Flow

The first two chapters are meant to lay out what can be done and why. The chapters that follow them

describe and specify how. Message profiles will support the major use cases outlined below. Each profile

will be in a separate chapter. All profiles will rely on the data type definitions in Chapter 4. Several

appendices support implementers with value sets and examples of use.

Boxed notes are used to call attention to areas where there are changes from the version 2.3.1

Implementation Guide or areas where readers should pay special attention.

Chapter 1-Introduction

This chapter describes the scope of the Guide and gives supporting background.

Chapter 2-Actors, Goals and Messaging Transactions

Chapter 2 describes the business motivations that this Guide will support. It will describe the entities

(actors) that will rely on the messages. It will lay out the transactions that will support the goals of these

This infrastructure is not specified in this document, but is a critical element to successful messaging. Trading partners must select a

methodology and should specify how it is used.

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Introduction

actors (use cases). Finally, it will describe the broader context that this messaging occurs in. There are

supporting business processes outside of the actual messaging that are keys to success.

Chapter 3-Messaging infrastructure

Chapter 3 focuses on the underlying rules and concepts that are the basis for HL7 messaging. It will

illustrate the components of messages, the grammatical rules for specifying the components and

subcomponents.

Chapter 4-Data-type Definitions

This chapter will describe and specify all data types anticipated for use by the messages supported by this

Guide. Where there are subcomponents to a data type, it will specify any rules related to use. Elements that

require the use of coded values will draw on the value sets specified in appendix A.

Chapter 5-Profile Z22 Send Unsolicited Immunization Update Using a VXU

Chapter 5 is the profile specifying a constrained VXU message.

Chapter 6- Profile Z23 Return an Acknowledgement

Chapter 6 is the profile specifying a constrained ACK message.

Chapter 7- Profile Z34 Request a Complete Immunization History

Chapter 7 is the profile with the specifications for a query requesting a Complete Immunization History.

Chapter 8—Profile Z32 Return Complete History

Chapter 8 is the profile with the specifications for a response returning a Complete Immunization History.

Chapter 9-Profile Z31 Return List of Candidates

Chapter 9 is the profile with the specifications for a response returning a list of candidate matches.

Chapter 10- Profile Z33 Return Response with No Matches

Chapter 10 is the profile with the specifications for a response returning no matches. It may return errors.

Chapter 11- Profile Z44 Request an Evaluated Immunization History and Forecast

Chapter 11 is the profile specifying a query requesting an evaluated history and forecast. It includes a child

profile for responses to this query.

Chapter 12-Profile Z42 Return Evaluated History and Forecast

Chapter 12 is the profile specifying the response to a Request for Evaluated Immunization History and

Forecast.

Chapter 13—Batch File Segments

This Chapter gives specifications for packaging messages into batches and files of batches.

Appendix A-Value Sets

This appendix lists expected values for all coded data elements used in this Guide. It is a point in time view

of the value sets.

Appendix B- Message examples

This appendix will show detailed examples of how to implement the messages specified in the body of the

Implementation Guide.

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Note that the focus of this guide is on the format and grammar of the messages between systems. The

activities shown within a system are intended to put the message in context and to highlight the local

responsibilities for successful messaging.

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Chapter 2: Actors, Goals, and Messaging Transactions

2. Actors, Goals, and Messaging Transactions

This chapter will describe the actors (entities) that may be involved in sending or receiving immunization-

related messages. It will list and describe the use cases (goals) that they have that can be met by the

messages. It will illustrate the messaging interface in context. Finally, it will associate specific HL7

messages with these goals.

Note that there are a number of supporting processes that are not included within the messaging

specifications. They are vital to success, but do not belong in this Implementation Guide, but rather in local

business rules documentation.

Actors and Goals

There are a number of primary actors involved in data exchange. These include

• Immunization Information System (IIS)

• Electronic Health Record Systems (EHR-S) and other systems

• An actor with a supporting role may be a Master Person Index (MPI)

• An actor with a supporting role may be a Health Information Exchange (HIE)

We will focus on the first 2 actors but will illustrate how the MPI actor may be integrated. These actors can

be suppliers of information/data and consumers/requesters of data. We will consider the initiator of a

messaging conversation the sender and the target of this first message the receiver. Obviously, a sender may

receive messages. For instance, a sender initiates a request for an immunization history for a client. The

receiver responds with a message that is received by the initiating sender. For clarity, the initiator will keep

the label of sender.

Note that we do not assume that the sender or receiver is a specific data source (IIS or EHR). One IIS may

query another IIS or an EHR-S. Similarly, an EHR-S may send an immunization history to another EHR-S.

Other actors have an interest in the functions of an IIS and messaging. These include:

• Clients/patients

• Users

• Policy makers

• Researchers

• Public Health agencies

• Clinicians

• Billing systems

These actors will not be directly addressed in this Guide. They interact with the primary actors to

accomplish their needs.

The diagrams often show an IIS and an EHRs/other system. The other system may be an IIS.

A Master Person Index is used by some health data systems to cross-reference a person’s identifiers across these systems. If system A

needs the person’s id from system B, then it may retrieve it from the MPI. The Patient Idenitifying Cross-referencing (PIX) query

asks for one system’s personal identifier, based on another system’s identifier. PIX is a profile published by Integrating the Healthcare

Enterprise (IHE).

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Table 2-1 Actors and Goals for Messaging

Chapter 2: Actors, Goals, and Messaging Transactions

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TABLE 2-1 ACTORS AND GOALS FOR MESSAGING

Actor Responsibility Messaging Goals

Immunization Information

System (IIS)

Provide access to a complete,

consolidated immunization record for

each person in its catchment area

Supply individual immunization

records to authorized users and

systems

Support aggregate reporting and

analysis

Evaluate immunization history and

make recommendations for next

doses

Store medical conditions that affect

what vaccines are recommended

Receive immunization histories and

updates

Receive demographic updates

Receive requests for individual

records

Receive observations about a person

Send observations about a person

Send immunization records to other

systems

Send other systems evaluated

immunization histories and forecasts

of next doses due for a specific

person

Request immunization record

Request person id

Acknowledge receipt of message

Report processing errors from receipt

of message

Chapter 2: Actors, Goals, and Messaging Transactions

TABLE 2-1 ACTORS AND GOALS FOR MESSAGING

Actor Responsibility Messaging Goals

Electronic Health Record

system (EHR-S)

House a person’s electronic health

record

Make a person’s record available to

authorized persons

Provide decision support for clinical

decisions.

Receive immunization histories and

updates

Receive demographic updates

Receive requests for individual

records

Send immunization records to IIS

Send demographic data

Receive observations about a person

Send observations about a person

Request Immunization record

Reque

st person id

Acknowledge receipt of message

Report processing errors from receipt

of message

Request evaluation on an

immunization history and

recommendations for next dose on a

given Schedule, such as ACIP

Master Person Index or

other identity broker.

Maintain a list of patients and

identifiers for a set of persons

Supply identifiers for other system’s

use

Be a central demographic supplier

for participating systems

Provide cross-reference for

identifiers for participating systems.

Send id for an individual for use in a

record request or record update

Receive request for person id.

Return complete demographic data

for an individual from central

demographic store

he table lists a number of messaging needs that relate to IIS and their trading partners. These are all

candidates for HL7 messaging. Some are not currently implemented, but give us the landscape that should

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Chapter 2: Actors, Goals, and Messaging Transactions

be considered. Note that the messaging for maintaining of an MPI is out of scope for this Implementation

Guide.

Another way to organize these tasks or goals is to decompose the goals of the entities (actors) into the

various roles they may play. These roles include:

1. Immunization history supplier

2. Immunization history consumer

3. Identity resolution broker

Each of the actors above may have the capacity and interest to support some constellation of these roles.

This approach is useful for system design and implementation and encourages a services approach to

development. Since the goal of this chapter is to provide a non-technical view to help system managers

understand how messaging can meet their needs, we will focus on the business entities and their goals.

High-Level View of Use Cases

We can map these actors and messaging goals to use cases. The following diagram maps the messaging

goals of the various players to use cases. These use cases will be defined below. These use cases are not

intended to be the basis of a software design process.

Several paths may accomplish the request for immunization history. Systems will return an immunization

history when they are confident that the person requested has been identified. One path separates identity

resolution from the request for immunization history. Another includes implicit identity resolution.

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Figure 1 Immunization Messaging Use Cases

n IIS is an Immunization Information System. An IIS AO is an IIS Authorized Organization. It is an entity

that is authorized to submit data to an IIS and to request data from an IIS.

Use Case Descriptions

Use Case 1—Send Immunization History

Goal: To send an immunization history for an individual client from one system to another. In addition to

EHR-S and IIS, other systems such as vital records systems or billing systems could use this message to

send immunization histories. This goal includes receiving the immunization history.

Supporting HL7 version 2.5.1 Message Type: VXU – Profile Z22

Precondition: A user or other actor requests that the sending system send an immunization history.

Post-condition: The receiving system has accepted the immunization history.

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Use Case 2—Request Complete Immunization History

Goal: The goal of this use case is to request and receive a complete immunization history from another

system.

Supporting HL7 Version 2.5.1 Message Type: QBP –Profile Z34 and RSP –Profile Z32.

Precondition: A user or other actor requests that the sending system send a request for an immunization

history using demographic information and/or other identifiers.

Post-condition: The requesting system receives an immunization history. Note that if no matches are

found or there are errors, no immunization history will be returned.

There are 5 possible results:

1. One client matches exactly

the criteria sent

2. One or more clients match the criteria sent (inexact match)

3. No clients match the criteria sent

4. An exact match is found but they have requested that their data not be shared

5. There were errors or other problems

Note that systems must deal with the situation where a Client has indicated that his/her records must be

protected. (Only the owning provider may view) This should be clearly documented.

Use Case 3—Request Evaluated History and Forecast

Goal: The goal of this use case is to request and receive an evaluated immunization history and forecast of

next doses due from another system.

Supporting HL7 Version 2.5.1 Message Type: QBP –Profile Z44 and RSP –Profile Z42.

Precondition: A user or other actor requests that the sending system send a request for an evaluated history

using demographic information and/or other identifiers.

Post-condition: The requesting system receives an evaluated immunization history and forecast. Note that

if no matches are found or there are errors, no immunization history will be returned. Typically, this is

presented to the person who requested the evaluated history and forecast.

There are 5 possible results:

1. One client matches exactly

the criteria sent

2. One or more clients match the criteria sent (inexact match)

3. No clients match the criteria sent

4. An exact match is found but they have requested that their data not be shared.

5. There were errors or other problems

The definition of “exact” is a local business rule and should be documented locally.

If more than one client has a high-confidence match with the query parameters, this is an inexact match.

The definition of “exact” is a local business rule and should be documented locally.

If more than one client has a high-confidence match with the query parameters, this is an inexact match.

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Note that systems must deal with the situation where a Client has indicated that his/her records must be

protected. (Only the owning provider may view) This should be clearly documented.

Use Case 4—Send Demographic Data

Goal: The goal of this use case is to send demographic data about a person. It may be an update or a new

record. This use case does not have responsibility for the processing of the message.

Precondition: A user or other actor requests that the sending system send demographic data.

Post-Condition: The receiving system processes and accepts the demographic data.

Demographic data may be sent in VXU messages (for example , the Z22 profile defined in this

Implementation Guide can be used to carry demographic only data) or ADT messages. Profiles for ADT

are not included in this Implementation Guide. Refer to the HL7 Standard and to profiles published by

groups such as IHE.

Use Case 5--Acknowledge Receipt

Goal:

The goal of this use case is to acknowledge receipt of a message. This can be an immunization history,

request for immunization history, demographic update, observation report or request for personal id. It may

indicate success or failure. It may include error messages. One example occurs when a query is well-

formed, but finds no candidates. In this case the acknowledgement reports this fact.

Supporting HL7 Version 2.5.1 Message Type: ACK –Profile Z23 and RSP – Profile Z33.

Use Case 6—Report Error

Goal:

The goal of this use case is to send error messages related to messages. These errors could result in

rejection of the message or parts of the message.

Supporting HL7 Version 2.5.1 Message Type: ACK –Profile Z23 and RSP – Profile Z33.

Messaging in the Context of the Business Process

While this document focuses on the format and content of messages from one system to another, it is useful

to understand where this fits into the bigger picture of interoperable communication.

The following diagram illustrates the most common message exchange in the IIS context, the VXU

(unsolicited immunization record). When the sending system wishes to send a VXU to a receiving system,

it must do several steps in preparation:

Create message

semble data on person of interest

Build the VXU message with this data

Send the message

Identifying which client’s record to send is an important consideration, but outside the scope of this document.

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Chapter 2: Actors, Goals, and Messaging Transactions

Connect to the receiving system. The partners must agree on how this is done.

he sending system now sends the message over the connection and the receiving system

catches the message.

The receiver accomplishes the following steps:

o P

rocess the received message

etermine that the message is in the appropriate format.

Parse the message into a format that it uses.

Evaluate the message components to determine that these are correctly formatted and

specified.

end an acknowledgement to the sender, indicating the message has been successfully processed.

ntegrate the received record into the existing data base.

eduplicate on client to be sure that each client only has one record.

eduplicate the events (immunizations, for instance).

Insert or update data.

o T

he sending system accepts the acknowledgment and processes it.

bviously, the interaction may be more complex than this

. The connection may be rejected or fail. The

message may be poorly formed or may not contain required information. Part of the message may contain

errors, but these errors are not sufficient to reject the entire message.

The business rules for both the sender and the receiver should be clearly specified so that each side

understands how the message will be handled.

When illustrating the processes involved in each message below, we will not elaborate on the processes that

occur outside the actual message exchange.

Local business rules determine how this occurs and should be documented clearly.

See Appendix B for illustrations of the processing rules expected when handling HL7 messages.

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Chapter 2: Actors, Goals, and Messaging Transactions

Figure 2 VXU Process Model

Note: It is vital that each implementation clearly document the business rules and special

handling in a local Implementation Guide or Profile. Local implementers may place further

constraints on the specifications found in this Guide. Optional fields or required fields that are

allowed to be empty in this Guide may be made required. Repeating fields may be constrained to

fewer repetitions.

Core Data Elements of an Immunization History

Systems that support immunization information have a number of important responsibilities including:

• Consolidation of Immunization records from various sources

• Supplying consolidated immunization history to users

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Chapter 2: Actors, Goals, and Messaging Transactions

• Forecasting next doses due

• Evaluating vaccine doses administered

• Supporting inventory management

• Supporting reports on vaccine usage by eligibility for funding programs

• Assessing coverage rates in a population

• Protecting the privacy of immunization data

• Supporting generation and sending of reminder notices

• Supporting tracking doses administered by lot so that recipients may be notified in the case where

the lot is recalled

Each if these requires specific data. The National Vaccine Advisory Committee (NVAC) has identified a

core set of data elements to support these responsibilities. These core data elements have been used to

determine the usage in this guide. It is expected that systems that are using this Implementation Guide will

be able to support these data elements and include them in a message. See Core Data Elements in Appendix

These core data elements will also be included in conformance statements. This may be at the HL7 message

component level or a data concept level.

It is important that these data elements are supported by both

sender and receiver.

Key Technical Decisions

One of the primary features of this implementation guide is its focus on key points of broad

interoperability.

Pre-Adoption Of Some Features Of HL7 Version 2.7.1

This implementation Guide pre-adopts some features of HL7 Version 2.7.1 to support improved

consistency in implementation with the goal of improving interoperability. These include:

• Conformance statements

• Conditional predicates

• Usage guidance

• New fields in MSH segment

Use of Vocabulary Standards

This guide calls for specific vocabulary standards for the exchange of immunization information such as

LOINC and SNOMED. Standard vocabularies enable automated decision support for patient healthcare, as

well as for public health surveillance of populations. Terminology is updated periodically and it is best

practice to use the most current version of the coding system.

The ability to send in an HL7 message is required for systems the output from clinical decisions support engines. The ability to

consume is required for systems requesting evaluated history and forecast.

The ability to send in an HL7 message is required for systems the output from clinical decisions support engines. The ability to

consume is required for systems requesting evaluated history and forecast.

For instance, the vaccine administered is specified as a required element of the RXA segment by indicating a Usage of Required on

the RXA-5 field. The funding program eligibility is specified as conditionally required in a conformance statement not tied to a

specific HL7 message component.

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Processing Mode

Consolidation of immunization records from multiple sources is a complex process. Receiving systems

have varying rules for this process. They expect complete immunization histories (i.e. all immunization

information known to sender). They don’t process in Snapshot Mode. (Incoming data completely replaces

existing data)

Note that receiving systems are responsible for publishing the business rules they apply when consolidating

records from different sources.

Message Profiles

This implementation guide defines a number of constrainable profiles. These profiles will be identified in

the Message Header (MSH-21).

Conventions

This guide adheres to the following conventions:

• The guide is constructed assuming the implementer has access to the Version 2.5.1 of the HL7

Standard. Although some information from the standard is included in this implementation

guide, much information from the standard has not been repeated here.

• The rules outlined in HL7 2.7.1, Chapter 2B, Section 2B5, Conformance Using Message

Profiles, were used to document the use case for, and constraints applied to, the messages

described in this guide.

• Data types have been described separately from the fields that use the data types.

• No conformance information is provided for optional message elements. This includes length,

usage, cardinality, value sets and descriptive information. Implementers who want to use

optional message elements should refer to the base HL7 V2.5.1 Standard to determine how

these optional message elements will be used.

• This guide uses “X” as a conformance usage indicator very sparingly. Where the underlying

standard indicates the segments/field/component is present for backwards compatibility (“B”)

or withdrawn ("W") an “X” will be used. Some conditional elements may have a usage of “X”

if the predicate condition is the only case where the element is used. For all other

fields/components “O” is used to enable trading partners to explore additional capabilities.

Note that without a clearly agreed to complementary profile between trading partners, a sender

does not have to send any elements marked as an "O", nor does a receiver have to process any

elements marked as an "O".

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Chapter 3: HL7 Messaging Infrastructure

3. HL7 Messaging Infrastructure

This section will contain a basic description of the terms and definitions, which are used in this document

in order to understand the Health Level 7 standard as it applies to immunization information systems. More

detail may be found in the HL7 2.5.1 standard in Chapters 1, 2 and 2A.

Keywords

The following keywords in this document are to be interpreted as follows:

MUST or the terms "REQUIRED" or "SHALL", mean that the definition is an absolute requirement of the

specification.

MUST NOT or the phrase "SHALL NOT", mean that the definition is an absolute prohibition of the

specification.

SHOULD or the adjective "RECOMMENDED", mean that there may exist valid reasons in particular

circumstances to ignore a particular item, but the full implications must be understood and carefully

weighed before choosing a different course.

SHOULD NOT or the phrase "NOT RECOMMENDED" mean that there may exist valid reasons in

particular circumstances when the particular behavior is acceptable or even useful, but the full implications

should be understood and the case carefully weighed before implementing any behavior described with this

label.

MAY or the adjective "OPTIONAL", mean that an item is truly optional. One software supplier may

choose to include the item to enable certain capabilities while another software supplier may omit the same

item. In either case, the communication partner cannot be expected to either provide it (sender) or process it

(receiver) without clear and voluntary agreement between the partners.

An implementation which does not include a particular segment/field/component marked as optional

MUST be prepared to interoperate with another implementation which does include the optional

segment/field/component, though perhaps with reduced functionality. In the same vein an implementation

which includes a particular segment/field/component marked as optional MUST be prepared to interoperate

with another implementation which does not include the optional segment/field/component.

HL7 definitions

The terms below are organized to move from the message to subsequently more granular components.

Message: A message is the entire unit of data transferred between systems in a single transmission. It is a

series of segments in a sequence defined by the message specifications. These specifications are based on

constraints to the HL7 specifications, as described in an Implementation Guide.

Example:

Segment Description

MSH|… Message Header

PID|… Personal Identifiers

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ORC|… Order Segment

RXA|… Vaccine administered segment

he table above shows an immunization history for the patient identified in the PID. This person has one

immunization ordered and recorded.

Segment Group: A segment group is a logical collection of segments. Segment groups defined within a

message may be required or optional, may occur only once or may be allowed to repeat.

Segment: A segment is a logical grouping of data fields. Segments within a defined message may be

required or optional, may occur only once, or may be allowed to repeat. Each segment is named and is

identified by a segment ID, a unique 3-character code.

Example:

PID|||12322^^^Assigning authority^MR^||Savage^Robert^^^^^L^|

This PID segment includes a medical record number and a person’s name.

Field: A field is a string of characters and is of a specific data type. Each field is identified by the segment

it is in and its position within the segment; e.g., PID-5 is the fifth field of the PID segment. A field is

preceded by the | character.

Component: A component is one of a logical grouping of items that comprise the contents of a coded or

composite field. Within a field having several components, not all components are required to be valued.

Example: RXA-5 administered code is composed of 6 components.

Code 1^text 1^code set 1^alternate code 2^alt text 2^alt code set 2

Null and empty fields: The null value is transmitted as two double quote marks (“”). A null-valued field

differs from an empty field. An empty field should not overwrite previously entered data in the field, while

the null value means that any previous value in this field should be overwritten.

Value in Field

Meaning

“”

|””|

Nullify the value recorded in the receiving system data base.

Make no changes to the record in the receiving data base. The sending system

has no information on this field.

Null fields (“”) should not be sent in immunization messages. Systems which will send null fields (“”) must

specify their use in local implementation guides. Systems which will accept and process null fields, as

described above, must specify their use in local implementation guides.

Data type: A data type restricts the contents and format of the data field. Some data types are coded or

composite types with several components. The applicable data type is listed and defined in each field

definition.

Code Sets/Systems and Value sets: Most data elements will have associated lists of acceptable values in

tables supported by a standards organization such as HL7 or CDC. These code sets will include definitions

to support common usage.

Delimiters: Delimiter characters are used to separate segments, fields and components in an HL7 message.

The delimiter values are given in MSH-2 and used throughout the message. Applications must use agreed

upon delimiters to parse the message. Messages used in this Guide SHALL use the following delimiters:

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<CR> = Segment Terminator;

| = Field Separator;

^ = Component Separator;

& = Sub-Component Separator;

~ = Repetition Separator;

\ = Escape Character.

Message syntax: Each message is defined in special notation that lists the segment 3-letter identifiers in

the order they will appear in the message. Braces, {}, indicate that one or more of the enclosed group of

segments may repeat, and brackets, [ ], indicate that the enclosed group of segments is optional. Note that

segments may be nested within the braces and brackets. This will indicate that the nested segments are units

within a subgroup of segments. Their Usage is relative to the parent segment in the group.

Z segments: All message types, trigger event codes, and segment ID codes beginning with Z are reserved

for locally defined messages. No such codes will be defined within the HL7 Standard. The users of this

Guide have agreed to eliminate Z segments from their implementations in order to produce a standard

method that will be used nationally to transmit immunization data. The query profiled in this document

does have a name code which begins with Z as specified by HL7. This is not a Z segment.

Basic Message Processing Rules

Message Acknowledgement

Original Mode processing is supported by this Implementation Guide. Enhanced Mode Acknowledgement

is not supported.

The conversation between a sending system and a receiving system consists of a Message (VXU, QBP) and

a response (ACK, RSP). Receiving systems are expected to process the message and send a response. The

system receiving the acknowledgement response does not acknowledge the response. In other words, the

system receiving a VXU is expected to return an ACK. The system receiving that ACK is not expected to

respond back to that ACK. Receipt and processing of ACK messages has a number of significant benefits:

• Notification of errors and rejected data alerts sender that message has errors and may require

correction

• Alerting sending user that the data did not get into the receiver’s system

Some messages pass through intermediary systems like a Health Information Exchange (HIE). It is

important that the intermediary system pass the ACK back to the sending system to allow the sending

system to be aware of and deal with messaging errors.

The HL7 Standard has two ways to convey acknowledgements: standard mode and enhanced mode.

The scope of this document includes only standard mode acknowledgments, i.e. "application

acknowledgements" only, which means that the receiving system accept responsibility for the data or

identify the error in the message or reject the message for a reason not related to the message itself.

Encoding Rules for Sending

1. Encode each segment in the order specified in the abstract message format.

2. Place the Segment ID first in the segment.

3. Precede each data field with the field separator.

4. Encode the data fields in the order and data type specified in the segment definition table.

5. End each segment with the segment terminator (carriage return).

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6. Components, subcomponents, or repetitions that are not valued at the end of a field need not be

represented by component separators. The data fields below, for example, are equivalent:

|^XXX&YYY&&^| is equal to |^XXX&YYY^|

|ABC^DEF^^| is equal to |ABC^DEF|

7. Components, subcomponents, or repetitions that are not valued, but precede components,

subcomponents or repetitions that are valued must be represented by appropriate separators. For

example, the following CE data type element has the first triplicate empty and a populated second

triplicate:

|^^^ABC^Text^Codesystem|

8. If a field allows repetition (Cardinality maximum > 1), then the length of the field applies to

EACH repetition.

9. No field separator is required after the last required field unless other following fields have data.

The presence of a field separator after the last required field is NOT an error and may be ignored.

Processing Rules for Receiving System:

The following table contains the rules for processing received messages. Note that these outcomes may

cascade. That is, if a required field has bad data, it is empty. If that required field is empty, the segment is

treated as empty. It that segment is not a part of a segment group and is empty, the message is rejected.

ble 3-1 Receiving System Processing Rules

TABLE 3-1 RECEIVING SYSTEM PROCESSING RULES

Condition Outcome Acknowledgment Action

Data fields are populated

after last required field in

segment.

Ignore the extra fields.

No Error

Continue processing

message.

Data field violates data type

specifications or contains

unacceptable data.

Treat the field as empty.

Send Error

Continue processing

message.

Required data field is

empty.

Treat the segment as

empty.

Send Error

Continue processing

message.

Required But May Be

Empty field is empty.

No outcome

No Error

Continue processing

message.

Required or conditionally

required segment is empty

or missing.

All data fields in

segment are not present

Send Error

Continue processing

message.

Optional segment or

unexpected segment

included.

Ignore the segment.

This is not an error.

No error

Continue processing

message.

Data segment out of proper

Treat segment as empty.

Send Error

Continue processing

A segment is not expected if it has been deprecated or is unsupported. A segment that does not belong in the message is also not

expected.

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TABLE 3-1 RECEIVING SYSTEM PROCESSING RULES

Condition Outcome Acknowledgment Action

order.

message.

Required segment that is

not part of a segment group

is empty.

Reject message

Send Error

Reject message

Required segment that is

part of a segment group is

empty or missing.

Treat segment group as

empty.

Send Error

Continue processing

message.

Required segment group is

empty or missing.

Reject message

Send Error

Reject message

ote that all errors in processing a message should be communicated back to the sending system.

Determining Usage of Segments, Fields and Components

Many fields and segments in HL7 are optional. This guide tightens constraints on some fields to support

functionality required for meaningful use of immunization data. The following lists the rules applied to the

decisions used to determine usage in this Guide.

1. Any segment, field, or component that is required by HL7 standard is required or required but may be

empty.

2. Any field or component that is a required National Vaccine Advisory Committee (NVAC) Core Data

element is required or required but may be empty

3. Any segment that contains a required NVAC Core data element is required but may be empty.

4. Any segment, field, or component that is retained for backward compatibility in Version 2.5.1 SHALL

be unsupported in this Guide.

5. Any segment, field, or component that is conditional but may be empty in Version 2.5.1 shall be

conditional or conditional but may be empty in this Guide, unless this conflicts with 2 or 3 above.

6. All other fields will be left optional.

Usage Conformance Testing Recommendations

The following text is pre-adopted from the HL7 V2.7.1 Conformance (Chapter 2B) Please refer to the base

standard documentation for a full explanation of conformance concepts. Usage is described here as it

introduces the revised approach to conditional element handling.

---------- start citation---------

In some cases they may not be empty. Client name may never be empty or null, for instance. The NVAC core data elements are

listed in the beginning of Appendix B.

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Usage

Message content is governed by the cardinality specification associated (explicitly or implicitly) with each

element of an HL7 message. Usage rules govern the expected behavior of the sending application and

receiving application with respect to the element. The usage codes expand/clarify the optionality codes

defined in the HL7 standard. Usage codes are employed in a message profile to constrain the use of

elements defined in the standard. The usage code definitions are given from a sender and receiver

perspective and specify implementation and operational requirements.

The standard allows broad flexibility for the message structures that HL7 applications must be able to

receive without failing. But while the standard allows that messages may be missing data elements or may

contain extra data elements, it should not be inferred from this requirement that such messages are

conformant. In fact, the usage codes specified in a message profile place strict conformance requirements

on the behavior of the application.

Definition Of Conditional Usage

C(a/b) - “a” and “b” in the expression are placeholders for usage codes representing the true (“a”) predicate

outcome and the false (“b”) predicate outcome of the condition. The condition is expressed by a conditional

predicate associated with the element (“See the Error section in V2.7.1 Chapter 2B). “a” and “b” shall be

one of “R”, “RE”, “O” and/or “X”. The values of “a” and “b” can be the same.

The example C(R/RE) is interpreted as follows. If the condition predicate associated with the element is

true then the usage for the element is R-Required. If the condition predicate associated with the element is

false then the usage for the element is RE- Required but may be empty.

There are cases where it is appropriate to value “a” and “b” the same. For example, the base standard

defines the usage of an element as “C” and the condition predicate is dependent on the presence or non-

presence of another element. The profile may constrain the element that the condition is dependent on to X;

in such a case the condition should always evaluate to false. Therefore, the condition is profiled to C(X/X)

since the desired effect is for the element to be not supported. Note it is not appropriate to profile the

element to X since this breaks the rules of allowable usage profiling (see in V2.7.1 Chapter 2B table HL7

Optionality and Conformance Usage).

Sending And Receiving Application Conformance Requirements

Table 3-2 Sending Application Conformance

TABLE 3-2 SENDING APPLICATION CONFORMANCE

Symbol Definition Operation Requirement

Required The application SHALL implement

“R” elements.

The application SHALL populate “R”

elements with a non-empty value.

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TABLE 3-2 SENDING APPLICATION CONFORMANCE

Symbol Definition Implementation

Requirement

Operation Requirement

RE Required but

may be empty

The application SHALL

implement “RE” elements.

The application SHALL populate “RE”

elements with a non-empty value if there

is relevant data. The term “relevant” has

a confounding interpretation in this

definition

C(a/b) Conditional An element with a conditional usage code has an associated condition

predicate that determines the operational requirements (usage code) of the

element.If the condition predicate associated with the element is true, follow

the rules for a which shall be one of “R”, “RE”, “O” or X”:

If the

condition predicate associated with the element is false, follow the rules

for b which shall be one of “R”, “RE”, “O” or X”.a and b can be valued the

same.

Note: wh

en C(O/X) or similar is used a condition predicate will not be provided.

X Not supported

in this guide

The application (or as configured)

SHALL NOT implement “X”

elements.

The application SHALL NOT populate

“X” elements.

Optional None. The usage indicator for this

element has not yet been defined.

For an implementation profile all

optional elements must be profiled

to R, RE, C(a/b), or X.

Not Applicable

te: Implementation Requirement the capability of the system. The Operation Requirement indicates

what is included in the message.

There are multiple interpretations of “RE” when a value is known. One is “the capability must always be supported and a value is

sent if known”, the other is “the capability must always be supported and a value may or may not be sent even when known based on a

condition external to the profile specification. The condition may be noted in the profile but cannot be processed automatically”. This

is what can be interpreted from the “relevant” part of the definition. Regardless of the interpretation the “RE” usage code, a set of test

circumstances can be developed to sufficiently test the “RE” element. See the “Conformity Assessment of Conformance Constructs”

section for more details.

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Table 3-2 Receiving Application Conformance

TABLE 3-2 RECEIVING APPLICATION CONFORMANCE

Symbol Definition Operation Requirement

Required The application SHALL

implement “R” elements.

The

receiving application SHALL

process (save/print/archive/etc.) the

information conveyed by a required

element.

receiving application SHALL raise an

exception due to the absence of a

required element. A receiving application

SHALL NOT raise an error due to the

presence of a required element.

Required but

may be empty

The application SHALL

implement “RE” elements.

The receiving application SHALL

process (save/print/archive/etc.) the

information conveyed by a required but

may be empty element. The receiving

application SHALL process the message

if the element is omitted (that is, an

exception SHALL NOT be raised

because the element is missing).

C(a/b)

Conditional The usage code has an associated condition predicate that determines the

operational requirements (usage code) of the element.

If the

condition predicate associated with the element is true, follow the rules

for a which SHALL be one of “R”, “RE”, “O” or X” (If the condition predicate

associated with the element is false, follow the rules for b which SHALL be

one of “R”, “RE”, “O” or X”.

a and b can be the same.)

Note: wh

en C(O/X) or similar is used a condition predicate will not be

provided.

Not supported in

this guide

The application (or as configured)

SHALL NOT implement “X”

None, if the element is not sent.

Processing does not necessarily require permanent storage of the required element. For instance OBX-4 (sub-id) is used to group

associated OBX segments, but will probably not be stored.

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TABLE 3-2 RECEIVING APPLICATION CONFORMANCE

Symbol Definition Operation Requirement

elements.

If the element is sent the receiving

application may process the message,

SHALL ignore the element, and MAY

raise an exception. The receiving

application SHALL NOT process

(save/print/archive/etc.) the information

conveyed by a not-supported element.

Optional None. The usage indicator for

this element has not yet been

defined. For an implementation

profile all optional elements must

be profiled to R, RE, C(a/b), or X.

None

--------- en

d citation ---------

Note that local implementations may constrain the requirements of this Implementation Guide.

These guides should indicate that an element that will be ignored by the local application should use

symbol IX (Element will be ignored) to indicate that the element will be ignored by the local application.

The Operation Requirement will be: If the element is not sent, no action is taken. If the element is sent, it is

ignored.

Message Element Attributes

The following describe how message specifications will be illustrated in this Guide. These terms will be

used in the tables specifying messages throughout this Guide.

Tab

le 3-3 Sending Application Conformance

TABLE 3-3 MESSAGE ELEMENT ATTRIBUTES

Abbreviation Description

SEQ

Sequence of the elements (fields) as they are numbered in the HL7 message element.

The SEQ attribute applies to the data type attribute table and the segment attribute table.

Segment

Three-character code for the segment and the abstract syntax (i.e., the square and curly

braces)

[ XXX ] Optional

{ XXX } Repeating

XXX Required (not inside any braces)

[{ XXX }] Optional and Repeating

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TABLE 3-3 MESSAGE ELEMENT ATTRIBUTES

Abbreviation Description

[ B

egin segment group

XXX

[YYY]

] End segment group

YY is nested within the segment block starting with XXX. It is an optional sub-segment to

XXX

. The whole block is optional.

Note that for Segment Groups there will not be a segment code present, but the square

and curly braces will still be present.

Conditional

predicate

Logic for determining the usage of conditional usage for an element.

Data Type

Data type used for HL7 element. Data type specifications can be found in Chapter 4.

Usage

Usage of the message element for this profile. Indicates whether the message element

(segment, segment group, field, component, or subcomponent) is R, RE, O, X or C(a/b) in

the corresponding message element. Usage applies to the message attribute table, data

type attribute table and the segment attribute table.

Cardinality

Indicator of the minimum and maximum number of times the element may appear.

[0..0] Element never present.

[0..1] Element may be omitted and can have at most, one occurrence.

[1..1] Element must have exactly one occurrence.

[0..n] Element may be omitted or may repeat up to n times.

[1..n] Element must appear at least once, and may repeat up to n times.

[0..*] Element may be omitted or repeat for an unlimited number of times.

[1..*] Element must appear at least once, and may repeat unlimited number of times.

[m..n] Element must appear at least m and, at most, n times.

Cardinality applies only to message attribute tables and segment attribute tables.

Value Set

The set of coded values to be used with the field. The value set attribute applies only to the

data type attribute tables and the segment attribute tables. The value set may equate with

an entire code system part of a code system, or codes drawn from multiple code systems.

YYY may only be included if XXX is present. XXX may be present without YYY.

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TABLE 3-3 MESSAGE ELEMENT ATTRIBUTES

Abbreviation Description

HL7 Element

Name

HL7 descriptor of the element in the segment.

Description

/Comment

Context and usage for the element. Description/Comments applies to the message

attribute table, data type attribute table and the segment attribute table.

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Chapter 4: HL7 Data Types

4. HL7 Data Types

Data types are the building blocks that are the foundation of successful interoperability. Each field, component or subcomponent has a data type. Conforming systems

agree to adhere to the data type assigned to each component, assuring smooth communication. For example, dates may be formatted in many ways, but to assure

interoperability, these need to be constrained and defined. HL7 specifies several formats, but these are compatible with each other. They allow dates to be as granular as

needed. The format allows for just a year (YYYY) or for month, day, year, hour, minute, second, etc.

Appendix A contains the tables of value sets referenced by these data types.

Data Types Used In This Implementation Guide

Data types specify the format and type of data used. A data type may be as simple as a numeric data type, which allows a number. It may be a more complex coded entry

that requires a specific set of code values and the name of the code system. Data types may contain subcomponents that are specified by data types.

The following list of data types only includes those that are used by elements that are used in this guide. Data types for elements that are not used in this Guide are not

included, even if they are part of segment that is used.

Data types are further defined in this implementation guide for all elements that have a usage of R, RE, C(a/b). Data types used only for optional elements are not

included. Many of these data types place constraints on the data types from the base HL7 standard. These constrained data type specifications only apply to elements that

have a usage of Required (R), Required But May be Empty (RE) or Conditional. All other elements do not have the constraints applied. Please refer to the base standard

for those data types.

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Table 3 Data Types

Table 4-1 Data Types

Data type Data Type Name

Coded element

CE_TX

Text only CE data type

Composite Quantity with Units

CWE

Coded with Exceptions

Extended Composite Id with Check digit

Date

DT_D

Date with precision to day

DTM

Date/Time

Entity Identifier

ERL

Error Location

Family Name

Formatted text

Hierarchic Designator

Coded Values for HL7 Tables

Coded value for User-Defined Tables

LA2

Location with address variation 2

MSG

Message Type

Numeric

Processing Type

SAD

Street Address

Sequence ID

String

Time Stamp

TS_M

Time Stamp with optional precision to the day and no time zone

TS_NZ

Time Stamp with precision to the day and no time zone

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Table 4-1 Data Types

Data type Data Type Name

TS_Z Time Stamp requiring time zone

VID

Version Identifier

XAD

Extended Address

XCN Extended Composite ID Number and Name for Persons

XON

Extended Name and Id Number for Organizations

XPN

Extended Person Name

XTN Extended telephone number

CE -- Coded Element (most uses)

Definition: This data type transmits codes and the text associated with the code.

Table 4 Coded Element (CE)

Table 4-2 Coded Element (CE)

SEQ Component

Name

Data

Type

Usage LEN Conditional Predicate Value

Set

Comments

Identifier

1..50

Identifying Code.

Text

1..999

Human readable text that may be used to

review segment content.

Name of Coding

System

1..20

HL70396

Value set identifier

Alternate

Identifier

1..50

Alternate Identifying code.

Alternate Text

C(RE/X)

1..999

If CE-4 (Alternate Identifier) is

valued

Human readable text.

Name of

Alternate Coding

system

C(R/X)

1..20

If CE-4 (Alternate Identifier) is

valued

HL70396

Value set identifier.

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Note:

The alternate identifier (from the alternate coding system) should be the closest match for the identifier found in CE-1.

The order of the contents is not specified. In the previous guide, the first triplet was reserved for CVX codes in RXA-5. This is no longer true, based on HL7

usage of CE data type.

Identifier (ST)

Definition: Sequence of characters (the code) that uniquely identifies the item being referenced. Different coding schemes will have different elements here.

Text (ST)

Definition: The descriptive or textual name of the identifier, e.g., DTaP. This is not used by the sending or receiving system, but rather facilitates human

interpretation of the code. It may be used as the display text.

Name of Coding System (ID)

Definition: Identifies the coding system being used in the identifier component. The combination of the identifier and name of coding system components will

be a unique code for a data item. Each system has a unique identifier.

Alternate Identifier (ST)

Definition: An alternate sequence of characters (the code) that uniquely identifies the item being referenced. See usage note in section introduction.

Alternate Text (ST)

Definition: The descriptive or textual name of the alternate identifier, e.g., DTaP. This is not used by the sending or receiving system, but rather facilitates human

interpretation of the code.

Name of Alternate Coding System (ID)

Definition: Identifies the coding scheme being used in the alternate identifier component.

Example usage:

From RXA 5, Administered Code:

|50^DTAP-HIB^CVX^90721^DTAP-HIB^C4|

CE_TX -- Coded Element (text only in RXA-9)

Definition: The CE_TX data type definition is used to transmit text only notes in RXA-9 (Administration Notes).

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Table 5 Coded Element (CE) for Text Only RXA-9

Table 4-3 Coded Element (CE) for Text Only RXA-9

SEQ Component

Name

Data

Type

Usage LEN Conditional Predicate Value

Set

Comments

Identifier

Text

999

Human readable text that is not further

processed. It may be stored by the receiving

system.

Name of Coding

Alternate

Identifier

Alternate Text

Name of

Alternate

Note: When transmitting text note only, only the first triplet shall be populated.

Text (ST)

Definition: Free text note regarding the immunization reported in this RXA.

CQ -- Composite Quantity with Units

Definition: This data type carries a quantity and attendant units. Its’ primary use in this Guide will be for indicating the maximum number of records to return in a query

response.

Tabl

e 6 Composite Quantity with Units (CQ)

Table 4-4 Composite Quantity with Units (CQ)

SEQ

COMPONENT

NAME

Usage LEN Conditional Predicate Value set COMMENTS

1 Quantity NM R 16

2 Units CE R HL7 0126

(constrained)

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Conformance Statement:

IZ-1: CQ-1 (Quantity) shall be a positive integer.

IZ-2: CQ-2 (Units) shall be the literal value “RD”.

Examples:

|10^RD&records&HL70126| 10 records

Reminder that the subcomponent separator is used when CE data type is a component of another data type

Quantity (NM)

Definition: This component specifies the numeric quantity or amount of an entity.

Units (CE)

Definition: This component species the units in which the quantity is expressed.

CWE -- Coded With Exceptions

Definition: Specifies a coded element and its associated detail. The CWE data type is used when 1) more than one table may be applicable or 2) the specified

HL7 or externally defined table may be extended with local values or 3).

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Chapter 4: HL7 Data Types

Table 7 Coded with Exceptions (CWE)

Table 4-5 Coded with Exceptions (CWE)

SEQ Usage LEN Conditional Predicate Comments

Identifier

1..999

Identifying Code.

Text

1..999

Human readable text that is not further used.

Name of Coding

C(R/X)

1..20

If CWE.1(Identifier) is valued

HL70396

Alternate

Identifier

1..999

Alternate Identifying coded.

Alternate Text

C(RE/X)

1..999

If CWE.4 (Alternate Identifier) is

valued

Human readable text that is not further used.

Name of

Alternate System

C(R/X)

1..20

If CWE.4 (Alternate Identifier) is

valued

HL70396

7 Coding

System

Version Id

ST O

8 Alternate

Coding

System

Version Id

ST O

9 Original Text ST O

Note: The alternate identifier (from the alternate coding system) should be the closest match for the identifier found in component 1.

Identifier (ST)

Definition: Sequence of characters (the code) that uniquely identifies the item being referenced. Different coding schemes will have different elements here.

Text (ST)

Definition: The descriptive or textual name of the identifier, e.g., DTaP. This is not used by the sending or receiving system, but rather facilitates human

interpretation of the code.

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Component

Name

Data

Type

Value

Set

Chapter 4: HL7 Data Types

Name of Coding System (ID)

Definition: Identifies the coding scheme being used in the identifier component. The combination of the identifier and name of coding system components will

be a unique code for a data item. Each system has a unique identifier.

Alternate Identifier (ST)

Definition: An alternate sequence of characters (the code) that uniquely identifies the item being referenced. See usage note in section introduction.

Alternate Text (ST)

Definition: The descriptive or textual name of the alternate identifier, e.g., DTaP. This is not used by the sending or receiving system, but rather facilitates human

interpretation of the code.

Name of Alternate Coding System (ID)

Definition: Identifies the coding scheme being used in the alternate identifier component.

Example usage:

From RXR: |C28161^IM^NCIT^IM^INTRAMUSCULAR^HL70162|

CX -- Extended Composite ID With Check Digit

Definition: This data type is used for specifying an identifier with its associated administrative detail.

able 8 Extended Composite ID with Check Digit (CX)

Table 4-6 Extended Composite ID with Check Digit (CX)

SEQ

COMPONENT

NAME

Data

Type

Usage LEN Conditional Predicate

Value

set

COMMENTS

1 ID Number ST R 15

2 Check Digit ST O

3 Check Digit

Scheme

ID C(O/X) If CX. 2 (check digit) is valued HL70061

4 Assigning Authority HD R HL70363

5 Identifier Type ID R 2..5 HL70203

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Chapter 4: HL7 Data Types

Table 4-6 Extended Composite ID with Check Digit (CX)

Code

6 Assigning Facility HD O

7 Effective Date DT O

8 Expiration Date DT O

9 Assigning

Jurisdiction

CWE O

10 Assigning Agency

or Department

CWE O

Example:

|1234567^^^ME129^MR|

ID Number (ST)

Definition: The value of the identifier itself.

Assigning Authority (HD)

The assigning authority is a unique name of the system (or organization or agency or department) that creates the data. Refer to User-defined Table 0363 –

Assigning authority for suggested values. This table shall be populated by each IIS. The first component shall be used for this unique name. The second and third

may be used if OIDs

are recorded.

Identifier Type Code (ID)

A code corresponding to the type of identifier. In some cases, this code may be used as a qualifier to the “Assigning authority” component. Refer to HL7 Table

0203 - Identifier type for suggested values.

OIDs are object identifiers. According to Wikipedia: “Health Level Seven (HL7), a standards-developing organization in the area of electronic health care data exchange, is an assigning authority at the

2.16.840.1.113883 (joint-iso-itu-t.country.us.organization.hl7) node. HL7 maintains its own OID registry, and as of January 1, 2008 it contained almost 3,000 nodes, most of them under the HL7 root. The Centers

for Disease Control and Prevention has also adopted OIDs to manage the many complex values sets or "vocabularies" used in public health. The various OIDs are available in the Public Health Information

Network (PHIN) Vocabulary Access and Distribution System (VADS).”

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Chapter 4: HL7 Data Types

DT -- Date

Definition: Specifies the century and year with optional precision to month and day.

Tabl

e 9 Date (DT)

Table 4-7 Date (DT)

SEQ LEN Conditional Predicate Comments

Date

4..8

As of v 2.3, the number of digits populated specifies the precision using the format specification YYYY[MM[DD]]). Thus:

• Four digits are used to specify a precision of "year"

• Six are used to specify a precision of "month"

• Eight are used to specify a precision of "day."

Examples:

|19880704|

|199503|

|2000|

DT_D -- Date with precision to day

Definition: Specifies the century and year with optional precision to month and day.

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Component

Name

Data

Type

Usage Value

Set

Chapter 4: HL7 Data Types

Table 10 Date With Precision to Day (DT_D)

Table 4-8 Date (DT_D)

SEQ

Usage LEN Conditional Predicate Comments

Date

4..8

The Precision of this DT_D data type has the following constraints.

YYYY R

[SS[.S[S[S[S]]]]]

+/-ZZZZ

DTM -- Date/Time

Table 11 Date/Time (DTM)

Table 4-9 Date/Time (DTM)

SEQ Component

Name

Data

Type

Usage LEN Conditional Predicate Value

Set

Comments

Date/time

4..24

he number of characters populated (excluding the time zone specification) specifies the precision.

Format: YYYY[MM[DD[HH[MM[SS[.S[S[S[S]]]]]]]]][+/-ZZZZ].

Thus:

• Eight are used to specify a precision of "day."

• the first ten are used to specify a precision of "hour”

• the first twelve are used to specify a precision of "minute”

• the first fourteen are used to specify a precision of "second”

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Component

Name

Data

Type

Value

Set

Chapter 4: HL7 Data Types

• the first sixteen are used to specify a precision of "one tenth of a second”

• the first nineteen are used to specify a precision of " one ten thousandths of a second”

When the time zone is not included, it is presumed to be the time zone of the sender.

Example: |199904| specifies April 1999.

Note that this data type will be constrained at the field level, depending on the use.

EI -- Entity Identifier

Definition: The entity identifier defines a given entity within a specified series of identifiers.

able 12 Entity Identifier (EI)

Table 4-10 Entity Identifier (EI)

SEQ

COMPONENT

NAME

Data

Type

Usage LEN Conditional Predicate

Value

Set

COMMENTS

1 Entity Identifier ST R 1..199

2 Namespace ID IS C(R/O) 20 If EI.3 (Universal Id) is not valued HL70363

3 Universal ID ST C(R/O) 199 If EI.2 (Namespace ID) is not

valued

4 Universal ID Type ID C(R/X) 6 If EI.3 (Universal Id) is valued HL70301

(constrained

)

Conformance Statement:

IZ-3: Conformance Statement: If populated EI.3 (Universal Id), it shall be valued with an ISO-compliant OID.

IZ-4: Conformance Statement: If populated EI.4 is populated (Universal ID Type), it shall contain the value “ISO”.

Entity Identifier (ST)

The first component, <entity identifier>, is defined to be unique within the series of identifiers created by the <assigning authority>, defined by a hierarchic

designator, represented by component 2.

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Chapter 4: HL7 Data Types

Namespace ID (IS)

The assigning authority is a unique identifier of the system (or organization or agency or department) that creates the data. Refer to User-defined Table 0363 –

Assigning authority for suggested values.

Universal ID (ST)

This is a universal id associated with this entity. It must be linked to the Universal Id Type below. If populated, it shall be an OID.

Universal ID Type (ID)

This universal id type is drawn from HL7 Table 0301. If populated, it shall be ISO.

Example:

From MSH 21 profile identifier:

|Z34^CDCPHINVS|

ERL -- Error Location

Definition: This data type identifies the segment and its constituent where an error has occurred.

Table 13 Error Location (ERL)

Table 4-11 Error Location (ERL)

SEQ

COMPONENT

NAME

Data

Type

Usage LEN Conditional Predicate

Value

Set

COMMENTS

1 Segment ID ST R 3..3 The 3-character name for the segment (i.e.

PID)

2 Segment

Sequence

NM R 1.2

3 Field Position NM C(R/RE) 2 If ERL.4 (Field Repetition) is

valued

This should not be populated if the error refers

to the whole segment.

4 Field Repetition NM C(R/RE) 2 If ERL.5 (Component Number)

is valued

5 Component

Number

NM C(R/RE) 2 If ERL.6 (Sub-Component

Number) is valued

Should be populated ONLY when a particular

component cause the error.

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Chapter 4: HL7 Data Types

Table 4-11 Error Location (ERL)

SEQ

COMPONENT

NAME

Data

Type

Usage LEN Conditional Predicate

Value

Set

COMMENTS

6 Sub-Component

Number

NM RE 2 Should be populated ONLY when a particular

sub-component cause the error.

Segment ID (ST)

Definition: Specifies the 3-letter name for the segment.

Segment Sequence (NM)

Definition: Identifies the segment occurrence within the message. That is, for the first instance of the segment in the message the number shall be 1 and for the

second 2. It is not the sequence within a sequence group. For example if a message had 3 order groups and each order group had 3 OBX, the Sequence number

of the last OBX in the message would be 9.

Field Position (NM)

Definition: Identifies the number of the field within the segment. The first field is assigned a number of 1. Field number should not be specified when referring to

the entire segment.

Field Repetition (NM)

Definition: Identifies the repetition number of the field. The first repetition is counted as 1. If a Field Position is specified, but Field Repetition is not, Field

Repetition should be assumed to be 1. If Field Position is not specified, Field Repetition should not be specified.

Component Number (NM)

Definition: Identifies the number of the component within the field. The first component is assigned a number of 1. Component number should not be specified

when referring to the entire field.

Sub-Component Number (NM)

Definition: Identifies the number of the sub-component within the component. The first sub-component is assigned a number of 1. Sub-component number

should not be specified when referring to the entire component.

Example:

|RXA^1^5^1|

Error in the fifth field of the first occurrence.

