ICVP Model Questionnaire - XML Representation

SMART ICVP, published by WHO. This guide is not an authorized publication; it is the continuous build for version 0.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/WorldHealthOrganization/smart-icvp/tree/main and changes regularly. See the Directory of published versions
Questionnaire: Questionnaire/Questionnaire-ICVPModel - XML Profile

XML representation of the Questionnaire-ICVPModel questionnaire.
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<Questionnaire xmlns="http://hl7.org/fhir">
  <id value="Questionnaire-ICVPModel"/>
  <meta>
    <profile
             value="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-extr-smap"/>
  </meta>
  <text>
    <status value="extensions"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: Questionnaire Questionnaire-ICVPModel</b></p><a name="Questionnaire-ICVPModel"> </a><a name="hcQuestionnaire-ICVPModel"> </a><a name="Questionnaire-ICVPModel-en-US"> </a><table border="1" cellpadding="0" cellspacing="0" style="border: 1px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top;"><tr style="border: 2px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top"><th style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/formats.html#table" title="The linkID for the item">LinkID</a></th><th style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/formats.html#table" title="Text for the item">Text</a></th><th style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/formats.html#table" title="Minimum and Maximum # of times the item can appear in the instance">Cardinality</a></th><th style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/formats.html#table" title="The type of the item">Type</a></th><th style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/formats.html#table" title="Additional information about the item">Description &amp; Constraints</a><span style="float: right"><a href="http://hl7.org/fhir/R4/formats.html#table" title="Legend for this format"><img src="data:image/png;base64,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" alt="doco" style="background-color: inherit"/></a></span></th></tr><tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_q_root.gif" alt="." style="background-color: white; background-color: inherit" title="QuestionnaireRoot" class="hierarchy"/> </td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Questionnaire for ICVP Logical Model</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Questionnaire</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">http://smart.who.int/icvp/Questionnaire/Questionnaire-ICVPModel#0.1.0</td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" id="item.name" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="string" class="hierarchy"/> name</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Full Name of the client</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string">string</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" id="item.dob" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-date.png" alt="." style="background-color: white; background-color: inherit" title="date" class="hierarchy"/> dob</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Date of Birth</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-date">date</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" id="item.sex" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="coding" class="hierarchy"/> sex</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Sex</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Value Set: <a href="http://terminology.hl7.org/3.1.0/ValueSet-v2-0001.html">hl7VS-administrativeSex</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" id="item.nationality" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: white; background-color: inherit" title="coding" class="hierarchy"/> nationality</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Nationality</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Value Set: <a href="http://terminology.hl7.org/6.0.2/ValueSet-v3-Country.html">Country</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" id="item.nid" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="string" class="hierarchy"/> nid</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">National Identification Document</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string">string</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11.png)" id="item.guardian" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-group.png" alt="." style="background-color: white; background-color: inherit" title="group" class="hierarchy"/> guardian</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Parent or Guardian Details</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group">group</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)" id="item.guardianName" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="string" class="hierarchy"/> guardianName</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Name of Parent or Guardian</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string">string</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck100.png)" id="item.guardianRelationship" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: white; background-color: inherit" title="coding" class="hierarchy"/> guardianRelationship</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Relationship Status</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Value Set: <a href="ValueSet-Questionnaire-ICVPModel_DVCRelationshipStatus.html">Relationship Status for Contact in Patient</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck01.png)" id="item.vaccinDetails" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-group.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="group" class="hierarchy"/> vaccinDetails</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Vaccine Certificate Details</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..