A resource to store supporting data for antigens including target disease, vaccine groups, immunity criteria, contraindications, and vaccination series.

This resource consolidates various mapping and conflict information related to vaccine scheduling to support decision-making processes.

Profile for allergy intolerances relevant to immunization. The code (allergen/substance) may use SNOMED CT or ICD-10-CM. Reaction substances may use CVX, MVX, SNOMED CT, or RxNorm.

The forecast cicada returns. Constrains ImmunizationRecommendation to say which series group each recommendation belongs to, so that more than one recommendation for a single vaccine group can be told apart.

Profile for conditions where the code must be from the Vaccine Condition Codes value set. Accepts SNOMED CT and ICD-10-CM coded conditions.

An administered dose as the engine reads it: the vaccine as CVX, the date, the patient, and optionally the dose volume, the manufacturer and a subpotency reason. The engine's evaluation of the dose is returned on ImmunizationEvaluation (target-dose-status-ext, evaluation-detail-ext), not written back onto the Immunization; until 2026-09-07 this profile declared thirteen evaluation extensions nothing ever emitted.

Profile for medical procedures related to immunization based on SNOMED CT or CPT codes.

Profile for medication administrations with vaccine codes from CVX or MVX.

Profile for medication dispenses with vaccine codes from CVX or MVX.

Profile for medication requests with vaccine codes from CVX or MVX.

Profile for medication statements with vaccine codes from CVX or MVX.

Profile for Observation resources carrying lab evidence of immunity or other findings relevant to immunization decisions. Codes may be from SNOMED CT, ICD-10-CM, or LOINC.

A profile that extends the base FHIR Patient resource to include detailed vaccination-related information.

A vaccine product as CDC's supporting data describes one: the CVX, the trade name, the ages between which it is a preferable vaccine, and its type. Note that beginAge and endAge are FHIR Age values, which must be positive (age-1), so CDC's "0 days" cannot be carried; a begin age of 0 days is expressed by omitting beginAge.

An antigen within this vaccine group that needs the forecast dose. A multi-antigen group forecasts as one recommendation, so without this a caller cannot tell whether all of MMR is due or only the measles component. Repeats, one per antigen.

The age at which the vaccine becomes applicable.

One contributing series: its own status, its own four dates, and the component dates that produced them. A vaccine group forecast reports the aggregate over several series, so without this a group covered by more than one reports a single answer for all of them, and a due date arrives with no way to see whether age or interval produced it. Repeats, one per series.

How many doses remain in the series after the one being forecast, or 'Recurring' where the series ends in a recurring dose. seriesDoses and doseNumber allow a reader to subtract, but no arithmetic says the series never ends.

The age at which the vaccine is no longer applicable.

The engine build and the CDSi supporting-data release that produced this resource. A forecast is a function of both, so a stored response naming neither cannot be traced to what produced it. Parameters is not a DomainResource and carries no extension, so the stamp sits on each evaluation and on each recommendation.

The CDSi Chapter 6 sub-step outcomes behind a dose's evaluation: which of age, interval, conflict and vaccine choice passed, and for those that failed, which rule failed. doseStatusReason carries ten ImmDS codes; the engine knows more than that.

The series group this forecast is scoped to, per CDSi FORECASTVG-1. recommendation.series names the series; core FHIR has nowhere for the group.

Whether this recommendation came from the standard series group or a risk series group. Present so a client receiving two recommendations for one vaccine group can tell which pathway each describes.

The CDSi target dose status this administered dose produced.

CDC's vaccine recommendation category for one Best Patient Series in this forecast: Routine, High-Risk, or SCDM (shared clinical decision making), determined per CDC's Vaccine Recommendation Category Determination (CDSi supporting data 4.65) once the forecast is known, for a series whose status is Not Complete. Carries the series name, the category, and CDC's material for it. One extension per contributing series that has a category.

Type of the vaccine.

Every CDSi observation code, as published in the supporting data.

Reasons a dose was reported rather than evaluated.

Forecast reasons the engine can report.

Value set for dose evaluation status reasons, referencing the published ImmDS IG StatusReason CodeSystem.

The reason for the evaluation.

Combined value set for dose evaluation status, including HL7 THO standard codes (valid, notvalid) and the Cicada extension code (extraneous).

Combined value set for immunization forecast status, referencing published standard CodeSystems. Includes ImmDS IG ForecastStatus (CDSi-compatible), HL7 THO immunization-recommendation-status, and LOINC answer list LL940-8.

RxNorm codes for medications relevant to immunization decision support, including antivirals and aspirin.

CPT codes for procedures relevant to immunization decision support, including splenectomy and cochlear implant.

This value set includes codes for the reason an interval is considered to be invalid.

LOINC codes for laboratory tests that provide evidence of immunity, mapped to CDSi observation codes for immunization decision support. Serum IgG in every case, plus total antibody for hepatitis A, which is what evidence of immunity means for these antigens; IgM, cerebrospinal fluid and avidity codes are deliberately excluded.