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Chapter 4: HL7 Data Types

FN -- Family Name

Definition: This data type contains a person’s family name (i.e. surname ).

Tab

le 14 Family Name

Table 4-12 Family Name

SEQ

COMPONENT

NAME

Data

Type

Usage LEN Conditional Predicate

Value

Set

COMMENTS

1 Surname ST R 1..50

2 Own Surname

Prefix

ST O

3 Own Surname ST O

4 Surname Prefix

From

Partner/Spouse

ST O

5 Surname From

Partner/Spouse

ST O

Surname (ST)

This is the person's last name.

FT – Formatted Text

Table 15 Formated Text

Table 4-13 Formatted Text

SEQ

COMPONENT

NAME

Data

Type

Usage LEN Conditional Predicate

Value

Set

COMMENTS

1 Formatted Text

Data

1..65536

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Chapter 4: HL7 Data Types

Usage Note

The FT data type allows use of the formatting escape sequences documented in HL7 Version 2.5.1, Chapter 2, Section 2.7.1 - Use of Escape Sequences in Text Fields. In

this implementation guide, the only allowed escape sequences are those allowed in HL7 Version 2.5.1, Chapter 2, Section 2.7.4 - Special Characters. These are the escape

sequences for the message delimiters (i.e., |^&~\ ).

HD -- Hierarchic Designator

The use of OIDs in fields using this data type is encouraged. Note that either HD.1 (name space id) or HD.2 (universal id ) is required.

efinition: HD identifies an (administrative or system or application or other) entity that has responsibility for managing or assigning a defined set of instance identifiers

(such as placer or filler number, patient identifiers, provider identifiers, etc.). This entity could be a particular health care application such as a registration system that

assigns patient identifiers, a governmental entity such as a licensing authority that assigns professional identifiers or drivers’ license numbers, or a facility where such

identifiers are assigned.

** Note that when HD is a sub-component of another data type, the Sub-component Separator (&) is used to separate the subcomponents rather than the component

separator (^).

Table 16 Hierarchical Designator (HD)

Table 4-14 Hierarchical Designator (HD)

SEQ

COMPONENT

NAME

Data

Type

Usage LEN Conditional Predicate Value Set COMMENTS

1 Namespace ID IS C(R/O) 1..20 If the HD.2 (Universal ID) is not

valued

HL70300

HL70361

HL70362

HL70363

This field is used for a locally defined

name/id. It may be used as previous version

2.3.1 Implementation Guide specified.

The value set used depends on usage.

2 Universal ID ST C(R/O) 1..199 If the HD.1 (Namespace ID) is not

valued

3 Universal ID Type ID C(R/X) 1..6 If the HD.2 (Universal ID) is valued HL70301

(Constrained)

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Chapter 4: HL7 Data Types

Conformance Statement:

IZ-5: If populated, HD.2 (Universal ID) it SHALL be valued with an ISO--compliant OID.

IZ-6: If populated, HD.3 (Universal ID Type) SHALL be valued the literal value: “ISO”.

ID -- Coded Values for HL7 Tables

Definition: This data type is used for coded values from an HL7 table.

Table 17 ID Data Type

Table 4-15 ID Data Type

SEQ

COMPONENT

NAME

Data

Type

Usage LEN Conditional Predicate

Value

Set

COMMENTS

1 Coded Value for

HL7-defined

Tables

1..15

e value of such a field follows the formatting rules for an ST field except that it is drawn from a table of legal values. There shall be an HL7 table number associated

with ID data types. An example of an ID field is PID 24 –Multiple Birth Indicator. This data type should be used only for HL7 tables (see Appendix A).

Example from PID Multiple Birth Indicator:

|Y|

IS -- Coded Values for User Defined Tables

Definition: This data type is used for codes from User-defined Tables.

Table 18 Coded Values for User Defined Tables (IS)

Table 4-16 Coded Values for User Defined Tables (IS)

SEQ

COMPONENT

NAME

Data

Type

Usage

Leng

Conditional Predicate

Value

Sets

COMMENTS

1 Coded Value for

User-Defined

Tables

1..20

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Chapter 4: HL7 Data Types

The

value of such a field follows the formatting rules for a ST field except that it is drawn from a site-defined (or user-defined) table of legal values. There shall be an

HL7 table number associated with IS data types. This data type should be used only for user-defined tables.

Example from PID Sex:

|F|

LA2 -- Location with Address Variation 2

Definition: Specifies a location and its address.

Table 19 Location with Address Variation 2

Table 4-17 Location with Address Variation 2

SEQ

COMPONENT

NAME

Data

Type

Usage LEN Conditional Predicate

Value

Sets

COMMENTS

1 Point of Care IS O

This represents the location within a facility

that the service was provided. This is not the

clinic site where an event occurred.

2 Room IS O

3 Bed IS O

4 Facility HD R HL70362 This represents the location that the service

was provided. For example the clinic.

5 Location Status IS O

6 Patient Location

Type

IS O

7 Building IS O

8 Floor IS O

9 Street Address ST O

10 Other Designation ST O

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Chapter 4: HL7 Data Types

Table 4-17 Location with Address Variation 2

SEQ

COMPONENT

NAME

Data

Type

Usage LEN Conditional Predicate

Value

Sets

COMMENTS

11 City ST O

12 State or Province ST O

13 Zip or Postal

Code

ST O

14 Country ID O

15 Address Type ID O

16 Other Geographic

Designation

ST O

Facility (HD)

This is the location that the service was provided, for example a clinic. This may be a clinic that is a part of a larger provider organization or a provider organization. It is

the location that is responsible for the inventory used for this immunization. If it provides Vaccine for Children funded vaccines, then it has a VFC PIN assigned.

MSG -- Message Type

Definition: This field contains the message type, trigger event, and the message structure ID for the message.

Table 20 Message Type (MSG)

Table 4-18 Message Type (MSG)

SEQ

COMPONENT

NAME

Data

Type

Usage LEN Conditional Predicate Value Set COMMENTS

1 Message Code ID R 3..3 HL70076

(constrained)

2 Trigger Event ID R 3..3 HL70003

(constrained)

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Chapter 4: HL7 Data Types

Table 4-18 Message Type (MSG)

SEQ

COMPONENT

NAME

Data

Type

Usage LEN Conditional Predicate Value Set COMMENTS

3 Message

Structure

ID R 3..7 HL70354

(constrained)

Message Code (ID)

Definition: Specifies the message type code. Refer to HL7 Table – Message Type in section 2.17.1 for valid values.

This table contains values such as ACK, ADT, ORU etc.

See section 2.5.1- Messages for further discussion.

Trigger Event (ID)

Definition: Specifies the trigger event code. Refer to HL7 Table – Event Type in section 2.17.2 for valid values.

This table contains values like A01, V01, R01 etc.

Message Structure (ID)

Definition: Specifies the abstract message structure code. Refer to HL7 Table 0354.

xample from MSH:

|VXU^V04^VXU_V04|

NM -- Numeric

Definition: A number represented as a series of ASCII numeric characters consisting of an optional leading sign (+ or -), the digits and an optional decimal point.

In the absence of a sign, the number is assumed to be positive. If there is no decimal point the number is assumed to be an integer.

Tab

le 21 Numeric (NM)

Table 4-19 Numeric (NM)

SEQ

COMPONENT

NAME

Data

Type

Usage LEN Conditional Predicate

Value

Set

COMMENTS

1 Numeric R 1..16

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Chapter 4: HL7 Data Types

Examples:

|999|

|-123.792|

Leading zeros, or trailing zeros after a decimal point, are not significant. For example, the following two values with different representations, “01.20” and “1.2,"

are identical. Except for the optional leading sign (+ or -) and the optional decimal point (.), no non-numeric ASCII characters are allowed. Thus, the value <12

should be encoded as a structured numeric (SN) (preferred) or as a string (ST) (allowed, but not preferred) data type.

PT -- Processing Type

Definition: This data type indicates whether to process a message as defined in HL7 Application (level 7) Processing rules.

Tab

le 22 Processing Type (PT)

Table 4-20 Processing Type (PT)

SEQ

COMPONENT

NAME

Data

Type

Usage LEN Conditional Predicate

Value

Set

COMMENTS

1 Processing ID ID R 1..1 HL70103

2 Processing Mode ID O

Processing ID (ID)

A value that defines whether the message is intended for a production, training, or debugging system. Refer to HL7 Table 0103 - Processing ID for valid values.

SAD -- Street Address

Definition: This data type specifies an entity's street address and associated detail.

Table 23 Street Address (SAD)

Table 4-21 Street Address (SAD)

SEQ

COMPONENT

NAME

Data

Type

Usage

LEN

Conditional Predicate

Value Set

COMMENTS

1 Street or Mailing

Address

ST R 1..120

2 Street Name ST O

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Chapter 4: HL7 Data Types

Table 4-21 Street Address (SAD)

SEQ

COMPONENT

NAME

Data

Type

Usage

LEN

Conditional Predicate

Value Set

COMMENTS

3 Dwelling Number ST O

Note: Appears ONLY in the XAD data type

Street or Mailing Address (ST)

Definition: This component specifies the street or mailing address of a person or institution.

SI -- Sequence Id

Definition: A non-negative integer in the form of a NM field. The uses of this data type are defined in the chapters defining the segments and messages in which

it appears.

Tab

le 24 Sequence Id (SI)

Table 4-22 Sequence Id (SI)

SEQ

COMPONENT

NAME

Data

Type

Usage LEN Conditional Predicate

Value

set

COMMENTS

1 Sequence ID 1..4

ST – String

Definition: String data is left justified with trailing blanks optional. Any displayable (printable) ACSII characters (hexadecimal values between 20 and 7E,

inclusive, or ASCII decimal values between 32 and 126), except the defined escape characters and defined delimiter characters.

Tab

le 4-22 String (ST)

Table 4-22 String (ST)

SEQ

COMPONENT

NAME

Data

Type

Usage LEN Conditional Predicate

Value

set

COMMENTS

1 String Data

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Chapter 4: HL7 Data Types

Usage Note

The ST data type is normally used for short text strings. No leading blanks (space characters) are permitted. Trailing blanks are permitted. In this implementation guide,

the only allowed escape sequences are those allowed in HL7 Version 2.5.1, Chapter 2, Section 2.7.4 - Special Characters. These are the escape sequences for the message

delimiters (i.e., |^&~\ )

TS -- Time Stamp

Definition: Specifies a point in time.

able 25 Time Stamp (TS)

Table 4-23 Time Stamp (TS)

SEQ

COMPONENT

NAME

Data

Type

Usage LEN Conditional Predicate

Value

Set

COMMENTS

1 Time DTM R

2 Degree of

Precision

ID X

The DTM component of this Time Stamp has the following constraints:

YYYY R

MM R

DD R

HH O

MM O

[SS[.S[S[S[S]]]]] O

+/-ZZZZ O

TS_M -- Time Stamp to Month

Definition: Specifies a point in time. This data type requires a precision to the month. Precision to the day is optional.

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Table 26 Time Stamp Precision to Month (TS)

Table 4-24 Time Stamp Precision to Month (TS_M)

SEQ

COMPONENT

NAME

Data

Type

Usage LEN Conditional Predicate

Value

Set

COMMENTS

1 Time DTM R

2 Degree of

Precision

ID X

The DTM component of this Time Stamp has the following constraints:

YYYY R

MM R

DD O

HH O

MM O

[SS[.S[S[S[S]]]]] O

+/-ZZZZ O

TS_NZ -- Time Stamp No Time Zone

Definition: Specifies a point in time. This data type requires a precision to the day. No Time zone is included.

Tab

le 27 Time Stamp No Time Zone (TS_NZ)

Table 4-25 Time Stamp No time Zone (TS_NZ)

SEQ

COMPONENT

NAME

Data

Type

Usage LEN Conditional Predicate

Value

Set

COMMENTS

1 Time DTM R

2 Degree of

Precision

ID X

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Table 4-25 Time Stamp No time Zone (TS_NZ)

SEQ

COMPONENT

NAME

Data

Type

Usage LEN Conditional Predicate

Value

Set

COMMENTS

The DTM component of this Time Stamp has the following constraints:

YYYY R

MM R

DD R

HH O

MM O

[SS[.S[S[S[S]]]]] O

+/-ZZZZ X

TS_Z -- Time Stamp with Time Zone

Definition: Specifies a point in time. This data type requires a precision to the second and requires that the time zone be included.

able 28 Time Stamp with Time Zone (TS_Z)

Table 4-26 Time Stamp with time zone (TS_Z)

SEQ

COMPONENT

NAME

Data

Type

Usage LEN Conditional Predicate

Value

Set

COMMENTS

1 Time DTM R

2 Degree of

Precision

ID X

The DTM component of this Time Stamp has the following constraints:

YYYY R

MM R

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Table 4-26 Time Stamp with time zone (TS_Z)

SEQ

COMPONENT

NAME

Data

Type

Usage LEN Conditional Predicate

Value

Set

COMMENTS

DD R

HH O

MM O

[SS[.S[S[S[S]]]]] O

+/-ZZZZ R

VID -- Version Id

Definition: This specifies the HL7 version.

able 29 Version ID (VID)

Table 4-27 Version ID (VID)

SEQ

COMPONENT

NAME

Data

Type

Usage LEN Conditional Predicate

Value

Set

COMMENTS

1 Version ID ID R 5..5 HL70104

(constrained

)

2 Internationalization

Code

CE O

3 International

Version ID

CE O

Conformance Statement:

IZ-7: VID-1 (Version Id) SHALL be valued with the literal “2.5.1”

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Chapter 4: HL7 Data Types

Version ID (ID)

Used to identify the HL7 version. Only “2.5.1” will be accepted.

XAD -- Extended Address

Definition: This data type specifies the address of a person, place or organization plus associated information.

able 30 Extended Address (XAD)

Table 4-28 Extended Address (XAD)

SEQ

COMPONENT

NAME

Data

Type

Usage LEN Conditional Predicate

Value

Sets

COMMENTS

1 Street Address SAD RE

2 Other Designation ST RE 1..120

3 City ST RE 1..50

4 State or Province ST RE 1..50 US Postal

Service

state codes

Two character USPS codes, for example:

AL, AK, ME

5 Zip or Postal

Code

ST RE 1..12

6 Country ID RE 3..3 HL70399 Empty defaults to USA

7 Address Type ID R 1..3 HL70190

8 Other Geographic

Designation

ST O

9 County/Parish

Code

IS O

10 Census Tract IS O

11 Address

Representation

Code

ID O

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Table 4-28 Extended Address (XAD)

SEQ

COMPONENT

NAME

Data

Type

Usage LEN Conditional Predicate

Value

Sets

COMMENTS

12 Address Validity

Range

DR X deprecated as of v 2.5

13 Effective Date TS O

14 Expiration Date TS O

Example of usage for US:

|1000 Hospital Lane^Ste. 123^Ann Arbor ^MI^99999^^B|

This would be formatted for postal purposes as

1000 Hospital Lane

Ste. 123

Ann Arbor MI 99999

Street Address (SAD)

Definition: This is the street address.

Other Designation (ST)

Definition: Second line of address. In US usage, it qualifies address. Examples: Suite 555 or Fourth Floor. This can be used for dwelling number.

City (ST)

Definition: This component specifies the city, or district or place where the addressee is located depending upon the national convention for formatting addresses

for postal usage.

State or Province (ST)

Definition: This component specifies the state or province where the addressee is located. State or province should be represented by the official postal service

codes for that country. In the US it SHALL be the 2 character state codes (ie AK, ME, WI)

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Zip or Postal Code (ST)

Definition: This component specifies the zip or postal code where the addressee is located. Zip or postal codes should be represented by the official codes for that

country. In the US, the zip code takes the form 99999[-9999], while the Canadian postal code takes the form A9A9A9, and the Australian Postcode takes the

form 9999.

Country (ID)

Definition: This component specifies the country where the addressee is located. HL7 specifies that the 3-character (alphabetic) form of ISO 3166 be used for the

country code. Refer to HL7 Table 0399 – Country code in section 2.15.9.17 for valid values.

Address Type (ID)

Definition: This component specifies the kind or type of address. Refer to HL7 Table 0190 - Address type for valid values.

XCN - Extended Composite ID Number and Name for Persons

Definition: This data type identifies a person using a unique id and name. The ID is associated with an entity such as an organization, which

assigns the ID. This data type is used where there is a need to specify the ID number and name of a person.

Table 31 Extended Composite ID Number and Name (XCN)

Table 4-29 Extended Composite ID Number and Name (XCN)

SEQ

COMPONENT

NAME

Data

Type

Usage LEN Conditional Predicate

Value

Set

COMMENTS

1 ID Number ST C(R/RE) 1..15 If XCN.2.1 (Surname) and XCN.3

(Given Name) are not valued

2 Family Name FN RE

3 Given Name ST RE 30

4 Second and

Further Given

Names or Initials

Thereof

ST RE 30

5 Suffix (e.g., JR or

III)

ST O

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Table 4-29 Extended Composite ID Number and Name (XCN)

SEQ

COMPONENT

NAME

Data

Type

Usage LEN Conditional Predicate

Value

Set

COMMENTS

6 Prefix (e.g., DR) ST O

7 Degree (e.g., MD) IS X Use Professional suffix in sequence 21.

8 Source Table IS O

9 Assigning Authority HD C(R/X) If the XCN-1 (id number) is valued HL70363 Note that the subcomponent separator is &

when HD is a component of another data type.

10 Name Type Code ID RE 1 HL70200

11 Identifier Check

Digit

ST O

12 Check Digit

Scheme

ID C(O/X) If XCN-11 (check digit identifier) is

valued

13 Identifier Type

Code

ID O

14 Assigning Facility HD O

15 Name

Representation

Code

ID O

16 Name Context CE O

17 Name Validity

Range

DR X

18 Name Assembly

Order

ID X

19 Effective Date TS O

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Table 4-29 Extended Composite ID Number and Name (XCN)

SEQ

COMPONENT

NAME

Data

Type

Usage LEN Conditional Predicate

Value

Set

COMMENTS

20 Expiration Date TS O

21 Professional Suffix ST O

22 Assigning

Jurisdiction

CWE O

23 Assigning Agency

or Department

CWE O

ote: The ID Number component combined with the Assigning Authority (XCN.9) must uniquely identify the associated person.

Note: If XCN-2.1 (Surname) and XCN-3 (Given Name) are populated then XCN-10 ( name type code) defaults to L, legal name.

ID number (ST)

This string refers to the coded ID assigned by the assigning authority.

Family Name (FN)

This component contains the person’s surname.

Given Name (ST)

First name.

Second and Further Given Names or Initials Thereof (ST)

Multiple middle names may be included by separating them with spaces.

Suffix (ST)

Used to specify a name suffix (e.g., Jr. or III).

Prefix (ST)

Used to specify a name prefix (e.g., Dr.).

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Assigning Authority (HD)

The assigning authority is a unique identifier of the system (or organization or agency or department) that creates the identifier.. User-defined Table 0363 –

Assigning authority is used as the HL7 identifier for the user-defined table of values for the first sub-component of the HD component, <namespace ID>.

Note: When HD data type is used as a component of another data type, its components are demoted to subcomponents. This means that each component is

separated by & rather than ^. For example:

Name space id^some OID^ISO becomes Name space id&some OID&ISO

Note: User-defined Table 0363 is specified by this Implementation Guide for Assigning Authority.

Name Type Code (ID)

A code that represents the type of name. Refer to HL7 Table 0200 - Name type for valid values. If the field is not populated then the value is assumed to be L.

XON - Extended Composite Name and ID Number and Name for Organizations

Definition: This data type identifies an organization using a unique id and name. The ID is associated with an entity such as an organization, which assigns the

ID.

able 32 Extended Composite ID Number and Name for Organizations (XON)

Table 4-30 Extended Composite ID Number and Name for Organizations (XON)

SEQ

COMPONENT

NAME

Data

Type

Usage LEN Conditional Predicate

Value

Set

COMMENTS

1 Organization Name ST RE 1..50

2 Organization Name

Type Code

IS O

3 ID Number X

4 Check Digit O

5 Check Digit

Scheme

6 Assigning Authority HD C(R/O) If XON.10 (Organization Identifier)

is valued

The Assigning Authority is used to identify the

system, application or organization that

assigned the ID in Component 10.

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Table 4-30 Extended Composite ID Number and Name for Organizations (XON)

SEQ

COMPONENT

NAME

Data

Type

Usage LEN Conditional Predicate

Value

Set

COMMENTS

7 Identifier Type

Code

ID C(R/X) 2..5 If XON.10 (Organization Identifier)

is valued

HL70203

8 Assigning Facility HD O

9 Name

Representation

Code

ID O

10 Organization

Identifier

ST C(R/RE) 1..20 If XON.1 (Organization Name) is

not valued

XPN -- Extended Person Name

Definition: This is used for representing a person’s name.

able 33 Extended Person Name (XPN)

Table 4-31 Extended Person Name (XPN)

SEQ

COMPONENT

NAME

Data

Type

Usage LEN Conditional Predicate

Value

Sets

COMMENTS

1 Family Name FN R

2 Given Name ST R 30

3 Second and

Further Given

Names or Initials

Thereof

ST RE 30

4 Suffix (e.g., JR or

III)

ST O

5 Prefix (e.g., DR) ST O

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Table 4-31 Extended Person Name (XPN)

SEQ

COMPONENT

NAME

Data

Type

Usage LEN Conditional Predicate

Value

Sets

COMMENTS

6 Degree (e.g., MD) IS X Use Professional suffix in sequence 14

7 Name Type Code ID RE 1 HL70200

8 Name

Representation

Code

ID O

9 Name Context CE O

10 Name Validity

Range

DR X

11 Name Assembly

Order

ID O

12 Effective Date TS O

13 Expiration Date TS O

14 Professional

Suffix

ST O

Note: Replaces PN data type as of v 2.3.

Family Name (FN)

This is the person’s surname or family name.

Given Name (ST)

First name.

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Second and Further Given Names or Initials Thereof (ST)

Multiple middle names may be included by separating them with spaces.

Suffix (ST)

Used to specify a name suffix (e.g., Jr. or III).

Prefix (ST)

Used to specify a name prefix (e.g., Dr.).

Name Type Code (ID)

A code that represents the type of name. Refer to HL7 Table 0200 - Name type for valid values.

Note: The content of Legal Name is country specific. In the US the legal name is the same as the current married name.

Professional Suffix (ST)

This is the person’s professional suffix. Replaces degree above.

XPN_M -- Extended Person Name – Maiden Name

Definition: This is used for representing a mother’s maiden name.

able 34 Extended Person Name (XPN_M)

Table 4-32 Extended Person Name (XPN_M)

SEQ

COMPONENT

NAME

Data

Type

Usage LEN Conditional Predicate

Value

Sets

COMMENTS

1 Family Name FN R

2 Given Name ST RE 30

3 Second and

Further Given

Names or Initials

Thereof

ST O 30

4 Suffix (e.g., JR or

III)

ST O

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Table 4-32 Extended Person Name (XPN_M)

SEQ

COMPONENT

NAME

Data

Type

Usage LEN Conditional Predicate

Value

Sets

COMMENTS

5 Prefix (e.g., DR) ST O

6 Degree (e.g., MD) IS X Use Professional suffix in sequence 14

7 Name Type Code ID R 1 HL70200

8 Name

Representation

Code

ID O

9 Name Context CE O

10 Name Validity

Range

DR X

11 Name Assembly

Order

ID O

12 Effective Date TS O

13 Expiration Date TS O

14 Professional

Suffix

ST O

Note: Replaces PN data type as of v 2.3.

IZ-66

: XPN_M.7 (Name Type code) SHALL be valued “M”.

Family Name (FN)

This is the person’s surname or family name.

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Given Name (ST)

First name.

Second and Further Given Names or Initials Thereof (ST)

Multiple middle names may be included by separating them with spaces.

Name Type Code (ID)

A code that represents the type of name. This SHALL be valued “M”.

XTN - Extended Telecommunication Number

Definition: This contains the extended telephone number.

Table 35 XTN Extended Telecommunication Number (XTN)

Table 4-33 XTN Extended Telecommunication Number (XTN)

SEQ

COMPONENT

NAME

Data

Type

Usage LEN Conditional Predicate

Value

Set

COMMENTS

1 Telephone

Number

ST X Deprecated as of 2.3

2 Telecommunicatio

n Use Code

ID R HL70201

3 Telecommunicatio

n Equipment Type

ID RE HL70202

4 Email Address ST C(R/X) 1..199 If the XTN-2 (Telecommunication

Use Code) is valued “NET”

5 Country Code NM O

6 Area/City Code NM C(RE/X) 5 If the XTN-2 (Telecommunication

Use Code) is valued not “NET”

7 Local Number NM C(R/X) 9 If the XTN-2 (telecommunication

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Table 4-33 XTN Extended Telecommunication Number (XTN)

SEQ

COMPONENT

NAME

Data

Type

Usage LEN Conditional Predicate

Value

Set

COMMENTS

use code) is valued not “NET”

8 Extension NM O

9 Any Text ST O

10 Extension Prefix ST O

11 Speed Dial Code ST O

12 Unformatted

Telephone

number

ST O

Note: The old implementation guide (2.3.1) allowed the first component to be used for phone number. This is not supported by this Guide.

Note: Replaces TN data type as of v 2.3

Example: A primary residence number

^PRN^PH^^^734^6777777

Telecommunication Use Code (ID)

A code that represents a specific use of a telecommunication number. Refer to HL7 Table 0201 - Telecommunication use code for valid values.

Telecommunication Equipment Type (ID)

A code that represents the type of telecommunication equipment. Refer to HL7 Table 0202 - Telecommunication equipment type for valid values.

Email Address (ST)

The email address for the entity.

Area/city Code (NM)

The telephone area code for the entity.

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Phone Number (NM)

The phone number for the entity.

Extension (NM)

The extension to the phone.

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5. Profile Z22-Send Unsolicited Immunization Update Using a VXU

Introduction:

Profile Z22 – Send Unsolicited Immunization Update is a constrainable profile that supports messaging of immunization history of an individual. It has a

partner profile for acknowledging processing of the message, Z23 – Return Acknowledgment.

The goal of this interaction is to transfer immunization information from one health information system to another. The Sending System may be an Electronic

Health Record system (EHRs), an Immunization Information System (IIS) or another type of health information system.

See Use Case 1—Send Immunization History above for Use Case details.

Interaction Definition:

This sequence diagram illustrates the message flow. The sender sends an immunization record in a VXU message. The trigger may be an update or new record in

the sending system records or may be triggered by some other event. The receiver accepts the message and processes it. The receiver sends an acknowledgment

message in an ACK message. The transactions that are of interest are indicated by bold arrows.

It is important to note that the message may pass through intermediaries, such as a Health Information Exchange (HIE). The message comes from the initiating

sender and the acknowledgement MUST be returned to the initiating system.

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Figure 36 Send Immunization History Sequence Diagram

Dynamic Definition:

The following diagram illustrates the expected flow of events. Some event triggers the sending system to create and send a VXU. The receiving system accepts

the VXU. If the message is of an unsupported message type, has an unsupported event code, has an unsupported processing ID or is unable to be processed for

reasons unrelated to format or content, then the acknowledgement code is set to “AR". The receiving system returns an ACK with the acknowledgement code of

“AR”. Otherwise, the receiving system continues to process the message. It parses the message and processes according to the specifications of this profile and

applies local business rules. If there are no errors, the acknowledgment code is set to “AA”. If there are errors, the acknowledgement code is set to “AE”. If the

errors are fatal (See Processing Rules for Receiving Systems above), then the message is rejected, otherwise the data are integrated into the receiving system. The

acknowledgement code is returned to the sending system in an ACK message.

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Figure 37 Send VXU Activity Diagram

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Static Definition—Message Level:

Systems may send unsolicited immunization records using a VXU. This may be a record that is new to the receiving system or may be an update to an existing

record. The following table lists the segments that are part of a VXU. Some of the optional segments are not anticipated to be used. See Appendix B for detailed

example messages that illustrate the processing of this message.

able 5-1 VXU Segment Usage

Table 5-1 VXU Segment Usage

Segment Cardinality Usage Comment

MSH

[1..1] R Every message begins with an MSH.

[SFT]

[0..*] O Not described in this Guide. May be locally specified.

PID

[1..1] R Every VXU has one PID segment.

[PD1 ]

[0..1] RE Every PID segment in VXU may have one or less PD1 segment

{[NK1]}

[0..*] RE The PID segment in a VXU may have zero or more NK1

segments.

[ Begin

Patient Visit

Group

[0..1] O Not described in this Guide. May be locally specified.

PV1

[1..1] R

PV2

[0..1] O

End Patient

Visit]

{GT1 }

[0..*] O Not described in this Guide. May be locally specified.

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Table 5-1 VXU Segment Usage

[ Begin

Insurance

Group

[0..1] O The insurance group may not repeat.

IN1

[1..1] R

IN2

[0..1] O

Not described in this Guide. May be locally specified.

IN3

[0..1] O Not described in this Guide. May be locally specified.

End Insurance group ]

{[Begin Order

group

[0..*] RE Each VXU may have zero or more Order groups

ORC

[1..1] R The order group in a VXU must have one ORC segments.

[TQ1]

[0..1] O Not described in this Guide. May be locally specified.

[TQ2 ]

[0..1] O Not described in this Guide. May be locally specified.

RXA

[1..1] R Each ORC segment in a VXU must have one RXA segment.

Every RXA requires an ORC segment.

[RXR ]

[0..1] RE Every RXA segment in a VXU may have zero or one RXR

segments.

{[Begin

Observation

Group

[0..*] RE Every RXA segment in a VXU may have zero or more

observation groups.

OBX

[1..1] R

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Table 5-1 VXU Segment Usage

[NTE ]

[0..1] RE Every OBX segment in a VXU may have zero or one NTE

segment.

End Observation Group ]}

End Order Group ]}

Static Definition—Segment Level

IN1—Insurance Segment

Local implementations may document use for local purposes in local implementation Guide. Field level specifications follow. They have

been constrained, based on current usage. Local implementations that require IN1 should base requirements on this guide. Specifications

for IN1 are included because several IIS require this segment and this specification is intended to assure that implementations are

consistent across systems.

Note that only the current insurance data should be sent. Historical insurance information should not be sent.

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Table 5-2 Insurance Segment (IN1)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional Predicate Value

Set

Description/Comment

Set ID - IN1

[1..1]

Insurance Plan ID

[1..1]

250

HL70072

Insurance

Company ID

250

Insurance

Company Name

XON

250

Insurance

Company

Address

XAD

250

Insurance Co

Contact Person

XPN

250

Insurance Co

Phone Number

XTN

250

Group Number

Group Name

XON

250

Insured’s Group

Emp ID

250

Insured’s Group

Emp Name

XON

250

Plan Effective

Date

Plan Expiration

Date

Authorization

Information

AUI

239

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Table 5-2 Insurance Segment (IN1)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional Predicate Value

Set

Description/Comment

15 Plan Type IS R 3 HL70086

Name Of Insured

XPN

250

Insured’s

Relationship To

Patient

250

HL70063

18 Insured’s Date Of

Birth

TS O 26

Insured’s Address

XAD

250

20 Assignment Of

Benefits

IS O 2 HL70135

21 Coordination Of

Benefits

IS O 2 HL70173

Coord Of Ben.

Priority

Notice Of

Admission Flag

HL70136

24 Notice Of

Admission Date

DT O 8

Report Of

Eligibility Flag

HL70136

Report Of

Eligibility Date

27 Release

Information Code

IS O 2 HL70093

Pre-Admit Cert

(PAC)

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Table 5-2 Insurance Segment (IN1)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional Predicate Value

Set

Description/Comment

29 Verification

Date/Time

TS_NZ RE 26 Precision shall be at least to the

day. [YYYYMMDD]

Verification By

XCN

250

31 Type Of

Agreement Code

IS O 2 HL70098

32 Billing Status IS O 2 HL70022

Lifetime Reserve

Days

34 Delay Before L.R.

Day

NM O 4

35 Company Plan

Code

IS O 8 HL70042

Policy Number

37 Policy Deductible CP O 12

38 Policy Limit -

Amount

CP X 12

Policy Limit -

Days

40 Room Rate -

Semi-Private

CP X 12

41 Room Rate -

Private

CP X 12

Insured’s

Employment

Status

250

HL70066

Insured’s

Administrative

HL70001

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Table 5-2 Insurance Segment (IN1)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional Predicate Value

Set

Description/Comment

Sex

Insured’s

Employer’s

Address

XAD

250

45 Verification Status ST O 2

Prior Insurance

Plan ID

HL70072

47 Coverage Type IS O 3 HL70309

48 Handicap IS O 2 HL70295

Insured’s ID

Number

250

Signature Code

HL70535

51 Signature Code

Date

DT O 8

Insured’s Birth

Place

250

VIP Indicator

HL70099

IN1 Field Definitions

IN1-1 Set ID - IN1 (SI) 00426

Definition: IN1-1 - set ID contains the number that identifies this transaction. For the first occurrence the sequence number shall be 1, for the second occurrence

it shall be 2, etc.

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IN1-2 Insurance Plan ID (CE) 00368

Definition: This field contains a unique identifier for the insurance plan. Refer to User-defined Table 0072 - Insurance Plan ID for suggested values. To

eliminate a plan, the plan could be sent with null values in each subsequent element. If the respective systems can support it, a null value can be sent in the plan

field.

IN1-3 Insurance Company ID (CX) 00428

Definition: This field contains unique identifiers for the insurance company. The assigning authority and identifier type code are strongly recommended for all

CX data types.

IN1-15 Plan Type (IS) 00440

Definition: This field contains the coding structure that identifies the various plan types, for example, Medicare, Medicaid, Blue Cross, HMO, etc. Refer to

User-defined Table 0086 - Plan ID for suggested values.

IN1-29 Verification Date/Time (TS) 00454

Definition: This field contains the date/time that the healthcare provider verified that the patient has the indicated benefits.

MSH—Message Header Segment

This implementation guide pre-adopts the Version 2.7.1 MSH segment.

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Table 5-3 Message Header Segment (MSH)

Table 5-4 Message Header Segment (MSH)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional

Predicate

Value set Description/Comment

Field Separator

[1..1]

1..1

Encoding Characters

[1..1]

4..4

Sending Application

[0..1]

HL70361

Sending Facility

[0..1]

HL70362

5 Receiving

Application

HD RE [0..1] HL70361

Receiving Facility

[0..1]

HL70362

Date/Time Of

Message

TS_Z

[1..1]

Security

Message Type

MSG

[1..1]

Message Control ID

[1..1]

1..199

Processing ID

[1..1]

Version ID

VID

[1..1]

Sequence Number

14 Continuation Pointer ST O [0..1]

Acknowledgement

Type

[1..1]

HL70155

Application

Acknowledgment

Type

[1..1]

HL70155

(constrained)

Country Code

Character Set

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Table 5-4 Message Header Segment (MSH)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional

Predicate

Value set Description/Comment

Principal Language

Of Message

Alternate Character

Set Handling

Scheme

Message Profile

Identifier

[1..*]

Sending

Responsible

Organization

XON

[0..1]

The initiator of this message.

Receiving

Responsible

Organization

XON

[0..1]

The final recipient of this

message.

Sending Network

Address

Receiving Network

Address

MSH Conformance Statements:

IZ-12: The MSH.1 (Field Separator) SHALL be valued “|”

IZ-13: The MSH.2 (Encoding Characters) SHALL be valued “^~\& “

IZ-15: The MSH-12 (Version ID) SHALL be valued “2.5.1 “

IZ-17: MSH-9 (Message Type) SHALL contain the constant value “VXU^VO4^VXU_V04”

IZ-41: The value of MSH-16 (Application Acknowledgement) shall be “AL”.

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IZ-42: The value of MSH-15 (Accept Acknowledgement) shall be “ER”

IZ-43: One occurrence of MSH-21(Message Profile Identifier) SHALL contain the constant value “Z22^CDCPHINVS”

MSH field definitions

MSH-1 Field Separator (ST) 00001

Definition: This field contains the separator between the segment ID and the first real field, MSH-2-encoding characters. As such it serves as the separator and

defines the character to be used as a separator for the rest of the message. Required value is |, (ASCII 124).

Example:

MSH|



MSH-2 Encoding Characters (ST) 00002

Definition: This field contains the four characters in the following order: the component separator, repetition separator, escape character, and subcomponent

separator. Required values are ^~\& (ASCII 94, 126, 92, and 38, respectively).

MSH-3 Sending Application (HD) 00003

Definition: This field uniquely identifies the sending application. The value is locally define and often assigned by the IIS in User-defined table 0361. This is not

the product, but rather the name of the specific instance. For instance, the IIS in Georgia(GRITS) is an instance based on the Wisconsin IIS (WIR). The code for

GRITS would be specific to GRITS.

MSH-4 Sending Facility (HD) 00004

Definition: This field identifies the organization responsible for the operations of the sending application. Locally defined codes accommodate local needs. The

first component shall be the name space id found in User-defined Table 0362. The second and third components are reserved for use of OIDs.

This applies when the message will trigger an “AR” in MSA-1 because the incoming message had one of the following issues: Unsupported message type,

Unsupported event code, Unsupported processing ID or Unable to process for reasons unrelated for format or content.

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MSH-5 Receiving Application (HD) 00005

Definition: This field uniquely identifies the receiving application. This is not the product, but rather the name of the specific instance. For instance, the IIS in

Georgia(GRITS) is an instance based on the Wisconsin IIS (WIR). The code for GRITS would be specific to GRITS. Locally defined codes accommodate local

needs.

MSH-6 Receiving Facility (HD) 00006

Definition: This field identifies the organization responsible for the operations of the receiving application. Locally defined codes will accommodate local needs.

MSH-7 Date/Time Of Message (TS_Z) 00007

Definition: This field contains the date/time that the sending system created the message. The degree of precision must be to the second and include time zone.

MSH-9 Message Type (MSG) 00009

Definition: This field contains the message type, trigger event, and the message structure ID for the message.

MSH-10 Message Control ID (ST) 00010

Definition: This field contains the identifier assigned by the sending application (MSH.3) that uniquely identifies a message instance. This identifier is unique

within the scope of the sending facility (MSH.4), sending application (MSH.3), and the YYYYMMDD portion of message date (MSH.7). The receiving system

echoes this ID back to the sending system in the Message acknowledgment segment (MSA). The content and format of the data sent in this field is the

responsibility of the sender.

MSH-11 Processing ID (PT) 00011

Definition: This field is used to decide whether to process the message as defined in HL7 Application (level 7) Processing rules. Reference Table HL7 0103 in

Appendix A. The choices are Production, Debugging and Training. In most cases, P or Production should be used.

MSH-12 Version ID (VID) 00012

Definition: This field contains the identifier of the version of the HL7 messaging standard used in constructing, interpreting, and validating the message. Only the

first component need be populated.

Messages conforming to the specifications in this Guide shall indicate that the version is 2.5.1.

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MSH-15 Accept Acknowledgment Type (ID) 00015

Definition: This field identifies the conditions under which accept acknowledgments are required to be returned in response to this message. It is Required for

enhanced acknowledgment mode. This Implementation Guide does not support Enhanced acknowledgement mode. Refer to HL7 Table 0155 - Accept/application

acknowledgment conditions for valid values.

Accept acknowledgement indicates if the message was safely received or not. It does not indicate successful processing. Application acknowledgement indicates

the outcome of processing.

MSH-16 Application Acknowledgment Type (ID) 00016

Definition: This field contains the conditions under which application acknowledgments are required to be returned in response to this message.

MSH-17 Country Code (ID) 00017

Definition: This field contains the country of origin for the message. The values to be used are those of ISO 3166,.24. The ISO 3166 table has three separate

forms of the country code: HL7 specifies that the 3-character (alphabetic) form be used for the country code. If this field is not valued, then assume that the code

is USA.

Refer to HL7 Table 0399 – Country code for the 3-character codes as defined by ISO 3166-1.

MSH-21 Message Profile Identifier (EI) 01598

Definition: Sites may use this field to assert adherence to, or reference, a message profile. Message profiles contain detailed explanations of grammar, syntax, and

usage for a particular message or set of messages. Chapter 7 describes the query profile for requesting an immunization history. It also includes child profiles that

constrain the response to the query.

MSH-22 Responsible Sending Organization

Definition: Business organization that originated and is accountable for the content of the message.

Currently, MSH provides fields to transmit both sending/receiving applications and facilities (MSH.3 – MSH.6). However, these levels of organization

do not necessarily relate to or imply a legal entity such as a business organization. As such, multiple legal entities (organizations) may share a service

bureau, with the same application and facility identifiers. Another level of detail is required to delineate the various organizations using the same service

bureau.

Available from ISO 1 Rue de Varembe, Case Postale 56, CH 1211, Geneve, Switzerland

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Therefore, the Sending Responsible Organization field provides a complete picture from the application level to the overall business level. The Business

Organization represents the legal entity responsible for the contents of the message.

MSH-23 Responsible Receiving Organization

Definition: Business organization that is the intended receiver of the message and is accountable for acting on the data conveyed by the transaction.

This field has the same justification as the Sending Responsible Organization except in the role of the Receiving Responsible Organization. The

receiving organization has the legal responsibility to act on the information in the message.

NK1—Next of Kin Segment

The NK1 segment contains information about the patient’s other related parties. Any associated parties may be identified. Utilizing NK1-1 - set ID, multiple NK1

segments can be sent to patient accounts. That is, each subsequent NK1 increments the previous set ID by 1. So if 3 NK1 were sent in one message, the first

would have a set id of 1, the second would have 2 and the third would have 3.

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Table 5-4 Next of Kin Segment (NK1)

Table 5-5 Next of Kin Segment (NK1)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional Predicate Value

set

Description/Comment

Set ID - NK1

[1..1]

Name

XPN

[1..*]

The first instance is the legal

name and is required.

Relationship

[1..1]

HL70063

Address

XAD

[0..*]

The first instance shall be the

primary address.

Phone Number

XTN

[0..*]

The first instance shall be the

primary phone number.

Business Phone

Number

XTN

Contact Role

Start Date

End Date

Next of Kin /

Associated

Parties Job Title

Next of Kin /

Associated

Parties Job

Code/Class

JCC

Next of Kin /

Associated

Parties

Employee

Number

Organization

XON

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Table 5-5 Next of Kin Segment (NK1)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional Predicate Value

set

Description/Comment

Name - NK1

Marital Status

15 Administrative

Sex

IS O

Date/Time of

Birth

Living

Dependency

18 Ambulatory

Status

IS O

Citizenship

Primary

Language

21 Living

Arrangement

IS O

Publicity Code

Protection

Indicator

24 Student

Indicator

IS O

Religion

Mother’s Maiden

Name

XPN

27 Nationality CE O

Ethnic Group

Contact Reason

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Table 5-5 Next of Kin Segment (NK1)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional Predicate Value

set

Description/Comment

30 Contact

Person’s Name

XPN O

Contact

Person’s

Telephone

Number

XTN

32 Contact

Person’s

Address

XAD O

33 Next of

Kin/Associated

Party’s

Identifiers

CX O

Job Status

35 Race CE O

36 Handicap IS O

Contact Person

Social Security

Number

38 Next of Kin Birth

Place

ST O

39 VIP Indicator IS O

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NK1 field definitions

NK1-1 Set ID - NK1 (SI) 00190

Definition: This field contains the number that identifies this transaction. For the first occurrence of the segment, the sequence number shall be one, for

the second occurrence, the sequence number shall be two, etc.

NK1-2 Name (XPN) 00191

Definition: This field contains the name of the next of kin or associated party. Multiple names for the same person are allowed, but the legal name must

be sent in the first sequence. Refer to HL7 Table 0200 - Name Type for valid values.

NK1-3 Relationship (CE) 00192

Definition: This field contains the actual personal relationship that the next of kin/associated party has to the patient. Refer to User-defined Table 0063 -

Relationship for suggested values.

NK1-4 Address (XAD) 00193

Definition: This field contains the address of the next of kin/associated party. Multiple addresses are allowed for the same person. The mailing address

must be sent in the first sequence. If the mailing address is not sent, then the repeat delimiter must be sent in the first sequence.

Note that an NK1 with a relationship of Self, may contain the patient’s address, but the preferred location for a patient’s address

NK1-5 Phone Number (XTN) 00194

Definition: This field contains the telephone number of the next of kin/associated party. Multiple phone numbers are allowed for the same person. The

primary telephone number must be sent in the first sequence. If the primary telephone number is not sent, then the repeat delimiter must be sent in the

first sequence. Refer to HL7 Table 0201 - Telecommunication Use Code and HL7 Table 0202 - Telecommunication Equipment Type for valid values.

NK1-6 Business Phone Number (XTN) 00195

Definition: This field contains the business telephone number of the next of kin/associated party. Multiple phone numbers are allowed for the same

person. The primary business telephone number must be sent in the first sequence. If the primary telephone number is not sent, then the repeat delimiter

must be sent in the first sequence. Refer to HL7 Table 0201 - Telecommunication Use Code and HL7 Table 0202 - Telecommunication Equipment Type

for valid values.

NTE—Note Segment

The NTE segment is used for sending notes and comments.

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Table 5-5 Note Segment (NTE)

Table 5-6 Note Segment (NTE)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional Predicate Value

Set

Comment

Set ID - NTE

Source of

Comment

[1..1]

Comment Type

NTE field definitions

NTE-3 Comment (FT) 00098

Definition: This field contains the comment contained in the segment.

OBX—Observation Result Segment

The observation result segment has many uses. It carries observations about the object of its parent segment. In the VXU/RSP it is associated with the RXA or

immunization record. The basic format is a question (OBX-3) and an answer (OBX-5).

Consult Appendix B for detailed examples of each of the uses.

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Table 5-6 Observation Segment (OBX)

Table 5-7 Observation Segment (OBX)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional

Predicate

Value Sets Comment

Set ID – OBX

[1..1]

1..4

Value Type

[1..1]

2..3

HL70125

(constrained)

Observation

Identifier

[1..1]

NIP003

This indicates what this

observation refers to. It poses

the question that is answered by

OBX-5.

Observation

Sub-ID

[1..1]

1..20

Constrain to

positive

integers

Observation

Value

varies

[1..1]

varies

This is the observation value and

answers the question posed by

OBX-3

Units

C(R/O)

[0..1]

If OBX-2(Value Type) is

valued “NM” or “SN”

Note: If there is not a unit of

measure available while

the Condition Predicated is

true, then the value “NA”

SHALL be used in CE.1

and “HL70353” in CE.3.

UCUM

References

The length of the observation field is variable, depending upon value type. See OBX-2 value type.

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Table 5-7 Observation Segment (OBX)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional

Predicate

Value Sets Comment

Range

Abnormal

Flags

9 Probability NM O

10 Nature of

Abnormal Test

ID O

Observation

Result Status

[1..1]

HL70085

(constrained)

12 Effective Date

of Reference

Range Values

TS O

13 User Defined

Access

Checks

ST O

Date/Time of

the

Observation

TS_NZ

[0..1]

Producer's

Reference

16 Responsible

Observer

XCN O

Observation

Method

C(RE/O)

[0..1]

If OBX-3.1 is “64994-7”

CDCPHINVS

64994 -7 is a LOINC meaning

“funding program eligibility”. This

field is used to distinguish

between eligibility that is

captured at the visit level versus

at the immunization event level.

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Table 5-7 Observation Segment (OBX)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional

Predicate

Value Sets Comment

Equipment

Instance

Identifier

19 Date/Time of

the Analysis

TS O

Reserved for

harmonization

with V2.6

Reserved for

harmonization

with V2.6

22 Reserved for

harmonization

with V2.6

Performing

Organization

Name

XON

Performing

Organization

Address

XAD

25 Performing

Organization

Medical

Director

XCN O

Conformance Statement:

IZ-20: The Value of OBX-1 (Set ID-OBX) SHALL be valued sequentially starting with the value “1” within a message.

IZ-44: The value of OBX-4 SHALL be a positive integer.

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IZ-21: The value of OBX-2 (Value Type) SHALL be one of the following:

CE, NM, ST, DT, ID or TS

IZ-22: The value of OBX-11 (Observation Result Status) SHALL be “F”

IZ-35: If OBX-3.1 is “64994-7” and OBX-2 is “CE” then the value set for OBX-5 shall be HL70064.

IZ-36: If OBX-3.1 is “69764-9” and OBX-2 is “CE” then the value set for OBX-5 shall be cdcgs1vis.

IZ-37: If OBX-3.1 is “30956-7” and OBX-2 is “CE” then the value set for OBX-5 shall be CVX.

OBX field definitions

OBX-1 Set ID - OBX (SI) 00569

Definition: This field contains the sequence number. The first instance shall be set to 1 and each subsequent instance shall be the next number in

sequence. Numbering is not restarted within a message. That is, if a message had 3 order groups and each had 3 OBX, the last OBX in the message

would have value of 9 for this field.

OBX-2 Value Type (ID) 00570

Definition: This field contains the format of the observation value in OBX. If the value is CE then the result must be a coded entry.

OBX-3 Observation Identifier (CE) 00571

Definition: This field contains a unique identifier for the observation. The format is that of the Coded Element (CE).

Example: |64994-7^funding pgm elig^LN|.

The identifier will point to a master observation table that will provide other attributes of the observation that may be used by the receiving system to process the

observations it receives. This may be thought of as a question that the observation answers. In the example above, the question is “what funding program was this

person eligible for when this vaccine was administered” The answer in OBX-5 could be “VFC eligible - MEDICAID”.

LOINC shall be the standard coding system for this field if an appropriate LOINC code exists. Appropriate status is defined in the LOINC Manual Section 11.2

Classification of LOINC Term Status. If a local coding system is in use, a local code should also be sent to help with identification of coding issues. When no

valid LOINC exists the local code may be the only code sent. When populating this field with values, this guide does not give preference to the triplet in which

the standard (LOINC) code should appear

The 2.3.1 Implementation Guide used suffixes on the first sequence in OBX-3 to group related observations. For instance, reporting a VIS publication date and VIS

receipt date each added a suffix of one LOINC code to a second LOINC code when recording VIS dates for a component vaccine. (38890-0&29768-9^DATE

VACCINE INFORMATION STATEMENT PUBLISHED^LN) This is no longer acceptable. Grouping of related observations will be accomplished using Observation

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sub-id (OBX-4).

OBX-4 Observation Sub-ID (ST) 00572

Definition: This field is used to group related observations by setting the value to the same number. For example, recording VIS date and VIS receipt

date for a combination vaccination requires 6 OBX segments. One OBX would indicate the vaccine group. It would have a pair of OBX indicating the

VIS publication date and the VIS receipt date. These would have the same OBX-4 value to allow them to be linked. The second set of three would have

another OBX-4 value common to each of them.

This field may be used to link related components of an observation. Each related component of the observation would share an Observation sub-id.

For example:

OBX|1|LN|^observation 1 part 1^^^^^|1|…

OBX|2|LN|^ observation 1 part 2^^^^^|1|…

OBX|3|DT|^a different observation^^^^^|2|…

Example:

OBX|1|CE|64994-7^Eligibility Status^LN|1|V02^Medicaid^HL70064||||||F|||20120113|||VXC40^vaccine

level^CDCPHINVS<CR>

OBX

|2|DT|29769-7^VIS presented^LN|2|20120113||||||F|||20120113<CR>

OBX

|3|CE|69764-9^Document Type^LN|2|253088698300026411121116^Multivaccine

VIS^cdcgs1vis||||||F|||20120113<CR>

OBX-5 Observation Value (varies) 00573

Definition: This field contains the value observed by the observation producer. OBX-2-value type contains the data type for this field according to

which observation value is formatted.

This field contains the value of OBX-3-observation identifier of the same segment. Depending upon the observation, the data type may be a number

(e.g., dose number), a coded answer (e.g., a vaccine), or a date/time (the date/time that the VIS was given to the client/parent). An observation value is

always represented as the data type specified in OBX-2-value type of the same segment. Whether numeric or short text, the answer shall be recorded in

ASCII text.

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OBX-6 Units (CE) 00574

Definition: This shall be the units for the value in OBX-5. The value shall be from the UCUM list of units.

OBX-11 Observation Result Status (ID) 00579

Definition: This field contains the observation result status. The expected value is F or final.

OBX-14 Date/Time of the Observation (TS_NZ) 00582

Definition: Records the time of the observation. It is the physiologically relevant date-time or the closest approximation to that date-time of the

observation.

