Influenza_Immunization_Complete.xml

<?xml version="1.0" encoding="UTF-8"?>
<section>
    <!-- conforms to Immunizations section with entries optional -->
    <templateId root="2.16.840.1.113883.10.20.22.2.2"/>
    <!-- Immunizations section with entries required -->
    <templateId root="2.16.840.1.113883.10.20.22.2.2.1"/>
    <code code="11369-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"
        displayName="History of immunizations"/>
    <title>IMMUNIZATIONS</title>
    <text>
        <content ID="immunSect"/>
        <table border="1" width="100%">
            <thead>
                <tr>
                    <th>Vaccine</th>
                    <th>Lot Number</th>
                    <th>Date</th>
                    <th>Status</th>
                </tr>
            </thead>
            <tbody>
                <tr ID="immun1">
                    <td>Influenza Virus Vaccine</td>
                    <td>1</td>
                    <td>8/15/2010</td>
                    <td>Completed</td>
                </tr>
            </tbody>
        </table>
    </text>
    <entry typeCode="DRIV">
        <substanceAdministration classCode="SBADM" moodCode="EVN" negationInd="false">
            <!-- ** Immunization activity ** -->
            <templateId root="2.16.840.1.113883.10.20.22.4.52"/>
            <id root="e6f1ba43-c0ed-4b9b-9f12-f435d8ad8f92"/>
            <text>
                <reference value="#immun1"/>
            </text>
            <!-- Indicates the status of the substanceAdministartion -->
            <statusCode code="completed"/>
            <effectiveTime value="20100815"/>
            <consumable>
                <manufacturedProduct classCode="MANU">
                    <!-- ** Immunization medication information ** -->
                    <templateId root="2.16.840.1.113883.10.20.22.4.54"/>
                    <manufacturedMaterial>
                        <code code="88" codeSystem="2.16.840.1.113883.12.292"
                            displayName="Influenza virus vaccine" codeSystemName="CVX"/>                                           
                        <lotNumberText>1</lotNumberText>
                    </manufacturedMaterial>
                  <!-- Optional manufacturerOrganization
                    <manufacturerOrganization>
                        <name>Health LS - Immuno Inc.</name>
                    </manufacturerOrganization>-->
                </manufacturedProduct>  
            </consumable>
            <!-- Optional Performer 
            <performer>
                <assignedEntity>
                    <id root="2.16.840.1.113883.19.5.9999.456" extension="2981824"/>
                    <addr>
                        <streetAddressLine>1021 Health Drive</streetAddressLine>
                        <city>Ann Arbor</city>
                        <state>MI</state>
                        <postalCode>99099</postalCode>
                        <country>US</country>
                    </addr>
                    <telecom nullFlavor="UNK"/>
                    <assignedPerson>
                        <name>
                            <given>Amanda</given>
                            <family>Assigned</family>
                        </name>
                    </assignedPerson>
                    <representedOrganization>
                        <id root="2.16.840.1.113883.19.5.9999.1394"/>
                        <name>Good Health Clinic</name>
                        <telecom nullFlavor="UNK"/>
                        <addr nullFlavor="UNK"/>
                    </representedOrganization>
                </assignedEntity>
            </performer> -->
        </substanceAdministration>
    </entry>
</section>