Value set for medications and substances based on SNOMED CT, including both active ingredients and marketed products.

Comprehensive Value Set for medical procedures based on SNOMED CT codes.

Reasons why certain doses are Preferred or Allowed doses

Series types a forecast can be scoped to. In practice a forecast carries standard or risk: CDSi Table 8-14 excludes Evaluation Only series from best patient series.

CDSi target dose statuses.

Every code from CVX (vaccine administered) and MVX (manufacturer), the two CDC code systems a vaccine dose is recorded with.

Value set for conditions based on SNOMED CT, that may impact immunization.

Value set for conditions based on ICD-10-CM that may impact immunization decisions, mapped to CDSi observation codes.

Value set for gender categories relevant to vaccination data.

All codes from the Vaccine Recommendation Category code system.

Value set for reasons why a patient's age is considered valid/invalid for a vaccine.

Observations and Conditions that are important to indications or contraindications in vaccine forecasting

Records that cannot describe an administration. CDSi evaluates a vaccine dose administered and defines the assessment date as the current date, so these doses are excluded from evaluation and forecasting and reported in an OperationOutcome. They are statements about the data, never about the patient's immunity, which is why they are not evaluation statuses.

Extension codes for dose evaluation status beyond the HL7 THO immunization-evaluation-dose-status CodeSystem. Only codes not covered by the standard are defined here.

Why the engine forecast what it did. The ImmDS ForecastReason code system covers four of these; the rest have no ImmDS concept, and the ImmDS binding on ImmunizationRecommendation.recommendation.forecastReason is example strength, so they travel as a second coding rather than being dropped.

The reason for the evaluation.

Placeholder for the International Classification of Diseases, Tenth Revision, Clinical Modification, maintained by the US National Center for Health Statistics. No concepts are carried here; codes are validated by the terminology server.

This value set includes codes for the reason an interval is considered to be invalid.

Reasons why certain doses are Preferred or Allowed doses

CDSi series type: whether a patient series is the routine schedule, one indicated by a risk condition, or evaluation-only. Mirrors the seriesType attribute of the CDSi antigen supporting data.

CDSi Table 3-2. The status of the target dose an administered dose was evaluated against. R4 ImmunizationEvaluation carries only doseNumber, derived from this, so a skipped target dose and a satisfied one are otherwise indistinguishable.

Value set for gender categories relevant to vaccination data.

The three categories of CDC's Vaccine Recommendation Category Determination (CDSi supporting data 4.65): the type of recommendation a Best Patient Series carries for a patient who is recommended further doses. Displays are CDC's own words.

Value set for reasons why a patient's age is considered valid/invalid for a vaccine.

Define the usage of FHIR resource types with specific aliases

Maps ICD-10-CM codes to CDSi observation codes used in immunization decision support. Generated from the cicada crosswalk.

Maps SNOMED CT codes to CDSi observation codes used in immunization decision support. Generated from CDC's supporting data.

An allergy record the engine reads as a contraindication candidate: SNOMED 293104008, Vaccines adverse reaction, the root of the vaccine reaction concepts in the condition value set, with the substance as the CVX of the vaccine reacted to.

A vaccine product as a Medication: CVX 20 with a trade name, the ages between which CDC's Diphtheria standard series lists it as a preferable vaccine (6 weeks to 7 years), and its vaccine type. CDC's "0 days" begin ages cannot be examples here: FHIR's Age datatype requires a positive value (age-1).

A hepatitis B dose recorded as a MedicationAdministration, which the engine accepts as an administered dose.

A hepatitis B dose dispensed as a MedicationDispense.

A hepatitis B dose ordered as a MedicationRequest.

A hepatitis B dose recorded as a MedicationStatement, which the engine accepts as an administered dose.

A coded observation carrying CDSi observation 003, Immunocompromised, as its SNOMED coded value 370388006.

The performer of observation-immunocompromised. Practitioner is not profiled by this IG; the example exists so that the observation can carry a performer, as the base specification recommends.

A procedure the engine reads as an immunization-relevant history item: SNOMED 234336002, one of the roots of the immunization procedures value set.

The patient of CDC CDSi condition test case 2016-UC-0032, the case the forecast example is computed from.

The one condition in case 2016-UC-0032, CDSi observation 055 Health care personnel, as the engine reads it (VaccineConditionFhir).

The engine's evaluation of the case's MMR dose against measles, with the target-dose status and the sub-step detail extensions.

The engine's evaluation of the case's MMR dose against mumps.

The engine's evaluation of the case's MMR dose against rubella.

The one dose in case 2016-UC-0032, an MMR, as the engine reads it (vax-dose).

The engine's forecast for 2016-UC-0032, all 17 recommendations, regenerated from the engine by cicada/tool/write_ig_example.dart.

Expansion parameters for the build: SNOMED CT is expanded and validated against the US edition, which carries the US-extension concepts CDSi cites.