OBX-17 Observation Method (CE)

Definition: This optional field can be used to transmit the method or procedure by which an observation was obtained when the sending system wishes

to distinguish among one measurement obtained by different methods and the distinction is not implicit in the test ID.

In this Guide, it shall be used to differentiate the way that VFC Eligibility Status was collected. The two choices are:

• Recorded in the sending system at the visit level

• Recorded in the sending system at the immunization level

See examples in Appendix B (Example VXU #2)

Application Conformance Statement:

There are a number of core data elements that are important to support a complete immunization history and the functional requirements of a Immunization

Information System (IIS). Some of these utilize the OBX to carry their data. The following table lists the data elements and the usage responsibilities.

Tab

le 5-7 Application Conformance Statements

Table 5-8 Application Conformance Statements

Core Data Element

Description

Observation

Identifier

(OBX-3)

Observation

Value Set

(OBX-5)

Conformance Statements

Patient Eligibility Category for

Vaccine Funding Program

This value represents the funding

program that should pay for a

64994-7 HL70064

IZ-23: If RXA-20 is valued "CP" or "PA" and the

first occurrence of RXA-9.1 (Administration

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Table 5-8 Application Conformance Statements

Core Data Element

Description

Observation

Identifier

(OBX-3)

Observation

Value Set

(OBX-5)

Conformance Statements

given immunization. It is

determined based on

characteristics of the patient/client

and the type of vaccine

administered.

Note.code) is “00” then the message SHALL

include an OBX segment associated with the RXA

with OBX-3.1 shall equal “64994-7” . This OBX

will indicate the Patient Eligibility Category for

Vaccine Funding Program.

Vaccine Information Statement

(VIS) document type

This value represents the vaccine

type that the statement provides

information about.

69764-9 cdcgs1vis See VIS related Conformance Statements below.

Vaccine Information Statement

(VIS) version date

This value represents the date the

presented VIS was published

29768-9

Note that this approach to reporting VIS document

type is maintained for backward compatibility. The

preferred method uses VIS document type approach

using code 69764-9. See VIS related Conformance

Statements below

VIS vaccine type

This value represents the vaccine

type that the statement provides

information about. In the cases

where there are multiple vaccines

that can be used, the correct

choice is the unspecified vaccine

CVX (e.g. CVX 17 (HIB,

unspecified formulation) for any

HIB vaccine administered.

30956-7 CVX Note that this approach to reporting VIS document

type is maintained for backward compatibility. The

preferred method uses VIS document type approach

using code 69764-9.

Vaccine Information Statement

(VIS) delivery date

This value represents the date the

document was presented to the

29769-7

See VIS related Conformance Statements below

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Table 5-8 Application Conformance Statements

Core Data Element

Description

Observation

Identifier

(OBX-3)

Observation

Value Set

(OBX-5)

Conformance Statements

patient/responsible person.

OTE: There are three things that need to be recorded for documenting VIS:

1. Date VIS was shared with patient or parent

2. Vaccine that the VIS refers to

3. Edition Date of VIS

There are 2 ways that this data is captured. First, it may be captured as vaccine type, Edition/Version Date and presentation date. VIS is bar coded with a 2-d bar

code using a Global Document Type Identifier (GDTI). This bar code indicates the specific document type that has been presented and the edition date may be

inferred from the bar code.

The second approach (use the string representation of the GDTI) is preferred. There is a multi-vaccine VIS that cannot be represented using the vaccine type

approach. The vaccine type approach is included in this Implementation Guide for backward compatibility.

VIS documentation is required for all patients, but only for specific vaccines. Note that the most current list will be found on PHIN VADS.

See table Value Set Code: PHVS_VISVaccines_IIS in Appendix A.

VIS Conformance Statements:

IZ-24: If RXA-20 is valued "CP" or "PA" and the first occurrence of RXA- 9.1 is valued “00” and RXA-5.1 is valued with a CVX code from table

PHVS_VISVaccines_IIS (See Appendix A) then for each vaccine information statement that was shared there SHALL be:

• one OBX segment with OBX-3.1 valued “69764-9” (bar coded) and one OBX with OBX-3.1 valued “29769-7” (presentation /delivery date)

associated. Both OBX shall have the same value in OBX-4

• one OBX segment with OBX-3.1 valued “30956-7” (vaccine type) and one OBX segment with OBX-3.1 valued “29768-9” (version date)

and one OBX with OBX-3.1 valued “29769-7” (presentation /delivery date) associated. All three OBX shall have the same value in OBX-4

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Note that 30956-7 (vaccine type) is preferred over the alternative 38890-0 (Component Vaccine Type) even when the vaccine administered is a combination

vaccine. For this reason, the test will compare to the 30956-7 value.

ORC—Order Request Segment

The Common Order segment (ORC) is used to transmit fields that are common to all orders (all types of services that are requested). While not all immunizations

recorded in an immunization message are able to be associated with an order, each RXA must be associated with one ORC, based on HL7 2.5.1 standard.

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Table 5-8 Common Order Segment (ORC)

Table 5-9 Common Order Segment (ORC)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional

Predicate

Value Set Comment

Order Control

[1..1]

HL70119

(constrained)

Placer Order

Number

[0..1]

See Guidance below.

Filler Order

Number

[1..1]

See Guidance below.

Placer Group

Number

Order Status

Response Flag

Quantity/Timin

Parent

EIP

Date/Time of

Transaction

Entered By

XCN

[0..1]

This is the person that entered

this immunization record into the

system.

Verified By

XCN

Ordering

Provider

XCN

C(RE/O)

[0..1]

If the first occurrence of

RXA-9.1 is valued "00"

and RXA-20 is valued

"CP" or "PA"

This shall be the provider

ordering the immunization. It is

expected to be empty if the

immunization record is

transcribed from a historical

record.

Enterer's

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Table 5-9 Common Order Segment (ORC)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional

Predicate

Value Set Comment

Location

Call Back

Phone Number

XTN

15 Order Effective

Date/Time

TS O

Order Control

Code Reason

17 Entering

Organization

CE RE HL70362 This is the provider organization

that entered this record/order.

18 Entering

Device

CE O

Action By

XCN

20 Advanced

Beneficiary

Notice Code

CE O

21 Ordering

Facility Name

XON O

Ordering

Facility

Address

XAD

23 Ordering

Facility Phone

Number

XTN O

24 Ordering

Provider

Address

XAD O

Order Status

CWE

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Table 5-9 Common Order Segment (ORC)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional

Predicate

Value Set Comment

Modifier

Advanced

Beneficiary

Notice

Override

Reason

CWE

27 Filler's

Expected

Availability

Date/Time

TS O

Confidentiality

Code

CWE

Order Type

CWE

30 Enterer

Authorization

Mode

CNE O

Parent

Universal

Service

Identifier

CWE

Conformance Statement:

IZ-25: ORC.1 (Order Control) SHALL contain the value “RE “

IZ-45: If RXA-20 is valued “NA” or “RE” then ORC-3 SHALL be valued “9999”.

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ORC field definitions

ORC-1 Order Control (ID) 00215

Definition: Determines the function of the order segment.

The value for VXU and RSP shall be RE.

Placer Order Number (ORC-2) and Filler Order Number (ORC-3) are unique identifiers from the system where an order was placed and where the order

was filled. They were originally designed for managing lab orders. These fields have a usage status of Conditional in Version 2.5.1. The condition for each

is that they must be present in either the OBR or ORC of a message. There has been confusion about usage for these fields. The Orders and

Observations workgroup has addressed this confusion. In the context that ORC will be used in Immunization messaging ORC-3 must be populated. They

may both be populated.

This Guide specifies that Placer Order Number is RE (required, but may be empty). The Filler Order Number SHALL be the unique immunization id of the

sending system.

ORC-2 Placer Order Number (EI) 00216

The placer order number is used to uniquely identify this order among all orders sent by a provider organization.

ORC-2 is a system identifier assigned by the placer software application. The Placer Order Number and the Filler Order Number are essentially foreign

keys exchanged between applications for uniquely identifying orders and the associated results across applications.

In the case where the ordering provider organization is not known, the sending system may leave this field empty.

ORC-3 Filler Order Number (EI) 00217

The filler order number is used to uniquely identify this order among all orders sent by a provider organization that filled the order.

This shall be the unique identifier of the sending system in a given transaction. In the case where system A sends the record to system B and system B

then forwards to system C, system B will send its’ own unique identifier.

Use of this foreign key will allow the initiating system to accurately identify the previously sent immunization record, facilitating update or deletion of that

record.

In the case where a historic immunization is being recorded (i.e. from an immunization card), the sending system SHALL assign an identifier as if it were

an immunization administered by a provider associated with the provider organization owning the sending system.

In the case where an RXA is conveying information about an immunization which was not given (e.g. refusal) the filler order number shall be 9999.

Note that the receiving system will need to store this value in addition to it’s own internal id in order for this to be used.

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ORC-10 Entered By (XCN) 00224

Definition: This identifies the individual that entered this particular order. It may be used in conjunction with an RXA to indicate who recorded a

particular immunization.

ORC-12 Ordering Provider (XCN) 00226

Definition: This field contains the identity of the person who is responsible for creating the request (i.e., ordering physician). In the case where this

segment is associated with a historic immunization record and the ordering provider is not known, then this field should not be populated.

ORC-17 Entering Organization (CE) 00231

Definition: This field identifies the organization that the enterer belonged to at the time he/she enters/maintains the order, such as medical group or

department. The person who entered the request is defined in ORC-10 (entered by).

ORC –28 Confidentiality Code (CWE) 00615

This field allows a system to indicate if special privacy rules apply to the RXA that is associated with this ORC. For instance, if a state had special rules

about who may see records for HPV vaccinations, then this field could convey that. The recommended value to use in this case is R for restricted.

If this field is populated, it indicates the active choice of the patient or responsible person. In other words, if the value indicates that the information must

be protected, the person has stated that it must be protected. An empty field indicates that the client has not actively specified the way they want this data

to be handled.

Local implementation guides should describe the local usage of this field and value.

PD1—Patient Demographic Segment

The Patient Demographic Segment contains patient demographic information that may change from time to time. There are three primary uses PD1 for in

Immunization Messages. These include indicating whether the person wants his/her data protected, whether the person wants to receive recall/reminder notices

and the person’s current status in the registry.

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Table 5-9 Patient Demographic Segment (PD1)

Table 5-10 Patient Demographic Segment (PD1)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional Predicate Value

Set

Comment

Living

Dependency

Living

Arrangement

Patient Primary

Facility

XON

Patient Primary

Care Provider

Name & ID No.

XCN

Student

Indicator

Handicap

Living Will Code

Organ Donor

Code

Separate Bill

Duplicate

Patient

Publicity Code

[0..1]

HL70215

Protection

Indicator

[0..1]

HL70136

Protection

Indicator

Effective Date

DT_T

C(RE/X)

[0..1]

If PD1-12 (Protection Indicator)

is valued

Place of

XON

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Table 5-10 Patient Demographic Segment (PD1)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional Predicate Value

Set

Comment

Worship

Advance

Directive Code

16 Immunization

Registry Status

IS RE [0..1] HL70441

Immunization

Registry Status

Effective Date

DT_T

C(RE/X)

[0..1]

If the PD1-16 (Registry Status)

field is valued.

Publicity Code

Effective Date

DT_T

C(RE/X)

[0..1]

If the PD1-11 (Publicity Code)

field is valued.

19 Military Branch IS O

Military

Rank/Grade

Military Status

PD1 field definitions

PD1-3 Patient Primary Facility (XON) 00756

Definition: This field contains the name and identifier that specifies the "primary care" healthcare facility selected by the patient at the time of

enrollment in an HMO Insurance Plan. It is not the Primary Care Practitioner or Medical Home.

The meaning of this field should not be expanded to include the concept of medical home.

PD1-11 Publicity Code (CE) 00743

Definition: This field contains a user-defined code indicating what level of publicity is allowed (e.g., No Publicity, Family Only) for the patient. In the

context of immunization messages, this refers to how a person wishes to be contacted in a reminder or recall situation. Refer to User-defined Table 0215

- Publicity Code for suggested values.

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PD1-12 Protection Indicator (ID) 00744

Definition: This field identifies whether a person’s information may be shared with others

. Specific protection policies are a local consideration (opt in

or opt out, for instance). This field conveys the current state in the sending system.

The protection state must be actively determined by the clinician. If it is not actively determined, then the protection indicator shall be empty.

There are 3 states:

rotection State Code

Yes, protect the data. Client (or guardian) has indicated that the

information shall be protected. (Do not share data)

No, it is not necessary to protect data from other clinicians. Client (or

guardian) has indicated that the information does not need to be

protected. (Sharing is OK)

No determination has been made regarding client’s (or guardian’s) wishes

regarding information sharing

PD1-12 is empty.

Notes on use of Y for Protection Indicator in 2.5.1 Guide vs. earlier Guides.

Note that the previous Implementation Guide stated that Y meant that a person’s information could be shared. This was an incorrect interpretation of the

use of this field. The meaning now aligns with the definition of HL7. That is, Y means data must be protected. Existing systems that use the old meaning

will need to determine how they will send the correct value in a 2.5.1 message.

Note that the value sent in a message that is based on the 2.3.1 or 2.4 version of the HL7 standard shall continue to follow the old guidance. That is, Y

means sharing is allowed and N means sharing is not allowed.

Local policies determine how data are protected. In general, it indicates who may view the client’s data. It may be as narrow as just the provider that entered the information.

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Note on Null and Empty in HL7

See notes on null and empty fields in Chapter 3.

PD1-13 Protection Indicator Effective Date (DT) 01566

Definition: This field indicates the effective date for PD1-12 - Protection Indicator.

PD1-16 Immunization Registry Status (IS) 01569

Definition: This field identifies the current status of the patient in relation to the sending provider organization.. Refer to User-defined Table 0441 -

Immunization Registry Status for suggested values.

This field captures whether the sending provider organization considers this an active patient. There are several classes of responsibility. The status may

be different between the sending and receiving systems. For instance, a person may no longer be active with a provider organization, but may still be

active in the public health jurisdiction, which has the Immunization Information System (IIS). In this case the provider organization would indicate that the

person was inactive in their system using this field in a message from them. The IIS would indicate that person was active in a message from the IIS.

PD1-17 Immunization Registry Status Effective Date (DT) 01570

Definition: This field indicates the effective date for the registry status reported in PD1-16 - Immunization Registry Status.

PD1-18 Publicity Code Effective Date (DT) 01571

Definition: This is the effective date for PD1-11 - Publicity Code.

PID—Patient Identifier Segment

The PID is used by all applications as the primary means of communicating patient identification information. This segment contains permanent patient

identifying and demographic information that, for the most part, is not likely to change frequently.

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Table 5-10 Patient Identifier Segment (PID)

Table 5-11 Patient Identifier Segment (PID)

SEQ Element

Name

Data

Type

Usag

Cardinality LEN Conditional Predicate Value

Set

Constraint

Set ID - PID

[1..1]

Patient ID

Patient

Identifier List

[1..*]

Alternate

Patient ID -

00106

Patient Name

XPN

[1..*]

The first repetition shall contain the

legal name. Multiple given names

or initials are separated by spaces.

Mother’s

Maiden Name

XPN_M

[0..1]

Date/Time of

Birth

TS_NZ

[1..1]

Administrative

Sex

[0..1]

HL70001

Patient Alias

XPN

Race

[0..*]

HL70005

Patient

Address

XAD

[0..*]

The first repetition should be the

primary address.

County Code

County belongs in address field.

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Table 5-11 Patient Identifier Segment (PID)

SEQ Element

Name

Data

Type

Usag

Cardinality LEN Conditional Predicate Value

Set

Constraint

13 Phone

Number -

Home

XTN RE [0..*] The first instance shall be the

primary phone number.

Only one item is allowed per

repetition.

Phone

Number -

Business

XTN

Primary

Language

Marital Status

Religion

Patient

Account

Number

SSN Number -

Patient

Driver's

License

Number -

Patient

DLN

Mother's

Identifier

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Table 5-11 Patient Identifier Segment (PID)

SEQ Element

Name

Data

Type

Usag

Cardinality LEN Conditional Predicate Value

Set

Constraint

22 Ethnic Group CE RE [0..1] CDCREC

Birth Place

Multiple Birth

Indicator

RE [0..1]

HL70136

The acceptable values are Y and

N. If the status is undetermined,

then field shall be empty.

Birth Order

C(RE/O

)

[0..1]

1..2

If PID-24 (Multiple Birth

Indicator) is valued “Y “

This field contains a number

indicating the person’s birth order,

with 1 for the first child born and 2

for the second.

Citizenship

Veterans

Military Status

Nationality

Patient Death

Date and Time

C(RE/X

)

[0..1]

If PID-30 (patient death

indicator) is valued “Y”

Patient Death

Indicator

[0..1]

HL70136

Identity

Unknown

Indicator

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Table 5-11 Patient Identifier Segment (PID)

SEQ Element

Name

Data

Type

Usag

Cardinality LEN Conditional Predicate Value

Set

Constraint

32 Identity

Reliability

Code

IS O

Last Update

Date/Time

Last Update

Facility

35 Species Code CE O

Breed Code

Strain

38 Production

Class Code

CE O

Tribal

Citizenship

CWE

Conformance Statement:

IZ-46: PID-1 (Set ID) SHALL have the literal value “1”

PID field definitions

PID-1 Set ID - PID (SI) 00104

Definition: This field contains the number that identifies this transaction. For the first occurrence of the segment, the sequence number shall be one, for

the second occurrence, the sequence number shall be two, etc.

PID-3 Patient Identifier List (CX) 00106

Definition: This field contains the list of identifiers (one or more) used by the healthcare facility to uniquely identify a patient (e.g., medical record

number, billing number, birth registry, national unique individual identifier, etc.).

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PID-5 Patient Name (XPN) 00108

Definition: This field contains the names of the patient, The primary or legal name of the patient is reported first. Therefore, the name type code in this

field should be “L - Legal”. Refer to HL7 Table 0200 - Name Type for valid values.

PID-6 Mother's Maiden Name (XPN) 00109

Definition: This field contains the family name under which the mother was born (i.e., before marriage). It is used to distinguish between patients with

the same last name.

PID-7 Date/Time of Birth (TS_NZ) 00110

Definition: This field contains the patient’s date and time of birth.

PID-8 Administrative Sex (IS) 00111

Definition: This field contains the patient’s sex. Refer to User-defined Table 0001 - Administrative Sex for suggested values.

PID-10 Race (CE) 00113

Definition: This field refers to the patient’s race. Refer to User-defined Table 0005 - Race for suggested values. The second triplet of the CE data type

for race (alternate identifier, alternate text, and name of alternate coding system) is reserved for governmentally assigned codes.

PID-11 Patient Address (XAD) 00114

Definition: This field contains the mailing address of the patient. Address type codes are defined by HL7 Table 0190 - Address Type. Multiple addresses

for the same person may be sent in the following sequence: The primary mailing address must be sent first in the sequence (for backward compatibility);

if the mailing address is not sent, then a repeat delimiter must be sent in the first sequence.

This field is used for any type of address that is meaningfully associated with the client/patient. For instance Birth State is the state of the address of the

birthing location, address type = BDL.

A person’s address may be sent in this field or in the NK1 segment with a relationship code indicating Self. A patient’s address should be in PID-11. It

may also be in NK1.

PID-13 Phone Number - Home (XTN) 00116

Definition: This field contains the patient’s personal phone numbers. All personal phone numbers for the patient are sent in the following sequence. The

first sequence is considered the primary number (for backward compatibility). If the primary number is not sent, then a repeat delimiter is sent in the

first sequence. Each type of telecommunication shall be in its’ own repetition. For example, if a person has a phone number and an email address, they

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shall each have a repetition. Refer to HL7 Table 0201 - Telecommunication Use Code and HL7 Table 0202 - Telecommunication Equipment Type for

valid values.

PID-14 Phone Number - Business (XTN) 00117

Definition: This field contains the patient’s business telephone numbers. All business numbers for the patient are sent in the following sequence. The

first sequence is considered the patient’s primary business phone number (for backward compatibility). If the primary business phone number is not

sent, then a repeat delimiter must be sent in the first sequence. Refer to HL7 Table 0201 - Telecommunication Use Code and HL7 Table 0202 -

Telecommunication Equipment Type for valid values.

PID-22 Ethnic Group (CE) 00125

Definition: This field further defines the patient’s ancestry. Refer to Table CDCREC - Ethnic Group.

PID-24 Multiple Birth Indicator (ID) 00127

Definition: This field indicates whether the patient was part of a multiple birth. Refer to HL7 Table 0136 - Yes/No Indicator for valid values.

Y the patient was part of a multiple birth

N the patient was a single birth

Empty field multiple birth status is undetermined.

PID-25 Birth Order (NM) 00128

Definition: When a patient was part of a multiple birth, a value (number) indicating the patient’s birth order is entered in this field. If PID-24 is

populated, then this field should be populated.

PID-29 Patient Death Date and Time (TS) 00740

Definition: This field contains the date and time at which the patient death occurred.

PID-30 Patient Death Indicator (ID) 00741

Definition: This field indicates whether the patient is deceased. Refer to HL7 Table 0136 - Yes/no Indicator for valid values.

Y the patient is deceased

N the patient is not deceased

Empty status is undetermined

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PV1—Patient Visit Segment

The PV1 segment is used to convey visit specific information. The primary use in immunization messages in previous releases was to carry information

about the client’s eligibility status. This is now recorded at the immunization event (dose administered) level. Use of this segment for the purpose of

reporting client eligibility for a funding program at the visit level is not supported in the Implementation Guide.

RXA-- Pharmacy/Treatment Administration Segment

The RXA segment carries pharmacy administration data. It is a child of an ORC segment, which a repeating segment in the RSP and VXU messages. Because

ORC are allowed to repeat an unlimited numbers of vaccinations may be included in a message. Each RXA must be preceded by an ORC.

The HL7 Version 2.5.1 document clearly indicates that any RXA must be associated with an ORC. In the case of immunization, each immunization will have its own ORC.

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Table 5-11 Pharmacy/Treatment Administration (RXA)

Table 5-12 Pharmacy/Treatment Administration (RXA)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional Predicate Value

Set

Comment

Give Sub-ID

Counter

[1..1]

Administration

Sub-ID Counter

[1..1]

Date/Time Start

of Administration

TS_NZ

[1..1]

This segment may be used in

cases where a vaccine has not

been administered. For

instance a patient may refuse a

vaccination or the sending

system may be forecasting a

next dose due. See notes

below for guidance on the

relevant date to include here.

Date/Time End

of Administration

[0..1]

See not below

Administered

Code

[1..1]

CVX

Support for CVX code is

strongly preferred. Local IG

may identify NDC or CPT as

acceptable alternative code

sets.

Administered

Amount

[1..1]

Administered

Units

C(R/O)

[0..1]

If Administered Amount is not

valued “999”

UCUM

The preferred units of measure

for this is “mL”.

Administered

Dosage Form

[0..1]

Administration

varies

C(R/O)

[0..*]

If RXA-20 is valued “CP” or

NIP 0001

If this field is used for a notes

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Table 5-12 Pharmacy/Treatment Administration (RXA)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional Predicate Value

Set

Comment

Notes

“PA”

only entry, then the data type

shall be CE_TX otherwise the

data type shall be CE.

The

primary use of this field it to

convey if this immunization

record is based on a historical

record or was given by the

provider recording the

immunization. All systems

should be able to support this

use. Other uses of this field are

permitted, but need to be

specified locally.

10 Administering

Provider

XCN C(RE/O) [0..1] If the first occurrence of

RXA-9.1 is valued "00"

and RXA-20 is valued

"CP" or "PA"

This is the person who gave the

administration or the vaccinator.

It is not the ordering clinician.

Administered-at

Location

LA2

C(RE/O)

[0..1]

If the first occurrence of

RXA-9.1 is valued "00"

and RXA-20 is valued

"CP" or "PA"

This is the clinic/site where the

vaccine was administered.

12 Administered

Per (Time Unit)

ST O

13 Administered

Strength

NM O

Administered

Strength Units

Substance Lot

C(R/O)

[0..*]

If the first occurrence of

Note that “00” is double zero.

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Table 5-12 Pharmacy/Treatment Administration (RXA)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional Predicate Value

Set

Comment

Number

RXA-9.1 is valued "00"

and RXA-20 is valued

"CP" or "PA"

Substance

Expiration Date

TS_M

C(RE/O)

[0..1]

If the first occurrence of

RXA-9.1 is valued "00"

and RXA-20 is valued

"CP" or "PA"

17 Substance

Manufacturer

Name

CE C(R/O) [0..1] If the first occurrence of

RXA-9.1 is valued "00"

and RXA-20 is valued

"CP" or "PA"

MVX

Substance/Treat

ment Refusal

Reason

C(R/X)

[0..*]

If the RXA-20 (Completion

Status) is valued “RE “

NIP002

Indication

20 Completion

Status

ID RE [0..1] 2 HL70322

Action Code -

RXA

C(R/O)

[0..1]

If RXA-5.1 is not valued “998”

HL70323

System Entry

Date/Time

23 Administered

Drug Strength

Volume

NM O

Administered

Drug Strength

Volume Units

CWE

Administered

CWE

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Table 5-12 Pharmacy/Treatment Administration (RXA)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional Predicate Value

Set

Comment

Barcode

Identifier

26 Pharmacy Order

Type

ID O

Conformance Statement:

IZ-28: RXA-1 ( Give Sub-id counter) SHALL be valued “0” Note that “0” is zero.

IZ-29: RXA-2 (admin Sub-id) SHALL be valued “1 “

IZ-30: If RXA-4 (Date time of admin end ) is populated, then it SHALL be the same as Start time (RXA-3)

IZ-31: If RXA-20 is valued "CP" or "PA" then RXA-9.1 (admin notes) SHALL be valued one of the codes listed in NIP001 in the first occurrence

of this field and the following repetition should be empty or valued with a text notes.

IZ-32: If the RXA-18 (Refusal Reason) is populated, RXA-20 SHALL be valued “RE”.

IZ-47: If RA-20 is NOT valued "CP" or "PA" then the first occurrence of RXA-9.1 (admin notes) SHALL be empty and the following repetitions

should be empty or valued with text notes.

IZ-48: If RXA-20 is valued “RE” then RXA-6 shall be valued “999”.

IZ-49: If RXA-5.3 is valued “998” then RXA-6 shall be valued “999”.

IZ-50: If the first instance of RXA-9.1 is not valued “00” then RXA-6 (administered amount) SHALL be valued “999”

RXA field definitions

RXA-1 Give Sub-ID Counter (NM) 00342

Definition: This field is used to match an RXA and RXG. Not a function under IIS.

Constrain to 0 (zero).

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RXA-2 Administration Sub-ID Counter (NM) 00344

Definition: This field is used to track multiple RXA under an ORC. Since each ORC has only one RXA in immunization messages, constrain to 1. This

should not be used for indicating dose number, which belongs in an OBX.

Note that the previous Implementation Guide suggested that this be used for indicating dose number. This use is no longer supported.

RXA-3 Date/Time Start of Administration (TS_NZ) 00345

Definition: The date this vaccination occurred. In the case of refusal or deferral, this is the date that the refusal or deferral was recorded. In the case of a

forecast dose, this is the date the forecast was made.

RXA-4 Date/Time End of Administration (If Applies) (TS) 00346

Definition: In the context of immunization, this is equivalent to the Start date/time. If populated it should be = RXA-3.

Note: This field is specified as required in the HL7 standard. In spite of being Required by the standard, the standard acknowledges that it may be

empty. For immunization records, this has no use. An immunization is given at a point in time. For this reason, this Implementation Guide has relaxed

the usage to Optional.

RXA-5 Administered Code (CE) 00347

Definition: This field identifies the medical substance administered. If the substance administered is a vaccine, CVX codes are required (see CVX Table

- Codes for vaccines administered). The second set of three components may be used to represent the same vaccine using a different coding system.

NDC codes are preferred.

RXA-6 Administered Amount (NM) 00348

Definition: This field records the amount of pharmaceutical administered. The units are expressed in the next field, RXA-7. When the administered

amount is unknown, this field should record the value “999” in this field.

RXA-7 Administered units (CE) 00349

Definition: This field is conditional because it is required if the administered amount code does not imply units. This field must be in simple units that

reflect the actual quantity of the substance administered. It does not include compound units. This field is not required if the previous field is populated

with 999.

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RXA-9 Administration Notes (CE) 00351

Definition: This field is used to indicate whether this immunization record is based on a historical record or was given by the reporting provider. It

should contain the information source (see NIP-defined Table 0001 - Immunization Information Source). The first component shall contain the code, the

second the free text and the third shall contain the name of the code system. (NIP001) Sending systems should be able to send this information.

Receiving systems should be able to accept this information.

This field may be used for other notes if specified locally. The first repetition shall be the information source. If other notes are sent when information

source is not populated, then the first repetition shall be empty.

Other notes may include text only in component 2 of the repeat. Acceptance of text only is by local agreement only.

Information source is an NVAC core data element. It speaks to the reliability of the immunization record. IIS rely on this information.

RXA-10 Administering Provider (XCN) 00352

Definition: This field is intended to contain the name and provider ID of the person physically administering the pharmaceutical.

Note that previous Implementation Guide (2.3.1) overloaded this field by using local codes to indicate administering provider, ordering provider and

recording provider. This is a misuse of this field and not supported in this Guide. The ordering and entering providers are indicated in the associated ORC

segment.

RXA-11 Administered-at Location (LA2) 00353

Definition: The name and address of the facility that administered the immunization. Note that the components used are:

Component 4: The facility name/identifier.

Subcomponent 1: identifier

Subcomponent 2: Universal ID This shall be an OID, if populated. Note that this should not be a local code, but rather a universal id code.

Subcomponent 3: Universal ID type (specify which universal id type)

Component 9-15: Facility address.

This value should uniquely identify a specific facility. Systems may choose to publish a table with local values.

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Components not specifically mentioned here are not expected in immunization messages.

RXA-15 Substance Lot Number (ST) 01129

Definition: This field contains the lot number of the medical substance administered. It may remain empty if the dose is from a historical record.

Note: The lot number is the number printed on the label attached to the container holding the substance and on the packaging which houses the

container. If two lot numbers are associated with a product that is a combination of different components, they may be included in this field. The first

repetition should be the vaccine.

RXA-16 Substance Expiration Date (TS_M) 01130

Definition: This field contains the expiration date of the medical substance administered. It may remain empty if the dose is from a historical record.

Note: Vaccine expiration date does not always have a "day" component; therefore, such a date may be transmitted as YYYYMM.

RXA-17 Substance Manufacturer Name (CE) 01131

Definition: This field contains the manufacturer of the medical substance administered.

Note: For vaccines, code system MVX should be used to code this field.

RXA-18 Substance/Treatment Refusal Reason (CE) 01136

Definition: This field contains the reason the patient refused the medical substance/treatment. Any entry in the field indicates that the patient did not

take the substance. If this field is populated RXA-20, Completion Status shall be populated with RE.

RXA-20 Completion Status (ID) 01223

This field indicates if the dose was successfully given. It must be populated with RE if RXA-18.

RXA-21 Action Code – RXA (ID) 01224

This field indicates the action expected by the sending system. It can facilitate update or deletion of immunization records.

If this field is empty, no action is indicated.

ORC-3, Placer order number, may be used to link to a specific immunization if the system receiving the request has recorded this from the initial order.

Local implementers should specify its’ use in a local implementation guide.

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The action code U (Update) is used to indicate to a subordinate receiver that a previously sent immunization should be changed. Most IIS have specific

criteria for determining whether to add or update an immunization that does not rely directly on this field. For this reason it is common practice to indicate

action as Add even if this vaccination has been previously reported. It is important to not assume that Updates will be or need to be specifically indicated.

RXR-- Pharmacy/Treatment Route Segment

The Pharmacy/Treatment Route segment contains the alternative combination of route, site, administration device, and administration method that are

prescribed as they apply to a particular order.

able 5-12 Pharmacy/Treatment Route (RXR)

Table 5-13 Pharmacy/Treatment Route (RXR)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional

Predicate

Value

Set

Constraint

Route

[1..1]

NCIT

2 Administration

Site

CWE RE [0..1] HL70163

Administration

Device

Administration

Method

CWE

5 Routing

Instruction

CE O

Administration

Site Modifier

CWE

RXR field definitions

RXR-1 Route (CE) 00309

Definition: This field is the route of administration.

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RXR-2 Administration Site (CWE) 00310

Definition: This field contains the site of the administration route.

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6. Profile Z23 Return an Acknowledgement

Introduction:

Profile Z23 – Return Acknowledgement is a constrainable profile based on the ACK message.

The goal of this interaction is to acknowledge receipt and processing of a partner message (VXU or QBP). The Sending System may be an Electronic Health

Record system (EHRs), an Immunization Information System (IIS) or another type of health information system.

See Use Case 1—Send Immunization History.

Interaction Definition:

This sequence diagram illustrates the message flow. The sender sends an immunization record in a VXU message. The trigger may be an update or new record in

the sending system records or may be triggered by some other event. The receiver accepts the message and processes it. The receiver sends an acknowledgment

message in an ACK message. The transactions that are of interest are indicated by bold arrows.

It is important to note that the message may pass through intermediaries, such as a Health Information Exchange (HIE). The message comes from the initiating

sender and the acknowledgement MUST be returned to the initiating system.

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Figure 38 Send Immunization History Sequence Diagram

Dynamic Definition:

The following diagram illustrates the expected flow of events. Some event triggers the sending system to create and send a VXU. The receiving system accepts

the VXU. If the message is of an unsupported message type, has an unsupported event code, has an unsupported processing ID or in unable to be processed for

reasons unrelated to format or content, then the acknowledgement code is set to “AR". The receiving system returns an ACK with the acknowledgement code of

“AR”. Otherwise, the receiving system continues to process the message. It parses the message and processes according to the specifications of this profile and

applies local business rules. If there are no errors, the acknowledgment code is set to “AA”. If there are errors, the acknowledgement code is set to “AE”. If the

errors are fatal (See Processing Rules for Receiving Systems above), then the message is rejected, otherwise the data are integrated into the receiving system. The

acknowledgement code is returned to the sending system in an ACK message.

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Figure 39 Activity Diagram-Return Acknowledgement

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Static Definition- Message Level

The ACK returns an acknowledgement to the sending system. This may indicate errors in processing.

Tab

le 6-1 Message Acknowledgement Segment (ACK)

Table 6-1 Message Acknowledgement Segment (ACK)

Segment Cardinality Usage Comment

MSH

(1..1) R

[{SFT}]

(0..1) O

Not anticipated for use in immunization messages.

MSA

(1..1) R

[{ERR}]

(0..*) RE Include if there are errors.

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Static Definition—Segment Level:

ERR—Error Segment

Table 6-2 Error Segment (ERR)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional Predicate Value

Set

Description/Comment

Error Code

and Location

ELD

Not supported for Version 2.5

and above.

Error Location

ERL

[0..1]

HL7 Error

Code

CWE

[0..1]

HL70357

Severity

[1..1]

1..1

HL70516

Application

Error Code

CWE

HL70533

Application

Error

Parameter

Diagnostic

Information

User Message

This is a locally specified

informative text message about

the error.

Inform Person

Indicator

Override Type

CWE

This Guide does not support repeat of this field. It assumes that each error will be contained in one ERR segment. If the same error occurs more than once, there will be one ERR for each.

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[

0..1]

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Table 6-2 Error Segment (ERR)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional Predicate Value

Set

Description/Comment

11 Override

Reason Code

CWE O

Help Desk

Contact Point

XTN

Note: If an error involves the entire message (e.g. the message is not parse-able.) then location has no meaning. In this case, ERR-2 is left empty.

ERR field definitions:

Note that ERR-1 is not supported for use in messages starting with version 2.5.

ERR-2 Error Location (ERL) 01812

Definition: Identifies the location in a message related to the identified error, warning or message. Each error will have an ERR, so no

repeats are allowed on this field. This field may be left empty if location is not meaningful. For example, if it is unable to be parsed, an

ERR to that effect may be returned.

ERR-3 HL7 Error Code (CWE) 01813

Definition: Identifies the HL7 (communications) error code. Refer to HL7 Table 0357 – Message Error Condition Codes for valid values.

ERR-4 Severity (ID) 01814

Definition: Identifies the severity of an application error. Knowing if something is Error, Warning or Information is intrinsic to how an

application handles the content. Refer to HL7 Table 0516 - Error severity for valid values. If ERR-3 has a value of "0", ERR-4 will have a

value of "I". The Severity code indicates if the system sending the ACK or RSP (with error) is reporting an error that caused significant

error loss. For instance the message was rejected or an important segment was rejected (e.g. RXA). This allows the system that initiated

the message (VXU or QBP) to alert the user that there were issues with the data sent.

Note that the definitions of these codes has been clarified and corrected.

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ERR-5 Application Error Code (CWE) 01815

Definition: Application specific code identifying the specific error that occurred. Refer to User-Defined Table 0533 – Application Error Code

for appropriate values.

Note, this field is CWE data type. It includes 2 triplets for coded values. One triplet is reserved for Table 0533 values. The other may optionally contain

more granular, but equivalent, local codes.

ERR-8 User Message (TX) 01817

Definition: The text message to be displayed to the application user.

Example with error in PID:

ERR||PID^1^3|101^Required field missing^HL70357^^^|E||||Patient Id is required, Message rejected

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MSA—Message Acknowledgement Segment

Table 6-3 Message Acknowledgement Segment (MSA)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional Predicate Value

Set

Description/Comment

Acknowledgment

Code

[1..1]

2..2

HL70008

2 Message Control

ST R [1..1] 1..199

Text Message

Expected

Sequence

Number

5 Delayed

Acknowledgment

Type

Error Condition

MSA field definitions

MSA-1 Acknowledgment Code (ID) 00018

Definition: This field contains an acknowledgment code, see message processing rules. Refer to HL7 Table 0008 - Acknowledgment code for valid

values.

MSA-2 Message Control ID (ST) 00010

Definition: This field contains the message control ID of the message sent by the sending system. It allows the sending system to associate this response

with the message for which it is intended. This field echoes the message control id sent in MSH-10 by the initiating system.

MSH—Message Header Segment

This implementation guide pre-adopts the Version 2.7.1 MSH segment.

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Table 6-4 Message Header Segment (MSH)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional

Predicate

Value set Description/Comment

Field Separator

[1..1]

1..1

Encoding Characters

[1..1]

4..4

Sending Application

[0..1]

HL70361

Sending Facility

[0..1]

HL70362

5 Receiving

Application

HD RE [0..1] HL70361

Receiving Facility

[0..1]

HL70362

Date/Time Of

Message

TS_Z

[1..1]

Security

Message Type

MSG

[1..1]

Message Control ID

[1..1]

1..199

Processing ID

[1..1]

Version ID

VID

[1..1]

Sequence Number

14 Continuation Pointer ST O [0..1]

Acknowledgement

Type

[1..1]

HL70155

Default value is NE (Never)

Application

Acknowledgment

Type

[1..1]

HL70155

(constrained)

Country Code

Character Set

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Table 6-4 Message Header Segment (MSH)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional

Predicate

Value set Description/Comment

Principal Language

Of Message

Alternate Character

Set Handling

Scheme

Message Profile

Identifier

[1..*]

Sending

Responsible

Organization

XON

[0..1]

The initiator of this message.

Receiving

Responsible

Organization

XON

[0..1]

The final recipient of this

message.

Sending Network

Address

Receiving Network

Address

MSH Conformance Statements:

IZ-12: The MSH.1 (Field Separator) SHALL be valued “|”

IZ-13: The MSH.2 (Encoding Characters) SHALL be valued “^~\& “

IZ-15: The MSH-12 (Version ID) SHALL be valued “2.5.1 “

IZ-51: MSH-9 (Message Type) SHALL contain the constant value “ACK^VO4^ACK”

IZ-52: The value of MSH-16 (Application Acknowledgement) shall be “NE”.

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IZ-53: The value of MSH-15(Accept Acknowledgement) shall be “NE”

IZ-54: MSH-21(Profile Identifier ID) SHALL contain the constant value “Z23^CDCPHINVS”

MSH field definitions

See field definitions for MSH under Profile Z22 above.

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7.Profile Z34 - Request a Complete Immunization History

Introduction:

Profile Z34 – Request Complete Immunization History is a constrainable profile that supports request of an immunization history of an individual. It has a set

partner profiles which return the requested history, a list of candidate patients or an acknowledgement that no matches were found.

The goal of this query is to request a complete immunization history. This will support transferring a person’s immunization records from one information system

to another. The response will be very similar to a VXU message in content.

See Use Case 2—Request Immunization History above for Use Case details.

A complete immunization history consists of:

• demographic information about the patient,

• a list of the immunizations received,

• a list of any patient conditions that impact immunization (i.e. allergies, contraindications, history of vaccine preventable disease)

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Table 7-1 Request Complete Immunization History Query Profile

Query Statement ID (Query

ID=Z34):

Z34

Type:

Query

Query Name:

Request Immunization History

Query Trigger (= MSH-9):

QBP^Q11^QBP_Q11

Query Mode:

Both

Response Trigger (= MSH-9):

RSP^K11^RSP_K11

Query Characteristics:

The query parameters may include demographic and address data. No sorting is expected.

This profile does not specify the logic used when searching for matching clients/patients.

The query parameter contents may be used for simple query or as input for probabilistic

search algorithms. The search methodology should be specified by local implementations.

Purpose:

The purpose is to request a complete immunization history for one client.

Response Characteristics:

• In the case where no candidates are found, the acknowledgement response will

indicate that no candidates were found.

• In the case where exactly one high-confidence candidate is found, an immunization

history may be returned.

• In the case where one or more clients could match the criteria sent, a list of

candidates may be returned to allow for refinement of the query. If the number of

candidates exceeds the maximum number requested or allowed for return, the

acknowledgement response will indicate too many matches and no records will be

returned.

• In the case where one high confidence candidate is found, but that candidate does

not allow sharing of data, the acknowledgement response will indicate no

candidates were found.

• In the case where receiving system can’t process the query, the receiving system

will indicate an error in an acknowledgement.

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Table 7-1 Request Complete Immunization History Query Profile

Query Statement ID (Query

ID=Z34):

Z34

Based on Segment Pattern:

Interaction Definition:

The following sequence diagram shows the message flows involved in this transaction. The sending system creates a query and sends it. The responding system

sends a response.

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Figure 40 Sequence Diagram-Return Complete Immunization History

Dynamic Definition:

The following activity diagram shows the flow of activities associated with this profile and its partners. This is described in the table below the diagram.

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Figure 41 Request Complete History and Responses Activity Diagram

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Table 7-2 Response to Different Outcomes

Outcome of Query Response Message

No match found

Response indicates that message was successfully processed and that no clients matched the

criteria that were sent in the query. See Acknowledgement Profile (Z33).

Exactly one high confidence match found

Response includes a complete immunization history as specified below.

ee Profile Return Immunization History (Z32).

At least one lower confidence match

is found, but

<= maximum number allowed.

If state law allows, the Response returns one PID with associated PD1 and NK1 segments for

each potential match. No immunization history is returned.

ee Profile Return Candidate List (Z31).

More than the maximum number allowed is found.

Response indicates that the message was successfully processed, but that too many potential

matches were found. See Return Acknowledgement Profile (Z33)

he maximum number allowed is the lower of the maximum number requested and the

maximum number that the receiving system will return.

Message is not well formed and has fatal errors.

Response indicates that the message was not successfully processed and may indicate errors.

See Return Acknowledgement Profile (Z33).

Message was rejected because one of the following

occurred:

• Unsupported message type

Return ACK message with errors.

Definition of match is left to local business rules. These rules should be documented in a local implementation guide. For example, a system may only return an immunization history when the match

is exact, returning a list of 1 if one person for a lower probability match.

More than one high confidence match is considered a set of lower confidence matches.

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Outcome of Query Response Message

• Unsupported event code

• Unsupported processing ID

• Unable to process for reasons unrelated for

format or content

Message can’t be identified as an HL7 message.

No HL7 message is returned.

Static Definition - Message Level:

Table 7-3 Z34 Request Complete Immunization History

TABLE 7-3 Z34 REQUEST COMPLETE IMMUNIZATION HISTORY

QBP^Q11^QBP_Q11

Query Grammar: QBP

Message

Usage Comment

MSH Message Header Segment R

[{SFT}] Software Segment O Local profile

may

specify

QPD Query Parameter Definition R

RCP Response Control Parameter R

[ DSC ] Continuation Pointer X Not supported

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Static Definition – Segment Level:

MSH - Message Header Specification

Table 7-4 MSH Specification for Request Complete Immunization History Query

SEQ LEN Data

Type

Cardinalit

Value

set

ELEMENT NAME Usage Constraint

[1..1]

Field Separator

The MSH.1 field shall be |

[1..1]

Encoding Characters

The MSH.2 field shall be ^~\&

[0..1]

0361

Sending Application

No constraint

[0..1]

0362

Sending Facility

No constraint

[0..1]

0361

Receiving Application

No constraint

[0..1]

0362

Receiving Facility

No constraint

TS_Z

[1..1]

Date/Time Of Message

The degree of precision must be

at least to the second, (format

YYYYMMDDHHMMSS+/-ZZZZ).

[0..1]

Security

MSG

[1..1]

Message Type

QBP^Q11^QBP_Q11

199

[1..1]

Message Control ID

[1..1]

Processing ID

VID

[1..1]

Version ID

2.5.1

[0..1]

Sequence Number

180

[0..1]

Continuation Pointer

[0..1]

0155

Accept Acknowledgment

Type

ER-Error

[0..1]

0155

Application

Acknowledgment Type

AL-Always

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Table 7-4 MSH Specification for Request Complete Immunization History Query

SEQ LEN Data

Type

Cardinalit

Value

set

ELEMENT NAME Usage Constraint

17 3 ID [0..1] 0399 Country Code X blank

[0..1]

0211

Character Set

blank

[0..1]

Principal Language Of

Message

blank

20 20 ID [0..1] 0356 Alternate Character Set

Handling Scheme

X blank

[1..*]

Message Profile Identifier

Z34^CDCPHINVS

XON

[0..1]

0362

Sending Responsible

Organization

XON

0362

Receiving Responsible

Organization

Conformance Statement:

IZ-12: The MSH.1 (Field Separator) SHALL be valued “|”

IZ-13: The MSH.2 (Encoding Characters) SHALL be valued “^~\& “

IZ-15: The MSH-12 (Version ID) SHALL be valued “2.5.1 “

IZ-55: MSH-9 (Message Type) SHALL contain the constant value “QBP^Q11^QBP_Q11”

IZ-56: One occurrence of MSH-21 (Message Profile Identifier) SHALL contain the constant value “Z34^CDCPHINVS”

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IZ-57: MSH-15 (Accept Acknowledgement) SHALL have a value of “ER”.

IZ-58: MSH-16 (Application Acknowledgement) SHALL have a value of “AL”

MSH field definitions

See field definitions for MSH under Profile Z22 above.

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QPD Input Parameter Specification

Table 7-5 QPD Input Parameter Specification

Field

Seq

(Query

ID=Z34)

Name Key/

Sort LEN TYPE Usage Rep Match

TBL Segment

Field

Name

Service

Identif

ier

Code

Element

Name or

Value

MessageQue

ryName

Z34^Request

Complete

Immunization

History^CDCP

HINVS

QueryTag

PatientList

PID.3

PID-3: Patient

Identifier List

PatientName

XPN

PID.5

PID-5: Patient

Name

PatientMothe

rMaidenNam

XPN_M

PID.6

PID-6: Mother’s

maiden name

Patient Date

of Birth

TS_NZ

PID.7

PID-7: Patient

date of birth

Patient Sex

PID.8

PID-8: Patient

sex

Patient

Address

XAD

PID.11

PID-11: Patient

Address

Patient home

phone

XTN

PID.13

PID-13: Patient

home phone

Patient

PID-24

PID-24: Patient

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Table 7-5 QPD Input Parameter Specification

Field

Seq

(Query

ID=Z34)

Name Key/

Sort LEN TYPE Usage Rep Match

TBL Segment

Field

Name

Service

Identif

ier

Code

Element

Name or

Value

multiple birth

indicator

multiple birth

indicator

Patient birth

order

PID-25

PID-25: Patient

birth order

Client last

updated date

PID-33

PID-33: Patient

last update

date

Client last

update

facility

HD RE PID-34

PID-34: Patient

last update

faciliity

QPD Input Parameter Field Description and Commentary

Table 7-6 QPD Input Parameter Field Description and Commentary

Input Parameter (Query

ID=Z34)

Comp. Name Data Type Usage Description

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Table 7-6 QPD Input Parameter Field Description and Commentary

Input Parameter (Query

ID=Z34)

Comp. Name Data Type Usage Description

MessageQueryName

Z34^Request Immunization

History^HL70471

QueryTag

Unique to each query message

instance.

PatientList

The combination of values for

Patientlist.ID,

patientlst.identifiercode and

Patientlist.AssigningAuthority are

intended to allow unique

identification of a client, if the data

are found in the responding

system.

If this field, PID.3.1, is not valued,

PatientList is not considered when

seeking matching clients.

Assigning Authority

If this field, PID.3.4, is not valued,

PatientList is not considered when

seeking matching clients.

IdentifierTypeCode

If this field, PID.3.5, is not valued,

PatientList is not considered when

seeking matching clients.

PatientName

XPN

If this field, PID.5, is not valued,

then the query will return an error,

since this is a required field.

Family Name

If this field, PID.5.1, is not valued,

then patient name is considered to

contain no value.

Given Name

If this field, PID.5.2, is not valued,

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Table 7-6 QPD Input Parameter Field Description and Commentary

Input Parameter (Query

ID=Z34)

Comp. Name Data Type Usage Description

then patient name is considered to

contain no value. Given name is

required.

Second or further names

If this field, PID.5.3, is not valued,

then all values for this field are

considered a match.

Suffix

If this field, PID.5.4, is not valued,

then all values for this field are

considered a match.

Mother’s Maiden Name

XPN_M

If this field, PID.6, is not valued,

Mother’s maiden name is not

considered when seeking

matching clients.

Family Name

If this field, PID.6.1, is not valued,

then mother’s maiden name is

considered to contain no value.

Given Name

If this field, PID.6.2, is not valued,

then all values for this field are

considered a match.

Name Type Code

If the field, PID-6.7, is not valued,

then all values for this field are

considered a match.

DateOfBirth

TS_NZ

If this field, PID.7, is not valued to

an accuracy of at least day, then

this field is considered not valued.

Sex

If this field, PID.8, is not valued,

then all values for this field are

considered a match.

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Table 7-6 QPD Input Parameter Field Description and Commentary

Input Parameter (Query

ID=Z34)

Comp. Name Data Type Usage Description

Address

XAD

If this field, PID.11, is not valued,

then address will not be

considered when seeking

matching clients.

Street Address

SAD

If this field, PID.11.1, is not valued,

then all values for this field are

considered a match.

City

If this field, PID.11.3, is not valued,

then address is considered to

contain no value.

State

If this field, PID.11.4, is not valued,

then address is considered to

contain no value.

ZIP

If this field, PID.11.5, is not valued,

then all values for this field are

considered a match.

Address Type

If this field, PID.11.7 is not valued,

then it shall default to L, legal

address.

Phone

XTN

This field will be considered the

Home phone. If this field, PID.13,

is not valued, then phone number

is not considered when seeking

matching clients.

Area code

If this field, PID.13.6, is not valued,

then all values for this field shall

be considered matches.

Local number

If this field, PID.13.7, is not valued,

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Table 7-6 QPD Input Parameter Field Description and Commentary

Input Parameter (Query

ID=Z34)

Comp. Name Data Type Usage Description

then address is considered to

contain no value.

Multiple Birth Indicator

If this field, PID.24, is not valued,

then Multiple Birth Indicator is not

considered when seeking

matching clients.

Birth Order

If this field, PID.25, is not valued,

then birth order is not considered

when seeking matching clients.

Client last updated date

If this field, PID.33, is not valued,

then client last updated date is not

considered when seeking

matching clients.

Client last update facility

If this field, PID.34, is not valued,

then client last updating facility is

not considered when seeking

matching clients.

This Guide does not specify the methodology a system uses for searching. It specifies the structure and content of the message used to query. It is incumbent on

systems to publically document their expectations within the constraints of this guide.

RCP – Response Control Parameter Segment

The RCP segment is used to restrict the amount of data that should be returned in response to query. It lists the segments to be returned.

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Table 7-7 Response Control Parameter

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional Predicate Value

set

Comments

Query Priority

[0..1]

HL70091

Quantity

Limited

Request

[0..1]

HL70126

This field may contain a

maximum number of records

that may be returned. The first

component contains the count

and the second contains “RD”

for records.

Response

Modality

Execution and

Delivery Time

Modify

Indicator

Sort-by Field

SRT

Segment

group

inclusion

Conformance Statement:

IZ-27: Constrain RCP-1 (Query Priority) to empty or “I”. Immediate priority is expected.

RCP field definitions

RCP-1 Query Priority (ID) 00027

Definition: This field contains the time frame in which the response is expected. Refer to HL7 Table 0091 - Query priority for valid values. Table values

and subsequent fields specify time frames for response. Only “I” ( for immediate shall) be used for this field.

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RCP-2 Quantity Limited Request (CQ) 00031

Definition: This field contains the maximum length of the response that can be accepted by the requesting system. Valid entries are numerical values (in

the first component) given in the units specified in the second component. Default is LI (lines). The expected type is records, so the second component is

constrained to RD.

Note that this field is the maximum total records to return. The Version 2.5.1 standard indicates the maximum number to return in each batch. No batching

of responses is permitted in this Guide.

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8.Profile Z32 Response Profile – Return Complete Immunization

History

Introduction:

Profile Z32 – Return Complete Immunization History is a constrainable profile that supports return of an immunization history of an individual. It is a response

to the Z34-Request Immunization History query.

The goal of this response is to return a complete immunization history in response to a request for a person’s record. This will support transferring a person’s

immunization records from one information system to another. The response will be very similar to a VXU message in content.

Interaction Definition

See Interaction Definition In previous chapter.

Dynamic Definition

See Activity Diagram in previous chapter.

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Static Definition – Message Level

Table 8-1 Return Complete Immunization History Response GrammarSP^K11

Table 8-1 Return Complete Immunization History Response Grammar RSP^K11

Segment Cardinality Usage Comment

MSH

[1..1]

MSA

[1..1]

[ERR]

[0..1]

If errors exist, then this segment is populated.

QAK

[1..1]

QPD

[1..1]

Query Parameter Definition Segment

PID

[1..1] R

[PD1 ]

[0..1] RE

[{NK1 }]

[0..*] RE

[PV1]

[0..1] O

[IN1]

[0..1] O

[{

[0..*] RE Begin Order

ORC

[1..1] R Required if client has immunization records

(RXA). There is one ORC for each RXA

RXA

[1..1] R

Matches the information in the requesting QBP message.

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Table 8-1 Return Complete Immunization History Response Grammar RSP^K11

Segment Cardinality Usage Comment

[RXR ]

[0..1] RE

[{

[0..*] RE Begin Observation

OBX

[1..1] R

[NTE ]

[0..1] RE

}]

End observation

}]

End Order

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Static Definition -- Segment Level

ERR—Error Segment

Table 8-2 Error Segment (ERR)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional Predicate Value

Set

Description/Comment

Error Code

and Location

ELD

Not supported for Version 2.5

and above.

Error Location

ERL

[0..1]

HL7 Error

Code

CWE

[1..1]

HL70357

Severity

[1..1]

1..1

HL70516

Application

Error Code

CWE

HL70533

Application

Error

Parameter

Diagnostic

Information

User Message

This is a locally specified

informative text message about

the error.

Inform Person

Indicator

Override Type

CWE

This Guide does not support repeat of this field. It assumes that each error will be contained in one ERR segment. If the same error occurs more than once, there will be one ERR for each.

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Table 8-2 Error Segment (ERR)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional Predicate Value

Set

Description/Comment

11 Override

Reason Code

CWE O

Help Desk

Contact Point

XTN

Note: If an error involves the entire message (e.g. the message is not parse-able.) then location has no meaning. In this case, ERR-2 is left empty.

ERR field definitions:

See field definitions for ERR under Profile Z23 above.

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IN1—Insurance Segment

Local implementations may document use for local purposes in local implementation Guide. Field level specifications follow. They have

been constrained, based on current usage. Local implementations that require IN1 should base requirements on this guide. Specifications

for IN1 are included because several IIS require this segment and this specification is intended to assure that implementations are

consistent across systems.

Note that only the current insurance data should be sent. Historical insurance information should not be sent.

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Table 8-3 Insurance Segment (IN1)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional Predicate Value

Set

Description/Comment

Set ID - IN1

[1..1]

Insurance Plan ID

[1..1]

250

HL70072

Insurance

Company ID

250

Insurance

Company Name

XON

250

Insurance

Company

Address

XAD

250

Insurance Co

Contact Person

XPN

250

Insurance Co

Phone Number

XTN

250

Group Number

Group Name

XON

250

Insured’s Group

Emp ID

250

Insured’s Group

Emp Name

XON

250

Plan Effective

Date

Plan Expiration

Date

Authorization

Information

AUI

239

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Table 8-3 Insurance Segment (IN1)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional Predicate Value

Set

Description/Comment

15 Plan Type IS R 3 HL70086

Name Of Insured

XPN

250

Insured’s

Relationship To

Patient

250

HL70063

18 Insured’s Date Of

Birth

TS O 26

Insured’s Address

XAD

250

20 Assignment Of

Benefits

IS O 2 HL70135

21 Coordination Of

Benefits

IS O 2 HL70173

Coord Of Ben.

Priority

Notice Of

Admission Flag

HL70136

24 Notice Of

Admission Date

DT O 8

Report Of

Eligibility Flag

HL70136

Report Of

Eligibility Date

27 Release

Information Code

IS O 2 HL70093

Pre-Admit Cert

(PAC)

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Table 8-3 Insurance Segment (IN1)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional Predicate Value

Set

Description/Comment

29 Verification

Date/Time

TS_NZ RE 26 Precision shall be at least to the

day. [YYYYMMDD]

Verification By

XCN

250

31 Type Of

Agreement Code

IS O 2 HL70098

32 Billing Status IS O 2 HL70022

Lifetime Reserve

Days

34 Delay Before L.R.

Day

NM O 4

35 Company Plan

Code

IS O 8 HL70042

Policy Number

37 Policy Deductible CP O 12

38 Policy Limit -

Amount

CP X 12

Policy Limit -

Days

40 Room Rate -

Semi-Private

CP X 12

41 Room Rate -

Private

CP X 12

Insured’s

Employment

Status

250

HL70066

Insured’s

Administrative

HL70001

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Table 8-3 Insurance Segment (IN1)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional Predicate Value

Set

Description/Comment

Sex

Insured’s

Employer’s

Address

XAD

250

45 Verification Status ST O 2

Prior Insurance

Plan ID

HL70072

47 Coverage Type IS O 3 HL70309

48 Handicap IS O 2 HL70295

Insured’s ID

Number

250

Signature Code

HL70535

51 Signature Code

Date

DT O 8

Insured’s Birth

Place

250

VIP Indicator

HL70099

IN1 Field Definitions

See Field Definitions in Z22 Profile.

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MSA—Message Acknowledgement Segment

Table 8-4 Message Acknowledgement Segment (MSA)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional Predicate Value

Set

Description/Comment

Acknowledgment

Code

[1..1]

2..2

HL70008

2 Message Control

ST R [1..1] 1..199

Text Message

Expected

Sequence

Number

5 Delayed

Acknowledgment

Type

Error Condition

MSA field definitions

See field definitions for MSA under Profile Z23 above.

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MSH - Message Header Specification

Table 7-9 MSH Sp8-5 S for Request Complete Immunization History Query

Table 8-5 MSH Specification for Return Complete Immunization History Response

SEQ LEN Data

Type

Cardinality Value

set

ELEMENT NAME Usage Constraint

[1..1]

Field Separator

The MSH.1 field shall be |

2 4 ST [1..1] Encoding Characters R The MSH.2 field shall be ^~\&

[0..1]

0361

Sending Application

No constraint

4 HD [0..1] 0362 Sending Facility RE No constraint

5 HD [0..1] 0361 Receiving Application RE No constraint

[0..1]

0362

Receiving Facility

No constraint

7 26 TS_Z [1..1] Date/Time Of Message R The degree of precision must be

at least to the second, (format

YYYYMMDDHHMMSS+/-ZZZZ.

8 40 ST [0..1] Security O

MSG

[1..1]

Message Type

RSP^K11^RSP_K11

10 199 ST [1..1] Message Control ID R

11 3 PT [1..1] Processing ID R

VID

[1..1]

Version ID

2.5.1

[0..1]

Sequence Number

14 180 ST [0..1] Continuation Pointer O

[0..1]

0155

Accept Acknowledgment

Type

16 2 ID [0..1] 0155 Application

Acknowledgment Type

R AL

17 3 ID [0..1] 0399 Country Code X blank

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Table 8-5 MSH Specification for Return Complete Immunization History Response

SEQ LEN Data

Type

Cardinality Value

set

ELEMENT NAME Usage Constraint

18 16 ID [0..1] 0211 Character Set X blank

[0..1]

Principal Language Of

Message

blank

20 20 ID [0..1] 0356 Alternate Character Set

Handling Scheme

X blank

21 EI [1..*] Message Profile Identifier R Z32^CDCPHINVS

XON

[0..1]

0362

Sending Responsible

Organization

XON

0362

Receiving Responsible

Organization

Conformance Statement:

IZ-12: The MSH.1 (Field Separator) SHALL be valued “|”

IZ-13: The MSH.2 (Encoding Characters) SHALL be valued “^~\& “

IZ-15: The MSH-12 (Version ID) SHALL be valued “2.5.1 “

IZ-59: MSH-9 (Message Type) SHALL contain the constant value “RSP^K11^RSP_K11”

IZ-52: The value of MSH-16 (Application Acknowledgement) SHALL be “NE”.

IZ-53: The value of MSH-15 (Accept Acknowledgement) SHALL be “NE”

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IZ-60: One occurrence of MSH-21 (Message Profile Identifier) SHALL contain the constant value “Z32^CDCPHINVS”

MSH Field Definitions

See field definitions for MSH under Profile Z22 above.

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NK1—Next of Kin Segment

The NK1 segment contains information about the patient’s other related parties. Any associated parties may be identified. Utilizing NK1-1 - set ID, multiple NK1

segments can be sent to patient accounts. That is, each subsequent NK1 increments the previous set ID by 1. So if 3 NK1 were sent in one message, the first

would have a set id of 1, the second would have 2 and the third would have 3.

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Table 8-6 Next of Kin Segment (NK1)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional Predicate Value

set

Description/Comment

Set ID - NK1

[1..1]

Name

XPN

[1..*]

The first instance is the legal

name and is required.

Relationship

[1..1]

HL70063

Address

XAD

[0..*]

The first instance shall be the

primary address.

Phone Number

XTN

[0..*]

The first instance shall be the

primary phone number.

Business Phone

Number

XTN

Contact Role

Start Date

End Date

Next of Kin /

Associated

Parties Job Title

Next of Kin /

Associated

Parties Job

Code/Class

JCC

Next of Kin /

Associated

Parties

Employee

Number

Organization

XON

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Table 8-6 Next of Kin Segment (NK1)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional Predicate Value

set

Description/Comment

Name - NK1

Marital Status

15 Administrative

Sex

IS O

Date/Time of

Birth

Living

Dependency

18 Ambulatory

Status

IS O

Citizenship

Primary

Language

21 Living

Arrangement

IS O

Publicity Code

Protection

Indicator

24 Student

Indicator

IS O

Religion

Mother’s Maiden

Name

XPN

27 Nationality CE O

Ethnic Group

Contact Reason

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Table 8-6 Next of Kin Segment (NK1)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional Predicate Value

set

Description/Comment

30 Contact

Person’s Name

XPN O

Contact

Person’s

Telephone

Number

XTN

32 Contact

Person’s

Address

XAD O

33 Next of

Kin/Associated

Party’s

Identifiers

CX O

Job Status

35 Race CE O

36 Handicap IS O

Contact Person

Social Security

Number

38 Next of Kin Birth

Place

ST O

39 VIP Indicator IS O

NK1 field definitions

See field definitions for NK1 under Profile Z22 above.

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NTE—Note Segment

The NTE segment is used for sending notes and comments.

Tabl

e 8-7 Note Segment (NTE)

Table 8-7 Note Segment (NTE)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional Predicate Value

Set

Comment

Set ID - NTE

Source of

Comment

[1..1]

Comment Type

NTE field definitions

See field definitions for NTE under Profile Z22 above.

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OBX—Observation Result Segment

The observation result segment has many uses. It carries observations about the object of its parent segment. In the VXU/RSP it is associated with the RXA or

immunization record. The basic format is a question (OBX-3) and an answer (OBX-5).

Consult Appendix B for detailed examples of each of the uses.

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Table 8-8 Observation Segment (OBX)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional

Predicate

Value Sets Comment

Set ID – OBX

[1..1]

1..4

Value Type

[1..1]

2..3

HL70125

(constrained)

Observation

Identifier

[1..1]

NIP003

This indicates what this

observation refers to. It poses

the question that is answered by

OBX-5.

Observation

Sub-ID

[1..1]

1..20

Constrain to

positive

integers

Observation

Value

varies

[1..1]

varies

OBX-5 is the observation value

and answers the question posed

in OBX-3

Units

C(R/O)

[0..1]

If OBX-2(Value Type) is

valued “NM” or “SN”

Note: If th

ere is not a unit of

measure available while

the Condition Predicated is

true, then the value “NA”

SHALL be used in CE.1

and “HL70353” in CE.3.

UCUM

References

Range

Abnormal

Flags

Probability

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Table 8-8 Observation Segment (OBX)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional

Predicate

Value Sets Comment

Nature of

Abnormal Test

11 Observation

Result Status

ID R [1..1] 1 HL70085

(constrained)

Effective Date

of Reference

Range Values

13 User Defined

Access

Checks

ST O

14 Date/Time of

the

Observation

TS_NZ RE [0..1]

Producer's

Reference

16 Responsible

Observer

XCN O

17 Observation

Method

CE C(RE/O) [0..1] If OBX-3.1 is “64994-7” CDCPHINVS 64994 “-7” is a LOINC meaning

“funding program eligibility”. This

field is used to distinguish

between eligibility that is

captured at the visit level versus

at the immunization event level.

Equipment

Instance

Identifier

19 Date/Time of

the Analysis

TS O

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Table 8-8 Observation Segment (OBX)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional

Predicate

Value Sets Comment

Reserved for

harmonization

with V2.6

21 Reserved for

harmonization

with V2.6

Reserved for

harmonization

with V2.6

Performing

Organization

Name

XON

24 Performing

Organization

Address

XAD O

Performing

Organization

Medical

Director

XCN

Conformance Statement:

IZ-20: The Value of OBX-1 (Set ID-OBX) SHALL be valued sequentially starting with the value “1” within a message.

IZ-21: The value of OBX-2 (Value Type) SHALL be one of the following:

CE, NM, ST, DT, ID or TS

IZ-22: The value of OBX-11 (Observation Result Status) SHALL be “F”

IZ-35: If OBX-3.1 is “64994-7” and OBX-2 is “CE” then the value set for OBX-5 shall be HL70064.

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IZ-36: If OBX-3.1 is “69764-9” and OBX-2 is “CE” then the value set for OBX-5 shall be cdcgs1vis.

IZ-37: If OBX-3.1 is “30956-7” and OBX-2 is “CE” then the value set for OBX-5 shall be CVX.

OBX field definitions

See field definitions for OBX under Profile Z22 above.

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ORC—Order Request Segment

The Common Order segment (ORC) is used to transmit fields that are common to all orders (all types of services that are requested). While not all immunizations

recorded in an immunization message are able to be associated with an order, each RXA must be associated with one ORC, based on HL7 2.5.1 standard.

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Table 8-9 Common Order Segment (ORC)

Table 8-10 Common Order Segment (ORC)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional

Predicate

Value Set Comment

Order Control

[1..1]

HL70119

(constrained)

Placer Order

Number

[0..1]

See Guidance below.

Filler Order

Number

[1..1]

See Guidance below.

Placer Group

Number

Order Status

Response Flag

Quantity/Timin

Parent

EIP

Date/Time of

Transaction

Entered By

XCN

[0..1]

This is the person that entered

this immunization record into the

system.

Verified By

XCN

Ordering

Provider

XCN

C(RE/O)

[0..1]

If the first occurrence of

RXA-9.1 is valued "00"

and RXA-20 is valued

"CP" or "PA"

This shall be the provider

ordering the immunization. It is

expected to be empty if the

immunization record is

transcribed from a historical

record.

Enterer's

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Table 8-10 Common Order Segment (ORC)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional

Predicate

Value Set Comment

Location

Call Back

Phone Number

XTN

15 Order Effective

Date/Time

TS O

Order Control

Code Reason

17 Entering

Organization

CE RE HL70362 This is the provider organization

that entered this record/order.

18 Entering

Device

CE O

Action By

XCN

20 Advanced

Beneficiary

Notice Code

CE O

21 Ordering

Facility Name

XON O

Ordering

Facility

Address

XAD

23 Ordering

Facility Phone

Number

XTN O

24 Ordering

Provider

Address

XAD O

Order Status

CWE

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Table 8-10 Common Order Segment (ORC)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional

Predicate

Value Set Comment

Modifier

Advanced

Beneficiary

Notice

Override

Reason

CWE

27 Filler's

Expected

Availability

Date/Time

TS O

Confidentiality

Code

CWE

Order Type

CWE

30 Enterer

Authorization

Mode

CNE O

Parent

Universal

Service

Identifier

CWE

Conformance Statement:

IZ-25: ORC.1 (Order Control) SHALL contain the value “RE “

ORC field definitions

See field definitions for ORC under Profile Z22 above.

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PD1—Patient Demographic Segment

The Patient Demographic Segment contains patient demographic information that may change from time to time. There are three primary uses PD1 for in

Immunization Messages. These include indicating whether the person wants his/her data protected, whether the person wants to receive recall/reminder notices

and the person’s current status in the registry.

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Table 8-10 Patient Demographic Segment (PD1)

Table 8-11 Patient Demographic Segment (PD1)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional Predicate Value

Set

Comment

Living

Dependency

Living

Arrangement

Patient Primary

Facility

XON

Patient Primary

Care Provider

Name & ID No.

XCN

Student

Indicator

Handicap

Living Will Code

Organ Donor

Code

Separate Bill

Duplicate

Patient

Publicity Code

[0..1]

HL70215

Protection

Indicator

[0..1]

HL70136

Protection

Indicator

Effective Date

DT_D

C(RE/X)

[0..1]

If PD1-12 (Protection Indicator)

is valued

Place of

XON

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Table 8-11 Patient Demographic Segment (PD1)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional Predicate Value

Set

Comment

Worship

Advance

Directive Code

16 Immunization

Registry Status

IS RE [0..1] HL70441

Immunization

Registry Status

Effective Date

DT_D

C(RE/X)

[0..1]

If the PD1-16 (Registry Status)

field is valued.

Publicity Code

Effective Date

DT_D

C(RE/X)

[0..1]

If the PD1-11 (Publicity Code)

field is valued.

19 Military Branch IS O

Military

Rank/Grade

Military Status

PD1 field definitions

See field definitions for PD1 under Profile Z22 above.

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PID—Patient Identifier Segment

The PID is used by all applications as the primary means of communicating patient identification information. This segment contains permanent patient

identifying and demographic information that, for the most part, is not likely to change frequently.

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Table 8-11 Patient Identifier Segment (PID)

Table 8-12 Patient Identifier Segment (PID)

SEQ Element

Name

Data

Type

Usage Cardinality LEN Conditional Predicate Value

Set

Constraint

Set ID - PID

[1..1]

Patient ID

Patient

Identifier List

[1..*]

Alternate

Patient ID -

00106

Patient Name

XPN

[1..*]

The first repetition shall contain the

legal name. Multiple given names

or initials are separated by spaces.

Mother’s

Maiden Name

XPN_

[0..1]

Only last name and name type are

required. Set Name Type code to

“M” for maiden name usage.

Date/Time of

Birth

TS_N

[1..1]

Administrative

Sex

[0..1]

HL70001

Patient Alias

XPN

Race

[0..*]

HL70005

Patient

Address

XAD

[0..*]

The first repetition should be the

primary address.

County Code

County belongs in address field.

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Table 8-12 Patient Identifier Segment (PID)

SEQ Element

Name

Data

Type

Usage Cardinality LEN Conditional Predicate Value

Set

Constraint

13 Phone

Number -

Home

XTN RE [0..*] The first instance shall be the

primary phone number.

Only one item is allowed per

repetition.

Phone

Number -

Business

XTN

Primary

Language

Marital Status

Religion

Patient

Account

Number

SSN Number -

Patient

Driver's

License

Number -

Patient

DLN

Mother's

Identifier

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Table 8-12 Patient Identifier Segment (PID)

SEQ Element

Name

Data

Type

Usage Cardinality LEN Conditional Predicate Value

Set

Constraint

22 Ethnic Group CE RE [0..1] CDCREC

Birth Place

Multiple Birth

Indicator

RE [0..1]

HL70136

The acceptable values are Y and

N. If the status is undetermined,

then field shall be empty.

Birth Order

C(RE/O)

[0..1]

1..2

If PID-24 (Multiple Birth

Indicator) is valued “Y “

This field contains a number

indicating the person’s birth order,

with 1 for the first child born and 2

for the second.

Citizenship

Veterans

Military Status

Nationality

Patient Death

Date and Time

C(RE/X)

[0..1]

If PID-30 (patient death

indicator) is valued “Y”

Patient Death

Indicator

[0..1]

HL70136

Identity

Unknown

Indicator

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Table 8-12 Patient Identifier Segment (PID)

SEQ Element

Name

Data

Type

Usage Cardinality LEN Conditional Predicate Value

Set

Constraint

32 Identity

Reliability

Code

IS O

Last Update

Date/Time

Last Update

Facility

35 Species Code CE O

Breed Code

Strain

38 Production

Class Code

CE O

Tribal

Citizenship

CWE

Conformance Statement:

IZ-46: PID-1 (Set ID) SHALL have the literal value “1”

PID field definitions

See field definitions for PID under Profile Z22 above.

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PV1—Patient Visit Segment

The PV1 segment is used to convey visit specific information. The primary use in immunization messages in previous releases was to carry information

about the client’s eligibility status. This is now recorded at the immunization event (dose administered) level. Use of this segment for the purpose of

reporting client eligibility for a funding program at the visit level is not supported in the Implementation Guide.

QAK—Query Acknowledgement Segment

Table 8-12 Query Acknowledgement Segment (QAK)

Table 8-13 Query Acknowledgement Segment

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional Predicate Value

set

Comment

Query Tag

[1..1]

Query

Response

Status

[0..1]

Message

Query Name

[1..1]

Hit Count

[0..1]

This payload

[0..1]

Hits remaining

[0..1]

QAK field definitions

QAK-1 Query Tag (ST) 00696

Definition: This field contains the value sent in QPD-2 (query tag) by the initiating system, and will be used to match response messages to the

originating query. The responding system is required to echo it back as the first field in the query acknowledgement segment (QAK).

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QAK-2 Query Response Status (ID) 00708

Definition: This field allows the responding system to return a precise response status. It is especially useful in the case where no data is found that

matches the query parameters, but where there is also no error. It is defined with HL7 Table 0208 - Query Response Status.

QAK-3 Message Query Name (CE) 01375

Definition: This field contains the name of the query. This shall mirror the QPD-1 (Message Query Name) found in the query message that is being

responded to.

QPD Input Parameter Specification

Table 8-13 QPD Input Parameter Specification (QPD)

Table 8-14 QPD Input Parameter Specification

Field

Seq

(Query

ID=Z34)

Name Key/

Sort LEN TYPE Usage Rep Match

TBL Segment

Field

Name

Service

Identif

ier

Code

Element

Name or

Value

MessageQue

ryName

Z34^Request

Complete

Immunization

History^CDCP

HINVS

QueryTag

PatientList

PID.3

PID-3: Patient

Identifier List

PatientName

XPN

PID.5

PID-5: Patient

Name

PatientMothe

rMaidenNam

XPN

PID.6

PID-6: Mother’s

maiden name

Patient Date

of Birth

TS_NZ

PID.7

PID-7: Patient

date of birth

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Table 8-14 QPD Input Parameter Specification

Field

Seq

(Query

ID=Z34)

Name Key/

Sort LEN TYPE Usage Rep Match

TBL Segment

Field

Name

Service

Identif

ier

Code

Element

Name or

Value

Patient Sex

PID.8

PID-8: Patient

sex

Patient

Address

XAD

PID.11

PID-11: Patient

Address

Patient home

phone

XTN

PID.13

PID-13: Patient

home phone

Patient

multiple birth

indicator

PID-24

PID-24: Patient

multiple birth

indicator

Patient birth

order

2 NM RE PID-25

ID-25: Patient

birth order

Client last

updated date

PID-33

PID-33: Patient

last update

date

Client last

update

facility

PID-34

PID-34: Patient

last update

faciliity

QPD Input Parameter Field Description and Commentary

See Field Description under QPD in Profile Z34.

RXA-- Pharmacy/Treatment Administration Segment

The RXA segment carries pharmacy administration data.

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able 8-14 Pharmacy/Treatment Administration (RXA)

Table 8-15 Pharmacy/Treatment Administration (RXA)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional Predicate Value

Set

Comment

Give Sub-ID

Counter

[1..1]

Administration

Sub-ID Counter

[1..1]

Date/Time Start

of Administration

TS_NZ

[1..1]

This segment may be used in

cases where a vaccine has not

been administered. For

instance a patient may refuse a

vaccination or the sending

system may be forecasting a

next dose due. See notes

below for guidance on the

relevant date to include here.

Date/Time End

of Administration

[0..1]

See not below

Administered

Code

[1..1]

CVX

Support for CVX code is

strongly preferred. Local IG

may identify NDC or CPT as

acceptable alternative code

sets.

Administered

Amount

[1..1]

Administered

Units

C(R/O)

[0..1]

If Administered Amount is not

valued “999”

UCUM

The preferred units of measure

for this is “mL”.

Administered

Dosage Form

[0..1]

Administration

varies

C(R/O)

[0..*]

If RXA-20 is valued “CP” or

NIP 0001

If this field is used for a notes

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Table 8-15 Pharmacy/Treatment Administration (RXA)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional Predicate Value

Set

Comment

Notes

“PA”

only entry, then the data type

shall be CE_TX otherwise the

data type shall be CE.

The

primary use of this field it to

convey if this immunization

record is based on a historical

record or was given by the

provider recording the

immunization. All systems

should be able to support this

use. Other uses of this field are

permitted, but need to be

specified locally.

10 Administering

Provider

XCN C(RE/O) [0..1] If the first occurrence of

RXA-9.1 is valued "00"

and RXA-20 is valued

"CP" or "PA"

This is the person who gave the

administration or the vaccinator.

It is not the ordering clinician.

Administered-at

Location

LA2

C(RE/O)

[0..1]

If the first occurrence of

RXA-9.1 is valued "00"

and RXA-20 is valued

"CP" or "PA"

This is the clinic/site where the

vaccine was administered.

12 Administered

Per (Time Unit)

ST O

13 Administered

Strength

NM O

Administered

Strength Units

Substance Lot

C(R/O)

[0..*]

If the first occurrence of

Note that “00” is double zero.

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Table 8-15 Pharmacy/Treatment Administration (RXA)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional Predicate Value

Set

Comment

Number

RXA-9.1 is valued "00"

and RXA-20 is valued

"CP" or "PA"

Substance

Expiration Date

TS_M

C(RE/O)

[0..1]

If the first occurrence of

RXA-9.1 is valued "00"

and RXA-20 is valued

"CP" or "PA"

17 Substance

Manufacturer

Name

CE C(R/O) [0..1] If the first occurrence of

RXA-9.1 is valued "00"

and RXA-20 is valued

"CP" or "PA"

MVX

Substance/Treat

ment Refusal

Reason

C(R/X)

[0..*]

If the RXA-20 (Completion

Status) is valued “RE “

NIP002

Indication

20 Completion

Status

ID RE [0..1] 2 HL70322

Action Code -

RXA

[0..1]

HL70323

System Entry

Date/Time

23 Administered

Drug Strength

Volume

NM O

Administered

Drug Strength

Volume Units

CWE

Administered

CWE

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Table 8-15 Pharmacy/Treatment Administration (RXA)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional Predicate Value

Set

Comment

Barcode

Identifier

26 Pharmacy Order

Type

ID O

Conformance Statement:

IZ-28: RXA-1 ( Give Sub-id counter) ) SHALL be valued “0” Note that “0” is zero.

IZ-29: RXA-2 (admin Sub-id) SHALL be valued “1 “

IZ-30: If RXA-4 (Date time of admin end ) is populated, then it SHALL be the same as Start time (RXA-3)

IZ-31: If RXA-20 is valued "CP" or "PA" then RXA-9.1 (admin notes) SHALL be valued one of the codes listed in NIP001 in the first occurrence

of this field and the following repetition should be empty or valued with a text notes.

IZ-32: If the RXA-18 (Refusal Reason) is populated, RXA-20 SHALL be valued to “RE”.

IZ-47: If RXA-20 is NOT valued "CP" or "PA" then the first occurrence of RXA-9.1 (admin notes) SHALL be empty and the following repetitions

should be empty or valued with text notes.

IZ-48: If RXA-20 is valued “RE” then RXA-6 shall be valued “999”.

IZ-49: If RXA-5.3 is valued “998” then RXA-6 shall be valued “999”.

IZ-50: If the first instance of RXA-9.1 is not valued “00” then RXA-6 (administered amount) SHALL be valued “999”

RXA field definitions

See RXA field definitions in the Z22 profile.

RXR-- Pharmacy/Treatment Route Segment

The Pharmacy/Treatment Route segment contains the alternative combination of route, site, administration device, and administration method that are

prescribed as they apply to a particular order.

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Table 8-15 Pharmacy/Treatment Route (RXR)

Table 8-16 Pharmacy/Treatment Route (RXR)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional

Predicate

Value

Set

Constraint

Route

[1..1]

NCIT

Administration

Site

CWE

[0..1]

HL70163

Administration

Device

Administration

Method

CWE

Routing

Instruction

Administration

Site Modifier

CWE

RXR field definitions

See RXR field definitions in Profile Z22.

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9. Profile Z31 -- Return a List of Candidates Profile

Introduction:

Profile Z31 – Return List of Candidates is a constrainable profile that supports return of a list of candidate patients of interest. It is a response to the Z34-

Request Immunization History.

The goal of this response is to return a complete list of candidate patents in response to a request for a person’s record. This will support re-query by the initiator,

based on selection of a member of the list.

Interaction Definition

See Interaction Definition In previous chapter.

Dynamic Definition

See Activity Diagram in previous chapter.

Static Definition – Message Level

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Table 7-10 Base Response Grammar RSP^K11

Table 9-1 Return List Message Profile

Table 9-1 Base Response Grammar RSP^K11

Segment Cardinality Usage Comment

MSH

[1..1]

MSA

[1..1]

[ERR]

[0..1]

If errors exist, then this segment is populated.

QAK

[1..1]

QPD

[1..1]

Query Parameter Definition Segment

[1..1]

--- Response begin

{

[1..*]

Begin patient identifier list

PID

[1..1]

[PD1 ]

[0..1]

[{NK1 }]

[0..*]

End Patient Identifier

}

Response end

Matches the information in the requesting QBP message.

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Segment Level Profile

ERR—Error Segment

Table 9-2 Error Segment (ERR)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional Predicate Value

Set

Description/Comment

Error Code

and Location

ELD

Not supported for Version 2.5

and above.

Error Location

ERL

[0..1]

HL7 Error

Code

CWE

[1..1]

HL70357

Severity

[1..1]

1..1

HL70516

Application

Error Code

CWE

HL70533

Application

Error

Parameter

Diagnostic

Information

User Message

This is a locally specified

informative text message about

the error.

Inform Person

Indicator

Override Type

CWE

Override

Reason Code

CWE

Help Desk

XTN

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Table 9-2 Error Segment (ERR)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional Predicate Value

Set

Description/Comment

Contact Point

Note: If an error involves the entire message (e.g. the message is not parse-able.) then location has no meaning. In this case, ERR-2 is left empty.

ERR field definitions:

See field definitions for ERR under Profile Z23 above.

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MSA—Message Acknowledgement Segment

Table 9-3 Message Acknowledgement Segment (MSA)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional Predicate Value

Set

Description/Comment

1 Acknowledgment

Code

ID R [1..1] 2..2 HL70008

2 Message Control

ST R [1..1] 1..199

Text Message

4 Expected

Sequence

Number

NM O

5 Delayed

Acknowledgment

Type

Error Condition

MSA field definitions

See field definitions for MSA under Profile Z23 above.

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MSH - Message Header Specification

Table 7-9 MSH Sp9-4 S for Request Complete Immunization History Query

Table 9-4 MSH Specification for Return Complete Immunization History Response

SEQ LEN Data

Type

Cardinality Value

set

ELEMENT NAME Usage Constraint

[1..1]

Field Separator

The MSH.1 field shall be |

2 4 ST [1..1] Encoding Characters R The MSH.2 field shall be ^~\&

[0..1]

0361

Sending Application

No constraint

4 HD [0..1] 0362 Sending Facility RE No constraint

5 HD [0..1] 0361 Receiving Application RE No constraint

[0..1]

0362

Receiving Facility

No constraint

7 26 TS_Z [1..1] Date/Time Of Message R The degree of precision must be

at least to the second, (format

YYYYMMDDHHMMSS+/-ZZZZ.

8 40 ST [0..1] Security O

MSG

[1..1]

Message Type

RSP^K11^RSP_K11

10 199 ST [1..1] Message Control ID R

11 3 PT [1..1] Processing ID R

VID

[1..1]

Version ID

2.5.1

[0..1]

Sequence Number

14 180 ST [0..1] Continuation Pointer O

[0..1]

0155

Accept Acknowledgment

Type

16 2 ID [0..1] 0155 Application

Acknowledgment Type

R AL

17 3 ID [0..1] 0399 Country Code X blank

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Table 9-4 MSH Specification for Return Complete Immunization History Response

SEQ LEN Data

Type

Cardinality Value

set

ELEMENT NAME Usage Constraint

18 16 ID [0..1] 0211 Character Set X blank

[0..1]

Principal Language Of

Message

blank

20 20 ID [0..1] 0356 Alternate Character Set

Handling Scheme

X blank

21 EI [1..*] Message Profile Identifier R Z31^CDCPHINVS

XON

[0..1]

0362

Sending Responsible

Organization

XON

0362

Receiving Responsible

Organization

Conformance Statement:

IZ-12: The MSH.1 (Field Separator) SHALL be valued “|”

IZ-13: The MSH.2 (Encoding Characters) SHALL be valued “^~\& “

IZ-15: The MSH-12 (Version ID) SHALL be valued “2.5.1 “

IZ-59: MSH-9 (Message Type) SHALL contain the constant value “RSP^K11^RSP_K11”

IZ-52: The value of MSH-16 (Application Acknowledgement) shall be “NE”.

IZ-53: The value of MSH-15 (Accept Acknowledgemnt) shall be “NE”

IZ-61: One occurrence of MSH-21 (Message Profile Identifier) SHALL contain the constant value “Z31^CDCPHINVS”

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MSH Field Definitions

See field definitions for MSH under Profile Z22 above.

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NK1—Next of Kin Segment

The NK1 segment contains information about the patient’s other related parties. Any associated parties may be identified. Utilizing NK1-1 - set ID, multiple NK1

segments can be sent to patient accounts. That is, each subsequent NK1 increments the previous set ID by 1. So if 3 NK1 were sent in one message, the first

would have a set id of 1, the second would have 2 and the third would have 3.

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Table 9-5 Next of Kin Segment (NK1)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional Predicate Value

set

Description/Comment

Set ID - NK1

[1..1]

Name

XPN

[1..*]

The first instance is the legal

name and is required.

Relationship

[1..1]

HL70063

Address

XAD

[0..*]

The first instance shall be the

primary address.

Phone Number

XTN

[0..*]

The first instance shall be the

primary phone number.

Business Phone

Number

XTN

Contact Role

Start Date

End Date

Next of Kin /

Associated

Parties Job Title

Next of Kin /

Associated

Parties Job

Code/Class

JCC

Next of Kin /

Associated

Parties

Employee

Number

Organization

XON

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Table 9-5 Next of Kin Segment (NK1)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional Predicate Value

set

Description/Comment

Name - NK1

Marital Status

15 Administrative

Sex

IS O

Date/Time of

Birth

Living

Dependency

18 Ambulatory

Status

IS O

Citizenship

Primary

Language

21 Living

Arrangement

IS O

Publicity Code

Protection

Indicator

24 Student

Indicator

IS O

Religion

Mother’s Maiden

Name

XPN

27 Nationality CE O

Ethnic Group

Contact Reason

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Table 9-5 Next of Kin Segment (NK1)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional Predicate Value

set

Description/Comment

30 Contact

Person’s Name

XPN O

Contact

Person’s

Telephone

Number

XTN

32 Contact

Person’s

Address

XAD O

33 Next of

Kin/Associated

Party’s

Identifiers

CX O

Job Status

35 Race CE O

36 Handicap IS O

Contact Person

Social Security

Number

38 Next of Kin Birth

Place

ST O

39 VIP Indicator IS O

NK1 field definitions

See field definitions for NK1 under Profile Z22 above.

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QPD Input Parameter Specification

Table 9-6 QPD Input Parameter Specification

Field

Seq

(Query

ID=Z34)

Name Key/

Sort LEN TYPE Usage Rep Match

TBL Segment

Field

Name

Service

Identif

ier

Code

Element

Name or

Value

MessageQue

ryName

Z34^Request

Complete

Immunization

History^CDCP

HINVS

QueryTag

PatientList

PID.3

PID-3: Patient

Identifier List

PatientName

XPN

PID.5

PID-5: Patient

Name

PatientMothe

rMaidenNam

XPN

PID.6

PID-6: Mother’s

maiden name

Patient Date

of Birth

TS_NZ

PID.7

PID-7: Patient

date of birth

Patient Sex

PID.8

PID-8: Patient

sex

Patient

Address

XAD

PID.11

PID-11: Patient

Address

Patient home

phone

XTN

PID.13

PID-13: Patient

home phone

Patient

multiple birth

PID-24

PID-24: Patient

multiple birth

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Table 9-6 QPD Input Parameter Specification

Field

Seq

(Query

ID=Z34)

Name Key/

Sort LEN TYPE Usage Rep Match

TBL Segment

Field

Name

Service

Identif

ier

Code

Element

Name or

Value

indicator

Patient birth

order

PID-25

PID-25: Patient

birth order

Client last

updated date

PID-33

PID-33: Patient

last update

date

Client last

update

facility

PID-34

PID-34: Patient

last update

faciliity

QPD field definitions

See QPD field definitions in Profile Z34.

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PID – Patient Identification Segment

Table 9-7 PID Patient Identification Segment

Table 9-7 Patient Identification Segment

SEQ Element

Name

Data

Type

Usage Cardinality LEN Conditional Predicate Value

Set

Constraint

Set ID - PID

[1..1]

Each patient segment returned in

this message will be numbered,

starting with 1 for the first.

2 Patient ID CX X

3 Patient

Identifier List

CX R [1..*]

4 Alternate

Patient ID -

00106

CX X

5 Patient Name XPN R [1..*] The first repetition shall contain the

legal name. Multiple given names or

initials are separated by spaces.

6 Mother’s

Maiden Name

XPN_M RE [0..1]

Only last name and name type

are required. Set Name Type

code to “M” for maiden name

usage.

7 Date/Time of

Birth

TS_NZ R [1..1]

8 Administrative

Sex

IS RE [0..1] HL70001

9 Patient Alias XPN X

10 Race CE RE [0..*] HL70005

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Table 9-7 Patient Identification Segment

SEQ Element

Name

Data

Type

Usage Cardinality LEN Conditional Predicate Value

Set

Constraint

11 Patient

Address

XAD RE [0..*] The first repetition should be the

primary address.

County Code

County belongs in address field.

13 Phone Number

- Home

XTN RE [0..*] The first instance shall be the

primary phone number.

Only one item is allowed per

repetition.

14 Phone Number

- Business

XTN O

15 Primary

Language

CE O

16 Marital Status CE O

Religion

18 Patient Account

Number

CX O

19 SSN Number -

Patient

ST X

20 Driver's

License

Number -

Patient

DLN X

21 Mother's

Identifier

CX X

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Table 9-7 Patient Identification Segment

SEQ Element

Name

Data

Type

Usage Cardinality LEN Conditional Predicate Value

Set

Constraint

22 Ethnic Group CE RE [0..1] HL70189

23 Birth Place ST O

Multiple Birth

Indicator

RE [0..1]

HL70136

The acceptable values are Y and N.

If the status is undetermined, then

field shall be empty.

25 Birth Order NM C(RE/O) [0..1] 1..2 If PID-24 (Multiple Birth Indicator)

is valued “Y “

Thi

s field contains a number

indicating the person’s birth order,

with 1 for the first child born and 2

for the second.

26 Citizenship CE O

27 Veterans

Military Status

CE O

28 Nationality CE O

29 Patient Death

Date and Time

TS C(RE/X) [0..1] If PID-30 (patient death date) is

valued “Y”

30 Patient Death

Indicator

ID RE [0..1] HL70136

31 Identity

Unknown

Indicator

ID O

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Table 9-7 Patient Identification Segment

SEQ Element

Name

Data

Type

Usage Cardinality LEN Conditional Predicate Value

Set

Constraint

32 Identity

Reliability Code

IS O

Last Update

Date/Time

Last Update

Facility

35 Species Code CE O

Breed Code

37 Strain ST O

38 Production

Class Code

CE O

Tribal

Citizenship

CWE

Conformance Statement

IZ-46: PID-1 SHALL be a positive integer.

PID Field Definition

See PID field definitions in Z22 Profile.

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10.Profile Z33 --Return an acknowledgement with no person records

Introduction:

Profile Z33 – Return Acknowledgment is a constrainable profile that supports return of an acknowledgement indicating not patients being returned in response

to the Z34-Request Immunization History.

The goal of this profile is to return an acknowledgment message. It will indicate that either the message could be parsed, but there was an error processing the

message or that no candidates were found. No demographic or immunization history will be returned.

Interaction Definition

An acknowledgement is returned when one of the 3 cases occur.

1. An error has occurred when processing the query.

2. No high confidence matches are found. This includes when a match is found but is not allowed to be shared for privacy reasons or the receiving system

does not support the profile Z31-Return list of candidates.

3. Too many matches are found and so none will be returned.

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Figure 42 Return Acknowledgement

Dynamic Definition

See Activity Diagram in profile Z34.

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Static Definition – Message Level

Tab

le 10-1 Base Response Grammar RSP^K11

Table 10-1 Base Response Grammar RSP^K11

Segment Cardinality Usage Comment

MSH

[1..1]

MSA

[1..1]

[ERR]

[0..1]

If errors exist, then this segment is populated.

QAK

[1..1]

QPD

[1..1]

Query Parameter Definition Segment

Matches the information in the requesting QBP message.

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Static Definition -- Segment Level

ERR—Error Segment

Table 10-2 Error Segment (ERR)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional Predicate Value

Set

Description/Comment

Error Code

and Location

ELD

Not supported for Version 2.5

and above.

Error Location

ERL

[0..1]

HL7 Error

Code

CWE

[1..1]

HL70357

Severity

[1..1]

1..1

HL70516

Application

Error Code

CWE

HL70533

Application

Error

Parameter

Diagnostic

Information

User Message

This is a locally specified

informative text message about

the error.

Inform Person

Indicator

Override Type

CWE

Override

Reason Code

CWE

Help Desk

XTN

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Table 10-2 Error Segment (ERR)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional Predicate Value

Set

Description/Comment

Contact Point

Note: If an error involves the entire message (e.g. the message is not parse-able.) then location has no meaning. In this case, ERR-2 is left empty.

ERR field definitions:

See field definitions for ERR under Profile Z23 above.

HL7 Version 2.5.1 Message Profile for Returning an acknowledgement in Response to a Request Immunization History Query when no candidates are

found or an error has been found in the query.

Tabl

e 10-3 Query Response Possibilities

Table 10-3 Query Response Possibilities

Outcome

Action

No clients are found that match the requested person

Send acknowledgement indicating no matches found.

(See Z33 profile)

The message is so poorly formed it can’t be

processed. That is, the message can’t be parsed as a

query.

Return error acknowledgement (ACK)

The message can be parsed but has errors, such as

missing data elements that are required to support

query processing.

Return acknowledgement indicating errors. (See Z33

profile).

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MSA—Message Acknowledgement Segment

Table 10-4 Message Acknowledgement Segment (MSA)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional Predicate Value

Set

Description/Comment

Acknowledgment

Code

[1..1]

2..2

HL70008

2 Message Control

ST R [1..1] 1..199

Text Message

Expected

Sequence

Number

5 Delayed

Acknowledgment

Type

Error Condition

MSA field definitions

See MSA field definitions in Z23 Profile.

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MSH - Message Header Specification

Tabl

e 10-5 MSH Specification for Request Complete Immunization History Query

Table 10-5 MSH Specification for Acknowledgement Response

SEQ LEN Data

Type

Cardinality Value

set

ELEMENT NAME Usage Constraint

[1..1]

Field Separator

The MSH.1 field shall be |

[1..1]

Encoding Characters

The MSH.2 field shall be ^~\&

[0..1]

0361

Sending Application

No constraint

[0..1]

0362

Sending Facility

No constraint

[0..1]

0361

Receiving Application

No constraint

[0..1]

0362

Receiving Facility

No constraint

TS_Z

[1..1]

Date/Time Of Message

The degree of precision must be

at least to the second, (format

YYYYMMDDHHMMSS+/-ZZZZ).

[0..1]

Security

MSG

[1..1]

Message Type

RSP^K11^RSP_K11

199

[1..1]

Message Control ID

[1..1]

Processing ID

VID

[1..1]

Version ID

2.5.1

[0..1]

Sequence Number

180

[0..1]

Continuation Pointer

[0..1]

0155

Accept Acknowledgment

Type

[0..1]

0155

Application

Acknowledgment Type

[0..1]

0399

Country Code

blank

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Table 10-5 MSH Specification for Acknowledgement Response

SEQ LEN Data

Type

Cardinality Value

set

ELEMENT NAME Usage Constraint

18 16 ID [0..1] 0211 Character Set X blank

[0..1]

Principal Language Of

Message

blank

20 20 ID [0..1] 0356 Alternate Character Set

Handling Scheme

X blank

21 EI [1..1] Message Profile Identifier R Z33^CDCPHINVS

XON

[0..1]

0362

Sending Responsible

Organization

XON

0362

Receiving Responsible

Organization

Conformance Statement:

IZ-12: The MSH.1 (Field Separator) SHALL be valued “|”

IZ-13: The MSH.2 (Encoding Characters) SHALL be valued “^~\& “

IZ-15: The MSH-12 (Version ID) SHALL be valued “2.5.1 “

IZ-59: MSH-9 (Message Type) SHALL contain the constant value “RSP^K11^RSP_K11”

IZ-52: The value of MSH-16 (Application Acknowledgement) shall be “NE”.

IZ-53: The value of MSH-15 (Accept Acknowledgement) shall be “NE”

IZ-63: One occurrence of MSH-21 (Message Profile Identifier) SHALL contain the constant value “Z33^CDCPHINVS”

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MSH Field Definitions

See field definitions for MSH under Profile Z23 above.

QPD Input Parameter Specification

Tabl

e 10-6 QPD Input Parameter Specification

Table 10-6 QPD Input Parameter Specification

Field

Seq

(Query

ID=Z34)

Name Key/

Sort LEN TYPE Usage Rep Match

TBL Segment

Field

Name

Service

Identif

ier

Code

Element

Name or

Value

MessageQue

ryName

Z34^Request

Complete

Immunization

History^CDCP

HINVS

QueryTag

PatientList

PID.3

PID-3: Patient

Identifier List

PatientName

XPN

PID.5

PID-5: Patient

Name

PatientMothe

rMaidenNam

XPN

PID.6

PID-6: Mother’s

maiden name

Patient Date

of Birth

TS_NZ

PID.7

PID-7: Patient

date of birth

Patient Sex

PID.8

PID-8: Patient

sex

Patient

Address

XAD RE PID.11

PID-

11: Patient

Address

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Table 10-6 QPD Input Parameter Specification

Field

Seq

(Query

ID=Z34)

Name Key/

Sort LEN TYPE Usage Rep Match

TBL Segment

Field

Name

Service

Identif

ier

Code

Element

Name or

Value

Patient home

phone

XTN

PID.13

PID-13: Patient

home phone

Patient

multiple birth

indicator

PID-24

PID-24: Patient

multiple birth

indicator

Patient birth

order

PID-25

PID-25: Patient

birth order

Client last

updated date

PID-33

PID-33: Patient

last update

date

Client last

update

facility

PID-34

PID-34: Patient

last update

faciliity

QPD Field Definitions

See QPD field definitions in Profile Z34.

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Chapter 6: Messages for Transmitting Immunization Information

11. Profile Z44--Request Evaluated Immunization History and

Forecast Query Profile

Introduction

Profile Z44 – Request Evaluated History and Forecast is a constrainable profile that supports request of an immunization evaluated immunization history and

forecast of an individual. It has a set partner profiles which return the requested history or an acknowledgement that no matches were found.

The goal of this query is to request a evaluated immunization history and forecast of next doses due. I

See Use Case 3—Request Evaluated History above for Use Case details.

An evaluated immunization history and forecast consists of:

• Limited demographic information about the individual

• The history of immunizations administered with validation by a clinical decision support engine

• Forecast of what the person is due to receive next and the dates when due

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Table 11-1 Request Evaluated Immunization History and Forecast Query Profile

Table 11- 1 Request Evaluated Immunization History and Forecast Query Profile

Query Statement ID (Query ID=Z44):

Z44

Type:

Query

Query Name:

Request Evaluated History and Forecast

Query Trigger (= MSH-9):

QBP^Q11^QBP_Q11

Query Mode:

Both

Response Trigger (= MSH-9):

RSP^K11^RSP_K11

Query Characteristics:

The query parameters may include demographic and address data. No sorting is expected.

This profile does not specify the logic used when searching for matching clients/patients.

The query parameter contents may be used for simple query or as input for probabilistic

search algorithms. The search methodology should be specified by local implementations.

Purpose:

The purpose is to request an evaluated immunization history and forecast for one client.

Response Characteristics:

•

In the case where no candidates are found, the acknowledgement response will

indicate that no candidates were found.

• In the case where exactly one high-confidence candidate is found, an evaluated

immunization history and forecast will be returned.

• In the case where one or more clients are a lower-confidence match for the criteria

sent, the acknowledgement response will indicate no matches and no records will

be returned.

• In the case where receiving system can’t process the query, the receiving system

will indicate an error in an acknowledgement.

Based on Segment Pattern:

Each system will need to determine the business rules that deal with patients who wish to have their records protected. Some systems may choose to treat the

person as if they are not in the system. Others may choose to send a response indicating that the person exists in the system but does not allow sharing. This rule

should be clearly documented in the local profile.

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Tabl

e 11-2 Response Grammar to Different Outcomes

Table 11-2 Response Grammar to Different Outcomes

Outcome of Query Response Message

No match found

Response indicates that message was successfully processed and that no clients matched the

criteria that were sent in the query. See Acknowledgement Profile (Z33).

Exactly one high confidence match found

Response includes an evaluated immunization history and forecast as specified below.

See P

rofile Return Evaluated Immunization History and Forecast (Z42).

A lower confidence match (or matches) is found.

Response indicates that message was successfully processed and that no clients matched the

criteria that were sent in the query. See Acknowledgement Profile (Z33).

Message is not well formed and has fatal errors.

Response indicates that the message was not successfully processed and may indicate errors.

See Return Acknowledgement Profile (Z33).

Message can’t be parsed.

Return ACK, acknowledgement message indicating error, if message can be identified as an HL7

message.

Definition of match is left to local business rules. These rules should be documented in a local implementation guide. For example, a system may only return an immunization history when the match

is exact, returning a list of 1 if one person for a lower probability match.

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Interaction Definition

gure 43 Return Immunization Evaluated History Sequence Diagram

is diagram illustrates the context of the messages. The messages specified in this profile are shown with bolded.

Dynamic Definition

The following activity diagram shows the flow of activities associated with this profile and its partners. This is described in the table below the diagram.

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Figure 44 Activity Diagram -Response to Different Outcomes

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Table 11-3 Response to Different Outcomes

TABLE 11-3 RESPONSE TO DIFFERENT OUTCOMES

Outcome of Query Response Message

No high confidence match found

Response indicates that message was successfully processed and that no clients matched the

criteria that were sent in the query. See Acknowledgement Profile (Z33).

Exactly one high confidence match found

Response includes a complete immunization history as specified below.

See P

rofile Return Evaluated History and Forecast (Z42).

Message is not well formed and has fatal errors.

Response indicates that the message was not successfully processed and may indicate errors.

See Return Acknowledgement Profile (Z33).

Message was rejected because one of the following

occurred:

• Unsupported message type

• Unsupported event code

• Unsupported processing ID

• Unable to process for reasons unrelated for

format or content

Return ACK message with errors.

Message can’t be identified as an HL7 message.

No HL7 message is returned.

Definition of match is left to local business rules. These rules should be documented in a local implementation guide. For example, a system may only return an immunization history when the match

is exact, returning a list of 1 if one person for a lower probability match.

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Static Definition - Message Level:

Table 11-4 Z44 Request Complete Immunization History

QBP^Q11^QBP_Q11

Usage Comment

MSH Message Header Segment R

[{SFT}] Software Segment O

Local profile may

specify

QPD Query Parameter Definition R

RCP Response Control Parameter R

[ DSC ] Continuation Pointer X Not supported

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Query Grammar: QBP

Message

TABLE 11-4 Z44 REQUEST EVALUATED IMMUNIZATION HISTORY AND

FORECAST

Chapter 6: Messages for Transmitting Immunization Information

Static Definition—Segment Level

ERR—Error Segment

Table 11-5 Error Segment (ERR)

Table 11-4 Error Segment (ERR)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional Predicate Value

Set

Description/Comment

Error Code

and Location

ELD

Not supported for Version 2.5

and above.

Error Location

ERL

[0..1]

HL7 Error

Code

CWE

[1..1]

HL70357

Severity

[1..1]

1..1

HL70516

Application

Error Code

CWE

HL70533

Application

Error

Parameter

Diagnostic

Information

User Message

This is a locally specified

informative text message about

the error.

Inform Person

Indicator

Override Type

CWE

This Guide does not support repeat of this field.

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Table 11-4 Error Segment (ERR)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional Predicate Value

Set

Description/Comment

11 Override

Reason Code

CWE O

Help Desk

Contact Point

XTN

Note: If an error involves the entire message (e.g. the message is not parse-able.) then location has no meaning. In this case, ERR-2 is left empty.

ERR field definitions:

See field definitions for ERR under Profile Z23 above.

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MSA—Message Acknowledgement Segment

Table 11-6 Message Acknowledgement Segment (MSA)

Table 11-5 Message Acknowledgement Segment (MSA)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional Predicate Value

Set

Description/Comment

1 Acknowledgment

Code

ID R [1..1] 2..2 HL70008

2 Message Control

ST R [1..1] 1..199

Text Message

4 Expected

Sequence

Number

NM O

5 Delayed

Acknowledgment

Type

Error Condition

MSA field definitions

See field definitions for MSA under Profile Z23 above.

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MSH - Message Header Specification

Tabl

e 11-7 MSH Specification for Request Complete Immunization History Query

Table 11-6 MSH Specification for Request Evaluated History and Forecast Immunization History Query

SEQ LEN Data

Type

Cardinality Value

set

ITEM

ELEMENT NAME Usage Constraint

[1..1]

00001

Field Separator

The MSH.1 field shall be |

[1..1]

00002

Encoding Characters

The MSH.2 field shall be ^~\&

[0..1]

0361

00003

Sending Application

No constraint

[0..1]

0362

00004

Sending Facility

No constraint

[0..1]

0361

00005

Receiving Application

No constraint

[0..1]

0362

00006

Receiving Facility

No constraint

TS_Z

[1..1]

00007

Date/Time Of Message

The degree of precision must be

at least to the second, (format

YYYYMMDDHHMMSS+/-ZZZZ).

[0..1]

00008

Security

MSG

[1..1]

00009

Message Type

QBP^Q11^QBP_Q11

199

[1..1]

00010

Message Control ID

[1..1]

00011

Processing ID

VID

[1..1]

00012

Version ID

2.5.1

[0..1]

00013

Sequence Number

180

[0..1]

00014

Continuation Pointer

[0..1]

0155

00015

Accept Acknowledgment

Type

ER –On Error

[0..1]

0155

00016

Application

Acknowledgment Type

AL-Always

[0..1]

0399

00017

Country Code

blank

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Table 11-6 MSH Specification for Request Evaluated History and Forecast Immunization History Query

SEQ LEN Data

Type

Cardinality Value

set

ITEM

ELEMENT NAME Usage Constraint

18 16 ID [0..1] 0211 00692 Character Set X blank

[0..1]

00693

Principal Language Of

Message

blank

20 20 ID [0..1] 0356 01317 Alternate Character Set

Handling Scheme

X blank

21 EI [1..*] 01598 Message Profile Identifier R Z44^CDCPHINVS

XON

[0..1]

0362

01823

Sending Responsible

Organization

XON

0362

01824

Receiving Responsible

Organization

Conformance Statement:

IZ-64: One Occurrence of MSH-21 (Message Profile Identifier) SHALL contain the constant value “Z44^CDCPHINVS”

IZ-12: The MSH.1 (Field Separator) SHALL be valued “|”

IZ-13: The MSH.2 (Encoding Characters) SHALL be valued “^~\& “

IZ-15: The MSH-12 (Version ID) SHALL be valued “2.5.1 “

IZ-55: MSH-9 (Message Type) SHALL contain the constant value “QBP^Q11^QBP_Q11”

IZ-57: MSH-15 (Accept Acknowledgement) SHALL have a value of “ER”.

IZ-58: MSH-16 (Application Acknowledgemnt) SHALL have a value of “AL”

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MSH field definitions

See field definitions for MSH under Profile Z22 above.

QPD Input Parameter Specification

Table 11-8 QPD Input Parameter Specification

Table 11-7 QPD Input Parameter Specification

Field

Seq

(Query

ID=Z34

)

Name Key/

Sort LEN TYPE Usage Rep Match

TBL Segment

Field

Name

Service

Identif

ier

Code

Element

Name or

Value

MessageQueryN

ame

Z34^Request

Complete

Immunization

History^HL7

0471

QueryTag

PatientList

PID.3

PID-3:

Patient

Identifier List

PatientName

XPN

PID.5

PID-5:

Patient

Name

PatientMotherMa

idenName

XPN RE PID.6

PID-6:

Mother’s

maiden

name

Patient Date of

Birth

TS_NZ

PID.7

PID-7:

Patient date

of birth

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Table 11-7 QPD Input Parameter Specification

Field

Seq

(Query

ID=Z34

)

Name Key/

Sort LEN TYPE Usage Rep Match

TBL Segment

Field

Name

Service

Identif

ier

Code

Element

Name or

Value

Patient Sex

PID.8

PID-8:

Patient sex

Patient Address

XAD

PID.11

PID-11:

Patient

Address

Patient home

phone

XTN RE PID.13

PID

-13:

Patient home

phone

Patient multiple

birth indicator

PID-24

PID-24:

Patient

multiple birth

indicator

Patient birth

order

PID-25

PID-25:

Patient birth

order

Client last

updated date

PID-33

PID-33:

Patient last

update date

Client last

update facility

PID-34

PID-34:

Patient last

update

faciliity

QPD Field Definitions

The likelihood of finding a particular person is improved when all known parameters are populated. Requesting systems should strive to include values for each

query parameter.

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Tabl

e 11-9 QPD Input Parameter Field Description and Commentary

Table 11-8 QPD Input Parameter Field Description and Commentary

Input Parameter (Query

ID=Z34)

Comp. Name DT Usage Description

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Table 11-8 QPD Input Parameter Field Description and Commentary

Input Parameter (Query

ID=Z34)

Comp. Name DT Usage Description

MessageQueryName

Z44^Request Immunization

History^HL70471

QueryTag

Unique to each query message

instance.

PatientList

The combination of values for

Patientlist.ID,

patientlst.identifiercode and

Patientlist.AssigningAuthority are

intended to allow unique

identification of a client, if the data

are found in the responding

system.

If this field, PID.3.1, is not valued,

PatientList is not considered when

seeking matching clients.

Assigning Authority

If this field, PID.3.4, is not valued,

PatientList is not considered when

seeking matching clients.

IdentifierTypeCode

If this field, PID.3.5, is not valued,

PatientList is not considered when

seeking matching clients.

PatientName

XPN

If this field, PID.5, is not valued,

then the query will return an error,

since this is a required field.

Family Name

If this field, PID.5.1, is not valued,

then patient name is considered to

contain no value.

Given Name

If this field, PID.5.2, is not valued,

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Table 11-8 QPD Input Parameter Field Description and Commentary

Input Parameter (Query

ID=Z34)

Comp. Name DT Usage Description

then patient name is considered to

contain no value. Given name is

required.

Second or further names

If this field, PID.5.3, is not valued,

then all values for this field are

considered a match.

Suffix

If this field, PID.5.4, is not valued,

then all values for this field are

considered a match.

Mother’s Maiden Name

XPN_MDN

If this field, PID.6, is not valued,

Mother’s maiden name is not

considered when seeking

matching clients.

Family Name

If this field, PID.6.1, is not valued,

then mother’s maiden name is

considered to contain no value.

Given Name

If this field, PID.6.2, is not valued,

then all values for this field are

considered a match.

Name Type Code

If the field, PID-6.7, is not valued,

then all values for this field are

considered a match.

DateOfBirth

If this field, PID.7, is not valued to

an accuracy of at least day, then

this field is considered not valued.

Sex

If this field, PID.8, is not valued,

then all values for this field are

considered a match.

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Table 11-8 QPD Input Parameter Field Description and Commentary

Input Parameter (Query

ID=Z34)

Comp. Name DT Usage Description

Address

XAD

If this field, PID.11, is not valued,

then address will not be

considered when seeking

matching clients.

Street Address

SAD

If this field, PID.11.1, is not valued,

then all values for this field are

considered a match.

City

If this field, PID.11.3, is not valued,

then address is considered to

contain no value.

State

If this field, PID.11.4, is not valued,

then address is considered to

contain no value.

ZIP

If this field, PID.11.5, is not valued,

then all values for this field are

considered a match.

Address Type

If this field, PID.11.7 is not valued,

then it shall default to L, legal

address.

Phone

XTN

This field will be considered the

Home phone. If this field, PID.13,

is not valued, then phone number

is not considered when seeking

matching clients.

Area code

If this field, PID.13.6, is not valued,

then all values for this field shall

be considered matches.

Local number

If this field, PID.13.7, is not valued,

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Table 11-8 QPD Input Parameter Field Description and Commentary

Input Parameter (Query

ID=Z34)

Comp. Name DT Usage Description

then address is considered to

contain no value.

Multiple Birth Indicator

If this field, PID.24, is not valued,

then Multiple Birth Indicator is not

considered when seeking

matching clients.

Birth Order

If this field, PID.25, is not valued,

then birth order is not considered

when seeking matching clients.

Client last updated date

If this field, PID.33, is not valued,

then client last updated date is not

considered when seeking

matching clients.

Client last update facility

If this field, PID.34, is not valued,

then client last updating facility is

not considered when seeking

matching clients.

This Guide does not specify the methodology used by the responding system to search for a person. It specifies the structure and content of the message used to

query. It is incumbent on systems to publically document their expectations within the constraints of this guide.

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RCP Response Control Parameter Field Description and Commentary

Tab

le 11-10 RCP Response Control Parameter Field Description and Commentary

Table 11-9 RCP Response Control Parameter Field Description and Commentary

Field

Seq

(Query

ID=Z44)

Name

Component

Name

LEN

Usage

Description

Query Priority

If this field is not valued then it

shall default to I. The only value

permitted is I.

Quantity Limited Request

Quantity

Units

CWE

Response Modality

CWE

Segment group inclusion

256

RCP Field Definitions

See Z34 Profile above for details.

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12.Profile Z42 -- Return Evaluated History and Forecast

Introduction

The goal of this response is to return an evaluated immunization history and forecast. It is not intended to support transfer of complete immunization history. It is

a partner to Profile Z44, Request Evaluated History and Forecast.

Interaction Definition

See Interaction Definition in Profile Z44 above.

Dynamic Definition

See Dynamic Definition in Profile Z44 above.

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Static Definition --Message Level

Tab

le 12-1 Return Evaluated Immunization History and Forecast Response Grammar RSP^K11

Table 12-1 Return Evaluated Immunization History and Forecast Response Grammar RSP^K11

Segment Cardinality Usage Comment

MSH

[1..1]

MSA

[1..1]

[ERR]

[0..1]

If errors exist, then this segment is populated.

QAK

[1..1]

QPD

[1..1]

Query Parameter Definition Segment

PID

[1..1] R

{

[1..*] R IMMUNIZATION HISTORY and FORECAST

GROUP

ORC

[O..1] O

RXA

[1..1] R

[RXR ]

[0..1] RE

[{

[1..*] R Begin Observation

OBX

[1..1] R

Matches the information in the requesting QBP message.

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Table 12-1 Return Evaluated Immunization History and Forecast Response Grammar RSP^K11

Segment Cardinality Usage Comment

}]

End observation

}

End Immunization History

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Static Definition -- Segment Level

MSH - Message Header Specification

TABLE 12-2 MSH SPECIFICATION FOR RETURN EVALUATED IMMUNIZATION HISTORY AND

FORECAST RESPONSE

SEQ LEN Data

Type

Cardinality Value

set

ELEMENT NAME Usage Constraint

[1..1]

Field Separator

The MSH.1 field shall be |

[1..1]

Encoding Characters

The MSH.2 field shall be ^~\&

[0..1]

0361

Sending Application

No constraint

[0..1]

0362

Sending Facility

No constraint

[0..1]

0361

Receiving Application

No constraint

[0..1]

0362

Receiving Facility

No constraint

TS_Z

[1..1]

Date/Time Of Message

The degree of precision must be

at least to the second, (format

YYYYMMDDHHMMSS+/-ZZZZ).

[0..1]

Security

MSG

[1..1]

Message Type

RSP^K11^RSP_K11

199

[1..1]

Message Control ID

[1..1]

Processing ID

VID

[1..1]

Version ID

2.5.1

[0..1]

Sequence Number

180

[0..1]

Continuation Pointer

[0..1]

0155

Accept Acknowledgment

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Table

12-2 MSH Specification for Return Evaluated Immunization History and Forecast Response

Chapter 6: Messages for Transmitting Immunization Information

TABLE 12-2 MSH SPECIFICATION FOR RETURN EVALUATED IMMUNIZATION HISTORY AND

FORECAST RESPONSE

SEQ LEN Data

Type

Cardinality Value

set

ELEMENT NAME Usage Constraint

Type

[0..1]

0155

Application

Acknowledgment Type

[0..1]

0399

Country Code

blank

[0..1]

0211

Character Set

blank

[0..1]

Principal Language Of

Message

blank

[0..1]

0356

Alternate Character Set

Handling Scheme

blank

[1..*]

Message Profile Identifier

Z42^CDCPHINVS

XON

[0..1]

0362

Sending Responsible

Organization

XON

0362

Receiving Responsible

Organization

Conformance Statement:

IZ-65: One Occurrence of MSH-21 (Message Profile Identifier) SHALL contain the constant value “Z42^CDCPHINVS”

IZ-12: The MSH.1 (Field Separator) SHALL be valued “|”

IZ-13: The MSH.2 (Encoding Characters) SHALL be valued “^~\& “

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[0..1]

Chapter 6: Messages for Transmitting Immunization Information

IZ-15: The MSH-12 (Version ID) SHALL be valued “2.5.1 “

IZ-55: MSH-9 (Message Type) SHALL contain the constant value “QBP^Q11^QBP_Q11”

IZ-53: MSH-15 SHALL have a value of “NE”.

IZ-52: MSH-16 SHALL have a value of “NE”.

MSH field definitions

See field definitions for MSH under Profile Z22 above.

OBX—Observation Result Segment

The observation result segment has many uses. It carries observations about the object of its parent segment. In the VXU/RSP it is associated with the RXA or

immunization record. The basic format is a question (OBX-3) and an answer (OBX-5).

Consult Appendix B for detailed examples of each of the uses.

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Table 12-3 Observation Segment (OBX)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional

Predicate

Value Sets Comment

Set ID – OBX

[1..1]

1..4

Value Type

[1..1]

2..3

HL70125

(constrained)

Observation

Identifier

[1..1]

NIP003

This indicates what this

observation refers to. It poses

the question that is answered by

OBX-5.

Observation

Sub-ID

[1..1]

1..20

Constrain to

positive

integers

Observation

Value

varies

[1..1]

varies

This is the observation value and

answers the question posed by

OBX-3

Units

C(R/O)

[0..1]

If OBX-2(Value Type) is

valued “NM” or “SN”

Note: If there i

s not a unit of

measure available while

the Condition Predicated is

true, then the value “NA”

SHALL be used in CE.1

and “HL70353” in CE.3.

UCUM

References

The length of the observation field is variable, depending upon value type. See OBX-2 value type.

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Table 12-3 Observation Segment (OBX)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional

Predicate

Value Sets Comment

Range

Abnormal

Flags

9 Probability NM O

10 Nature of

Abnormal Test

ID O

Observation

Result Status

[1..1]

HL70085

(constrained)

12 Effective Date

of Reference

Range Values

TS O

13 User Defined

Access

Checks

ST O

Date/Time of

the

Observation

TS_NZ

[0..1]

Producer's

Reference

16 Responsible

Observer

XCN O

Observation

Method

[0..1]

Equipment

Instance

Identifier

19 Date/Time of TS O

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Table 12-3 Observation Segment (OBX)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional

Predicate

Value Sets Comment

the Analysis

Reserved for

harmonization

with V2.6

Reserved for

harmonization

with V2.6

22 Reserved for

harmonization

with V2.6

Performing

Organization

Name

XON

Performing

Organization

Address

XAD

25 Performing

Organization

Medical

Director

XCN O

Conformance Statement:

IZ-20: The Value of OBX-1 (Set ID-OBX) SHALL be valued sequentially starting with the value “1” within a message.

IZ-21: The value of OBX-2 (Value Type) SHALL be one of the following:

CE, NM, ST, DT, ID or TS

IZ-22: The value of OBX-11 (Observation Result Status) SHALL be “F”

IZ-37: If OBX-3.1 is “30956-7” and OBX-2 is “CE” then the value set for OBX-5 shall be CVX.

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OBX field definitions

See field definitions for OBX under Profile Z22 above.

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ORC—Order Request Segment

The Common Order segment (ORC) is used to transmit fields that are common to all orders (all types of services that are requested). While not all immunizations

recorded in an immunization message are able to be associated with an order, each RXA must be associated with one ORC, based on HL7 2.5.1 standard.

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Table 12-4 Common Order Segment (ORC)

Table 12-5 Common Order Segment (ORC)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional

Predicate

Value Set Comment

Order Control

[1..1]

HL70119

(constrained)

Placer Order

Number

[0..1]

See Guidance below.

Filler Order

Number

[1..1]

See Guidance below.

Placer Group

Number

Order Status

Response Flag

Quantity/Timin

Parent

EIP

Date/Time of

Transaction

Entered By

XCN

[0..1]

This is the person that entered

this immunization record into the

system.

Verified By

XCN

Ordering

Provider

XCN

[0..1]

This shall be the provider

ordering the immunization. It is

expected to be empty if the

immunization record is

transcribed from a historical

record.

Enterer's

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Table 12-5 Common Order Segment (ORC)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional

Predicate

Value Set Comment

Location

Call Back

Phone Number

XTN

15 Order Effective

Date/Time

TS O

Order Control

Code Reason

17 Entering

Organization

CE RE HL70362 This is the provider organization

that entered this record/order.

18 Entering

Device

CE O

Action By

XCN

20 Advanced

Beneficiary

Notice Code

CE O

21 Ordering

Facility Name

XON O

Ordering

Facility

Address

XAD

23 Ordering

Facility Phone

Number

XTN O

24 Ordering

Provider

Address

XAD O

Order Status

CWE

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Table 12-5 Common Order Segment (ORC)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional

Predicate

Value Set Comment

Modifier

Advanced

Beneficiary

Notice

Override

Reason

CWE

27 Filler's

Expected

Availability

Date/Time

TS O

Confidentiality

Code

CWE

Order Type

CWE

30 Enterer

Authorization

Mode

CNE O

Parent

Universal

Service

Identifier

CWE

Conformance Statement:

IZ-25: ORC.1 (Order Control) SHALL contain the value “RE “

ORC field definitions

See field definitions for ORC under Profile Z22 above.

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PID—Patient Identifier Segment

The PID is used by all applications as the primary means of communicating patient identification information. This segment contains permanent patient

identifying and demographic information that, for the most part, is not likely to change frequently.

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Table 12-5 Patient Identifier Segment (PID)

Table 12-6 Patient Identifier Segment (PID)

SEQ Element

Name

Data

Type

Usage Cardinality LEN Conditional Predicate Value

Set

Constraint

Set ID - PID

[1..1]

Patient ID

Patient

Identifier List

[1..*]

Alternate

Patient ID -

00106

Patient Name

XPN

[1..*]

The first repetition shall contain the

legal name. Multiple given names

or initials are separated by spaces.

Mother’s

Maiden Name

XPN_

[0..1]

Only last name and name type are

required. Set Name Type code to

“M” for maiden name usage.

Date/Time of

Birth

TS_N

[1..1]

Administrative

Sex

[0..1]

HL70001

Patient Alias

XPN

Race

[0..*]

HL70005

Patient

Address

XAD

[0..*]

The first repetition should be the

primary address.

County Code

County belongs in address field.

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Table 12-6 Patient Identifier Segment (PID)

SEQ Element

Name

Usage Cardinality LEN Conditional Predicate Constraint

13 Phone

Number -

Home

XTN O [0..*] The first instance shall be the

primary phone number.

Only one item is allowed per

repetition.

Phone

Number -

Business

XTN

Primary

Language

Marital Status

Religion

Patient

Account

Number

SSN Number -

Patient

Driver's

License

Number -

Patient

DLN

Mother's

Identifier

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Data

Type

Value

Set

Chapter 6: Messages for Transmitting Immunization Information

Table 12-6 Patient Identifier Segment (PID)

SEQ Element

Name

Data

Type

Usage Cardinality LEN Conditional Predicate Value

Set

Constraint

22 Ethnic Group CE O [0..1] CDCREC

Birth Place

Multiple Birth

Indicator

O [0..1]

HL70136

The acceptable values are Y and

N. If the status is undetermined,

then field shall be empty.

Birth Order

[0..1]

1..2

This field contains a number

indicating the person’s birth order,

with 1 for the first child born and 2

for the second.

Citizenship

Veterans

Military Status

Nationality

Patient Death

Date and Time

[0..1]

Patient Death

Indicator

[0..1]

HL70136

Identity

Unknown

Indicator

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Table 12-6 Patient Identifier Segment (PID)

SEQ Element

Name

Data

Type

Usage Cardinality LEN Conditional Predicate Value

Set

Constraint

32 Identity

Reliability

Code

IS O

Last Update

Date/Time

Last Update

Facility

35 Species Code CE O

Breed Code

Strain

38 Production

Class Code

CE O

Tribal

Citizenship

CWE

Conformance Statement:

IZ-46: PID-1 (Set ID) SHALL have the literal value “1”

PID field definitions

See field definitions for PID under Profile Z22 above.

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QAK—Query Acknowledgement Segment

12-6 Segment

Table 12-7 Query Acknowledgement Segment

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional Predicate Value

set

Comment

1 Query Tag ST R [1..1] 32

2 Query

Response

Status

ID RE [0..1]

Message

Query Name

[1..1]

Hit Count

[0..1]

5 This payload NM O [0..1]

Hits remaining

[0..1]

QAK field definitions

QAK-1 Query Tag (ST) 00696

Definition: This field contains the value sent in QPD-2 (query tag) by the initiating system, and will be used to match response messages to the

originating query. The responding system is required to echo it back as the first field in the query acknowledgement segment (QAK).

QAK-2 Query Response Status (ID) 00708

Definition: This field allows the responding system to return a precise response status. It is especially useful in the case where no data is found that

matches the query parameters, but where there is also no error. It is defined with HL7 Table 0208 - Query Response Status.

QAK-3 Message Query Name (CE) 01375

Definition: This field contains the name of the query. This shall mirror the QPD-1 (Message Query Name) found in the query message that is being

responded to.

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QPD Input Parameter Specification

12-7 S Specification

Table 12-8 QPD Input Parameter Specification

Field

Seq

(Query

ID=Z34)

Name Key/

Sort LEN TYPE Usage Rep Match

TBL Segment

Field

Name

Service

Identif

ier

Code

Element

Name or

Value

MessageQue

ryName

Z34^Request

Complete

Immunization

History^CDCP

HINVS

QueryTag

PatientList

PID.3

PID-3: Patient

Identifier List

PatientName

XPN

PID.5

PID-5: Patient

Name

PatientMothe

rMaidenNam

XPN RE PID.6

PID-6: Mother’s

maiden name

Patient Date

of Birth

TS_NZ

PID.7

PID-7: Patient

date of birth

Patient Sex

PID.8

PID-8: Patient

sex

Patient

Address

XAD

PID.11

PID-11: Patient

Address

Patient home

phone

XTN

PID.13

PID-13: Patient

home phone

Patient

multiple birth

PID-24

PID-24: Patient

multiple birth

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Table 12-8 QPD Input Parameter Specification

Field

Seq

(Query

ID=Z34)

Name Key/

Sort LEN TYPE Usage Rep Match

TBL Segment

Field

Name

Service

Identif

ier

Code

Element

Name or

Value

indicator

Patient birth

order

PID-25

PID-25: Patient

birth order

Client last

updated date

PID-33

PID-33: Patient

last update

date

Client last

update

facility

PID-34

PID-34: Patient

last update

faciliity

QPD Input Parameter Field Description and Commentary

See Field Description under QPD in Profile Z34.

RXA-- Pharmacy/Treatment Administration Segment

The RXA segment carries pharmacy administration data.

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able 12-8 Pharmacy/Treatment Administration (RXA)

Table 12-9 Pharmacy/Treatment Administration (RXA)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional Predicate Value

Set

Comment

Give Sub-ID

Counter

[1..1]

Administration

Sub-ID Counter

[1..1]

Date/Time Start

of Administration

TS_NZ

[1..1]

This segment may be used in

cases where a vaccine has not

been administered. For

instance a patient may refuse a

vaccination or the sending

system may be forecasting a

next dose due. See notes

below for guidance on the

relevant date to include here.

Date/Time End

of Administration

[0..1]

See not below

Administered

Code

[1..1]

CVX

Support for CVX code is

strongly preferred. Local IG

may identify NDC or CPT as

acceptable alternative code

sets.

Administered

Amount

[1..1]

Administered

Units

C(R/O)

[0..1]

If Administered Amount is not

valued “999”

UCUM

The preferred units of measure

for this is “mL”.

Administered

Dosage Form

[0..1]

Administration

varies

C(R/O)

[0..*]

If RXA-20 is valued “CP” or

NIP 0001

If this field is used for a notes

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Table 12-9 Pharmacy/Treatment Administration (RXA)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional Predicate Value

Set

Comment

Notes

“PA”

only entry, then the data type

shall be CE_TX otherwise the

data type shall be CE.

The pr

imary use of this field it to

convey if this immunization

record is based on a historical

record or was given by the

provider recording the

immunization. All systems

should be able to support this

use. Other uses of this field are

permitted, but need to be

specified locally.

10 Administering

Provider

XCN C(RE/O) [0..1] If the first occurrence of

RXA-9.1 is valued "00"

and RXA-20 is valued

"CP" or "PA"

This i

s the person who gave the

administration or the vaccinator.

It is not the ordering clinician.

Administered-at

Location

LA2

C(RE/O)

[0..1]

If the first occurrence of

RXA-9.1 is valued "00"

and RXA-20 is valued

"CP" or "PA"

This is the clinic/site where the

vaccine was administered.

12 Administered

Per (Time Unit)

ST O

13 Administered

Strength

NM O

Administered

Strength Units

Substance Lot

[0..*]

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Chapter 13: Batch File Specifications

Table 12-9 Pharmacy/Treatment Administration (RXA)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional Predicate Value

Set

Comment

Number

Substance

Expiration Date

TS_M

[0..1]

17 Substance

Manufacturer

Name

CE C(R/O) [0..1] If the first occurrence of

RXA-9.1 is valued "00"

and RXA-20 is valued

"CP" or "PA"

MVX

Substance/Treat

ment Refusal

Reason

C(R/X)

[0..*]

If the RXA-20 (Completion

Status) is valued “RE “

NIP002

19 Indication CE O

20 Completion

Status

ID RE [0..1] 2 HL70322

Action Code -

RXA

[0..1]

HL70323

22 System Entry

Date/Time

TS O

23 Administered

Drug Strength

Volume

NM O

Administered

Drug Strength

Volume Units

CWE

25 Administered

Barcode

Identifier

CWE O

26 Pharmacy Order

Type

ID O

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Chapter 13: Batch File Specifications

Conformance Statement:

IZ-28: RXA-1 ( Give Sub-id counter) ) SHALL be valued “0” Note that “0” is zero.

IZ-29: RXA-2 (admin Sub-id) SHALL be valued “1 “

IZ-30: If RXA-4 (Date time of admin end ) is populated, then it SHALL be the same as Start time (RXA-3)

IZ-31: If RXA-20 is valued "CP" or "PA" then RXA-9.1 (admin notes) SHALL be valued one of the codes listed in NIP001 in the first occurrence

of this field and the following repetition should be empty or valued with a text notes.

IZ-32: If the RXA-18 (Refusal Reason) is populated, RXA-20 SHALL be valued to “RE”.

IZ-47: If RXA-20 is NOT valued "CP" or "PA" then the first occurrence of RXA-9.1 (admin notes) SHALL be empty and the following repetitions

should be empty or valued with text notes.

IZ-48: If RXA-20 is valued “RE” then RXA-6 shall be valued “999”.

IZ-49: If RXA-5.3 is valued “998” then RXA-6 shall be valued “999”.

IZ-50: If the first instance of RXA-9.1 is not valued “00” then RXA-6 (administered amount) SHALL be valued “999”

RXA field definitions

See RXA field definitions in the Z22 profile.

RXR-- Pharmacy/Treatment Route Segment

The Pharmacy/Treatment Route segment contains the alternative combination of route, site, administration device, and administration method that are

prescribed as they apply to a particular order.

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Chapter 13: Batch File Specifications

Table 12-9 Pharmacy/Treatment Route (RXR)

Table 12-10 Pharmacy/Treatment Route (RXR)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional

Predicate

Value

Set

Constraint

Route

[1..1]

NCIT

Administration

Site

CWE

[0..1]

HL70163

Administration

Device

Administration

Method

CWE

Routing

Instruction

Administration

Site Modifier

CWE

RXR field definitions

See RXR field definitions in Profile Z22.

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Chapter 13: Batch File Specifications

13.Batch File Specifications

Sending Messages in a Batch

Systems may choose to send messages in batches. A batch begins with a batch header statement (BHS) and ends with a Batch Trailer Segment. Batches may in

turn be batched into files of batches using File Header Statement and File Trailer statement. If a system is sending a single batch, the FHS/FTS is not necessary. A

stream of messages may be sent without use of either BHS or FHS.

The generic layout of a batch message is as follows:

BHS

VXU

…

milarly, a file of batches is laid out as follows:

FHS

BHS

VXU

…

BTS

BHS

VXU

…

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Chapter 13: Batch File Specifications

BTS

…

FTS

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Chapter 13: Batch File Specifications

BHS—Batch Header Segment

Table 13-1 Batch Header Segment (BHS)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional Predicate Value

set

Description/Comment

Batch Field

Separator

[1..1]

1,,1

Batch

Encoding

Characters

[1..1]

4..4

^~\&

Batch Sending

Application

Batch Sending

Facility

Batch

Receiving

Application

Batch

Receiving

Facility

Batch Creation

Date/Time

Batch Security

Batch

Name/ID/Type

Batch

Comment

Batch Control

Reference

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Chapter 13: Batch File Specifications

Table 13-1 Batch Header Segment (BHS)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional Predicate Value

set

Description/Comment

Batch Control

Conformance Statement

IZ-8: BHS.1 (Batch Field Separator) SHALL be |

IZ-9: BHS.2 (Batch Encoding Characters) SHALL be ^~\&

BHS field definitions

BHS-1 Batch Field Separator (ST) 00081

Definition: This field contains the separator between the segment ID and the first real field, BHS-2-batch encoding characters. As such it serves as the

separator and defines the character to be used as a separator for the rest of the message. The required value is |,(ASCII 124). Note that this field is

different from other fields and immediately follows the Segment name code.

BHS|

⇑

separator

BHS-2 Batch Encoding Characters (ST) 00082

Definition: This field contains the four characters in the following order: the component separator, repetition separator, escape characters, and

subcomponent separator. The required values are ^~\& (ASCII 94, 126, 92, and 38, respectively).

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Chapter 13: Batch File Specifications

BTS—Batch Trailer Segment

Table 13-2 Batch Trailer Segment (BTS)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional Predicate Value

Set

Description/Comment

Batch

Message

Count

Batch

Comment

Batch Totals

BTS field definitions

BTS-1 - BTS-3 Not anticipated to be used for immunization messages.

xample: BTS||

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Chapter 13: Batch File Specifications

FHS—File Header Segment

Table 13-3 File Header Segment (FHS)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional Predicate Value

Set

Description/Comment

File Field

Separator

[1..1]

1..1

File Encoding

Characters

[1..1]

4..4

^~\&

File Sending

Application

File Sending

Facility

File Receiving

Application

File Receiving

Facility

File Creation

Date/Time

File Security

File Name/ID

File Header

Comment

File Control ID

Reference File

Control ID

Conformance Statement:

IZ-10: The FSH.1 (File Field Separator) SHALL be |

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Chapter 13: Batch File Specifications

IZ-11: The FSH.2 (File Encoding Characters) SHALL be ^~\&

FHS field definitions

FHS-1 File Field Separator (ST) 00067

Definition: This field has the same definition as the corresponding field in the MSH segment. The value shall be |.

Note that this field is different from other fields and follows the segment name code immediately.

FHS|

FHS-2 File Encoding Characters (ST) 00068

Definition: This field has the same definition as the corresponding field in the MSH segment. The value shall be ^~\&

FTS—File Trailer Segment

Table 13-4 File Trailer Segment (FTS)

SEQ ELEMENT

NAME

Data

Type

Usage Cardinality LEN Conditional Predicate Value

set

Description/Comment

File Batch

Count

File Trailer

Comment

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Change History

Change History Details

Release 1.1

Release 1.1 Changes

Location

Change

Page 100

PD1-4 Primary Provider. Corrected data type to XCN.

Page 46

Corrected usage definitions for EI-Entity Identifier data type.

Page 124

Clarified default action if RXA-21 Action Code is not populated.

Appendix A-1

Added copyright note on LOINC codes. Added reference to SNOMED.

Added reference to PHIN VADS

Appendix A-2 and A-3

Removed links to dead web pages on Race and Ethnicity.

Appendix A-33

Added NCIT to codes

Appendix A-2

Corrected Value set OID for race.

Appendix A-30

Corrected code for Allergy to protein of rodent origin.

Appendix A-30

Removed duplicate row VXC28

Appendix A-36

Corrected LOINC code for contraindication

Release 1.2

Rel

ease 1.2 Changes

Release 1.2 Changes

Location Change

Appendix A-18

Added example of response to query that found too many candidates.

Appendix A-multiple

Corrected use of profile identifiers in the responses. Changed HL70396

to CDCPHIVS.

Chapter 6, page 129

Corrected cardinality of GT1 and Insurance segment group.

Chapter 5, p72

Corrected spelling of BHS

HL7 Version 2.5.1 Implementation Guide: Immunization Messaging (Release 1.5) 10/1/2014 Page 1

Change History

Release 1.2 Changes

Location Change

Chapter 5, p72 and throughout Guide

Changed “null” to “empty” in data types, fields and segments. In some

cases deleted contents of cell

Chapter 7, p 140

Corrected cardinality

Chapter 7, page 156

Removed extraneous RCP row in table.

Chapter 7, page 157

Include profile id in the text explaining Z32^CDCPHINVS

Chapter 4, page 61

Illustrated use of HD data type in XCN

Appendix B, throughout

Corrected Query name to Z34^Request Immunization

History^CDCPHINVS

Appendix B-15

Corrected LOINC in example message. It was set to Reaction, but

should be 59779-9, schedule used.

Chapter 5, page 105

Corrected cardinality of PID-1

Chapter 5, various pages

Corrected cardinality of fields with usage of X (not supported) from [0..1]

to [0..0]

Chapter 5, page 108

Corrected data type of PID-39 Tribal citizenship from CE to CWE

Chapter 5, page 101

Corrected data types for all PD1 fields.

Chapter 5, page 91

Corrected usage of OBX-1

Chapter 4, page 50

Added reference to User defined tables 0361-0363

Chapter 5, page 82-3

Clarified usage of tables 0361 and 0362

Chapter 5, page 96

Corrected ORC-3 usage

Appendix A, Table 0363

Added table with value set

Release 1.3

Release 1.3 Changes

Location Change

HL7 Version 2.5.1 Implementation Guide: Immunization Messaging (Release 1.5) 10/1/2014 Page 2

Change History

Release 1.3 Changes

Location Change

Chapter 2, Use Case 9 – report error

Added clarifying statement.

Chapter 3, usage guidance

Clarified RE and CE usage. These are SHOULD rather than SHALL

Chapter 4, HD data type and

Appendix A

Changed references to Table HL70300 to the more specific HL70361-

HL70363

Chapter 4, FT data type

FT data type added

Chapter 5, MSH-11

Clarify use of field and attendant table

Chapter 5, PID 14

Correct cardinality

Chapter 5, PID-15 note box

Clarified difference between V2.3.1 and V2.5.1 IG value sets.

Chapter 5, RXA-10

Added clarifying statement.

Chapter 5, RXA 20

Clarified definition and codes

Chapter 5, NK1-20 and PID-15

Corrected table reference for language to ISO 0639

Appendix A, User-defined Table 0064

Updated to accommodate change in eligibility coding.

Appendix A, Table NIP 003

Added new LOINC for eligibility

Appendix A,

Added new value set for client risk factors to be used for priority groups.

Appendix B, immunization history

table

Added new concepts

Appendix B, Example VXU #2

Added description of messaging eligibility status using OBX, per

immunization.

Appendix B

Forecast examples updated to include ORC segment for each RXA

Appendix B, Forecasting messages

Added new examples and improved existing examples

Chapter 5, VXU table

Changed PV1 to optional

Chapter 5, page 112

Note on changing PV1 to optional

Chapter 5, page 115

Note on changing PV1 to optional

HL7 Version 2.5.1 Implementation Guide: Immunization Messaging (Release 1.5) 10/1/2014 Page 3

Change History

Release 1.3 Changes

Location Change

Chapter 6, page 131

Clarified cardinality and usage of Order group

Chapter 7, page 142

Changed cardinality and usage of PV1 in response grammar table

Appendix A, table 0064

Updated notes and definitions to reflect MIROW guidance

Appendix B, Example VXU #2

Extensive rewrite to reflect MIROW guidance

Appendix B, Example VXU #2

Removed guidance on use of PV1 for eligibility status

Appendix A and Appendix B

Removed references to messaging funding source.

Chapter 7, response grammar

Corrected usage of IN1 from RE to O.

Appendix A, Table 0064

And examples using VFC codes

throughout Appendix B

Corrected VFC codes. Deprecated V06 and V08

Release 1.4

Release 1.4. Changes

Release 1.4 Changes

Location

Change

Chapter 2

Added documentation of core data elements

XAD, table 4-23

Specified use of US Postal Service state codes

RXA, table 5-20,

Specified use of NIP002 for RXA-18

RXA-3 text, page 123

Clarified appropriate date for forecast.

Appendix A

Set table title to be a header, so it is included in Table of Contents

Table 0064-Financial Class

Clarified use of V07

Table 0289-County/Parish, page A-21

Corrected codes for county.

CDC-defined table NIP-003

Added new observation code for document type

Evidence of Immunity-IIS

Added new codes for evidence of immunity

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Change History

Release 1.4 Changes

Location

Change

VIS Document Type-IIS

Added new table for identifying VIS document types

Appendix B-core data elements

Updated table and added more data concepts.

Appendix B- VXU #2 example

Added guidance to incorporate guidance on eligibility from MIROW

work.

Appendix B-VXU #7 example

Added guidance on using the new barcodes for VIS document type.

Through out document

Added conformance statements for key elements

Chapter 3

Modified usage descriptions to separate sender and receiver

responsibilities.

Throughout document

Changed C and CE usage to use the pre-adopted Version 2.7.1

conditional usage

Throughout document

Reformatted the tables for elements to support changes to Conditional

usage

Appendix B

Restored table for indicating funding source for an immunization.

Appendix A

Added new table for VIS barcode, VIS vaccines and Eligibility

Observation Method

Release 1.5

Release 1.5 Changes

Location

Change

Reorganized IG, creating a separate profile for VXU, ACK and queries

ACK Z23 profile

Set MSH-15 and MSH-16 to “NE”

Appendix B

Updated Message examples to align with RXA-21 changes and correct

some RXA-20 positions.

CE data type

Changed CE.4 usage to O

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Change History

Release 1.5 Changes

Location

Change

Chapter 2, Preadoption of V 2.7.1

Dropped 2.7.1 guidance on field length.

Chapter 3, HL7 definitions

Added Segment Groups definition.

CWE data type

Changed CWE.4 usage to O (optional)

ERL (Error Location) Data type

Clarified how to count segment count when reporting error.

ERL data type

Clarified usage of subcomponents to harmonize across

implementations.

Ethnicity codes

Removed reference to HL70189 code table and associated ethnicity

codes (H,N,U)

HD data type

Added note on use of subcomponent separator when HD data type is a

subcomponent of another data type.

IN1 segment

Added constrained field level specifications. IN1 still optional segment.

Insurance Group

Optional, and not repeating

IZ-14

removed

IZ-16

Removed

IZ-23

Updated to match in Addendum

IZ-24

Updated to match in Addendum

IZ-34

Corrected to match addendum

MSH-15

Usage is required (R)

Z32,Z42,Z23,Z31 and Z33 set to “NE”,

Z22,Z34 and Z44 set to “ER”

MSH-16

Usage is required (R)

Z32,Z42,Z23,Z31 and Z33 set to “NE”,

Z22,Z34 and Z44 set to “AL”

MSH-21

Applied conditional predicates to each MSH segment requiring the

HL7 Version 2.5.1 Implementation Guide: Immunization Messaging (Release 1.5) 10/1/2014 Page 6

Change History

Release 1.5 Changes

Location

Change

appropriate profile ID.

MSH-22, MSH-23

Preadopted MSH22 and MSH 23 from V 2.7.1

MSH-7 (message date)

Changed data type to TS_Z, requiring precision to second and time

zone.

MSH-7 examples

Corrected all MSH-7 message examples to be TS_Z data type

NIP003

Added 59777-3, latest date to administer

And 59778-1, date overdue

And 59778-1, reason code

OBX

Correct typo from

cdcgi1vis to cdcgs1vis

OBX Application level conformance

statements Table 5-15

Clarified existing statements and added statements.

OBX-1

Clarified numbering across segment. Numbering is now continuous.

Corrected example messages

OBX-14

Changed data type to TS_NZ

OBX-4

Conformance statement requires positive integer.

ORC-12

Changed usage to C(RE/O)

ORC-17

Changed usage to RE

ORC-3

Conformance added

PID, IZ-26

removed

PID-1 for all profiles.

Changed usage to R and added conformance statement.

PID-29

Corrected conditional predicate

PID-6 , Mothers maiden name

Changed to XPN_M

QUERY /RESPONSE MSH-7

Changed data type to TS_Z

QUERY /RESPONSE PID-7

Changed Data type to TS_NZ

HL7 Version 2.5.1 Implementation Guide: Immunization Messaging (Release 1.5) 10/1/2014 Page 7

Change History

Release 1.5 Changes

Location

Change

RXA conformance statement

Added conformance statement: IZ-xx: If RXA-20 is NOT valued

"CP" or "PA" then the first occurrence of RXA-9.1 (admin

notes) SHALL be empty and the following repetitions should

be empty or valued with text notes.

RXA, IZ-34

removed

RXA, IZ-37, IZ-38

Removed

RXA-10

Updated conditional predicate

RXA-11

Updated conditional predicate

RXA-15

Updated conditional predicate and changed usage to C(R/0).

RXA-16

Updated conditional predicate

RXA-17

Updated conditional predicate and changed usage to C(R/0)

RXA-21

Changed usage to C(R/O). Deleted guidance indicating that an empty

field meant “A”.

RXA-3

Changed data type to TS_NZ

RXA-4

Changed usage to O (optional).

RXA-6

Conformance statement requiring “999” for non-administered doses.

Table 2-1

Added new goal, send evaluated history and forecast.

Table 2-1

Updated Use Cases. Collapse “send” and “receive” use cases into one

use case. Added use case for request evaluated history and forecast.

Table 2-1

Updated all use case narratives

Table 6-2

Corrected Patient visit group and PV1

TS_M data type

Constrained version of the TS data type, requiring precision to the

month and permitting to the day.

TS_NZ data type

Created a constrained version of the TS data type, requiring precision

to the day.

HL7 Version 2.5.1 Implementation Guide: Immunization Messaging (Release 1.5) 10/1/2014 Page 8

Change History

Release 1.5 Changes

Location

Change

TS_Z data type

Created a constrained version of the TS data type, requiring precision

to the second and time zone.

XPN_M data type

Added XPN_M to data types

XTN data type

Corrected typos in conditional predicates.

Z32 RXA-21

Set RXA-21 (Action code) to O

Z34 Message level definition

Set Changed ORC to O

Appendix B, VXU Example #9

Clarified when and how to send 2 lots number for one immunization

Profile Z32-Return Complete history

Loosened conditional predicates and removed conformance statements

for OBX segment

Profile Z42-Return Evaluated History

and Forecast

Loosened conditional predicates and removed conformance statements

for OBX segment

Profile Z42-Return Evaluated History

and Forecast

Loosened requirements and removed conditional predicates for ORC

segment

Profile Z42-Return Evaluated History

and Forecast

Loosened requirements and removed conditional predicates for PID

Profile Z42-Return Evaluated History

and Forecast

Loosened requirements and removed conditional predicates for RXA

CWE-1

Changed from RE to R

MSH-21 for all profiles

Change cardinality to [1..*]

Appendix B, Example #4

Corrected Reaction observation. Removed Reaction to Current

Immunization

Table 0361, Table 0362 and Table

0363

Added clarifying language

Appendix B, VXU Example #9

Clarified when and how to send 2 lots number for one immunization

MSH-3, MSH-4, MSH-5, MSH-6

Modified field definitions to clarify that values in tables 0361, 0362 and

0363 are defined locally.

Table 0086

Values recorded

HL7 Version 2.5.1 Implementation Guide: Immunization Messaging (Release 1.5) 10/1/2014 Page 9

Change History

Release 1.5 Changes

Location

Change

Value Set-Evidence of Immunity

Deprecated existing table and created 2 new tables. One for history of

disease and one for serological evidence of immunity.

Observation Identifier table

Added LOINC for Serological Evidence of Immunity

HL7 Version 2.5.1 Implementation Guide: Immunization Messaging (Release 1.5) 10/1/2014 Page 10

Change History

APPENDIX A:

Code Tables

Table A-1 Appendix A Revision History

Revision History

Author

Revision

Date

Rob Savage

Release 1

5/1/2010

Rob Savage

Release 1.1

8/15/2010

Rob Savage

Release 1.2

2/15/2011

Rob Savage

Release 1.3

8/15/2011

Rob Savage

Release 1.4

8/1/2012

Rob Savage

Release 1.5

10/1/2014

OTE: In this appendix, values are selected from standard code sets where available. The Value Sets

are maintained in the PHIN VADS for use in Public Health. The main purpose of PHIN VADS is to

distribute vocabulary subsets needed in Public Health. The latest version of value sets referenced in this

Implementation Guide can be obtained from PHIN VADS at (http://phinvads.cdc.gov

). Search using

keyword “immunization”.

Note that the PHIN VADS value sets are the source of truth for use in Meaningful Use testing.

This material contains content from LOINC® (http://loinc.org). The LOINC table and LOINC

Names and Codes (LOINC) Committee.

This material contains content from SNOMED CT. SNOMED CT (Systematized Nomenclature of

Medicine--Clinical Terms) is a comprehensive clinical terminology, originally created by the College

of American Pathologists (CAP) and, as of April 2007, owned, maintained, and distributed by the

International Health Terminology Standards Development Organization (IHTSDO), a non-for-profit

association in Denmark. The CAP continues to support SNOMED CT operations under contract to

the IHTSDO and provides SNOMED-related products and services as a licensee of the terminology.

User-defined Table 0001 - Sex

This code reflects the self reported gender. Use in PID-8, NK1-15. These codes are pre-adopted from HL7

Version 3 Administrative Gender.

Value set OID: 2.16.840.1.113883.1.11.1

Value Description Definition

Female

Person reports that she is female.

Male

Person reports that he is male.

Unknown/undifferentiated

No assertion Is made about the gender of the

person.

HL7 Version 2.5.1 Implementation Guide: Immunization Messaging (Release 1.5) 10/1/2014 Page 1

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HL7-defined Table 0003 - Event type

This code indicates the trigger event. Refer to Chapter 3, Version 2.5.1 for further information on HL7

event triggers.

Each profile identifies the appropriate value for Event Type in a conformance statement.

User-defined Table 0004 - Patient class

Use in PV1-2.

This code categorizes the patient in the current event. The only value supported is R for recurring patient.

For a current list of HL7 values please reference the HL7 version 2.5.1 documents.

User-defined Table 0005 - Race

These values are consistent with the OMB Notice of revised categories for collection of race and ethnicity

data—the combined format. Use in PID-10, NK1-35.

This code represents the client’s self-reported race.

https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.113883.3.2074.1.1.3

Val

ue set OID: 2.16.840.1.113883.3.2074.1.1.3

US race codes Description

1002-5

American Indian or Alaska Native

2028-9

Asian

2076-8

Native Hawaiian or Other Pacific Islander

2054-5

Black or African-American

2106-3

White

2131-1

Other Race

Unknown/undetermined

HL7-defined Table 0008 - Acknowledgment code

Use in MSA-1.

This code indicates the type of acknowledgement expected.

Value Description

Comment

Original mode: Application Accept

Enhanced mode: Application acknowledgment: Accept

Message was accepted without

error.

HL7 Version 2.5.1 Implementation Guide: Immunization Messaging (Release 1.5) 10/1/2014 Page 2

Change History

Value Description

Comment

Original mode: Application Error

Enhanced mode: Application acknowledgment: Error

Message was processed and

errors are being reported.

Original mode: Application Reject

Enhanced mode: Application acknowledgment: Reject

Message was rejected because

one of the following occurred:

• Unsupported message type

• Unsupported event code

• Unsupported processing ID

• Unable to process for

reasons unrelated for

format or content

Enhanced mode: Accept acknowledgment: Commit Accept

Not supported in this

Implementation Guide

Enhanced mode: Accept acknowledgment: Commit Error

Enhanced mode: Accept acknowledgment: Commit Reject

User-defined Table 0010 - Physician ID

Use in all XCN data types; including PV1-7,8,9,17, RXA-10.

Each registry should establish a system of coding its reporting physicians. The National Provider Identifier

(NPI) adopted for the HIPAA legislation may be used for this purpose.

HL7-defined Table 0061 - Check digit scheme

Use in all CX data types; including PID-2,3,4,18,21.

Value Description

M10

Mod 10 algorithm

M11

Mod 11 algorithm

ISO

ISO 7064: 1983

NPI

Check digit algorithm in the US National Provider Identifier

User-defined Table 0063 - Relationship

Use in NK1-3, IN1-17

AE is sent whenever an error is detected. This may range from data that are ignored because they are not wanted to rejection of the

entire message.

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Change History

Value Description

BRO

Brother

CGV

Care giver

CHD

Child

FCH

Foster child

FTH

Father

GRD

Guardian

GRP

Grandparent

MTH

Mother

OTH

Other

PAR

Parent

SCH

Stepchild

SEL

Self

SIB

Sibling

SIS

Sister

SPO

Spouse

User-defined Table 0064 - Financial class

Use in OBX-5 for client eligibility for a funding program at the dose administered level.

Financial class references a client’s eligibility status at the time of vaccine administration. It is the

eligibility of the client for the vaccine administered. The values in this table relate to eligibility for the

Vaccine for Children (VFC) program.

Local implementations may define and document local codes. Each state immunization program may have

locally specified funding programs for immunizations. In order to assure that each is unique across states,

codes should be created that begin with the grantee assigning authority code from table 0363 in the

Implementation Guide for Immunization Messaging, release 1.3. This would be followed by sequential

number, left padded to a length of 2. For example if Alaska had a funding program, they would create a

code of AKA01 for the first program. It is incumbent on the state or other jurisdiction to clearly describe

the requirements that qualify a person for that funding program. For instance if the hypothetical funding

program in Alaska covered people who were too old for VFC program but would otherwise qualify because

they were Medicaid eligible, then they would define the code as:

“Client is currently on MEDICAID and is older than 19 years old.”

Note that funding source for a specific immunization is different from client eligibility for funding program

(Financial Class).

Code Label Definition

V01

Not VFC eligible

Client does not qualify for VFC because they do not have one

of the statuses below. (V02-V05)

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Code Label Definition

V02

VFC eligible-

Medicaid/Medicaid

Managed Care

Client is currently on Medicaid or Medicaid managed care and

< 19 years old and the vaccine administered is eligible for VFC

funding.

V03

VFC eligible- Uninsured

Client does not have private insurance coverage and < 19 years

old and the vaccine administered is eligible for VFC funding.

V04

VFC eligible- American

Indian/Alaskan Native

Client is a member of a federally recognized tribe and < 19

years old and the vaccine administered is eligible for VFC

funding.

V05

VFC eligible-Federally

Qualified Health Center

Patient (under-insured)

Client has insurance, but insurance does not cover vaccines,

limits the vaccines covered, or caps vaccine coverage at a

certain amount and so client is eligible for VFC coverage at a

Federally Qualified Health Center. The client must be

receiving the immunizations at the FQHC or a FQHC

designated clinic and < 19 years old and the vaccine

administered is eligible for VFC funding.

V06

Deprecated [VFC

eligible- State specific

eligibility (e.g. S-CHIP

plan)]

Do not use this code. State specific funding should either use

V07 or a state generated code.

V07

Local-specific eligibility

Client is eligible for state supplied vaccine based on local

specific rules and the vaccine administered is eligible for state-

funding. It should only be used if the state has not published

local codes for these programs.

V08

Deprecated [Not VFC

eligible-underinsured]

Do not use this code. The MIROW effort determined that

persons in this situation are V01, not VFC eligible. It is not

necessary to differentiate this sub-class of Not VFC eligible.

HL7-defined Table 0076 - Message type

Only selected values listed. Use in MSH-9, first component.

Only these values are expected.

Value Description Usage in this

guide

ACK

General acknowledgment

Supported

ADT

ADT message

Supported

QBP

Query by Parameter

Supported

RSP

Response to Query by parameter

Supported

VXU

Unsolicited vaccination record update

Supported

HL7-defined Table 0078 - Abnormal flags

Use in OBX-8.

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Fields using this code set are expected to be empty. For a current list of HL7 values please reference the

HL7 version 2.5.1 documents.

HL7-defined Table 0085 - Observation result status codes

interpretation

Use in OBX-11.

Fields using this value set are constrained to F for Final. For a current list of HL7 values please reference

the HL7 version 2.5.1 documents.

User Defined Table 0086 - Plan Type ID

The

values in this value set are drawn from the Source of Payment Typology

(PHVS_SourceOfPaymentTypology_PHDSC). New values may be added from that value set.

Value Description Usage in this guide

Private Insurance

Medicaid

Medicare

Self pay

HL7-defined Table 0091 - Query priority

Fields using this code set are expected to be I or empty, which indicates Immediate processing is expected.

For a current list of HL7 values please reference the HL7 version 2.5.1 documents.

HL7-defined Table 0102 - Delayed acknowledgment type

Use in MSA-5.

Fields using this code set are expected to be empty. For a current list of HL7 values please reference the

HL7 version 2.5.1 documents.

HL7-defined Table 0103 - Processing ID

Use in MSH-11.

Value Description

Debugging

Production

Training

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HL7-defined Table 0104 - Version ID

Use in MSH-12. Only these values are expected.

Value Description

2.5.1

Release 2.5.1 April 2007

HL7-defined Table 0119 - Order Control Codes

Use in ORC-1.

Value Description Usage

Order accepted & OK

Not supported

Observations to follow

Supported

HL7-defined Table 0125 – Value Type

Constrained for this Implementation Guide.

Value Description

Coded element

CE_TX

Text only CE data type

Composite Quantity with Units

CWE

Coded with Exceptions

Extended Composite Id with

Check digit

Date

DT_D

Date with precision to day

DTM

Date/Time

Entity Identifier

ERL

Error Location

Family Name

Formatted text

Hierarchic Designator

Coded Values for HL7 Tables

Coded value for User-Defined

Tables

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Value Description

LA2

Location with address variation

MSG

Message Type

Numeric

Processing Type

SAD

Street Address

Sequence ID

String

Time Stamp

TS_M

Time Stamp with optional

precision to the day and no time

zone

TS_NZ

Time Stamp with precision to

the day and no time zone

TS_Z

Time Stamp requiring time zone

VID

Version Identifier

XAD

Extended Address

XCN

Extended Composite ID Number

and Name for Persons

XON

Extended Name and Id Number

for Organizations

XPN

Extended Person Name

XTN

Extended telephone number

HL7-defined Table 0126 - Quantity limited request

Use in RCP-2.

Fields using this code set are expected to be set to RD for records. For a current list of HL7 values please

reference the HL7 version 2.5.1 documents.

HL7-defined Table 0136 - Yes/No indicator

Use in PID-24,30; PD1-12

Value Description

Yes

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n fields that may be empty, such as PD1-12 no value should be entered if the value is not Y or N. In HL7

“” means remove the previous value. If the field is empty, then it means do nothing to existing values.

Note on Null and Empty in HL7

Note that in the previous Implementation Guide, the undetermined state was signified by “” (HL7

null). This has a specific meaning in HL7. It means “change the state in the receiving system to

null”. The empty field means that the existing state should remain unchanged in the receiving

system.

Value in Field Meaning

“”

|””|

Nullify the value recorded in the receiving system data base.

Make no changes to the record in the receiving data base. The sending

system has no information on this field.

HL7-defined Table 0155 - Accept/Application acknowledgment

conditions

Use in MSH-15 and 16

Value Description

Always

Never

Error/Reject conditions only

Successful completion only

NCI Thesaurus (NCIT) – Route of Administration

HL7-defined Table 0162 - Route of administration

Note that HITSP has specified the use of the FDA route of administration. The following table

maps these to the HL7 table 0162 values. NCIT values should be used.

FDA

NCI

Thesaurus

(NCIT)

HL7-0162 Description Definition

C38238

Intradermal

within or introduced between the layers of

the skin

C28161

Intramuscular

within or into the substance of a muscle

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FDA

NCI

Thesaurus

(NCIT)

HL7-0162 Description Definition

C38284

Nasal

Given by nose

Intranasal

{Do not use this older code}

C38276

Intravenous

administered into a vein

C38288

Oral

administered by mouth

OTH

Other/Miscellaneous

C38676

Percutaneous

made, done, or effected through the skin.

C38299

Subcutaneous

Under the skin or between skin and muscles.

C38305

Transdermal

describes something, especially a drug, that

is introduced into the body through the skin

ample

|C28161^Intramuscular^NCIT|

HL7-defined Table 0163 - Administrative site

Only selected values listed. Use in RXR-2. Only these values are expected.

HL7 0163 Description

Left Thigh

Left Arm

Left Deltoid

Left Gluteous Medius

LVL

Left Vastus Lateralis

LLFA

Left Lower Forearm

Right Arm

Right Thigh

RVL

Right Vastus Lateralis

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HL7 0163 Description

Right Gluteous Medius

Right Deltoid

RLFA

Right Lower Forearm

CDCREC - Ethnic Group

User-defined Table 0189

Table 0189 values should not be used. The codes from the CDCREC value set are the correct ones to use.

Legacy systems may still send HL70189, so receivers should be prepared to accept.

The US ethnicity codes are actually from the CDCREC table. They should be identified as CDCREC.

US ethnicity codes

(CDCREC)

Description

2135-2

Hispanic or Latino

2186-5

not Hispanic or Latino

Unknown

HL7-defined Table 0190 - Address type

Use in all XAD data types; including PID-11

Value Description

Current or temporary

Permanent

Mailing

Firm/Business

Office

Home

Birth (nee)

Country of origin

Legal address

BDL

Birth delivery location [use for birth facility]

Residence at birth [use for residence at birth]

Registry home

Bad address

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Recording of Birth State uses the BDL, birth delivery location code.

HL7-defined Table 0200 - Name type

Use in all XCN, XPN data types; including PID-5, 6, 9

Value Description Definition

Alias name

This is a nickname or other assumed

name.

Legal name

This a person’s official name. It is the

primary name recorded in the IIS.

Display name

This is the preferred name displayed on a

user interface.

Maiden name

This is a woman’s name before marriage.

Adopted name

This is the name of a person after

adoption.

Name at birth

This is name recorded at birth (prior to

adoption).

Name of partner/spouse

This is the name of the partner or spouse.

Unspecified

This is a name of unspecified type.

HL7-defined Table 0201 - Telecommunication use code

Use in all XTN data types including PID-13,14.

Value Description

PRN

Primary residence number

ORN

Other residence number

WPN

Work number

VHN

Vacation home number

ASN

Answering service number

EMR

Emergency number

NET

Network (email) address

BPN

Beeper number

HL7-defined Table 0202 - Telecommunication equipment type

Use in all XTN data types; including PID-13,14

Value Description

Telephone

Fax

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Value Description

Modem

Cellular phone

Beeper

Internet

Internet address: Use only if telecommunication use code is NET

X.400

X.400 email address: Use only if telecommunication use code is NET

TDD

Telecommunications Device for the Deaf

TTY

Teletypewriter

User-defined Table 0203 - Identifier type

Values suggested by HL7; with CDC-suggested additions. Use in all CX, XCN type codes; including PID-

2,3,4,18,21 and RXA-10

Value Description Comment

Account number

An identifier that is unique to an account.

ANON

Anonymous identifier

An identifier for a living subject whose real

identity is protected or suppressed

Justification: For public health reporting

purposes, anonymous identifiers are

occasionally used for protecting patient

identity in reporting certain results. For

instance, a state health department may

choose to use a scheme for generating an

anonymous identifier for reporting a patient

that has had a positive human

immunodeficiency virus antibody test.

Anonymous identifiers can be used in PID

3 by replacing the medical record number

or other non-anonymous identifier. The

assigning authority for an anonymous

identifier would be the state/local health

department.

ANC

Account number Creditor

Class: Financial

A more precise definition of an account

number: sometimes two distinct account

numbers must be transmitted in the same

message, one as the creditor, the other as

the debtor.

AND

Account number debitor

Class: Financial

A more precise definition of an account

number: sometimes two distinct account

numbers must be transmitted in the same

message, one as the creditor, the other as

the debtor.

ANT

Temporary Account Number

Class: Financial

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Value Description Comment

Temporary version of an Account Number.

Use Case: An ancillary system that does not

normally assign account numbers is the

first time to register a patient. This ancillary

system will generate a temporary account

number that will only be used until an

official account number is assigned.

APRN

Advanced Practice Registered

Nurse number

An identifier that is unique to an advanced

practice registered nurse within the

jurisdiction of a certifying board

Bank Account Number

Class: Financial

Bank Card Number

Class: Financial

An identifier that is unique to a person’s

bank card. Replaces AM, DI, DS, MS, and

VS beginning in v 2.5.

Birth registry number

CC Cost Center number Class: Financial

Use Case: needed especially for

transmitting information about invoices.

County number

DDS Dentist license number An identifier that is unique to a dentist

within the jurisdiction of the licensing

board

DEA

Drug Enforcement Administration

registration number

An identifier for an individual or

organization relative to controlled

substance regulation and transactions.

Use case: This is a registration number that

identifies an individual or organization

relative to controlled substance regulation

and transactions.

A DEA number has a very precise and

widely accepted meaning within the United

States. Surprisingly, the US Drug

Enforcement Administration does not

solely assign DEA numbers in the United

States. Hospitals have the authority to issue

DEA numbers to their medical residents.

These DEA numbers are based upon the

hospital’s DEA number, but the authority

rests with the hospital on the assignment to

the residents. Thus, DEA as an Identifier

Type is necessary in addition to DEA as an

Assigning Authority.

DFN

Drug Furnishing or prescriptive

authority Number

An identifier issued to a health care

provider authorizing the person to write

drug orders

Use Case: A nurse practitioner has

authorization to furnish or prescribe

pharmaceutical substances; this identifier is

in component 1.

Driver’s license number

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Value Description Comment

Doctor number

DPM

Podiatrist license number

An identifier that is unique to a podiatrist

within the jurisdiction of the licensing

board.

Osteopathic License number

An identifier that is unique to an osteopath

within the jurisdiction of a licensing board.

Donor Registration Number

Employee number

A number that uniquely identifies an

employee to an employer.

Employer number

Facility ID

Guarantor internal identifier

Class: Financial

General ledger number

Class: Financial

Guarantor external identifier

Class: Financial

Health Card Number

JHN Jurisdictional health number

(Canada)

Class: Insurance

2 uses: a) UK jurisdictional CHI number;

b) Canadian provincial health card number:

IND

Indigenous/Aboriginal

A number assigned to a member of an

indigenous or aboriginal group outside of

Canada.

Labor and industries number

License number

Local Registry ID

Patient Medicaid number

Class: Insurance

Member Number

An identifier for the insured of an insurance

policy (this insured always has a

subscriber), usually assigned by the

insurance carrier.

Use Case: Person is covered by an

insurance policy. This person may or may

not be the subscriber of the policy.

Patient's Medicare number

Class: Insurance

MCD

Practitioner Medicaid number

Class: Insurance

MCN

Microchip Number

MCR

Practitioner Medicare number

Class: Insurance

Medical License number

An identifier that is unique to a medical

doctor within the jurisdiction of a licensing

board.

Use Case: These license numbers are

sometimes used as identifiers. In some

states, the same authority issues all three

identifiers, e.g., medical, osteopathic, and

physician assistant licenses all issued by

one state medical board. For this case, the

CX data type requires distinct identifier

types to accurately interpret component 1.

Additionally, the distinction among these

license types is critical in most health care

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Value Description Comment

settings (this is not to convey full licensing

information, which requires a segment to

support all related attributes).

Military ID number

A number assigned to an individual who

has had military duty, but is not currently

on active duty. The number is assigned by

the DOD or Veterans’ Affairs (VA).

Medical record number

An identifier that is unique to a patient

within a set of medical records, not

necessarily unique within an application.

MRT

Temporary Medical Record

Number

Temporary version of a Medical Record

Number

Use Case: An ancillary system that does not

normally assign medical record numbers is

the first time to register a patient. This

ancillary system will generate a temporary

medical record number that will only be

used until an official medical record

number is assigned.

National employer identifier

In the US, the Assigning Authority for this

value is typically CMS, but it may be used

by all providers and insurance companies in

HIPAA related transactions.

National Health Plan Identifier

Class: Insurance

Used for the UK NHS national identifier.

In the US, the Assigning Authority for this

value is typically CMS, but it may be used

by all providers and insurance companies in

HIPAA related transactions.

National unique individual

identifier

Class: Insurance

In the US, the Assigning Authority for this

value is typically CMS, but it may be used

by all providers and insurance companies in

HIPAA related transactions.

NII National Insurance Organization

Identifier

Class: Insurance

In Germany a national identifier for an

insurance company. It is printed on the

insurance card (health card). It is not to be

confused with the health card number itself.

NIIP

National Insurance Payor Identifier

(Payor)

Class: Insurance

Use case: a subdivision issues the card with

their identifier, but the main division is

going to pay the invoices.

NNxxx

National Person Identifier where

the xxx is the ISO table 3166 3-

character (alphabetic) country code

Nurse practitioner number

An identifier that is unique to a nurse

practitioner within the jurisdiction of a

certifying board.

NPI

National provider identifier

Class: Insurance

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Value Description Comment

In the US, the Assigning Authority for this

value is typically CMS, but it may be used

by all providers and insurance companies in

HIPAA related transactions.

Optometrist license number

A number that is unique to an individual

optometrist within the jurisdiction of the

licensing board.

Physician Assistant number

An identifier that is unique to a physician

assistant within the jurisdiction of a

licensing board

PCN Penitentiary/correctional institution

Number

A number assigned to individual who is

incarcerated.

Living Subject Enterprise Number

An identifier that is unique to a living

subject within an enterprise (as identified

by the Assigning Authority).

PEN

Pension Number

PI Patient internal identifier A number that is unique to a patient within

an Assigning Authority.

Person number

A number that is unique to a living subject

within an Assigning Authority.

PNT

Temporary Living Subject Number

Temporary version of a Lining Subject

Number.

PPN Passport number A unique number assigned to the document

affirming that a person is a citizen of the

country. In the US this number is issued

only by the State Department.

PRC

Permanent Resident Card Number

PRN

Provider number

A number that is unique to an individual

provider, a provider group or an

organization within an Assigning Authority.

Use case: This allows PRN to represent

either an individual (a nurse) or a

group/organization (orthopedic surgery

team).

Patient external identifier

QA number

Resource identifier

A generalized resource identifier.

Use Case: An identifier type is needed to

accommodate what are commonly known

as resources. The resources can include

human (e.g. a respiratory therapist), non-

human (e.g., a companion animal),

inanimate object (e.g., an exam room),

organization (e.g., diabetic education class)

or any other physical or logical entity.

RPH

Pharmacist license number

An identifier that is unique to a pharmacist

within the jurisdiction of the licensing

board.

RN Registered Nurse Number An identifier that is unique to a registered

nurse within the jurisdiction of the

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Value Description Comment

licensing board.

Railroad Retirement number

RRI

Regional registry ID

State license

Subscriber Number

Class: Insurance

An identifier for a subscriber of an

insurance policy which is unique for, and

usually assigned by, the insurance carrier.

Use Case: A person is the subscriber of an

insurance policy. The person’s family may

be plan members, but are not the subscriber.

State registry ID

Social Security number

TAX

Tax ID number

Unspecified identifier

UPIN

Medicare/CMS (formerly HCFA)’s

Universal Physician Identification

numbers

Class: Insurance

Visit number

WIC identifier

WCN

Workers’ Comp Number

Organization identifier

User-defined Table 0204 - Organizational name type

Values suggested by HL7 Use in all XON data types

Value Description

Legal name

Display name

HL7-defined Table 0207 - Processing mode

Use in MSH-11

Fields using this code set are expected to be empty. For a current list of HL7 values please reference the

HL7 version 2.5.1 documents.

User-defined Table 0208 - Query response status

Values suggested by HL7. Use in QAK-2)

Value Description Comment

Data found, no errors (this is

the default)

Similar to AA in table HL70008

No data found, no errors

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Value Description Comment

Application error

Query had an error in content of format.

Application reject

Message was rejected because one of the

following occurred:

• Unsupported message type

• Unsupported event code

• Unsupported processing ID

Unable to process for reasons unrelated for

format or content

Too many candidates found

User-defined Table 0215 - Publicity code

Values suggested by CDC. (use in PD1-11)

Value Description

No reminder/recall

Reminder/recall - any method

Reminder/recall - no calls

Reminder only - any method

Reminder only - no calls

Recall only - any method

Recall only - no calls

Reminder/recall - to provider

Reminder to provider

Only reminder to provider, no recall

Recall to provider

Only recall to provider, no reminder

User-defined Table 0220 - Living arrangement

Fields using this code set are expected to be empty. For a current list of HL7 values please reference the

HL7 version 2.5.1 documents.

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HL7-defined Table 0227 - Manufacturers of vaccines (code =

MVX)

(use in RXA-17) The table below represents the February 2010 version of the MVX code set. The CDC’s

National Center for Immunization and Respiratory Diseases (NCIRD) maintains the HL7 external code set

MVX. http://www2a.cdc.gov/vaccines/IIS/IISStandards/vaccines.asp?rpt=mvx

NOTE: The MVX table reflects name changes and changes in corporate status. Where there have been company

mergers/acquisitions, the affected old codes have been labeled “inactive. The inactive manufacturer codes are retained

to allow manufacturer to be identified for historic immunization records. They should not be used for current

immunizations. Inactive codes should not be cross-walked to the code for the current manufacturer.

Alphabetized by manufacturer name

MVX CODE Manufacturer Name Notes

AB Abbott Laboratories

includes Ross Products Division,

Solvay

ACA

Acambis, Inc

acquired by sanofi in sept 2008

Adams Laboratories, Inc.

AKR Akorn, Inc

ALP

Alpha Therapeutic Corporation

Armour

part of CSL

AVB

Aventis Behring L.L.C.

part of CSL

AVI

Aviron

acquired by Medimmune

Baxter Healthcare Corporation-

inactive

BAH Baxter Healthcare Corporation

includes Hyland Immuno, Immuno

International AG,and North

American Vaccine, Inc./acquired

some assets from alpha therapeutics

BAY Bayer Corporation

Bayer Biologicals now owned by

Talecris

Berna Products

BPC Berna Products Corporation

includes Swiss Serum and Vaccine

Institute Berne

BRR

Barr Laboratories

Subsidiary of Teva Pharmaceuticals

BTP

Biotest Pharmaceuticals

New owner of NABI HB as of

This link is current as of 2/15/2011.

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MVX CODE Manufacturer Name Notes

Corporation

December 2007, Does NOT replace

NABI Biopharmaceuticals in this

code list.

CEN

Centeon L.L.C.

CHI

Chiron Corporation

Part of Novartis

CMP

Celltech Medeva Pharmaceuticals

Part of Novartis

CNJ

Cangene Corporation

CON

Connaught

acquired by Merieux

CRU Crucell

acquired Berna, now a J & J

company

CSL CSL Behring, Inc

CSL Biotherapies renamed to CSL

Behring

DVC

DynPort Vaccine Company, LLC

EVN

Evans Medical Limited

Part of Novartis

GEO

GeoVax Labs, Inc.

GRE

Greer Laboratories, Inc.

GRF

Grifols

IAG

Immuno International AG

Part of Baxter

IDB

ID Biomedical

Merieux

Part of sanofi

INT

Intercell Biomedical

IUS

Immuno-U.S., Inc.

JNJ Johnson and Johnson

acquired CRUCELL which acquired

Berna

JPN

The Research Foundation for

Microbial Diseases of Osaka

University (BIKEN)

KGC

Korea Green Cross Corporation

LED Lederle

became a part of WAL, now owned

by Pfizer

Massachusetts Public Health

Biologic Laboratories

MBL

Massachusetts Biologic

formerly Massachusetts Public

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MVX CODE Manufacturer Name Notes

Laboratories

Health Biologic Laboratories

MED MedImmune, Inc.

acquisitions of U.S. Bioscience in

1999 and Aviron in 2002, as well as

the integration with Cambridge

Antibody Technology and the

strategic alignment with our new

parent company, AstraZeneca, in

2007.

MIL

Miles

MIP

Emergent BioDefense Operations

Lansing

Bioport renamed. Formerly

Michigan Biologic Products Institute

MSD

Merck and Co., Inc.

NAB NABI

formerly North American Biologicals,

Inc.

NAV North American Vaccine, Inc. part of Baxter

NOV

Novartis Pharmaceutical

Corporation

includes Chiron, PowderJect

Pharmaceuticals, Celltech Medeva

Vaccines and Evans Limited, Ciba-

Geigy Limited and Sandoz Limited

NVX

Novavax, Inc.

NYB

New York Blood Center

ORT Ortho-clinical Diagnostics

a J & J company (formerly Ortho

Diagnostic Systems, Inc.)

OTC

Organon Teknika Corporation

OTH

Other manufacturer

PD Parkedale Pharmaceuticals

no website and no news articles

(formerly Parke-Davis)

PFR Pfizer, Inc

includes Wyeth-Lederle Vaccines

and Pediatrics, Wyeth Laboratories,

Lederle Laboratories, and Praxis

Biologics,

PMC sanofi pasteur

formerly Aventis Pasteur, Pasteur

Merieux Connaught; includes

Connaught Laboratories and Pasteur

Merieux. Acquired ACAMBIS.

PRX Praxis Biologics

became a part of WAL, now owned

by Pfizer

HL7 Version 2.5.1 Implementation Guide: Immunization Messaging (Release 1.5) 10/1/2014 Page 22

Change History

MVX CODE Manufacturer Name Notes

PSC

Protein Sciences

PWJ

PowderJect Pharmaceuticals

See Novartis

SCL

Sclavo, Inc.

Swiss Serum and Vaccine Inst.

Part of Berna

SKB GlaxoSmithKline

includes SmithKline Beecham and

Glaxo Wellcome

SOL

Solvay Pharmaceuticals

Part of Abbott

TAL

Talecris Biotherapeutics

includes Bayer Biologicals

UNK

Unknown manufacturer

USA

United States Army Medical

Research and Material Command

VXG VaxGen

acquired by Emergent Biodefense

Operations Lansing, Inc

Wyeth-Ayerst

became WAL, now owned by Pfizer

WAL

Wyeth

acquired by Pfizer 10/15/2009

ZLB

ZLB Behring

acquired by CSL

User-defined Table 0288 - Census tract

Use in all XAD; including PID-11

Fields using this code set are expected to be empty. For a current list of HL7 values please reference the

HL7 version 2.5.1 documents.

User-defined Table 0289 - County/parish

Use in all XAD; including PID-11

A complete list of FIPS 6-4 county codes is available at

https://phinvads.cdc.gov/vads/ViewValueSet.action?id=20D34BBC-617F-DD11-B38D-

00188B398520

For

example:

04001 = Apache County, Arizona

01001 = Autauga County, Alabama

HL7 Version 2.5.1 Implementation Guide: Immunization Messaging (Release 1.5) 10/1/2014 Page 23

Change History

HL7-defined Table 0292 - Codes for Vaccines administered

(code=CVX)

Use in RXA-5

The table below represents the March 2014 version of the CVX code set. New codes are added as needed;

therefore, see the most current version of this code set at the website Web site:

http://www2a.cdc.gov/vaccines/IIS/IISStandards/vaccines.asp?rpt=cvx

The CDC’s National Center for Immunization and Respiratory Diseases (NCIRD) maintains the HL7

external code set CVX.

CVX – Vaccines Administered

CVX

Code

Short Description Full Vaccine Name Note

RESERVED - do not use

Code 99 will not be used in this

table to avoid confusion with

code 999.

998

no vaccine administered

Code 998 was added for use in

VXU HL7 messages where the

OBX segment is nested with

the RXA segment, but the

message does not contain

information about a vaccine

administration. An example of

this use is to report the

vaccines due next for a patient

when no vaccine

administration is being

reported.

999

unknown

unknown vaccine or immune

globulin

This CVX code has little utility

and should rarely be used.

143 Adenovirus types 4 and 7

Adenovirus, type 4 and

type 7, live, oral

This vaccine is administered

as 2 tablets.

54 adenovirus, type 4

adenovirus vaccine, type 4,

live, oral

55 adenovirus, type 7

adenovirus vaccine, type 7,

live, oral

adenovirus, unspecified

formulation

adenovirus vaccine,

unspecified formulation

This CVX code allows

reporting of a vaccination

when formulation is

unknown (for example,

when recording a

Link is current as of 8/1/2011.

HL7 Version 2.5.1 Implementation Guide: Immunization Messaging (Release 1.5) 10/1/2014 Page 24

Change History

CVX

Code

Short Description Full Vaccine Name Note

adenovirus vaccination

when noted on a

vaccination card)

anthrax

anthrax vaccine

801

AS03 Adjuvant

This is the adjuvant that is

packaged with H5N1

vaccine, adjuvanted

BCG

Bacillus Calmette-Guerin

vaccine

botulinum antitoxin

cholera

cholera vaccine

CMVIG

cytomegalovirus immune

globulin, intravenous

dengue fever

dengue fever vaccine

diphtheria antitoxin

DT (pediatric)

diphtheria and tetanus

toxoids, adsorbed for

pediatric use

DTaP

diphtheria, tetanus toxoids

and acellular pertussis

vaccine

106

DTaP, 5 pertussis antigens

diphtheria, tetanus toxoids

and acellular pertussis

vaccine, 5 pertussis

antigens

107

DTaP, unspecified

formulation

diphtheria, tetanus toxoids

and acellular pertussis

vaccine, unspecified

formulation

This CVX code allows

reporting of a vaccination

when formulation is

unknown (for example,

when recording a DTaP

vaccination when noted on

a vaccination card)

HL7 Version 2.5.1 Implementation Guide: Immunization Messaging (Release 1.5) 10/1/2014 Page 25

Change History

CVX

Code

Short Description Full Vaccine Name Note

146

DTaP,IPV,Hib,HepB

Diphtheria and Tetanus

Toxoids and Acellular

Pertussis Adsorbed,

Inactivated Poliovirus,

Haemophilus b Conjugate

(Meningococcal Outer

Membrane Protein

Complex), and Hepatitis B

(Recombinant) Vaccine.

Note that this vaccine is

different from CVX 132.

110

DTaP-Hep B-IPV

DTaP-hepatitis B and

poliovirus vaccine

DTaP-Hib

DTaP-Haemophilus

influenzae type b

conjugate vaccine

120

DTaP-Hib-IPV

diphtheria, tetanus toxoids

and acellular pertussis

vaccine, Haemophilus

influenzae type b

conjugate, and poliovirus

vaccine, inactivated (DTaP-

Hib-IPV)

130

DTaP-IPV

Diphtheria, tetanus toxoids

and acellular pertussis

vaccine, and poliovirus

vaccine, inactivated

132

DTaP-IPV-HIB-HEP B,

historical

Historical record of vaccine

containing

* diphtheria, tetanus

toxoids and acellular

pertussis,

* poliovirus, inactivated,

* Haemophilus

influenzae type b

conjugate,

* Hepatitis B (DTaP-Hib-

IPV)

This is not the same as CVX

146, Hexavalent vaccine.

DTP

diphtheria, tetanus toxoids

and pertussis vaccine

DTP-Hib

DTP-Haemophilus

influenzae type b

HL7 Version 2.5.1 Implementation Guide: Immunization Messaging (Release 1.5) 10/1/2014 Page 26

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CVX

Code

Short Description Full Vaccine Name Note

conjugate vaccine

102

DTP-Hib-Hep B

DTP- Haemophilus

influenzae type b

conjugate and hepatitis b

vaccine

hantavirus

hantavirus vaccine

HBIG

hepatitis B immune

globulin

Hep A, adult

hepatitis A vaccine, adult

dosage

154

Hep A, IG

Hepatitis A immune

globulin

Do not use this code. This

product may be used for

Hep A and other viral

infections. The correct

vaccine / CVX is 86 (IG).

Hep A, ped/adol, 2 dose

hepatitis A vaccine,

pediatric/adolescent

dosage, 2 dose schedule

Hep A, ped/adol, 3 dose

hepatitis A vaccine,

pediatric/adolescent

dosage, 3 dose schedule

This vaccine formulation is

inactive and should not be

used, except to record

historic vaccinations with

this formulation.

Hep A, pediatric,

unspecified formulation

hepatitis A vaccine,

pediatric dosage,

unspecified formulation

Do NOT use this code. If

formulation is unknown,

use CVX 85. There is only

one formulation of Hep A,

peds.

Hep A, unspecified

formulation

hepatitis A vaccine,

unspecified formulation

This CVX code allows

reporting of a vaccination

when formulation is

unknown (for example,

when recording a HepA

vaccination when noted on

a vaccination card)

104

Hep A-Hep B

hepatitis A and hepatitis B

vaccine

HL7 Version 2.5.1 Implementation Guide: Immunization Messaging (Release 1.5) 10/1/2014 Page 27

Change History

CVX

Code

Short Description Full Vaccine Name Note

Hep B, adolescent or

pediatric

hepatitis B vaccine,

pediatric or

pediatric/adolescent

dosage

This code applies to any

standard pediatric

formulation of Hepatitis B

vaccine. It should not be

used for the 2-dose

hepatitis B schedule for

adolescents (11-15 year

olds). It requires Merck's

Recombivax HB® adult

formulation. Use code 43

for that vaccine

Hep B, adolescent/high

risk infant

hepatitis B vaccine,

adolescent/high risk infant

dosage

As of August 27, 1998,

Merck ceased distribution

of their adolescent/high risk

infant hepatitis B vaccine

dosage. Code 42 should

only be used to record

historical records. For

current administration of

hepatitis B vaccine,

pediatric/adolescent

dosage, use

Hep B, adult

hepatitis B vaccine, adult

dosage

As of September 1999, a 2-

dose hepatitis B schedule

for adolescents (11-15 year

olds) was FDA approved for

Merck's Recombivax HB®

adult formulation. Use code

43 for the 2-dose. This code

should be used for any use

of standard adult

formulation of hepatiti

Hep B, dialysis

hepatitis B vaccine, dialysis

patient dosage

HL7 Version 2.5.1 Implementation Guide: Immunization Messaging (Release 1.5) 10/1/2014 Page 28

Change History

CVX

Code

Short Description Full Vaccine Name Note

Hep B, unspecified

formulation

hepatitis B vaccine,

unspecified formulation

This CVX code allows

reporting of a vaccination

when formulation is

unknown (for example,

when recording a HepB

vaccination when noted on

a vaccination card)

Hep C

hepatitis C vaccine

Hep E

hepatitis E vaccine

herpes simplex 2

herpes simplex virus, type

2 vaccine

Hib (HbOC)

Haemophilus influenzae

type b vaccine, HbOC

conjugate

Hib (PRP-D)

Haemophilus influenzae

type b vaccine, PRP-D

conjugate

Hib (PRP-OMP)

Haemophilus influenzae

type b vaccine, PRP-OMP

conjugate

Hib (PRP-T)

Haemophilus influenzae

type b vaccine, PRP-T

conjugate

Hib, unspecified

formulation

Haemophilus influenzae

type b vaccine, conjugate

unspecified formulation

Hib-Hep B

Haemophilus influenzae

type b conjugate and

Hepatitis B vaccine

HIV

human immunodeficiency

virus vaccine

118

HPV, bivalent

human papilloma virus

vaccine, bivalent

HPV, quadrivalent

human papilloma virus

vaccine, quadrivalent

HL7 Version 2.5.1 Implementation Guide: Immunization Messaging (Release 1.5) 10/1/2014 Page 29

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CVX

Code

Short Description Full Vaccine Name Note

137

HPV, unspecified

formulation

HPV, unspecified

formulation

This CVX code allows

reporting of a vaccination

when formulation is

unknown (for example,

when recording a HPV

vaccination when noted on

a vaccination card)

immune globulin,

intramuscular

IG, unspecified

formulation

immune globulin,

unspecified formulation

IGIV

immune globulin,

intravenous

160

Influenza A monovalent

(H5N1), ADJUVANTED-

2013

Influenza A monovalent

(H5N1), adjuvanted,

National stockpile 2013

Approved by FDA 2013,

adjuvant is mixed at point of

adminstration.

151

influenza nasal,

unspecified formulation

influenza nasal,

unspecified formulation

This CVX should only be

used for historical records

where the formulation of

nasal flu vaccine is not

known.

123

influenza, H5N1-1203

influenza virus vaccine,

H5N1,

A/Vietnam/1203/2004

(national stockpile)

135

Influenza, high dose

seasonal

influenza, high dose

seasonal, preservative-free

153

Influenza, injectable,

MDCK, preservative free

Influenza, injectable,

Madin Darby Canine

Kidney, preservative free

ccIIV3

158

influenza, injectable,

quadrivalent

influenza, injectable,

quadrivalent, contains

preservative

New in 2013. IIV4

150

influenza, injectable,

quadrivalent,

preservative free

Influenza, injectable,

quadrivalent, preservative

free

New in 2012. IIV4

111

influenza, live, intranasal

influenza virus vaccine,

live, attenuated, for

intranasal use

LAIV3

HL7 Version 2.5.1 Implementation Guide: Immunization Messaging (Release 1.5) 10/1/2014 Page 30

Change History

CVX

Code

Short Description Full Vaccine Name Note

149

influenza, live, intranasal,

quadrivalent

influenza, live, intranasal,

quadrivalent

new in 2012. LAIV4

155

influenza, recombinant,

injectable, preservative

free

Seasonal, trivalent,

recombinant, injectable

influenza vaccine,

preservative free

RIV

141

Influenza, seasonal,

injectable

Influenza, seasonal,

injectable

IIV3. This is one of two

codes replacing CVX 15,

which is being retired.

140

Influenza, seasonal,

injectable, preservative

free

Influenza, seasonal,

injectable, preservative

free

IIV3. This vaccine code is

one of two which replace

CVX 15, influenza, split

virus.

144

influenza, seasonal,

intradermal, preservative

free

seasonal influenza,

intradermal, preservative

free

IIV3

influenza, split (incl.

purified surface antigen)

influenza virus vaccine,

split virus (incl. purified

surface antigen)-retired

CODE

This code is being retired. It

will still be found in older

immunization records. It

included both preservative

free and non-preservative

free.

influenza, unspecified

formulation

influenza virus vaccine,

unspecified formulation

This CVX code allows

reporting of a vaccination

when formulation is

unknown (for example,

when recording a Influenza

vaccination when noted on

a vaccination card)

influenza, whole

influenza virus vaccine,

whole virus

IPV

poliovirus vaccine,

inactivated

134

Japanese Encephalitis IM

Japanese Encephalitis

vaccine for intramuscular

administration

Japanese encephalitis SC

Japanese Encephalitis

HL7 Version 2.5.1 Implementation Guide: Immunization Messaging (Release 1.5) 10/1/2014 Page 31

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CVX

Code

Short Description Full Vaccine Name Note

Vaccine SC

129

Japanese Encephalitis,

unspecified formulation

Japanese Encephalitis

vaccine, unspecified

formulation

This CVX code allows

reporting of a vaccination

when formulation is

unknown (for example,

when recording a JE

vaccination when noted on

a vaccination card)

Junin virus

Junin virus vaccine

leishmaniasis

leishmaniasis vaccine

leprosy

leprosy vaccine

Lyme disease

Lyme disease vaccine

M/R

measles and rubella virus

vaccine

malaria

malaria vaccine

measles

measles virus vaccine

melanoma

melanoma vaccine

103

meningococcal C

conjugate

meningococcal C conjugate

vaccine

148

Meningococcal C/Y-HIB

PRP

Meningococcal Groups C

and Y and Haemophilus b

Tetanus Toxoid Conjugate

Vaccine

147

meningococcal MCV4,

unspecified formulation

Meningococcal, MCV4,

unspecified

formulation(groups A, C, Y

and W-135)

This CVX should only be

used for historical doses of

meningococcal conjugate

vaccine where the

formulation is unknown

(oligosaccharide vs

polysaccharide). It is not the

same as CVX 108,

Meningococcal, unspecified

formulation.

136

Meningococcal MCV4O

meningococcal

oligosaccharide (groups A,

C, Y and W-135) diphtheria

toxoid conjugate vaccine

HL7 Version 2.5.1 Implementation Guide: Immunization Messaging (Release 1.5) 10/1/2014 Page 32

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CVX

Code

Short Description Full Vaccine Name Note

(MCV4O)

114

meningococcal MCV4P

meningococcal

polysaccharide (groups A,

C, Y and W-135) diphtheria

toxoid conjugate vaccine

(MCV4P)

meningococcal MPSV4

meningococcal

polysaccharide vaccine

(MPSV4)

108

meningococcal,

unspecified formulation

meningococcal vaccine,

unspecified formulation

This CVX code allows

reporting of a vaccination

when formulation is

unknown (for example,

when recording a

meningococcal vaccination

when noted on a

vaccination card)

MMR

measles, mumps and

rubella virus vaccine

MMRV

measles, mumps, rubella,

and varicella virus vaccine

mumps

mumps virus vaccine

127

Novel influenza-H1N1-09

Novel influenza-H1N1-09,

injectable

128

Novel Influenza-H1N1-09,

all formulations

Novel influenza-H1N1-09,

all formulations

This code is used whenever

the actual formulation is

not determined or when

aggregating all Novel H1N1

Influenza-09 immunizations

for reporting to CRA. It

should not be used for

seasonal influenza vaccine

that is not otherwise

specified. (NOS)

125

Novel Influenza-H1N1-09,

nasal

Novel Influenza-H1N1-09,

live virus for nasal

administration

126

Novel influenza-H1N1-09,

preservative-free

Novel influenza-H1N1-09,

preservative-free,

HL7 Version 2.5.1 Implementation Guide: Immunization Messaging (Release 1.5) 10/1/2014 Page 33

Change History

CVX

Code

Short Description Full Vaccine Name Note

injectable

OPV

poliovirus vaccine, live,

oral

parainfluenza-3

parainfluenza-3 virus

vaccine

pertussis

pertussis vaccine

plague

plague vaccine

133

Pneumococcal conjugate

PCV 13

pneumococcal conjugate

vaccine, 13 valent

100

pneumococcal conjugate

PCV 7

pneumococcal conjugate

vaccine, 7 valent

152

Pneumococcal Conjugate,

unspecified formulation

Pneumococcal Conjugate,

unspecified formulation

This CVX should only be

used for historical records

where the formulation of

pneumococcal conjugate

vaccine is not known.

pneumococcal

polysaccharide PPV23

pneumococcal

polysaccharide vaccine, 23

valent

109

pneumococcal,

unspecified formulation

pneumococcal vaccine,

unspecified formulation

This CVX code allows

reporting of a vaccination

when formulation is

unknown (for example,

when recording a

pneumococcal vaccination

when noted on a

vaccination card)

polio, unspecified

formulation

poliovirus vaccine,

unspecified formulation

This CVX code allows

reporting of a vaccination

when formulation is

unknown (for example,

when recording a polio

vaccination when noted on

a vaccination card)

Q fever

Q fever vaccine

rabies, intradermal

injection

rabies vaccine, for

intradermal injection

rabies, intramuscular

rabies vaccine, for

HL7 Version 2.5.1 Implementation Guide: Immunization Messaging (Release 1.5) 10/1/2014 Page 34

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CVX

Code

Short Description Full Vaccine Name Note

injection

intramuscular injection

rabies, unspecified

formulation

rabies vaccine, unspecified

formulation

This CVX code allows

reporting of a vaccination

when formulation is

unknown (for example,

when recording a rabies

vaccination when noted on

a vaccination card)

rheumatic fever

rheumatic fever vaccine

159

Rho(D) - Unspecified

formulation

Rho(D) Unspecified

formulation

157

Rho(D) -IG IM

Rho(D) Immune globulin -

This immune globulin may

be administered IM only.

156

Rho(D)-IG

Rho(D) Immune globulin-

IV or IM

This immune globulin may

be administered either IM

or IV.

Rift Valley fever

Rift Valley fever vaccine

RIG

rabies immune globulin

119

rotavirus, monovalent

rotavirus, live, monovalent

vaccine

116

rotavirus, pentavalent

rotavirus, live, pentavalent

vaccine

rotavirus, tetravalent

rotavirus, live, tetravalent

vaccine

122

rotavirus, unspecified

formulation

rotavirus vaccine,

unspecified formulation

RSV-IGIV

respiratory syncytial virus

immune globulin,

intravenous

RSV-MAb

respiratory syncytial virus

monoclonal antibody

(palivizumab),

intramuscular

145

RSV-MAb (new)

respiratory syncytial virus

monoclonal antibody

(motavizumab),

HL7 Version 2.5.1 Implementation Guide: Immunization Messaging (Release 1.5) 10/1/2014 Page 35

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CVX

Code

Short Description Full Vaccine Name Note

intramuscular

rubella

rubella virus vaccine

rubella/mumps

rubella and mumps virus

vaccine

Staphylococcus bacterio

lysate

Staphylococcus

bacteriophage lysate

138

Td (adult)

tetanus and diphtheria

toxoids, not adsorbed, for

adult use

Note that this Td is not

adsorbed.

113

Td (adult) preservative

free

tetanus and diphtheria

toxoids, adsorbed,

preservative free, for adult

use

Td (adult), adsorbed

tetanus and diphtheria

toxoids, adsorbed, for

adult use

Note that this vaccine name

has changed. See also Td

(adult). It is not adsorbed.

139

Td(adult) unspecified

formulation

Td(adult) unspecified

formulation

This CVX code allows

reporting of a vaccination

when formulation is

unknown (for example,

when recording a Td

vaccination when noted on

a vaccination card)

115

Tdap

tetanus toxoid, reduced

diphtheria toxoid, and

acellular pertussis vaccine,

adsorbed

tetanus toxoid, adsorbed

142

tetanus toxoid, not

adsorbed

tetanus toxoid, not

adsorbed

112

tetanus toxoid,

unspecified formulation

tetanus toxoid, unspecified

formulation

tick-borne encephalitis

vaccine

TIG

tetanus immune globulin

TST, unspecified

formulation

tuberculin skin test;

unspecified formulation

TB Skin test is not vaccine.

HL7 Version 2.5.1 Implementation Guide: Immunization Messaging (Release 1.5) 10/1/2014 Page 36

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CVX

Code

Short Description Full Vaccine Name Note

TST-OT tine test

tuberculin skin test; old

tuberculin, multipuncture

device

TB Skin test is not vaccine.

TST-PPD intradermal

tuberculin skin test;

purified protein derivative

solution, intradermal

TB Skin test is not vaccine.

TST-PPD tine test

tuberculin skin test;

purified protein derivative,

multi-puncture device

TB Skin test is not vaccine.

tularemia vaccine

typhoid, oral

typhoid vaccine, live, oral

typhoid, parenteral

typhoid vaccine,

parenteral, other than

acetone-killed, dried

typhoid, parenteral, AKD

(U.S. military)

typhoid vaccine,

parenteral, acetone-killed,

dried (U.S. military)

typhoid, unspecified

formulation

typhoid vaccine,

unspecified formulation

This CVX code allows

reporting of a vaccination

when formulation is

unknown (for example,

when recording a typhoid

vaccination when noted on

a vaccination card)

101

typhoid, ViCPs

typhoid Vi capsular

polysaccharide vaccine

131

typhus, historical

Historical record of a

typhus vaccination

vaccinia (smallpox)

vaccinia (smallpox) vaccine

105

vaccinia (smallpox)

diluted

vaccinia (smallpox)

vaccine, diluted

vaccinia immune globulin

varicella

varicella virus vaccine

VEE, inactivated

Venezuelan equine

encephalitis, inactivated

HL7 Version 2.5.1 Implementation Guide: Immunization Messaging (Release 1.5) 10/1/2014 Page 37

Change History

CVX

Code

Short Description Full Vaccine Name Note

VEE, live

Venezuelan equine

encephalitis, live,

attenuated

VEE, unspecified

formulation

Venezuelan equine

encephalitis vaccine,

unspecified formulation

This CVX code allows

reporting of a vaccination

when formulation is

unknown (for example,

when recording a VEE

vaccination when noted on

a vaccination card)

VZIG

varicella zoster immune

globulin

117

VZIG (IND)

varicella zoster immune

globulin (Investigational

New Drug)

yellow fever

yellow fever vaccine

121

zoster

zoster vaccine, live

User-defined Table 0296 - Language

ISO 639 shall be used for Language. It is available from PHIN-VADS at:

http://phinvads.cdc.gov/vads/ViewValueSet.action?id=43D34BBC-617F-DD11-B38D-

00188B398520#

The code used from HL70396 table is ISO6392.

Exam

ple codes are found in the table below, but use is not restricted to this list.

Value Description

ara

Arabic

arm

Armenian

cat

Catalan; Valencian

chi

Chinese

dan

Danish

eng

English

fre

French

HL7 Version 2.5.1 Implementation Guide: Immunization Messaging (Release 1.5) 10/1/2014 Page 38

Change History

Value Description

ger

German

hat

Haitian; Haitian Creole

heb

Hebrew

hin

Hindi

hmn

Hmong

jpn

Japanese

kor

Korean

rus

Russian

som

Somali

spa

Spanish; Castilian

vie

Vietnamese

User-defined Table 0297 - CN ID source

Use in all XCN data types. [locally-defined]

User-defined Table 0300 - Namespace ID

Use in all EI, HD data types

[locally-defined]

See tables 0361-0363 for Application Identifier, Facility Identifier, and Assigning Authority. These tables are

more specific than 0300 and are preferred.

HL7-defined Table 0301 - Universal ID type

Use in all HD data types. Constrained to “OID”

HL7-defined Table 0322 - Completion status

Use in RXA-20

Value Description

Complete

Refused

Not Administered

Partially Administered

HL7 Version 2.5.1 Implementation Guide: Immunization Messaging (Release 1.5) 10/1/2014 Page 39

Change History

HL7-defined Table 0323 - Action code

Use in RXA-21

Value Description

Add

Delete

Update

HL7-defined Table 0354 - Message structure

Use in MSH-9, third component. [only selected values listed] These are the only values expected.

Value Events

ACK

QBP_Q11

QBP

RSP_K11

RSP

VXU_V04

VXU

HL7-defined Table 0356 - Alternate character set handling

scheme

Use in MSH-20

Fields using this code set are expected to be empty. For a current list of HL7 values please reference the

HL7 version 2.5.1 documents.

HL7-defined Table 0357 - Message error status codes

(use in ERR-3)

Status

code

Status text Description/Comment

Success

Message accepted

Success. Optional, as the AA conveys

this. Used for systems that must always

return a status code.

Error status codes

100

Segment sequence error

The message segments were not in the

proper order or required segments are

missing.

101

Required field missing

A required field is missing from the

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Status

code

Status text Description/Comment

segment.

102

Data type error

The field contained data of the wrong data

type, e.g., an NM field contained letters of

the alphabet.

103

Table value not found

A field of data type ID or IS was

compared against the corresponding table,

and no match was found.

Rejection status codes

200

Unsupported message type

The Message type is not supported.

201

Unsupported event code

The Event Code is not supported.

202

Unsupported processing ID

The Processing ID is not supported.

203

Unsupported version ID

The Version ID is not supported.

204

Unknown key identifier

The ID of the patient, order, etc. was not

found. Used for transactions other than

additions, e.g., transfer of a non-existent

patient.

205

Duplicate key identifier

The ID of the patient, order, etc. already

exists. Used in response to addition

transactions (Admit, New Order, etc.).

206

Application record locked

The transaction could not be performed at

the application storage level, e.g.,

database locked.

207

Application internal error

A catchall for internal errors not explicitly

covered by other codes.

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User-defined Table 0360 - Degree

Selected values suggested by HL7. ; (use in all XPN data types, including PID-5, 6, 9)

Value Description

Advanced Practice Nurse

Associate of Arts

Associate of Science

Bachelor of Arts

Bachelor of Nursing

Bachelor of Science

BSN

Bachelor of Science in Nursing

CER

Certificate

CANP

Certified Adult Nurse Practitioner

CMA

Certified Medical Assistant

CNP

Certified Nurse Practitioner

CNM

Certified Nurse Midwife

CNA

Certified Nurse’s Assistant

CRN

Certified Registered Nurse

CNS

Certified Nurse Specialist

CPNP

Certified Pediatric Nurse Practitioner

DIP

Diploma

PHD

Doctor of Philosophy

Doctor of Medicine

Doctor of Osteopathy

EMT

Emergency Medical Technician

EMT-P

Emergency Medical Technician – Paramedic

FPNP

Family Practice Nurse Practitioner

High School Graduate

Juris Doctor

LPN

Licensed Practical Nurse

Master of Arts

MBA

Master of Business Administration

MPH

Master of Public Health

Master of Science

MSN

Master of Science – Nursing

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Value Description

MDA

Medical Assistant

Medical Technician

Non-Graduate

Nurse Practitioner

PharmD

Doctor of Pharmacy

Physician Assistant

PHN

Public Health Nurse

RMA

Registered Medical Assistant

Registered Nurse

RPH

Registered Pharmacist

SEC

Secretarial Certificate

Trade School Graduate

User-defined Table 0361 - Application

No suggested values defined. The values are locally defined by the Immunization Information System (IIS)

or by mutual agreement.

Note: In most cases, the value set will be managed by the IIS.

User-defined Table 0362 - Facility

No suggested values defined. The values are locally defined by the Immunization Information System (IIS)

or by mutual agreement.

Note: In most cases, the value set will be managed by the IIS.

User-defined Table 0363 - Assigning Authority

Local implementations will need to add codes to this table to identify local assigning authorities. The

values in this table are intended to be used by state and regional immunization programs. In the case of an

ID generated by a facility, such as a medical record number, the identifier from Table 0362 should be used.

Code Grantee

AKA

ALASKA

ALA

ALABAMA

ARA

ARKANSAS

ASA

AMERICAN SAMOA

AZA

ARIZONA

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Code Grantee

BAA

NEW YORK CITY

CAA

CALIFORNIA

CHA

CHICAGO

COA

COLORADO

CTA

CONNECTICUT

DCA

DISTRICT OF

COLUMBIA

DEA

DELAWARE

FLA

FLORIDA

FMA

FED STATES MICRO

GAA

GEORGIA

GUA

GUAM

HIA

HAWAII

IAA

IOWA

IDA

IDAHO

ILA

ILLINOIS

INA

INDIANA

KSA

KANSAS

KYA

KENTUCKY

LAA

LOUISIANA

MAA

MASSACHUSETTS

MDA

MARYLAND

MEA

MAINE

MHA

REP MARS ISLANDS

MIA

MICHIGAN

MNA

MINNESOTA

MOA

MISSOURI

MPA

NO. MARIANA ISLAND

MSA

MISSISSIPPI

MTA

MONTANA

NCA

NORTH CAROLINA

NDA

NORTH DAKOTA

NEA

NEBRASKA

NHA

NEW HAMPSHIRE

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Code Grantee

NJA

NEW JERSEY

NMA

NEW MEXICO

NVA

NEVADA

NYA

NEW YORK STATE

OHA

OHIO

OKA

OKLAHOMA

ORA

OREGON

PAA

PENNSYLVANIA

PHA

PHILADELPHIA

PRA

PUERTO RICO

RIA

RHODE ISLAND

RPA

REPUBLIC PALAU

SCA

SOUTH CAROLINA

SDA

SOUTH DAKOTA

TBA

SAN ANTONIO

THA

HOUSTON

TNA

TENNESSEE

TXA

TEXAS

UTA

UTAH

VAA

VIRGINIA

VIA

VIRGIN ISLANDS

VTA

VERMONT

WAA

WASHINGTON

WIA

WISCONSIN

WVA

WEST VIRGINIA

WYA

WYOMING

User-defined Table 0396 - Coding system

[only selected values listed] See Version 2.5.1 Table 0396 for other values. Use in CE data types to denote

the coding system used for coded values

Value Description

99zzz or L

Local general code (where z is an alphanumeric character)

ART

WHO Adverse Reaction Terms

CPT-4

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Value Description

CPT-5

CDCA

CDC Analyte Codes

CDCM

CDC Methods/Instruments Codes

CDCPHINVS

PHIN VS (CDC Local Coding System)

CDS

CDC Surveillance

CPTM

CPT Modifier Code

CST

COSTART

CVX

CDC Vaccine Codes

EUCLIDES

Euclides quantity codes

Euclides Lab method codes

Euclides Lab equipment codes

ENZC

Enzyme Codes

HIBCC

HCPCS

HCFA Common Procedure Coding System

HHC

Home Health Care

HL7nnnn

HL7 Defined Codes where nnnn is the HL7 table number

HPC

HCFA Procedure Codes (HCPCS)

I10

ICD-10

I10P

ICD-10 Procedure Codes

ICD9

I9C

ICD-9CM

ISOnnnn

ISO Defined Codes where nnnn is the ISO table number

Local billing code

Logical Observation Identifier Names and Codes (LOINC



)

MCD

Medicaid

MCR

Medicare

MEDR

Medical Dictionary for Drug Regulatory Affairs (MEDDRA)

MVX

CDC Vaccine Manufacturer Codes

NDC

National drug codes

NCIT

NCI Thesaurus

NPI

National Provider Identifier

SNM

Systemized Nomenclature of Medicine (SNOMED



)

SCT

SNOMED Clinical Terminology

SCT2

SNOMED Clinical Terms alphanumeric codes

SNM3

SNOMED International

SNT

SNOMED topology codes (anatomic sites)

UML

Unified Medical Language

UPC

Universal Product Code

UPIN

WHO record # drug codes (6 digit)

WHO record # drug codes (8 digit)

WHO record # code with ASTM extension

WHO ATC

User-defined Table 0441 - Immunization registry status

Use in PD1-16.

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Value

Description

Active

Inactive--Unspecified

Inactive-Lost to follow-up (cannot contact)

Inactive-Moved or gone elsewhere (transferred)

Inactive-Permanently inactive (do not re-activate or add new entries to this

record)

Unknown

The code O (Other) has been removed, do not use

User-defined Table 0471 - Query Name

Value Description

Z34

Request Immunization History

Z44

Request Evaluated History and Forecast

HL7 Table 0516 - Error Severity

Value Description Comment

Information

Transaction successful, but

includes returned information.

Warning

Transaction successful, but there

may be issues. These may

include non-fatal errors with

potential for loss of data.

Error

Transaction was not successful.

The application rejected data that

it views as important. This could

include required fields or the

entire message. The sender

should be alerted to review and

correct the message.

User-defined Table 0533 - Application Error Code

This User-defined table has values agreed to by the Immunization Information System Community.

Status code Status text Description/Comment

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Status code Status text Description/Comment

Illogical Date error

Date conflicts with another date in the

message.

Invalid Date

Date is not valid or lacks required

precision.

Illogical Value error

The value conflicts with other data in

the message

Invalid value

The value is not valid. This applies for

fields that are not associated with a

table of values.

Table value not found

The value is not found in the associated

table.

Required observation missing

A required observation, such as VFC

eligibility status, is missing.

Illo

gical Date Error would include:

• Before birth immunization date

• Immunization date in the future

Invalid Date Error would include:

• 20130230 (February 30, 2013)

• 201302 (lacks required precision)

CDC-defined NIP001- Immunization information source

Use in RXA-9

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Value Description Operational Definition

00 New immunization record The record of a newly administered dose of

vaccine. The dose was administered by the

organization that is reporting this dose.

01 Historical information - source

unspecified

The record of a vaccine dose from a reliable

historical source, such as an immunization card.

02 Historical information - from other

provider

The record of a vaccine dose from another health

care provider’s historical records.

03 Historical information - from

parent’s written record

The record of a vaccine dose from parentally

maintained written records.

04 Historical information - from

parent’s recall

The record of a vaccine dose from a parents

recall. The reliability of this record is considered

low.

05 Historical information - from other

registry

The record of a vaccine dose from another

Immunization Information System (IIS).

06 Historical information - from birth

certificate

The record of a vaccine dose from a birth record.

07 Historical information - from

school record

The record of a vaccine dose from a written

school record.

08 Historical information - from public

agency

The record of a vaccine dose from a written

public health agency record.

CDC-defined NIP002 - Substance refusal reason

Use in RXA-18

Value Description

Parental decision

Religious exemption

Other (must add text component of the CE field with description)

Patient decision

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CDC-defined NIP003 - Observation identifiers

Use in OBX-3)

LOINC

® Code

Description Correspondin

g data type

(indicate in

OBX-2)

Corresponding observation value

EXAMPLE OR code table to use (value in

OBX-5)

Vaccine Funding Program Eligibility Category—Use in OBX-3 to indicate that OBX-5 will contain the

funding program eligibility category for a given immunization.

64994-7 Vaccine funding program

eligibility category

(CE)

HL70064

Vaccine Funding Source – Use in OBX-3 to indicate that OBX-5 will contain the funding source for a

given immunization.

30963-3 Vaccine funding source (CE)

Value Set OID - 2.16.840.1.114222.4.11.3287

Value Set Code::

PHVS_ImmunizationFundingSource_IIS

Vaccine Type Identifier

30956-7 Vaccine Type (Vaccine

group or family)

(CE) CVX

(CVX codes – use the codes described as

“unspecified formulation” as needed.)

TE: this code is preferred over 38890-0.

38890-0 Component Vaccine Type (CE) CVX

(CVX codes – use the codes described as

“unspecified formulation” as needed.)

Contraindications, Precautions, Indications and Immunities

All VAERS-only items removed.

This material contains content from LOINC® (http://loinc.org ). The LOINC table and LOINC codes are

Codes (LOINC) Committee.

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LOINC

® Code

Description Correspondin

g data type

(indicate in

OBX-2)

Corresponding observation value

EXAMPLE OR code table to use (value in

OBX-5)

30946-8 Vaccination

contraindication/precautio

n effective date

(DT) 19970522

30944-3 Vaccination temporary

contraindication/precautio

n expiration date

(DT) 19990523

30945-0 Vaccination

contraindication/precautio

(CE)

Value Set OID - 2.16.840.1.114222.4.11.3288

Value Set Code::

PHVS_VaccinationContraindication_IIS

31044-1 Reaction (CE)

Value Set OID - 2.16.840.1.114222.4.11.3289

Value Set Code::

PHVS_VaccinationReaction_IIS

59784-9 Disease with presumed

immunity

(CE) Value Set OID - 2.16.840.1.114222.4.11.3293

Value Set Code::

PHVS_EvidenceOfImmunity_IIS

75505-8

Diseases with serological

evidence of immunity

(CE)

Value Set OID - 2.16.840.1.114222.4.11.7245

Value Set Code::

PHVS_SerologicalEvidenceOfImmunity_IIS

59785-6 Indications to immunize (CE)

Value Set OID - 2.16.840.1.114222.4.11.3290

Value Set Code::

PHVS_VaccinationSpecialIndications_IIS

Vaccine Information Statement (VIS) Dates

69764-9

ocument type CE

Value Set OID: 2.16.840.1.114222.4.11.6041

Value Set Code: PHVS_VISBarcodes_IIS

29768-9 Date Vaccine Information

Statement Published

(TS) 19900605

29769-7 Date Vaccine Information

Statement Presented

(TS) 199307311615

Forecasting and Evaluating Immunizations

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LOINC

® Code

Description Correspondin

g data type

(indicate in

OBX-2)

Corresponding observation value

EXAMPLE OR code table to use (value in

OBX-5)

30973-2 30973-2 -- Dose number

in series

(NM) 2

30979-9 Vaccines due next

(CE) H

L70292 (CVX)

30980-7 30980-7 – Date vaccine

due

(TS_NZ) 19980526

30981-5 30981-5 – Earliest date to

give

(TS_NZ) 19980522

30982-3 30982-3 – Reason applied

by forecast logic to project

this vaccine

(CE) or (ST) Codes for forecast logic reason locally

defined.

59779-9 Immunization Schedule

used

Value Set OID -

2.16.840.1.114222.4.11.23292

Value Set Code::

PHVS_ImmunizationScheduleIdentifier_II

59777-3 Latest date next dose may

be given

TS_NZ 19980522

59778-1

Reason Code

Locally Defined

59780-7

Immunization Series name

Locally Defined

59782-3 Number of doses in

primary series

NM 2

59781-5

Dose validity

Y, N or empty

59783-1 Status in immunization

series

CE Locally defined value set

Smallpox Take Read: These codes allow information about evaluation of a smallpox vaccination,

called the take response.

46249-9 VACCINATION TAKE-

RESPONSE TYPE

(ST) Major Take, Equivocal, Not Available

46250-7 VACCINATION TAKE-

RESPONSE DATE

(TS) 20091221

e following CDC defined tables are not included in this Guide. They support VAERS reporting,

which is not within the scope of this Guide.

• NIP 005 – Event Consequences

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• NIP 007 – Vaccinated at Location

• NIP 008 – Vaccine purchased with Funds

• NIP 009 – Adverse event previously reported

• NIP 010 – Report type

The following value sets replace a number of CDC defined tables. These have been registered in the CDC

local value set, CDCPHINVS. Where appropriate, existing codes are used. For example SNOMED codes

are used for some contraindications. Local codes (VXCxx) will be replaced as new SNOMED codes are

published.

CDC-defined NIP004 - Contraindications, Precautions, and

Immunities

This table has been replaced by separate tables for contraindications, indications, reactions and immunities.

Value Set Name – Immunization Funding Source

Used in OBX- 5

Value Set OID -

2.16.840.1.114222.4.11.3287

Value Set Code:: PHVS_ImmunizationFundingSource_IIS

Value set definition: Indicates funding source for an immunization. This is used to support vaccine inventory

management.

Code Set OID:

NULLFL:

2.16.840.1.113883.5.1008

CDCPHINVS: 2.16.840.1.114222.4.5.274

Local implements may expand this list.

Concept

Code

Concept Name

Definition

HL7 Table 0396

Code

V 2.3.1 Value

NIP008

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Concept

Code

Concept Name

Definition

HL7 Table 0396

Code

V 2.3.1 Value

NIP008

PHC70 Private funds Immunization

was funded by

private funds,

including

insurance.

CDCPHINVS PVF

VXC1 Federal funds Immunization

was funded with

public funds

from the federal

government.

CDCPHINVS

VXC2 State funds Immunization

was funded with

public funds

from a state.

CDCPHINVS

PHC68 Military funds Immunization

was paid for

with military

funds.

CDCPHINVS MLF

VXC3 Tribal funds Immunization

was paid for

with tribal funds.

CDCPHINVS

OTH Other Immunization

was paid for by

funding not

listed above.

NULLFL OTH

UNK Unspecified Funding source

for

immunization is

not specified.

NULLFL

Exa

mples:

HC70^Private funds^CDCPHINVS|

|OTH^Other^NULLFL|

Value Set Name – Vaccination Contraindications

Used in OBX- 5

Value Set OID -

2.16.840.1.114222.4.11.3288

Value Set Code:: PHVS_VaccinationContraindication_IIS

Value set definition: indicates a contraindication to vaccination.

Code Set OID:

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SNOMED: 2.16.840.1.113883.6.96

CDCPHINVS: 2.16.840.1.114222.4.5.274

Concept Code Concept Name Definition HL7 Table 0396

Code

V 2.3.1

Value

NIP004

VXC30

allergy (anaphylactic) to

proteins of rodent or neural

origin

allergy (anaphylactic)

to proteins of rodent

or neural origin

CDCPHINVS

VXC17

allergy (anaphylactic) to 2-

phenoxyethanol

allergy (anaphylactic)

to 2-phenoxyethanol

CDCPHINVS

VXC18

allergy to baker’s yeast

(anaphylactic)

allergy to baker’s

yeast (anaphylactic)

CDCPHINVS

91930004

Allergy to eggs (disorder)

allergy to egg

ingestion

(anaphylactic)

SCT

294847001

Gelatin allergy (disorder)

allergy to gelatin

(anaphylactic)

SCT

294468006

Neomycin allergy (disorder)

allergy to neomycin

(anaphylactic)

SCT

294466005

Streptomycin allergy

(disorder)

allergy to

streptomycin

(anaphylactic)

SCT

VXC19

allergy to thimerosal

(anaphylactic)

allergy to thimerosal

(anaphylactic)

CDCPHINVS

VXC20

allergy to previous dose of

this vaccine or to any of its

unlisted vaccine

components (anaphylactic)

allergy to previous

dose of this vaccine

or to any of its

unlisted vaccine

components

(anaphylactic)

CDCPHINVS

402306009

Allergy to aluminum

(disorder)

allergy (anaphylactic)

to alum

SCT

300916003

Latex allergy (disorder)

allergy (anaphylactic)

to latex

SCT

294530006

Polymyxin B allergy

(disorder)

allergy (anaphylactic)

to polymycin B

SCT

VXC21

Previous history of

intussusception

Previous history of

intussusception

CDCPHINVS

VXC22

encephalopathy within 7

days of previous dose of

DTP or DTaP

encephalopathy

within 7 days of

previous dose of DTP

or DTaP

CDCPHINVS

VXC23

current fever with moderate-

current fever with

CDCPHINVS

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Concept Code Concept Name Definition HL7 Table 0396

Code

V 2.3.1

Value

NIP004

to-severe illness

moderate-to-severe

illness

VXC24

current acute illness,

moderate to severe (with or

without fever) (e.g.,

diarrhea, otitis media,

vomiting)

current acute illness,

moderate to severe

(with or without

fever) (e.g., diarrhea,

otitis media,

vomiting)

CDCPHINVS

27624003

Chronic disease (disorder)

chronic illness (e.g.,

chronic

gastrointestinal

disease)

SCT

VXC25

History of Arthus

hypersensitivity reaction to

a tetanus-containing vaccine

administered < 10 yrs

previously

History of Arthus

hypersensitivity

reaction to a tetanus-

containing vaccine

administered < 10 yrs

previously

CDCPHINVS

VXC26

underlying unstable,

evolving neurologic

disorders, (including seizure

disorders, cerebral palsy,

and developmental delay)

underlying unstable,

evolving neurologic

disorders, (including

seizure disorders,

cerebral palsy, and

developmental delay)

CDCPHINVS

VXC27

immunodeficiency due to

any cause, including HIV

(hematologic and solid

tumors, congenital

immunodeficiency, long-

term immunosuppressive

therapy, including steroids)

immunodeficiency

due to any cause,

including HIV

(hematologic and

solid tumors,

congenital

immunodeficiency,

long-term

immunosuppressive

therapy, including

steroids)

CDCPHINVS

77386006

Patient currently pregnant

(finding)

pregnancy (in

recipient)

SCT

302215000

Thrombocytopenic disorder

(disorder)

thrombocytopenia

SCT

161461006

History of - purpura

(situation)

thrombocytopenic

purpura (history)

SCT

amples:

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|VXC18^allergy to bakers yeast^CDCPHINVS|

|77386006^patient currently pregnant^SCT|

Value Set Name – Vaccination Reaction - IIS

Used in OBX- 5

Value Set OID -

2.16.840.1.114222.4.11.3289

Value Set Code:: PHVS_VaccinationReaction_IIS

Value set definition: indicates a reaction or adverse event associate in time with an immunization.

Code Set OID:

SNOMED: 2.16.840.1.113883.6.96

CDCPHINVS: 2.16.840.1.114222.4.5.274

Concept Code Concept Name Definition HL7 Table 0396

Code

V 2.3.1

Value

NIP004

39579001

Anaphylaxis (disorder)

Anaphylaxis

SCT

81308009

Disorder of brain (disorder)

Encephalopathy

SCT

VXC9

persistent, inconsolable

crying lasting > 3 hours

within 48 hours of dose

persistent,

inconsolable crying

lasting > 3 hours

within 48 hours of

dose

CDCPHINVS

VXC10

collapse or shock-like state

within 48 hours of dose

collapse or shock-like

state within 48 hours

of dose

CDCPHINVS

VXC11

convulsions (fits, seizures)

within 72 hours of dose

convulsions (fits,

seizures) within 72

hours of dose

CDCPHINVS

VXC12

fever of >40.5C (105F)

within 48 hours of dose

fever of >40.5C

(105F) within 48

hours of dose

CDCPHINVS

VXC13

Guillain-Barre syndrome

(GBS) within 6 weeks of

dose

Guillain-Barre

syndrome (GBS)

within 6 weeks of

dose

CDCPHINVS

VXC14

Rash within 14 days of dose

Rash within 14 days

of dose

CDCPHINVS

VXC15

Intussusception within 30

days of dose

Intussusception

within 30 days of

dose

CDCPHINVS

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Examples:

|39579001^

anaphylaxis^SCT|

|VXC14^Rash within 14 days^CDCPHINVS|

Value Set Name – Vaccination Special Indications - IIS

Used in OBX- 5

Value Set OID -

2.16.840.1.114222.4.11.3290

Value Set Code:: PHVS_VaccinationSpecialIndications_IIS

Value set definition: Describes a factor about the client which may impact forecasting of next dose of vaccine

needed.

Code Set OID:

CDCPHINVS: 2.16.840.1.114222.4.5.274

Concept Code

Concept Name

Definition

HL7 Table 0396

Code

V 2.3.1

Value

VXC7

Rabies exposure within

previous 10 days.

Rabies exposure

within previous 10

days.

CDCPHINVS

VXC8

Member of special group

Member of special

group

CDCPHINVS

ample:

|VXC7^Rabies exposure^CDCPHINVS|

Value Set Name – Immunization Profile Identifiers - IIS

Used in MSH-21

Value Set OID -

2.16.840.1.114222.4.11.3291

Value Set Code:: PHVS_ImmunizationProfileIdentifier_IIS

Value set definition: Identifies the profile used by the message.

Code Set OID:

CDCPHINVS: 2.16.840.1.114222.4.5.274

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Change History

Concept Code

Concept Name

Definition

HL7 Table 0396

Code

Z31

Return Candidate Clients

Return Candidate

Clients

CDCPHINVS

Z32

Return Immunization

History

Return Immunization

History

CDCPHINVS

Z33

Return acknowledgment

Return

acknowledgement

(no match, too many

match, error)

CDCPHINVS

Z34

Request Immunization

History

Request

Immunization

History

CDCPHINVS

Z44

Request Evaluated History

and Forecast

Request Evaluated

History and Forecast

CDCPHINVS

Z42

Return Evaluated History

and Forecast

Return Evaluated

History and Forecast

CDCPHINVS

ample:

34^

CDCPHINVS|

Value Set Name – Immunization Schedule Identifiers - IIS

Used in OBX-5

Value Set OID -

2.16.840.1.114222.4.11.3292

Value Set Code:: PHVS_ImmunizationScheduleIdentifier_IIS

Value set definition: Identifies the schedule used for immunization evaluation and forecast.

Code Set OID:

CDCPHINVS: 2.16.840.1.114222.4.5.274

Concept Code

Concept Name

Definition

HL7 Table 0396

Code

V 2.3.1

Value

VXC16

ACIP Schedule

This indicates that the

current ACIP Schedule of

recommendations were used

to forecast next doses due.

CDCPHINVS

ample:

|VXC1

6^ACIP Schedule^CDCPHINVS|

HL7 Version 2.5.1 Implementation Guide: Immunization Messaging (Release 1.5) 10/1/2014 Page 59

Change History

ocal Implementations may add local codes for local schedules. In order to do this, the local

implementation guide should publish the code in a local table. The code system identifier

(CDCPHINVS use above is an example) needs to be included in a local copy of Table 0396. See first

row for example. The local schedule code should be recorded as follows:

yourLocalcode^your schedule name here^99xxx|

The 99xxx is the local code table identifier. xxx are alpha characters.

Value Set Name – History of Disease as Evidence of Immunity -

IIS

Used in OBX- 5

Value Set OID - 2.16.840.1.114222.4.11.7244

Value Set Code::

PHVS_HistoryOfDiseaseAsEvidenceOfImmunity_IIS

Value set definition: History of Disease as

Evidence of immunity indicates that a person has been

diagnosed with a particular disease.

Code Set OID:

SNOMED:

2.16.840.1.113883.6.96

Concept Code Concept Name Definition HL7 Table

0396 Code

V 2.3.1

Value

NIP004

409498004

Anthrax (disorder)

History of anthrax infection.

SCT

397428000

Diphtheria

(disorder)

History of diphteria infection.

SCT

76902006

Tetanus (disorder)

History of tetanus infection.

SCT

27836007

Pertussis (disorder)

History of pertussis infection.

SCT

40468003

Viral hepatitis, type

A (disorder)

History of Hepatitis A infection.

SCT

66071002

Type B viral

hepatitis (disorder)

History of Hepatitis B infection.

SCT

91428005

Haemophilus

influenzae

infection (disorder)

History of HIB infection.

SCT

240532009

Human papilloma

virus infection

(disorder)

History of HPV infection.

SCT

6142004

Influenza

(disorder)

History of influenza infection.

SCT

HL7 Version 2.5.1 Implementation Guide: Immunization Messaging (Release 1.5) 10/1/2014 Page 60

Change History

Concept Code Concept Name Definition HL7 Table

0396 Code

V 2.3.1

Value

NIP004

52947006

Japanese

encephalitis virus

disease (disorder)

History of Japanese encephalitis

infection.

SCT

14189004

Measles (disorder)

History of measles infection.

SCT

36989005

Mumps (disorder)

History of mumps infection.

SCT

36653000

Rubella (disorder)

History of rubella infection.

SCT

23511006

Meningococcal

infectious disease

(disorder)

History of meningococcal infection.

SCT

16814004

Pneumococcal

infectious disease

(disorder)

History of pneumococcal infection.

SCT

398102009

Acute poliomyelitis

(disorder)

History of polio infection.

SCT

14168008

Rabies (disorder)

History of rabies infection.

SCT

18624000

Disease due to

Rotavirus

(disorder)

History of rotavirus infection.

SCT

4834000

Typhoid fever

(disorder)

History of typhoid infection.

SCT

111852003

Vaccinia (disorder)

History of vaccinia infection.

SCT

38907003

Varicella (disorder)

History of Varicella infection.

SCT

16541001

Yellow fever

(disorder)

History of yellow fever infection.

SCT

Value Set Name – Serological Evidence of Immunity - IIS

Used in OBX- 5

Value Set OID - 2.16.840.1.114222.4.11.7245

Value Set Code::

PHVS_SerologicalEvidenceOfImmunity_IIS

Value set definition: Serological

Evidence of immunity to a particular disease indicates that a person

immunity to that disease.

Code Set OID:

SNOMED: 2.16.840.1.113883.6.96

HL7 Version 2.5.1 Implementation Guide: Immunization Messaging (Release 1.5) 10/1/2014 Page 61

Change History

Concept Code Concept Name Definition HL7 Table

0396 Code

V 2.3.1

Value

NIP004

341112003

Mumps (finding)

Serology confirmed mumps

SCT

278968001

Rubella (finding)

Serology confirmed rubella

SCT

371111005

Measles (finding)

Serology confirmed measles

SCT

371113008

Varicella (finding)

Serology confirmed varicella

SCT

271511000

Hepatitis B

(finding)

Serology confirmed hepatitis B

SCT

278971009

Hepatitis A

(finding)

Serology confirmed hepatitis A

SCT

341112003

Mumps (finding)

Serology confirmed mumps

SCT

Value Set Code – PHVS_VISBarcodes_IIS

Value Set Name: VIS Bar Codes (IIS)

Value Set OID: 2.16.840.1.114222.4.11.6041

Value Set Definition: The purpose of the barcode on the bottom of the Vaccine Information Statement

(VIS) is to provide an opportunity to electronically capture the VIS document type (e.g. influenza, MMR)

and the edition date of the VIS, as required by the National Childhood Vaccine Injury Act (NCVIA). For

more information, please visit - http://www.cdc.gov/vaccines/pubs/vis/vis-barcodes.htm

VIS Document Type

Description / Concept Name

Edition Date VIS Fully-encoded text string

(Concept Code)

Code System

Code (HL7

Table 0396)

Adenovirus VIS

7/14/2011

253088698300001111110714

cdcgs1vis

Anthrax VIS

3/10/2010

253088698300002811100310

cdcgs1vis

Hepatitis A VIS

10/25/2011

253088698300004211111025

cdcgs1vis

Hepatitis B VIS

2/2/2012

253088698300005911120202

cdcgs1vis

Haemophilus Influenzae type

b VIS

12/16/1998

253088698300006611981216

cdcgs1vis

Human papillomavirus

Vaccine (Cervarix) VIS

5/3/2011

253088698300007311110503

cdcgs1vis

Human papillomavirus

Vaccine (Gardasil) VIS

2/22/2012

253088698300008011120222

cdcgs1vis

Influenza Vaccine - Live,

Intranasal VIS

7/2/2012

253088698300009711120702

cdcgs1vis

Influenza Vaccine -

Inactivated VIS

7/2/2012

253088698300010311120702

cdcgs1vis

HL7 Version 2.5.1 Implementation Guide: Immunization Messaging (Release 1.5) 10/1/2014 Page 62

Change History

VIS Document Type

Description / Concept Name

Edition Date VIS Fully-encoded text string

(Concept Code)

Code System

Code (HL7

Japanese Encephalitis VIS

12/7/2011

253088698300011011111207

cdcgs1vis

Measles/Mumps/Rubella VIS

4/20/2012

253088698300012711120420

cdcgs1vis

Measles/Mumps/Rubella/Vari

cella VIS

5/21/2010

253088698300013411100521

cdcgs1vis

Meningococcal VIS

10/14/2011

253088698300014111111014

cdcgs1vis

Pneumococcal Conjugate

(PCV13) VIS

4/16/2010

253088698300015811100416

cdcgs1vis

Pneumococcal

Polysaccharide VIS

10/6/2009

253088698300016511091006

cdcgs1vis

Polio VIS

11/8/2011

253088698300017211111108

cdcgs1vis

Rabies VIS

10/6/2009

253088698300018911091006

cdcgs1vis

Shingles VIS

10/6/2009

253088698300020211091006

cdcgs1vis

Tetanus/Diphtheria/(Pertussis

) VIS

1/24/2012

253088698300022611120124

cdcgs1vis

Typhoid VIS

5/29/2012

253088698300023311120529

cdcgs1vis

Value Set Name – Funding Eligibility Observation Method (IIS)

Value Set OID - 2.16.840.1.114222.4.11.6039

Value Set Code: PHVS_FundingEligibilityObsMethod_IIS

Value set definition: The Funding Eligibility Observation Method identifies the method for capturing

funding program eligibility. Note that it is always reported at the immunization level. Used in OBX- 17

Concept Names Concept code Code System Identifier –

HL7 Table 0396

Eligibility captured at the immunization

level

VXC40

CDCPHINVS

Eligibility captured at the visit level

VXC41

CDCPHINVS

Value Set Name – VIS Vaccines (IIS)

Value Set OID - 2.16.840.1.114222.4.11.6040

Value Set Code:: PHVS_VISVaccines_IIS

Value set definition: This table lists the vaccines which require that a Vaccine Information Statement (VIS)

be shared with a patient/parent. The VIS document type, edition date and presentation date are reported in a

set of OBX. The current list will be found on PHIN VADS, as the list may change over time.

HL7 Version 2.5.1 Implementation Guide: Immunization Messaging (Release 1.5) 10/1/2014 Page 63

Change History

Table 1 -- CVX Codes of Vaccines Requiring VIS Recording

CVX Description Code System Table 0396 code

106

DTaP, 5 pertussis antigens

CVX

146

DTaP,IPV,Hib,HepB

CVX

110

DTaP-Hep B-IPV

CVX

DTaP-Hib

CVX

120

DTaP-Hib-IPV

CVX

130

DTaP-IPV

CVX

Hep A, adult

CVX

Hep A, ped/adol, 2 dose

CVX

104

Hep A-Hep B

CVX

Hep B, adolescent or pediatric

CVX

Hep B, adolescent/high risk infant

CVX

Hep B, adult

CVX

Hep B, dialysis

CVX

Hib (PRP-OMP)

CVX

Hib (PRP-T)

CVX

Hib-Hep B

CVX

118

HPV, bivalent

CVX

HPV, quadrivalent

CVX

135

Influenza, high dose seasonal

CVX

111

influenza, live, intranasal

CVX

141

Influenza, seasonal, injectable

CVX

140

Influenza, seasonal, injectable,

preservative free

CVX

144

influenza, seasonal, intradermal,

preservative free

CVX

IPV

CVX

148

Meningococcal C/Y-HIB PRP

CVX

136

Meningococcal MCV4O

CVX

114

meningococcal MCV4P

CVX

meningococcal MPSV4

CVX

MMR

CVX

MMRV

CVX

133

Pneumococcal conjugate PCV 13

CVX

100

pneumococcal conjugate PCV 7

CVX

HL7 Version 2.5.1 Implementation Guide: Immunization Messaging (Release 1.5) 10/1/2014 Page 64

Change History

CVX Description Code System Table 0396 code

119

rotavirus, monovalent

CVX

116

rotavirus, pentavalent

CVX

138

Td (adult)

CVX

113

Td (adult) preservative free

CVX

Td (adult), adsorbed

CVX

115

Tdap

CVX

varicella

CVX

HL7 Version 2.5.1 Implementation Guide: Immunization Messaging (Release 1.5) 10/1/2014 Page 65

Appendix B: Guidance on Usage and Example Messages

Appendix B – Guidance on Usage and

Example Messages

Table

B-1 Appendix B Revision History

Revision History

Author

Revision

Date

Rob Savage

Release 1

5/1/2010

Rob Savage

Release 1.1

2/15/2011

Rob Savage

Release 1.3

8/15/2011

Rob Savage

Release 1.4

8/1/2012

Rob Savage

Release 1.5

10/1/14

HL7 Version 2.5.1 Implementation Guide: Immunization Messaging (Release 1.5) 10/1/2014 Page 1

Appendix B: Guidance on Usage and Example Messages

Core Data Elements for an Immunization History

A number of core data elements are messaged in OBX (observation segments). While they are not directly

specified in the HL7 standards, they are crucial to support immunization information systems. The

following table lists all core data elements and indicates their usage.

ble B-2--Immunization History Core Data Elements

Data Element Description Support

Status

Location in

Message

Client Related Data Elements

Client Id

A list of client identifiers for the

person that is the subject of a

given immunization history. The

id includes both a unique

identifier and the context/owner

of the identifier.

Required

PID-3

Client Name

A list of names for the subject of

the immunization history. The

name is composed of both the

names and the name type (legal,

alias, etc.)

Required

PID-5

Mother’s Maiden Name

The family name of the person’s

mother. This is an important key

to assuring an accurate match.

Required

PID-6

Race

Patient’s self reported race.

Required

PID-10

Ethnicity

Patient’s self reported ethnicity

Required

PID-22

Gender

Patients gender

Required

PID-8

Birth date

Date patient was born

Required

PID-7

Birth order

If patient was part of a multiple

birth, this indicates the ordinal

position in that birth.

Required

PID-24

Multiple Birth Indicator

Indicates if person was member

of multiple birth.

Optional

PID-25

Birth State

The state the person was born in.

Required

PID-11

Birth facility

The name of the facility where

the person was born.

Required

Client address

Address of the client’s residence

Required

PID-11

Client Phone

List of telecommunication

numbers/address

Required

PID-13

Client IIS status

Indicates if client is currently

Required

PD1-16

Support Status indicates whether the field must be supported by the information system and messaged if known. It does not indicate

whether all messages must contain the data element. That is indicated in the usage column for each field.

HL7 Version 2.5.1 Implementation Guide: Immunization Messaging (Release 1.5) 10/1/2014 Page 2

Appendix B: Guidance on Usage and Example Messages

Data Element Description Support

Status

Location in

Message

associated with the IIS

Client Provider organization status

(Registry status)

Indicates if client is currently

associated with the provider

organization

Required

PD1-16

Responsible person name

A list of names of a responsible

person

Required

NK1-2

Responsible person address

Address of the responsible

person

Optional

NK1-4

Responsible person relationship

Relationship of the responsible

person to the patient/client

Required

NK1-3

Responsible person phone

Phone number of responsible

person

Optional

NK1-5

Client Primary language

Primary language of

client/patient

optional

PID-15

Vaccination Related Data Elements

Vaccine administered product type

Indicates which product

(vaccine) was administered

Required

RXA-5

Vaccine product manufacturer

Indicates the company which

manufactured the vaccine

Required

RXA-17

Vaccine administered date

Indicates the date that the

vaccine was administered

Required

RXA-3

Vaccine Lot Number

Indicates the lot number for the

vaccine administered

Required

RXA-15

Vaccine Lot Expiration Date

Indicates the expiry date for the

vaccine administered

Required

RXA-16

Vaccine site of administration

Indicates the body site where the

vaccine was administered

Required

RXR-2

Vaccine route of administration

Indicates the route that was used

to administer the vaccine

Required

RXR-1

Vaccine ordering provider

Indicates the clinician who

ordered the vaccination

Required

ORC-12

Vaccine administering provider

Indicates the clinician who

administered the vaccine

Required

RXA-10

Vaccine Event information source

Indicates whether the vaccine

was administered by the provider

organization recording the

immunization or obtained from a

Required

RXARXA-9

PD1-16 indicates the status from the message sender’s perspective. In the case of a message coming from a provider, it indicates if

the client is an active patient of that sender.

HL7 Version 2.5.1 Implementation Guide: Immunization Messaging (Release 1.5) 10/1/2014 Page 3

Appendix B: Guidance on Usage and Example Messages

Data Element Description Support

Status

Location in

Message

historical record

Vaccine Information Sheet (VIS)

type

Indicates the subject of the VIS,

that is which vaccine(s) it refers

Required

OBX-5

Vaccine Information Sheet (VIS)

version date

Indicates the publication date of

the VIS

Required

OBX-5

Vaccine information Sheet date

given to client/responsible person

Indicates the date the VIS was

given to the patient/responsible

person

Required

OBX-5

Patient Eligibility Category for

Vaccine Funding Program

This value represents the funding

program that should pay for a

given immunization. It is

determined based on

characteristics of the

patient/client and the type of

vaccine administered.

Required

OBX-5

Vaccine Funding Source

Indicates the Funding Source of

the vaccine administered. That is

was the vaccine administered

federally funded, privately

funded, etc.

Optional

OBX-5

Observations About the Client

Contraindications/precautions

A contraindication is categorical

indicator of the medical

conditions of the patient which

has that indicate that the patient

should not receive a vaccine. A

precaution is a medical condition

of the patient that indicates the

clinician should make a

determination whether the

patient should receive the

vaccine.

Required

OBX-5

Contraindication observation date

Indicates the date that the

contraindication was noted

Required

OBX-14

Exemption/refusal reason

Indicates the reason the patient is

either exempt from the

immunization or refuses the

immunization.

Required

RXA-18

Exemption / refusal date

Date the patient refused or was

exempted from vaccination

Required

RXA-3

Vaccine reaction

A categorical indicator of an

adverse health consequence with

onset that follows immunization

Optional

OBX-5

History of vaccine preventable

Indicates a vaccine preventable

Required

OBX-5

HL7 Version 2.5.1 Implementation Guide: Immunization Messaging (Release 1.5) 10/1/2014 Page 4

Appendix B: Guidance on Usage and Example Messages

Data Element Description Support

Status

Location in

Message

disease

disease that a patient has had

Date of history of vaccine

preventable disease

Indicates the date the disease

occurred (or was noted if onset is

uncertain)

Required

OBX-14

Send Immunization History (VXU)

Business Process

The following activity diagram illustrates the process of sending and receiving an immunization history. It

is meant to be illustrative and not prescriptive. With the exception of the HL7 message structure processing

and the return of an acknowledgement, the activities are based on local business rules. These rules must be

documented for smooth interoperability. HL7 only addresses the messages, VXU and ACK.

HL7 Version 2.5.1 Implementation Guide: Immunization Messaging (Release 1.5) 10/1/2014 Page 5

Appendix B: Guidance on Usage and Example Messages

Figure B-45-VXU Business Process

1. T

he process for sending a VXU (Immunization history) begins with the sending system building

the VXU message.

2. The sending system connects to the receiving system and sends the VXU.

3. The receiving system accepts the message.

4. The receiving system parses the message and validates.

a. Determine if message meets HL7 rules

b. Validate based on local business rules

5. Seek matching client in receiver data base

See Send Error in ACK for dealing with errors if either of these two tasks identifies problems.

HL7 Version 2.5.1 Implementation Guide: Immunization Messaging (Release 1.5) 10/1/2014 Page 6

Appendix B: Guidance on Usage and Example Messages

a. No match is found

i. Ad

d the client to the receiver database.

ii. Send acknowledgement message

b. Exactly one match found

i. Determine if client in receiver data base has indicated that his/her data is to be

protected (protection indicator = Y)

ii. Pr

otection indicator = Y

1. Do not integrate record into receiver data base

2. Send acknowledgement

iii. Protection indicator = N

1. Based on local business rules, integrate incoming record into receiver

data base.

2. Send acknowledgement

c. More than one match found

i. Send acknowledgement

6. Send acknowledgment to sending system

7. Sending system accepts acknowledgement message.

te that sending system may indicate that it does not accept acknowledgement messages. In this case, no

acknowledgement is returned. This is not recommended.

It is expected that a client’s immunization history is the complete history known to the sending system, and

not just updates on new information in the sending system. While some systems may send updates only,

the receiving system should make no assumptions about this. This has important implications for

processing those incoming records. At the same time, the sending system may not know of all

immunizations, so receiving system must have a process for integrating the received data into an existing

record. The Modeling Immunization Registry Operations Workgroup (MIROW) has produced a chapter of

best practices on this process. This is available on the American Immunization Registry Association web

site (www.immregistries.org).

The following example messages represent straightforward immunization history messages. They do not

illustrate dealing with specific use cases, such as messaging reactions, client specific conditions or vaccine

forecasts. Clearly, these may be components of a VXU, but will be addressed separately to simplify the

messages.

It is important to reiterate here that conformant systems should be able to successfully populate and process

the VXU message segments and fields identified as Required or Required but may be empty. They should

be able to populate and process conditional items when the predicate conditions are met. If segments or

fields are optionally repeating, they should be able to gracefully handle the repetitions. Systems that do not

conform to these expectations risk missed data.

Local business rules determine what happens next, but we assume that it is a simple insert of the client record. The receiving system

may require review and confirmation prior to insertion. Other systems may choose to require human review before adding to data

base.

See Send Acknowledgement with no error.

Locally, this may be known as the sharing indicator. In this case, the equivalent value is sharing = N.

Local business rules may vary. In general, the acknowledgement may reject the client record, but not indicate the existence of the

client record in the receiver system.

Local business rules will determine how the multiple matches are to be handled. The record could be put into a pending state,

rejected outright, loaded in as a new record for clean up later.

The sending system response to an acknowledgement message (ACK) is locally determined. Good practice would be to have a way

to use the ACK to alert user to outcome and to allow trouble-shooting of problem messages.

HL7 Version 2.5.1 Implementation Guide: Immunization Messaging (Release 1.5) 10/1/2014 Page 7

Appendix B: Guidance on Usage and Example Messages

Example VXU # 1-Basic message:

Note that all example messages that follow are hand-crafted and may contain errors. They are not

the source of truth for message format and content.

Storyboard:

On 01/13/2012 Mom brought her son ,Johnny New Patient (male), to the clinic. He was born 4/14/11 has

had 1 dose of Hep B on 4/15/11, according the medical record brought in by Mom (Sally Patient). They

live at 123 Any Street, Somewhere, Wisconsin 54000. Mom gives her maiden name as Lastname. Johnny’s

mom indicates that his Native American and not Hispanic. There home phone number is (111)232-0112.

Mom was given the Vaccine Information Sheet (VIS) that covered the following vaccine types:

• DTaP, IPV, Hib, PCV, Hepatitis B, and Rotavirus (publication date 11/16/12)

The clinician scanned the VIS bar code on the VIS (253088698300026411121116).

Nurse Sticker at Dalittle Clinic (name space id =DCS_DC), administers the following shots on 1/13/2012:

DTAP-Hep B-IPV (Pediarix), 0.5 mL, lot # xy3939, lot expiration 12/12/14, IM, right thigh

HIB (ActHIB) , 0.5 mL, lot # 33k2a, lot expiration 03/09/13, IM, left thigh

They were all ordered by Dr. Mary Pediatric who belongs to Dabig Clinical System (DCS). Mom

acknowledged that his data may be shared with other providers. Johnny is eligible for Medicaid. His

medical record number in Dabig Clinical System is 432155. Myron Clerk entered the information into the

EHRs (MYEHR).

The information was sent from Dabig Clinical System to the State IIS

Note that we will indicate the end of each segment with a <CR>. Segments may wrap around in this

document. We will insert a blank line between each segment for increased readability.

Message Example

MSH|^~\&|MYEHR|DCS|MYIIS||201201130000-

500||VXU^V04^VXU_V04|45646ug|P|2.5.1|||ER|AL|||||Z22^CDCPHINVS <CR>

PID

|1||432155^^^dcs^MR||Patient^Johnny^New^^^^L|Lastname^Sally^^^^^M

|20110411|M||1002-5^Native American^HL70005|123 Any

St^^Somewhere^WI^54000^^L||^PRN^PH^^^111^2320112|||||||||2186-5^not

Hispanic^CDCREC<CR>

NK1

|1|Patient^Sally^^^^^L|MTH^Mom^HL70063|123 Any

St^^Somewhere^WI^54000^^L<CR>

ORC|RE||65929^DCS|||||||^Clerk^Myron||<CR>

RXA

|0|1|20110415||85^hep B,

unspec^CVX|999|||01^historical^NIP001|||||||||||CP|A<CR>

HL7 Version 2.5.1 Implementation Guide: Immunization Messaging (Release 1.5) 10/1/2014 Page 8

Appendix B: Guidance on Usage and Example Messages

ORC|RE||65930^DCS||||||20120113|^Clerk^Myron||^Pediatric^Mary^^^^^^^

^^^^^^^^^^^MD|||||||||Dabig Clinic System<CR>

RXA|0

|1|20120113||110^DTaP HIB IPV^CVX|0.5|mL^^UCUM||00^New

admin^NIP001|^Sticker^Nurse^^^^^^^^^^^^^^^^^^RN|^^^DCS_DC||||xy3939|

20141212|SKB^GlaxoSmithKline^MVX|||CP|A<CR>

RXR|C

28161^IM^NCIT^IM^^HL70162|RT^Right Thigh^HL70163<CR>

OBX|1

|CE|64994-7^Eligibility

Status^LN|1|V02^Medicaid^HL70064||||||F||||||VXC40^vaccine

level^CDCPHINVS<CR>

OBX|2

|DT|29769-7^VIS presented^LN|2|20120113||||||F<CR>

OBX|3

|CE|69764-9

^Document type^LN|2|253088698300026411121116^Multivaccine

VIS^cdcgs1vis||||||F<CR>

ORC|R

E||65949^DCS||||||20120113|^Clerk^Myron||^Pediatric^Mary^^^^^^^

^^^^^^^^^^^MD|||||||||Dabig Clinic System<CR>

RXA|0|1|20120113||48^HIB PRP-T^CVX|0.5|mL^^UCUM||00^New

admin^NIP001|^Sticker^Nurse^^^^^^^^^^^^^^^^^^RN|^^^DCS_DC||||32k2a|2

0130309|PMC^sanofi^MVX|||CP|A<CR>

RXR|C

28161^IM^NCIT^IM^^HL70162|LT^left Thigh^HL70163<CR>

OBX|4

|CE|64994-7^Eligibility

Status^LN|1|V02^Medicaid^HL70064||||||F||||||VXC40^vaccine

level^CDCPHINVS<CR>

OBX|5

|DT|29769-7^VIS presented^LN|2|20120113||||||F<CR>

OBX|6

|CE|69764-9^Eligibility

Status^LN|2|253088698300026411121116^Multivaccine

VIS^cdcgs1vis||||||F<CR>

HL7 Version 2.5.1 Implementation Guide: Immunization Messaging (Release 1.5) 10/1/2014 Page 9

Appendix B: Guidance on Usage and Example Messages

Example VXU #2 - Indicate client eligibility status for a funding

program for vaccines administered:

Federal regulations specify that Patient Eligibility status be assessed at each immunization encounter. It is a

key data element for creating the Vaccines for Children (VFC) report on vaccine usage. Support for this

report requires that systems store a history of eligibility statuses at the dose administered level.

Immunization messages must be able to convey the eligibility status of a recipient when they received

immunizations. That is, for each dose administered, the person’s eligibility should be recorded. Eligibility

refers to what funding program should pay for the vaccine. This is distinctly different from funding source,

which refers to what funding program actually paid for the vaccine. This document will illustrate the

former.

Guidance for systems which collect eligibility at the encounter level:

Some systems may not have the capability to capture eligibility for each immunization administered. The

eligibility should be messaged using the OBX with each immunization record. Ideally, these systems would

know the vaccines that are VFC eligible (or state program eligible) and correctly associate VFC eligibility

with each vaccine administered. In practical terms if the person was VFC eligible because they were

covered by MEDICAID, and received 2 doses of vaccine, each vaccine record would have an associated

OBX segment. These segments would indicate V02 as the eligibility.

Patient Eligibility Status:

In the past, eligibility was recorded for each visit where a patient received an immunization. Recent

guidance from the Modeling Immunization Registry Operations Workgroup (MIROW)

has clarified that

the eligibility status of the patient should be recorded for each vaccine dose administered. It does not need

to be recorded for immunizations that represent a historical record of an immunization.

Sending systems which collect the eligibility status for each visit will need to associate the status recorded

for that visit on each immunization administered at that visit. They should consider if the vaccine

administered was eligible for the funding program when deciding what to assign as the eligibility for each

immunization.

The method of capture is messaged in OBX-17 (observation method). If the eligibility is captured by

vaccine dose, OBX-17 will be valued:

“VXC40^per immunization^CDCPHINVS”

If the method of capture is per visit, OBX-17 shall be valued:

“VXC41^per visit^CDCPHINV”

Patient Eligibility Status is conveyed in an OBX segment for each vaccine dose administered. While this

document will describe how to accomplish this in an HL7 message and give a high-level view of patient

eligibility status, readers should refer to the MIROW document for a complete understanding of correct

usage.

As described in the MIROW document, a variety of factors play a role in determination of Patient

Eligibility Status: VFC and grantee policies, age, private insurance coverage, type of provider, and type of

vaccine to be administered. For instance a person who was an Alaska Native receiving an MMR would

have an eligibility status code of V04. The following table gives a simplified view of the most common

cases.

http://www.aira.browsermedia.com/resources/AIRA-MIROW_DQA_Selected_Aspects_best_practice_guide_05-17-2013.pdf

HL7 Version 2.5.1 Implementation Guide: Immunization Messaging (Release 1.5) 10/1/2014 Page 10

Appendix B: Guidance on Usage and Example Messages

Technical Note: The design of the information systems interface and validation functionality should ensure

a match between reported/messaged Patient Eligibility Status and administered Vaccine Eligibility Status –

they have to be eligible for the same funding program. The following table is an illustration of the logic

found in table 0064.

Note that a person can’t be eligible for VFC and a state program for the same immunization. That is, only

one eligibility should apply to a given immunization.

Table B-2 -- Eligibility Outcomes

Determined Patient

Eligibility

Vaccine type eligibility Record for patient

eligibility for vaccine

dose administered

VFC eligible (V02-V05)

Vaccine type is eligible

for VFC (e.g. DTAP,

MMR, etc.)

V02-V05

Any patient eligibility

reason

Vaccine type is not

eligible for VFC ( e.g.

Yellow fever)

V01

Not VFC eligible (V01)

and no state or local

program applies.

Any

V01

Eligible for state or

local vaccine program

and not eligible for VFC

Vaccine is eligible for

state or local program.

State or local eligibility

code.

The

funding programs listed in table HL70064 are those associated with the Vaccines for Children program.

Local funding program eligibility would be published in the local Implementation Guide in table 0064. The

code V07 may be used if the person is not eligible for VFC funding program, but is eligible or a state or

local funding program. The use of locally specified codes may be preferable to provide more granular

information. If a locally defined funding program eligibility code is sent, then the person is presumed to be

not eligible for VFC funded vaccine.

The coding scheme uses codes in table HL70363 to indicate the assigning authority. The code is composed

of the code from table HL70363 and 2 character number assigned by the state (The state may add to this list

for other local assigning authorities. )

For example, if Alaska had a funding program and the person and vaccination met the eligibility criteria,

the code in OBX-5 would be as follows:

|AKA01^Alaska special eligibility^AKA|

AKA01 is the code. AKA in the third triplet is the assigning authority. The text is the second triplet is not

processed and so may be any text.

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Appendix B: Guidance on Usage and Example Messages

The OBX segment indicating patient eligibility in association with the dose administered is composed of a

number of data elements. OBX-3 indicates that the segment contains patient eligibility status (LOINC

64994-7). OBX-5 indicates the eligibility status. OBX-17 indicates the method of observation (per visit or

per immunization).

Technical note on LOINC code 64994-7:

The formal short name for this LOINC code is “Vaccine fund pgm elig cat”, this means it is the

patient eligibility status associated with a vaccine dose administered.

The following message fragment indicates that the patient was eligible for VFC vaccine for the associated

vaccination because they were Native American/Alaskan Native and the vaccine administered was an

eligible vaccine type. The method of capture was per immunization.

VFC Eligible Client Received Vaccine That Is VFC eligible

RXA|0|1|....

RXR

…

OBX

|1|CE|64994-7^vaccine fund pgm elig cat^LN|1|V04^VFC eligible

NA/AN^HL70064||||||F|||20090531|||XVC40XVC40^per imm^

CDCPHINVS <CR>

VFC Ineligible Client Received Vaccine That Is VFC eligible

RXA...

RXR

…

OBX

|1|CE|64994-7^vaccine fund pgm elig cat^LN|1|V01^Not VFC eligible

^HL70064||||||F|||20090531||| XVC40XVC40^per imm^

CDCPHINVS <CR>

VFC Eligible Client Received Vaccine That Is Not VFC eligible

RXA...

RXR.

OBX

|1|CE|64994-7^vaccine fund pgm elig cat^LN|1|V01^Not VFC elig

^HL70064||||||F|||20090531|XVC40XVC40^per imm^

CDCPHINVS <CR>

VFC Eligible Client Received Vaccine That Is Eligible for Local Funding Program

RXA...

HL7 Version 2.5.1 Implementation Guide: Immunization Messaging (Release 1.5) 10/1/2014 Page 12

Appendix B: Guidance on Usage and Example Messages

RXR...

OBX|1

|CE|64994-7^vaccine fund pgm elig cat^LN|1|AKA01^Alaska Special

Funding Program^AKA||||||F|||20090531|XVC40XVC40^per imm^

CDCPHINVS

<CR>

Example VXU #3 - Include immunization history evaluation and

forecast in VXU

is uncommon that a VXU will include an evaluated history and forecast. Therefore there it is not an

example shown. The example has been removed. See QBP/RSP example below.

Example VXU #4 - Send client specific conditions

aluation of immunization history and forecasting next dose due are important services provided by many

IIS. There are a number of factors that can impact these evaluations and forecasts. In general terms, some

factors contraindicate next doses, while others recommend next doses. These factors may be messaged in

OBX segments associated with an RXA.

Reaction Associated with a Previous Dose of Vaccine

Some people experience adverse events after receipt of an immunization. In many cases, Immunization

Information Systems (IIS) record these in conjunction with a specific immunization event. Occasionally,

the exact immunization event information is unknown. (e.g. anaphylaxis occurred after a previous dose,

years in the past.)

finition:

An adverse reaction is a negative physical condition that occurs shortly after one or more immunizations

have been received.

Adverse Reaction:

ORC|RE||9999^DCS|||||||^Clerk^Myron| <CR>

RXA|0|1|20090412|20090412|998^No vaccine

administered^CVX|999||||||||||||||NA<CR>

OBX|1|CE|

31044-1^Reaction^LN|1|39579001^Anaphylaxis^SCT

||||||F|||20090412<CR>

Evidence of immunity:

Infection with the diseases that are the target of immunizations leads to long-term immunity. Further

immunization against the disease is not likely to provide benefit.

Definition:

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Appendix B: Guidance on Usage and Example Messages

Evidence of immunity indicates that a person has plausible evidence that they have already developed

immunity to a particular disease. The strongest evidence of immunity is when serological evidence

indicates immunity. An alternative evidence of immunity is when a clinician has determined that the patient

has a history of the disease.

The example below shows that no dose of vaccine was given because the person had evidence of previous

infection with Hep B.

ORC|RE||9999^DCS|||||||^Clerk^Myron| <CR>

RXA|0|1|20090412|20090412|998^No vaccine

administered^CVX|999||||||||||||||NA<CR>

OBX|1|

CE|59784-9^Disease with presumed immunity ^LN|1|

66071002^HISTORY

OF HEP B INFECTION^SCT||||||F|||20090412<CR>

Contraindications to immunization:

There are a number of contraindications to immunization. These may be temporary or permanent. One is a

history of reactions to previous immunization. That is dealt with above. Others include allergies to

components of vaccines, physical conditions, current medication and current illnesses.

efinition:

A contraindication is any physical condition, current medication or other factor that indicates that a person

should not receive an immunization that may be associated with the contraindication. This contraindication

may be temporary or permanent.

LOINC: 30945-0

Examples:

OBX|1|CE|30945-0^Vaccination contraindication^LN|1|91930004^allergy

to eggs^SCT||||||F|||20090415<CR>

OBX|1|CE|30945-0^Vaccination contraindication^LN|1|VXC19^allergy to

thimerasol(anaphylactic)^CDCPHINVS||||||F|||20090415<CR>

Factors which indicate the need for an immunization or a changed

recommendation:

Several factors can drive the need for a specific immunization or a change in the normal schedule for

immunization. These may be an exposure to an infection, such as rabies. Other risk factors may include

membership in a risk group.

efinition:

A risk factor is some characteristic of an individual, which may lead to a recommendation for a specific

vaccine.

HL7 Version 2.5.1 Implementation Guide: Immunization Messaging (Release 1.5) 10/1/2014 Page 14

Appendix B: Guidance on Usage and Example Messages

OBX|1|CE|59785-6^Special Indication for

vaccination^LN|1|VXC7^exposure to

rabies^CDCPHINVS||||||F|||20090415<CR>

Example VXU #6 –Delete an Immunization Record

There are occasions when a system that has sent an immunization record to another system wishes to delete

the record on the other system. Each system may have rules about the requester’s right to delete records.

If a system allows deletions by HL7 message, use the RXA-21, Action Code to request deletion of a

specific record. The following diagram illustrates how the ORC-3 may be used to identify an

immunization record for deletion

. Note that the sending system includes the sending system unique id for

the immunization in the ORC-3 first component. The second component is the assigning authority, in this

case a system that is labeled MYIIS. In order for a later delete request to be successful, the receiving

system must store those values. A subsequent request to delete an immunization record includes the

sending system id and assigning authority. The receiving system searches for an immunization record with

the same sending system id and assigning authority. In this case we show that the record match is made

and the record is deleted from the receiving system.

gure B-46 Sequence Diagram-Deleting an Immunization Record

The other approaches will not be further illustrated here.

HL7 Version 2.5.1 Implementation Guide: Immunization Messaging (Release 1.5) 10/1/2014 Page 15

Appendix B: Guidance on Usage and Example Messages

VXU Example #7--Send Information About Vaccine Information

Statement (VIS)

The Vaccine Information Statement (VIS) is a document that explains the reasons for a vaccine and the

potential risks from receiving the vaccine. IIS track the fact that a VIS was shared with the client or parent.

There are three pieces of information about each event.

• The focus of the VIS or the VIS document type

• The date that the VIS was presented to the client/parent.

• The publication date (also known as Edition Date) of the VIS that was presented.

ese are carried in separate OBX segments associated with a vaccination event (RXA). These OBX are

linked by the value in the sub-id field. (OBX-4)

e VIS type may be indicated in one of two ways. The original way is to indicate the vaccine type in an

OBX using a CVX code. For a vaccine that is a combination of vaccines, there are often separate VIS for

each vaccine. This may be handled by sending 2 sets of OBX, one for each vaccine component.

This method will not allow reporting of presentation of the multi-vaccine VIS and so all systems are urged

to support the bar code approach illustrated below.

e preferred method for indicating VIS type is based on a scanned bar code of a Global Document Type

Identifier (GDTI). The GDTI is composed of a document owner, an application, a document type identifier

and a check digit. The fully encoded text string of the GDTI will be sent in an OBX segment. The mapping

of the fully encoded string will be found in a table supported by the CDC. The publication date maybe

inferred from the fully encoded GDTI. Therefore only the presentation date and GDTI need to be sent.

ample 1-Single vaccine (GDTI approach)

RXA|...

OBX|1|CE|

69764-9^document type^LN|1|253088698300012711120420^MMR^

cdcgs1vis

||||||F|||20091010<CR>

OBX|2|TS|29769-7^VIS Presentation

Date^LN|1|20091010||||||F|||20091010<CR>

this example the person received a dose of MMR on 10/10/2009. They received a VIS sheet on the same

day. The document had a publication date of 1/10/2008 (determined from the lookup table of VIS GDTI.

ample 2-Combination vaccine, 2 VIS (GDTI approach)

RXA|0|1|20091010||94^MMRV^CVX|…

OBX|1

|CE|69764-9^Document Type^LN|1|

253088698300012711120420^MMR^

cdcgs1vis ||||||F|||20091010<CR>

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Appendix B: Guidance on Usage and Example Messages

OBX|2|TS|29769-7^VIS Presentation

Date^LN|1|20101010||||||F|||20091010<CR>

OBX|3|CE|69764-9^Document

Type^LN|2|253088698300024011080313^varicella^ cdcgs1vis

||||||F|||20091010<CR>

OBX|

4|TS|29769-7^VIS Presentation Date^LN|3|20101010||||||F<CR>

This example shows that a person received an MMRV on 10/10/2009. They received 1 VIS document for

MMR and one for Varicella.

ample 3-Single vaccine (vaccine type approach)

RXA|...

OBX|1|CE|30956-7^vaccine type^LN|1|03^MMR^CVX||||||F|||20120223<CR>

OBX|2|TS|29768-9^VIS Publication

Date^LN|1|20080110||||||F|||20120223<CR>

OBX|

3|TS|29769-7^VIS Presentation

Date^LN|1|20091010||||||F|||20120223<CR>

In this example the person received a dose of MMR on 10/10/2009. They received a VIS sheet on the same

day. The document had a publication date of 1/10/2008.

VXU Example #8—Send Information Indicating Immunization

Refusal

Clients or their parents may choose not to be immunized against a particular disease or diseases. It is

important to share this information when sending immunization histories using HL7. There are several

components to messaging a refusal. The refusal reason is indicated in RXA-18. The Completion Status in

RXA-20 indicates that the vaccine was not given. The amount given should be 0. The following example

illustrates how to accomplish this.

ORC|RE||9999^DCS|||||||^Clerk^Myron <CR>

RXA|0|1|20091010||107^DTAP-NOS^CVX|999||||||||||||00^Parental

refusal^NIP002||RE<CR>

is example shows that on 10/10/2009 this client’s parent refused to have the child receive a DTAP

immunization. Note that the ORC is still required. Filler Order Number is still required, but meaningless.

Note that RXA-2 is NOT used to indicate dose number, as it had in the past 2.3.1 Guide. It is constrained

to have a value of 1.

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Appendix B: Guidance on Usage and Example Messages

VXU Example #9—Send Two Lot Numbers in RXA

There are a number of situations when a vaccine has more than one lot number. The way these are recorded

depends on the specific situation. Each is defined below and guidance is given for recording lot number.

Two Vaccine Components Are Packaged Together And The Lot Numbers

Are Inextricable Linked

here are occasions when two vaccines or a vaccine component, such as a diluent are combined at the time

of administration. This does not apply to the case where an adjuvant must be reported as well as the

vaccine. (See below) In most cases, the components are packaged together and the lot numbers of each

component are linked by the manufacturer. In this case record it is not necessary to message both lot

numbers.

For example, if we needed to include an immunization record where the vaccine was Pentacel, we would

put the lot number from the first component in sequence 15. The specific RXA field is highlighted below in

yellow.

Example:

RXA|0|1|20080907|20080907|120^DTAP-IPV-HIB^CVX^^^

|0.5|mL^^UCUM||00^NEW

IMMUNIZATION RECORD^NIP001|1234567890^SMITH^SALLY^S||

|||1234ad||PMC^Sanofi^MVX|||CP|A<CR>

Adjuvant Is Recorded Separately From Vaccine

When a vaccine has an adjuvant added at the time of administration and their lot numbers are not

inextricably linked, it may be important to record each component as a separate event. That is, each is

recorded in a separate RXA. The vaccine is recorded in one order group (ORC/RXA) and the adjuvant is

recorded in a second order group (ORC/RXA).

Example:

RXA|0|1|20140907|20140907|160^Influenza H5N1 -2013^CVX^^^

|0.5|mL^^UCUM||00^NEW

IMMUNIZATION RECORD^NIP001|1234567890^SMITH^SALLY^S||

|||1234ad||IDB^ID Biomedical^MVX|||CP|A <CR>

RXA|0|1|20140907|20140907|801^AS03^CVX^^^ |0.5|mL^^UCUM||00^NEW

IMMUNIZATION RECORD^NIP001|1234567890^SMITH^SALLY^S||

|||455sd|| |||CP|A|<CR>

VXU Example #10—Recording Birth Information

Birth information can be a powerful tool in identity resolution. Components of birth information are listed

in the NVAC core data elements. The information that can be carried in an HL7 message includes:

Table B-3--Birth Information Fields

Field HL7 message Component Example

Birth date

PID-7

19500512

Birth Registration

PID-3 (as one identifier in list)

12345^^^assigning authority^BR

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Appendix B: Guidance on Usage and Example Messages

Field HL7 message Component Example

Number

Birth order

PID-24

Multiple Birth

Indicator

PID-25

Birth State

PID-11 (as one address in list, use

address type BDL)

^^^WI^^^BDL

Birth facility

PID-23

Children’s Hospital

Note that Birth Facility is not used for Birth State.

VXU Example #11—Recording an incompletely administered

dose or a non-potent dose.

There are occasions when a dose is not completely administered. For example a child may jump away

during injection and an unknown quantity was administered. In this case, the dose needs to be recorded to

support accurate inventory management and to allow for recall of the client if there is a recall of the

vaccine. This is accomplished using the Completion status in RXA-20. The RXA is completed as usual,

but the completion status is set to PA. If more details are of interest, then this information may be placed in

an NTE segment under an OBX segment.

RXA|0|1|20091010||03^MMR^CVX|0.5|mL^^UCUM||||||||A23E1||MSD^^MVX|||P

A|A<CR>

Send Acknowledgement ACK In Response To VXU

Sending an acknowledgement can accomplish one of a number of tasks. It can indicate that the message

that was sent was successfully received and processed. It can also indicate that the message had errors.

The ability to accept ACK messages allows sending system managers to trouble-shoot communications. It

allows them to identify systematic problems with message creation. Being able to send ACK allows

receiving system managers to inform sending system managers about the nature of errors received. The

process can keep senders informed that some or all of the data they had sent did not make into the receiving

system.

It is vital that when messages are passed on by an intermediary, like a Health Information Exchange (HIE),

the ACK is passed back to the initiating system.

Errors may be of a number of types. The error may be caused by:

• a violation of an HL7 standard

• a violation of local processing rules

• a failure in the transport layer between the 2 systems

• a failure by the sending system to be authenticated by the receiving system

Only the first 2 types of errors are addressed by this Implementation Guide.

HL7 Version 2.5.1 Implementation Guide: Immunization Messaging (Release 1.5) 10/1/2014 Page 19

Appendix B: Guidance on Usage and Example Messages

Send acknowledgement of success in ACK

Initiating system may expect to receive an acknowledgment message, regardless of whether the receiving

system had problems with the message. There is a straightforward response.

MSH|^~\&|DCS|MYIIS|MYIIS||200906040000-

0500||ACK^V04^ACK|1234567|P|2.5.1|||NE|NE|||||Z23^CDCPHINVS <CR>

MSA|A

A|9299381<CR>

In the example above, the system with the code DCS is sending an acknowledgement to the system with the

code MYIIS on June 4, 2009. The message indicates that there were no errors in processing. Note that

MSH-10 (Message Control ID) is unique identifier generated by the system sending the ACK.

Send Error in ACK

An error may be as serious as rejection of an entire message or as trivial as receipt of an

unexpected field of data. ACK messages are intended to inform the original sender of the

outcome of the message they had sent.

Acknowledging An Error That Causes Message Rejection ( AR response):

If a system received a message with an unrecognized version id (10.0, for instance) the system

would return an ACK with an application reject message.

MSH|^~\&|DCS|MYIIS|MYIIS||200906040000-

0500||ACK^V04^ACK|12343467|P|2.5.1|||<CR>

MSA|AR|9299381<CR>

ERR||MSH^1^12|203^unsupported version id^^HL70357|E||||Unsupported

HL7 Version ID—Message rejected<CR>

The AR response is reserved by HL7 for 4 errors:

nsupported message type

nsupported event code

Unsupported processing ID

Unable to process for reasons unrelated for format or content

Acknowledging An HL7 Processing Error That Causes Message Rejection (AE

response)

There are a number of errors that may cause message rejection when processing an HL7 message

that are based on HL7 rules.

• Empty or missing required (R) segment group

• Empty or missing PID segment or MSH segment (Required segments not in segment

group)

The following example reports that the PID-5 (patient name) was missing. It is a required field.

This leads to rejection of the PID segment. Because this is an error, the MSA-1 reports an error

(“AE”) . This error caused the receiving system to identify this as a serious error with data loss.

ERR-4 (severity) is set to ‘E’. Note that ERR-8 contains a free text note about the error. These

are generated locally by the responding system. They may be standardized locally.

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Appendix B: Guidance on Usage and Example Messages

MSH|^~\&|DCS|MYIIS|MYIIS||200906040000-

0500||ACK^V04^ACK|13434534|P|2.5.1||| <CR>

MSA|AE|9299381<CR>

ERR||

PID^1^5|101^required field missing^HL70357|E|7^required data

missing^HL70533||||Patient name is required <CR>

ERR||

PID|100^required segment missing^HL70357|E||||PID is required

segment. Message rejected <CR>

Acknowledging An HL7 Processing Error That Causes Segment Group Rejection:

The following error illustrates a case where a required (R) field in a required(R) segment is

treated as empty. The segment is a child of a segment group. The value in RXA-5 (administered

vaccine) is not valid causing the field to be treated as empty. Since it is an R field the segment is

treated as empty. RXA is child of the Order Segment group. Any segments in that order group

would be treated as empty. (RXR, OBX, NTE). If this is the only order group in the message,

then the entire message would be rejected. The following assumes that there were other order

groups in the message.

MSH|^~\&|DCS|MYIIS|MYIIS||200906040000-

0500||ACK^V04^ACK|49348812|P|2.5.1<CR>

MSA|A

E|9299381<CR>

ERR||

RXA^1^5|103^table value not found^HL70357|E|5^table value not

found^HL70533||||Vaccine code not recognized—field rejected <CR>

ERR||

RXA^1^5|101^required field missing^HL70357|E|7^required data

missing^HL70533||||RXA-5 is required segment rejected<CR>

ERR||

RXA|100^required segment missing^HL70357|E||||RXA is required

segment segment-group rejected <CR>

Acknow

ledging An HL7 Processing Error That Causes Segment Rejection:

The following error illustrates a case where a required (R) field in a required but may be empty

(RE) segment is treated as empty. The value in NK1-3 (Relationship) is empty. Since it is an R

field the segment is treated as empty. NK1 is not a child of a Segment group. The message is not

rejected.

MSH|^~\&|DCS|MYIIS|MYIIS||200906040000-

0500||ACK^V04^ACK|49348812|P|2.5.1<CR>

MSA|AE|9299381<CR>

ERR||NK1^3|101^required field missing^HL70357|E|7^required data

missing^HL70533||||Relationship missing -- segment rejected <CR>

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Appendix B: Guidance on Usage and Example Messages

Acknowledging An HL7 Processing Error That Caused a Warning :

A non-fatal error may occur for a number of reasons. One example would occur when a field is

not supported and the message contains data in that field. For instance, PID-2 (Patient Id) is not

supported. If the message had an identifier, then the system would generate an error.

MSH|^~\&|DCS|MYIIS|MYIIS||200906040000-

0500||ACK^V04^ACK|1234886|P|2.5.1<CR>

MSA|AA|9299381<CR>

ERR

||PID^2| |W||||PID-2 is not supported -- data ignored<CR>

The example above indicates that an error occurred in PID-2 (patient id). The data were ignored,

but the initiating system is notified of the error.

Acknowledging an Application Error That Causes Message Rejection Due to Local

Business Rule Violation;

The following example shows an error that causes an error based on the application rules or

functioning. A local business rule may be that “The date of birth shall be on or before today.” If a

message were received with a birth date in the future for the patient, the application would

generate an error. The field would be treated as empty. The field is a Required field in a Required

Segment (Not part of a segment group). The message is rejected.

MSH|^~\&|DCS|MYIIS|MYIIS||200906040000-

0500||ACK^V04^ACK|9492823|P|2.5.1<CR>

MSA|AE|9299381<CR>

ERR||PID^1^7|101^required field missing^HL70357 |E|1^illogical date

error^HL700533|||| Birth data after today <CR>

ERR||PID|100^required segment missing^HL70357|E||||PID is required

segment. Message rejected <CR>

Example Return an Evaluated History and Forecast (RSP(Z42))

Evaluating an immunization history, based on the recommendations of the ACIP schedule or other schedule

is an important function provided by many IIS. Based on this evaluation and other factors,

recommendations may be made for next doses due. Some of their trading partners would like to receive the

outcome of this evaluation. The previous implementation guide included a method for accomplishing this

using OBX segments, but showed it in a VXU. This document illustrates how this is done in response to a

request and expands on the types of information that may be messaged.

A requesting system sends a query requesting and evaluated history and forecast for a specific person.

(QBP^Q11^QBP_Q11, profile id = Z44) If that person is found in the responding system, the responding

system evaluates the immunizations administered against a schedule (e.g. ACIP) and forecasts when next

doses are due. These are returned in an RSP message. (RSP^K11^RSP_K11, profile id = Z42) If an exact

match can’t be found an acknowledgement message is returned indicating no match or errors in the

message.

This document does not describe nor specify the functionality or accuracy of the forecasting service. The

focus is only on the content of the messages. Implementations should publish documentation on local

specifics.

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This document is not meant to support a call to a forecasting and evaluation service. It is meant to support

existing applications that message vaccine forecasts and evaluation as a part of a complete immunization

history.

en a clinician evaluates a person’s immunization history and makes recommendations, she/he must use

a standard (schedule). Traditionally, clinicians have evaluated based on vaccine groups or families. The

schedule has one or more sets of immunization events that can be satisfied to indicate protection against the

diseases of the vaccine group of interest. These constitute a series.

The

following table lays out the information needed to convey an evaluation and forecast.

Table B-3--Codes Supporting Messaging Evaluation and Forecasting

Data element Use OBX-3 Value Optionality for

meaningful evaluation

and forecast

Schedule

Identifies the standards

used. ACIP is the

prototypical example.

59779-9

Required

Vaccine

group/family

Identifies which diseases

are expected to be

prevented by completion

of series.

Vaccine type 30956-7

mbination vaccine

component 38890-0

Required

Series name

Name of the specific set

of doses and

recommendations that

were used to evaluate

this dose and make

recommendations.

59780-7

Optional

Ordinal position

in primary

series

Indicates which dose in

a series this given

immunization fulfills.

30973-2

Required

Dose Validity

Indicates if this dose was

given appropriately for

this series in this

schedule.

59781-5

Optional

Number of

doses in

primary Series

Indicates how many

appropriately given

doses are required to

meet the goals of this

series.

59782-3

Optional

This does not mean that every message must have one of the required OBX. It just means that this concept needs to be known to put

the evaluation and forecast in context.

Vaccine type 30956-7 is preferred, but support for 38890-0 is needed to support backward compatibility.

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Data element Use OBX-3 Value Optionality for

meaningful evaluation

and forecast

Note that in the case

where there are doses

that may be skipped, due

to the age of the

client/patient, the

number shall reflect the

adjusted number of

doses.

Series Status

This indicates the status

of the client’s progress

toward meeting the

goals of the series

selected. This could be

complete, overdue, in

progress, etc.

59783-1

optional

Next dose

forecast

Earliest date dose should

be given.

30981-5

Required for forecast

Date next dose

recommended

30980-7

Latest date next dose

should be given

59777-3

Date dose is overdue

59778-1

Reason code

This can indicate why a

dose is not valid or that

the recommendation was

changed because of a

special circumstance.

30982-3

Optional

It is

important to note that evaluation relates to doses received, but recommendations relate to doses not yet

given. Each will be addressed separately. Evaluation will be associated with an immunization received.

Recommendations will be associated with future events. That is, they will be associated with an RXA that

indicates that no dose was given. They will not be associated with existing immunization records (RXA).

This means that if a person has received one hep B dose (valid). The evaluation will be associated with the

first RXA indicating that she/he received the dose. The OBX following this will indicate the evaluation.

The recommendations for the next dose due will be associated with a second RXA.

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There are other factors relating to forecasting, such as exemption and previous immunity. These are dealt

with in the client specific conditions impacting forecasting.

en a given dose is evaluated against a schedule, we can make a number of observations about it. Each

dose of vaccine recorded is transmitted in an RXA segment. Each RXA segment may have one or more

OBX, observation segments. Each distinct piece of information is found in its own OBX segment and

follows its associated RXA.

Note that the order of the OBX segments is not regulated. The receiving system will need to link the OBX

with the appropriate data elements.

The basic structure for including evaluation in a message is:

ORC-O

rder segment

RXA-the immunization and vaccine

OBX-vaccine group

OBX-the schedule

OBX-series used

OBX-dose number in series (ordinal position)

OBX-doses in series

OBX-dose validity

OBX-series status

e basic structure for evaluation of combination vaccine components is:

ORC-or

der segment

RXA-the immunization and vaccine

OBX-vaccine group one

OBX-the schedule

OBX-series used

OBX-dose number in series (ordinal position)

OBX-doses in series

OBX-dose validity

OBX-vaccine group two

OBX-the schedule

OBX-series used

All of the related observations are linked to the vaccine group using the OBX-4, observation sub-id.

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OBX-dose number in series (ordinal position)

OBX-doses in series

OBX-dose validity

OBX-series status

e basic structure for the recommendation in the message is:

ORC-or

der segment

RXA-vaccine, CVX-Unspecified formulation (no dose given)

OBX-the schedule

OBX-the series used

OBX-dose number in the series

OBX-number of doses in the series

OBX-earliest next dose due

OBX-recommended next dose due

OBX-overdue next dose due

OBX-series status

is document will first illustrate how to build each OBX to support reporting the key information. The

next section will show how to put these pieces together to create evaluation and recommendations in RSP

message. Note that the same approach may be used in a VXU.

Indicating the Schedule that was used:

Evaluation is only meaningful in the context of a defined schedule. Schedule is a required element in a

message that is carrying evaluation or recommendation information.

The only schedule supported by CDC is the ACIP schedule. Some systems may choose to develop other

schedules that meet local needs. We assume that ACIP is the schedule used in our examples.

There are no differences between recommendation and evaluation in the OBX indicating the schedule used.

The following example shows that the ACIP schedule was used to evaluate this immunization.

ORC|RE||197027^DCS|||||||^Clerk^Myron||^Pediatric^MARY^^^^^^^L^^^^^^

^^^^^MD<CR>

RXA|0|1|20090412|20090412|48^HIB PRP-T^CVX|0.5|mL^^UCUM||00^new

immunization

record^NIP0001|^Sticker^Nurse|^^^DCS_DC||||33k2a||PMC^sanofi^MVX|||C

P|A<CR>

RXR|

C28161^IM^NCIT^IM^IM^HL70162|<CR>

OBX|1

|CE|59779-9^Schedule

used^LN|1|VXC16^ACIP^CDCPHINVS||||||F|||20090415<CR>

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Indicating Vaccine Group associated:

Evaluation and forecast are considered by vaccine group. Some immunizations are composed of one

vaccine group while others are combinations of several vaccine groups. The first is more straightforward

when constructing a message. The second requires 2 sets of observations, one for each vaccine group. The

vaccine group is indicated in an OBX. All following OBX relate to that vaccine group, using the OBX-4

Observation sub-id.

Sin

gle Vaccine group Vaccine:

RXA|0|1|20091010||03^MMR^CVX|0.5|mL^^UCUM||||||||EZ342|20111001|MSD^

^MVX|||CP|A<CR>

OBX|1|CE|30956-7^vaccine type^LN|1|03^MMR^CVX||||||F|||20091010<CR>

In the case where a combination vaccine is given, each vaccine group is identified and has segments

describing its evaluation. This case requires that the information about each vaccine group be handled

separately. Each vaccine group is associated with a group of OBX, using the OBX-4 observation sub-id.

Combination vaccine:

RXA|0|1|20091010||94^MMRV^CVX|0.5|mL^^UCUM||||||||EZ342|20111001|MSD

^^MVX|||CP|A<CR>

OBX|1|CE|30956-7^vaccine type^LN |1|21^Varicella^CVX||||||F<CR>

… evaluat

ion observations about this vaccine group

OBX|4|CE|30956-7^vaccine type^LN |2|03^MMR^CVX||||||F<CR>

… evaluat

ion observations about this vaccine group

Note that the vaccine group could also be indicated with 38890-0^Component Vaccine Type^LN.

Reporting the Ordinal Position In A Series:

Evaluation:

Reporting the ordinal position in a selected series may be reported in an OBX segment. The ordinal

position is the dose number being satisfied by a given immunization. (dose #1 in a 3 dose series) The next

section illustrates how to report the expected number of doses in the series. (3 in the example above) It

would be empty for a booster dose and for doses which are not valid.

ORC|RE||197027^DCS|||||||^Clerk^Myron||^Pediatric^MARY^^^^^^^L^^^^^^^^^

^^MD<CR>

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RXA|0|1|20090412|20090412|48^HIB PRP-T^CVX|0.5|mL^^UCUM||00^new

immunization

record^NIP0001|^Sticker^Nurse|^^^DCS_DC||||33k2a||PMC^sanofi^MVX|||CP|A

<CR>

RXR|C28161^IM^NCIT^IM^IM^HL70162|<CR>

OBX|1|CE|30956-7^vaccine type^LN|1|17^HIB, NOS^CVX||||||F<CR>

OBX|2|CE|59779

-9^Immunization Schedule

used^LN|1|VXC16^ACIP^CDCPHINVS||||||F|||20090415<CR>

OBX|3|N

M|30973-2^dose number in series^LN|1|1||||||F|||20090415<CR>

Recommendation:

There is a different code to be used for indicating the number of the next dose due.

Note that the preferred LOINC codes are not vaccine group specific. The use of old vaccine specific

LOINC should not occur. For example, 30936-9 DTaP/DTP dose count in combination vaccine

should not be used.

Reporting the Number of Doses in a Series:

There are no differences between recommendations and evaluations when reporting number of doses in

series. This numeric field indicates the number of doses required to meet the goals of the primary series for

this vaccine group. It would be empty for a booster dose.

OBX|1|NM|59782-3^number of doses in

series^LN|1|1||||||F|||20090415<CR>

Reporting Next Dose Recommendation Dates (forecast only):

Forecasting next dose due is an important function that can be reported in a message. There are a number

of key dates that can be communicated:

Table B-4--Due Date Definitions

Date type Definition

The earliest acceptable date based on the schedule

used

This is the earliest date that a person should

receive the next dose for the vaccine group. It

does not include any grace period. For example,

the earliest data a person should receive a DTAP is

age 42 days.

The recommended date

This is the date that a person should ideally receive

the next dose for the vaccine group.

The overdue date (the date the person is considered

late for getting the vaccine)

This is the date that the person is considered late

for getting the next dose for the vaccine group. It

is a locally defined value.

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Date type Definition

The latest date that a dose should be given (e.g. for

HIB it is currently 5 years old)

This is the last possible date that a person should

receive the next dose for the vaccine group.

Generally, this is related to age of recipient. For

example the oldest a person should receive a dose

of HIB is 5 years old.

Not all dates may be relevant and so may be omitted.

RXA|0|1|20090412|20090412|998^No vaccine administered^CVX|999|||

||||||||||NA<CR>

OBX|1|CE|30956-7^vaccine type^LN|1|17^HIB, NOS^CVX||||||F<CR>

OBX|2|CE|59779

-9^Immunization Schedule

used^LN|1|VXC16^ACIP^CDCPHINVS||||||F|||20090415<CR>

OBX|3

|DT|30980-7^Date vaccination

due^LN|1|20090615||||||F|||20090415<CR>

OBX|4|DT|59777-3^Latest date to give

vaccine^LN|1|20100615||||||F|||20090415<CR>

Reporting Recommendation Reasons:

Sometimes a dose may break a specific rule in the schedule. Alternatively conditions may trigger special

rules, such as the need for accelerating the recommendations to catch up with the preferred schedule. This

may be reported from the system in a message. The list of values is locally determined. These should be

documented locally.

cal Codes drive the answers.

Complete Example Of Evaluation And Forecasting:

MSH|^~\&|MYEHR|DCS|||200910311452-

0500||RSP^K11^RSP_K11|3533469|P|2.5.1|||NE|NE|||||Z42^CDCPHINVS|DCS

<CR>

MSA|A

A|793543<CR>

QAK|3

7374859|OK|Z44^request evaluated Immunization

history^CDCPHINVS<CR>

QPD|

Z44^Request Evaluated Immunization History^CDCPHINVS

214|M|10 East Main St^^Myfaircity^GA^^^L<CR>

PID|1

||123456^^^MYEHR^MR|| Child^Bobbie^Q^^^^L||20090214|M|||10 East

Main St^^Myfaircity^GA^^^L<CR>

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ORC

|RE||197023^DCS|||||||^Clerk^Myron|||||||DCS^Dabig Clinical

System^StateIIS<CR>

RXA

|0|1|20090415132511|20090415132511|31^Hep B Peds

NOS^CVX|999|||01^historical record^NIP0001|||||||||||CP|A <CR>

OBX|1|CE|30956-7^vaccine type^LN|1|31^Hep B Peds NOS^CVX ||||||F<CR>

OBX|

2|CE|59779-9^Immunization Schedule

used^LN|1|VXC16^ACIP^CDCPHINVS||||||F|||200900531<CR>

OBX|3|NM|30973-2^dose number in series^LN|1|1||||||F|||200900531<CR>

OBX|4|NM|59782-3^number of doses in series^LN|1|3||||||F|||20090531<CR>

ORC

|RE||197027^DCS|||||||^Clerk^Myron||^Pediatric^MARY^^^^^^^L^^^^^^

^^^^^MD<CR>

RXA

|0|1|20090731132511|20090731132511|48^HIB PRP-

T^CVX|0.5|ML^^UCUM||00^new immunization

record^NIP0001|^Sticker^Nurse|^^^DCS_DC||||33k2a||PMC^sanofi^MVX|||C

P|A<CR>

RXR

|C28161^IM^NCIT^IM^IM^HL70162|<CR>

OBX|5|CE|30956-7^vaccine type^LN|2|17^HIB NOS^CVX ||||||F<CR>

OBX|

6|CE|59779-9^Immunization Schedule

used^LN|2|VXC16^ACIP^CDCPHINVS||||||F|||200900731<CR>

OBX|7|NM|30973-2^dose number in series^LN|2|1||||||F<CR>

OBX|8|NM|59782-3^number of doses in series^LN|2|4||||||F<CR>

ORC

|RE||197028^DCS|||||||^Clerk^Myron||^Pediatric^MARY^^^^^^^L^^^^^^

^^^^^MD<CR>

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RXA|0|1|20091051132511|20091051132511|110^DTAP-Hep B-

IPV^CVX|0.5|ML^^UCUM||00^new immunization

record^NIP0001|^Sticker^Nurse|^^^DCS_DC||||xy3939||SKB^GSK^MVX|||CP<

CR>

RXR|I

M^IM^HL70162^C28161^IM^NCIT|<CR>

OBX|9

|CE|30956-7^vaccine type^LN|1|

31^Hep B Peds NOS^CVX ||||||F<CR>

OBX|10|CE|59779

-9^Immunization Schedule

used^LN|3|VXC16^ACIP^CDCPHINVS||||||F|||200900531<CR>

OBX|11|NM|30973-2^dose number in series^LN|3|2||||||F<CR>

OBX|13|NM|59782-3^number of doses in series^LN|3|3||||||F<CR>

OBX|14

|CE|30956-7^vaccine type^LN|4|

10^IPV^CVX ||||||F<CR>

OBX|15|CE

|59779-9^Immunization Schedule

used^LN|2|VXC16^ACIP^CDCPHINVS||||||F|||200901031<CR>

OBX|16|NM|30973-2^dose number in series^LN|4|1||||||F<CR>

OBX|17|NM|59782-3^number of doses in series^LN|4|4||||||F<CR>

OBX|18|CE|30956-7^vaccine type^LN|5|

20^DTAP^CVX ||||||F<CR>

OBX|19|CE|59779

-9^Immunization Schedule

used^LN|5|VXC16^ACIP^CDCPHINVS||||||F<CR>

OBX|20|NM|30973-2^dose number in series^LN|5|1||||||F<CR>

OBX|21|NM|59782-3^number of doses in series^LN|5|5||||||F<CR>

ORC|RE||197023^DCS|||||||^Clerk^Myron|||||||DCS^Dabig Clinical

System^StateIIS<CR>

RXA|0

|1|20091031|20091031|998^no vaccine admin^CVX|999|||

|||||||||||NA <CR>

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OBX|22|CE|30956-7^vaccine type^LN|1|31^Hep B Peds NOS^CVX ||||||F<CR>

OBX|

23|CE|59779-9^Immunization Schedule

used^LN|1|VXC16^ACIP^CDCPHINVS||||||F<CR>

OBX|

24|DT|30980-7^Date vaccination due^LN|1|20091015||||||F<CR>

Important notes:

1. Note that the OBX set id increases for each OBX through out the message

2. The observation sub-id holds to one value for each related set of observations under the vaccine

group OBX.

3. Either of the LOINC for vaccine group could have been used under the combination vaccine

(30956-7 (vaccine type) or 38890-0 (component vaccine type)), but 30956-7 is preferred.

4. If VIS observation (OBX) is included in the above message, it requires its’ own OBX with vaccine

group and has a different sub-id from the evaluation observations.

Using The NTE Segment Associated With An OBX To Provide More

Information:

Each OBX may have an associated NTE segment. This may be used for sending notes or comments that

the receiving system may choose to display to a user. Any use of this is local and requires local

documentation.

ssues That Are Outside Of Messaging But Impact The Value Sent In A Message

1. There are some series where doses may be skipped. For instance a person who gets significantly

behind on some HIB series may skip a dose and complete “early”. Local profiles should specify

how these doses will be handled and messaged.

2. Some vaccines have a numbered primary series and are followed by intermittent booster doses.

These do not increase the number of doses in the primary series.

3. Persons who have been previously infected may not need further doses of vaccine. This can be

messaged in an OBX reporting client immunity.

Send Request for Complete Immunization History (QBP/RSP)

Process for requesting Immunization History

Requesting an immunization history is a key function supported by messaging. As described above, a

complete immunization history includes all the information needed for evaluating what immunizations

have been received and what ones are needed next. This query is defined in a Query Profile in Chapter 7 of

the Implementation Guide. The requesting system sends a request with some combination of demographic

and identifier information.

When a client is does not want his/her data shared and is found, local business rules need to be applied. For

instance, some applications may behave as if the client record does not exist in the system. That is, it

would respond with a “no records found” message. The exception to this would be if the requesting

provider were the one who set the protection indicator. In this case, the person may be a candidate that is

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Appendix B: Guidance on Usage and Example Messages

returned. Another response might be to send limited information notifying the requesting system that the

person exists, but wants his/her records protected.

The sending system must deal with the returned messages. While it is outside the scope of this

implementation guide, there are some logical actions. These actions should be documented locally. The

following indicate some of the possibilities. The list is neither prescriptive nor complete.

• On

e candidate immunization history is returned.

ser reviews and accepts

ser reviews and rejects

Requesting system accepts and marks for review.

• A list of candidates are returned

ser reviews and selects one

· Ne

w QBP is sent using the identifying information from the RSP list

User reviews and rejects all

· User creates a new query with more or different information

Requesting system accepts and stores the list for later review.

The following is an example query using the QBP^Q11 Z34 query profile specified in the Implementation

Guide.

MSH|^~\&|||||201405150010-

0500||QBP^Q11^QBP_Q11|793543|P|2.5.1|||||||||Z34^CDCPHINVS <CR>

QPD| Z34^Request Immunization History^CDCPHINVS

512|M|10 East Main St^^Myfaircity^GA^^^L<CR>

RCP|I

|5^RD&records&HL70126 <CR>

This query is being sent from a system with a name space identifier of MYEHR. It is requesting an

immunization history for a person named Bobbie Q Child. His mother’s maiden name was Suzy Que. He

was born 5/12/2005 and lives at 10 East Main St, Myfaircity, Georgia. His medical record number with

MYEHR is 12345. The most records that the requesting system wants returned if lower confidence

candidates are returned is 5. Processing is expected to be “immediate”.

Local implementations will specify which fields are required in the QPD. All fields have a usage of RE

(required, but may be empty). This means that sending systems may populate any or all of these fields.

Receiving systems must accept values in any of these fields, but may specify which are required and which

will be ignored.

Returning a list of candidate clients in response to QBP^Q11 query

When a system receives a QBP^Q11 Request for Immunization History query, it may find one or more,

lower confidence candidates. In this case it returns an RSP that contains a list of these candidates. It

includes all pertinent information in PID, NK1 and PD1 segments. If the number of candidates is greater

than the maximum number requested by the querying system or greater than the maximum number the

responding system allows to be returned, then an error acknowledgment will be sent. (See below)

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Note that PID-1, Set Id, is required when returning a list of PID. It is incremented for each PID returned

(i.e. 1,2,3…)

The following example RSP message illustrates the case when 2 candidates have been found by the

responding system. All known information for each candidate that can be included in PID, NK1 and PD1

segments is returned. We assume that the medical record number sent in the query is not known to the

responding system. If it were, it is unlikely that the responding system would find lower confidence

candidates.

The actual logic used to find the candidates is not specified by this document. It may be as simple as exact

string and date matching or as complex as a probabilistic search algorithm.

MSH|^~\&|SOME_SYSTEM|A_Clinic |MYIIS|MyStateIIS|200911051000-

0500||RSP^K11^RSP_K11|37374859|P|2.5.1|||NE|NE|||||Z31^CDCPHINVS|

A_Clinic <CR>

MSA|AA|793543<CR>

QAK|3

7374859|OK<CR>

QPD|

Z34^Request Immunization History^CDCPHINVS

512|M|10 East Main St^^Myfaircity^GA^^^L<CR

PID|1

||99445566^^^MYStateIIS^SR||Child^Robert^^^^^L||20050512|M<CR>

NK1|1

|Child^Susan|MTH^Mother^HL70063|^^Myfaircity^GA<CR>

PID|2

||123456^^^MYStateIIS^SR||Child^Robert^^^^^L||20050512|M<CR>

This response includes 2 candidates that must be reviewed by the person requesting records. If

they select a specific client and repeat the Request Immunization History query with the refined

information, they should receive a response that includes the complete immunization history from

the IIS. Note the use of PID-1, set id.

Returning an immunization history in response to a Request for

Immunization History query

When the Request Immunization History query finds one high-confidence match, the matching client’s

immunization history is returned in the response. The following example message shows a simple

response. Note that this query could have been a secondary query that occurred after preliminary identity

resolution or a primary query with sufficient demographic data to permit matching.

MSH|^~\&|MYIIS|MyStateIIS|MYEHR|Myclinic|200911300200-

0500||RSP^K11^RSP_K11|7731029|P|2.5.1|||NE|NE|||||Z32^CDCPHINVS|MySt

ateIIS|Myclinic<CR>

MSA|A

A|793543<CR>

QAK|3

7374859|OK| Z34^Request Immunization History^CDCPHINVS <CR>

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QPD| Z34^Request Immunization History^CDCPHINVS

512|M|10 East Main St^^Myfaircity^GA^^^L<CR

PID|1||123456^^^MYEHR^MR~987633^^^MYIIS^SR||Child^Robert^Quenton^^^^

L|Que^Suzy^^^^^M|||||10 East Main St^^Myfaircity^GA<CR>

PD1

||||||||||||N|20091130<CR>

NK1

|1|Child^Suzy^^^^^L|MTH^Mother^HL70063<CR>

ORC

|RE||142324567^YOUR_EHR|||||||^Shotgiver^Fred||^Orderwriter^Sally

^^^^^^^^^^^^^^^^^^MD<CR>

RXA

|0|1|20050725||03^MMR^CVX|0.5|mL^^UCUM||00^New Immunization

Record^NIP001<CR>

RXR

|SC^^HL70162<CR>

Note that the response returned the medical record number from the MYEHR system. It also returned the

IIS id.

Acknowledging Query That Returns No Clients/Patients

Acknowledging a Query that finds no candidate clients

A well-formed query may find no matching candidates. This is not an error, but should be acknowledged in

a response message. The following example message shows how this may be done. Note that the Request

Immunization History response grammar indicates that MSH, MSA, QAK and QPD are required segments.

Figure B-47--Sequence Diagram Acknowledging Response Indicating No Matchesa

QAK-2 indicates that no data were found that matched the query parameters.

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MSH|^~\&|MYIIS|MyStateIIS||MYEHR|200911302300-

0500||RSP^K11^RSP_K11|7731029|P|2.5.1|||NE|NE|||||Z33^

CDCPHINVS|MyStateIIS|MYEHR<CR>

MSA|A

A|793543<CR>

QAK|3

7374859|NF|Z34^request Immunization history^CDCPHINVS<CR>

QPD| Z3

4^Request Immunization History^CDCPHINVS

512|M|10 East Main St^^Myfaircity^GA^^^L<CR>

Acknowledging a query that finds more candidates than requested

The sending system sets an upper limit on the number of candidates it will accept in response to a query in

RCP-2. It expects that a responding system will send no more candidates that this number. In addition, the

responding system may have an upper limit on the number of candidates that it will return. This number

may be lower than the requesting system. It will trump the requesting system upper limit. In either case, if

the responding system finds more candidates than the upper limit, then it responds with and

acknowledgement indicating that too many candidates were found. QAK-2 indicates that there were too

many candidates found that matched the query parameters.

MSH|^~\&|MYIIS|MyStateIIS||MYEHR|200911300000-

0500||RSP^K11^RSP_K11|7731029|P|2.5.1|||NE|NE|||||Z33^CDCPHINVS|MySt

ateIIS|MYEHR <CR>

MSA|AA|793543<CR>

QAK|37374859|TM|Z34^request Immunization history^CDCPHINVS<CR>

QPD|

Z34^Request Immunization History^CDCPHINVS

512|M|10 East Main St^^Myfaircity^GA^^^L<CR>

Using a Two-step process to request an immunization history

The IHE profile defines 2 queries for obtaining an ID of interest. One query requests an id based on the

demographic information included in the query (PDQ, using the Pediatric Demographic profile). When a

match is found, it returns the relevant id and demographic information. The other query seeks an id for a

person from one registered provider based on the id from another registered provider (PIX).

The use of the IHE Patient Identification Cross-Referencing (PIX) and

Patient Demographic Query (PDQ) transactions is an alternative approach

which separates retrieval/update of a patient identifier and

retrieval/update of immunization data into two messaging transactions.

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A Patient Demographic Supplier may be a Master Person Index or other source of patient demographic and

identification information. While we will focus on an MPI below, any Patient Demographic Supplier may

be substituted.

A Master Person Index is a database that contains demographic and locating information of registered

persons and associates each person with the identifiers for the person from each of the participating

systems. This allows one system to request the identifier for a person that was assigned by another system.

This id may be used to request data from that second system and assures a positive match.

Systems that participate in an MPI should register each person they are interested in with the MPI. An

excellent profile for maintaining and interacting with an MPI has been published by the group, Integrating

the Healthcare Enterprise (IHE). That profile will not be replicated here. However, the process for

requesting personal identifier outlined below is based on that profile.

Adding a patient record to an MPI is done by a PIX transaction using an ADT message. This method may

be used by an EHR or by an IIS, or both, to add a patient identifier to an MPI. The PIX profile, described

in the IHE Technical Framework Volume I, includes specific transactions that describe the segments and

fields to be used. These ADT-based transactions are described in the IHE Technical Framework Volume

II. The standard transaction used by PIX is ITI-8, which uses an HL7 V2.3.1 ADT. The Pediatric

Demographics Option, described at this writing in a supplement to PIX and PDQ, is preferred for

interactions with MPIs managing IIS data. The use of the Pediatric Demographics Option adds ITI-30,

which uses an HL7 V2.5 ADT.

Once a person has been registered with the MPI, a PIX Query may be used to retrieve the cross-referenced

IIS identifier (if any).

The following diagram illustrates the use of the PIX query to get a pre-registered patient identifier. This

requires that the cross-referenced identifiers are registered using the ADT message.

igure B-48-- Sequence Diagram -Two Step Request

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te that this interaction is simplified. The initiating system sends a request for a patient identifier. The

request includes one identifier in a PID-3. The identity supplier looks for a matching identifier of interest

and returns it along with the patient name (PID-5). This information is included in the request

immunization history query (QBP^Q11). Assuming that the identifier used is the one in the immunization

history supplier, there should be a one to one match.

If the EHR wishes to retrieve the IIS id without previously registering the patient with the MPI, or if it

wishes to query the MPI by demographics for some other reason, it may use a Patient Demographics Query

to do so.

The following diagram illustrates the use of PDQ to obtain an id and how this would be used to request an

immunization record. The record seeker uses a Patient Demographic Query (PDQ) to a Master Person

Index (MPI), requesting the identifiers for the person of interest. The MPI finds the person of interest and

returns the demographic information and identifiers. The record seeker system uses this information to

create a request for immunization history, which it sends to the record source. The record source uses this

information to find the immunization history for the person of interest.

Figure B-49—Sequence Diagram- Request Immunization History using PDQ

Note that this interaction is simplified. The client of interest would be selected and that client’s information

would populate the query requesting an immunization history. To be assured of success, the record source

system would need to have registered the person in the MPI. In that way the person id in the record source

would be available in the MPI.

Receiving system determines that message has errors

HL7 Message Rule Errors

There are two classes of error related to HL7 message rules. The first is when a message is well formed,

but the query has errors in content or format. The second occurs when the message is malformed and

cannot be parsed by the recipient.

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The

following examples illustrate how each is reported.

Content or Format Error

Initiating Query:

MSH|^~\&||SendingOrg||ReceivingOrg|20091130000-

0500||QBP^Q11^QBP_Q11|793543|P|2.5.1|||ER|AL|||||Z34^CDCPHINVS|

SendingOrg|ReceivingOrg<CR>

QPD|Z34^Request Immunization

History^CDCPHINVS||123456^^^MYEHR^MR|Child^Bobbie^Q^^^^L|Que^Suzy^^^

^^M|20050512|M|10 East Main St^^Myfaircity^GA^^^L<CR>

te that only the MSH and QPD segments will be displayed above. The QPD does not have data in a

required field, the Query Tag field (QPD-2).

MSH|^~\&|MYIIS|ReceivingOrg||SendingOrg|200911300000-

0500||RSP^K11^RSP_K11|7731029|P|2.5.1|||NE|NE|||||

Z33^CDCPHINVS|ReceivingOrg|SendingOrg <CR>

MSA|AE|7731029<CR>

ERR||

QPD^1^2|101^required field missing^HL70357|E<CR>

QAK||

AE|Z34^CDCPHINVS<CR>

QPD|

Z34^Request Immunization History^CDCPHINVS

||123456^^^MYEHR^MR|Child^Bobbie^Q^^^^L|Que^Suzy^^^^^M|20050512|M|10

East Main St^^Myfaircity^GA^^^L<CR>

te that QAK-1 Query tag is empty in this case, because it was missing in the initiating query.

Message Is Rejected Due to Unrecognized Message Type

en a message is received that is an unrecognized message type, the response is an ACK with AR in the

MSA-1 (Acknowledgement Code)

MSH|^~\&|MYIIS|MyStateIIS||MYEHR|200911301000-0500||ACK^Q11^ACK||P

<CR>

MSA|A

R|<CR>

This message indicates that the application rejected the message.

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