*</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group">group</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck010.png)" id="item.doseNumber" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: white; background-color: inherit" title="coding" class="hierarchy"/> doseNumber</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Dose Number</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Value Set: <a href="ValueSet-Questionnaire-ICVPModel_doseNumber.html">Dose Number</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck010.png)" id="item.disease" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="coding" class="hierarchy"/> disease</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Name of disease of condition vaccinated or received prophylaxis against</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Value Set: <a href="ValueSet-Questionnaire-ICVPModel_ICVPDiseaseTargeted.html">ICVP Disease Targeted</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck010.png)" id="item.vaccineClassification" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: white; background-color: inherit" title="coding" class="hierarchy"/> vaccineClassification</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Vaccine or Prophylaxis classification code</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Value Set: <a href="ValueSet-Questionnaire-ICVPModel_ICVPVaccineCodes.html">ICVP - Vaccine Codes</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck010.png)" id="item.vaccineTradeItem" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="string" class="hierarchy"/> vaccineTradeItem</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Vaccine Trade Item</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string">string</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck010.png)" id="item.date" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-date.png" alt="." style="background-color: white; background-color: inherit" title="date" class="hierarchy"/> date</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Date of Vaccination</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-date">date</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck010.png)" id="item.clinicianName" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="string" class="hierarchy"/> clinicianName</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Name of supervising clinician</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string">string</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck010.png)" id="item.issuer" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: white; background-color: inherit" title="string" class="hierarchy"/> issuer</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Relevant authoring reponsible for issuing the certificate, or for overseeing the administration center</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string">string</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck010.png)" id="item.manufacturerId" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="string" class="hierarchy"/> manufacturerId</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Manufacturer ID</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string">string</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck010.png)" id="item.manufacturer" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: white; background-color: inherit" title="string" class="hierarchy"/> manufacturer</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Name of Manufacturer of Vaccine</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string">string</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck010.png)" id="item.batchNo" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="string" class="hierarchy"/> batchNo</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Batch Number</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string">string</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck001.png)" id="item.validityPeriod" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-group.png" alt="." style="background-color: white; background-color: inherit" title="group" class="hierarchy"/> validityPeriod</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Certificate Validity Period</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group">group</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0010.png)" id="item.startDate" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-date.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="date" class="hierarchy"/> startDate</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">From</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-date">date</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0000.png)" id="item.endDate" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-date.png" alt="." style="background-color: white; background-color: inherit" title="date" class="hierarchy"/> endDate</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">To</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-date">date</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr><td colspan="5" class="hierarchy"><br/><a href="http://hl7.org/fhir/R4/formats.html#table" title="Legend for this format"><img src="data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAABAAAAAQCAYAAAAf8/9hAAAABmJLR0QA/wD/AP+gvaeTAAAACXBIWXMAAAsTAAALEwEAmpwYAAAAB3RJTUUH3goXBCwdPqAP0wAAAldJREFUOMuNk0tIlFEYhp9z/vE2jHkhxXA0zJCMitrUQlq4lnSltEqCFhFG2MJFhIvIFpkEWaTQqjaWZRkp0g26URZkTpbaaOJkDqk10szoODP//7XIMUe0elcfnPd9zsfLOYplGrpRwZaqTtw3K7PtGem7Q6FoidbGgqHVy/HRb669R+56zx7eRV1L31JGxYbBtjKK93cxeqfyQHbehkZbUkK20goELEuIzEd+dHS+qz/Y8PTSif0FnGkbiwcAjHaU1+QWOptFiyCLp/LnKptpqIuXHx6rbR26kJcBX3yLgBfnd7CxwJmflpP2wUg0HIAoUUpZBmKzELGWcN8nAr6Gpu7tLU/CkwAaoKTWRSQyt89Q8w6J+oVQkKnBoblH7V0PPvUOvDYXfopE/SJmALsxnVm6LbkotrUtNowMeIrVrBcBpaMmdS0j9df7abpSuy7HWehwJdt1lhVwi/J58U5beXGAF6c3UXLycw1wdFklArBn87xdh0ZsZtArghBdAA3+OEDVubG4UEzP6x1FOWneHh2VDAHBAt80IbdXDcesNoCvs3E5AFyNSU5nbrDPZpcUEQQTFZiEVx+51fxMhhyJEAgvlriadIJZZksRuwBYMOPBbO3hePVVqgEJhFeUuFLhIPkRP6BQLIBrmMenujm/3g4zc398awIe90Zb5A1vREALqneMcYgP/xVQWlG+Ncu5vgwwlaUNx+3799rfe96u9K0JSDXcOzOTJg4B6IgmXfsygc7/Bvg9g9E58/cDVmGIBOP/zT8Bz1zqWqpbXIsd0O9hajXfL6u4BaOS6SeWAAAAAElFTkSuQmCC" alt="doco" style="background-color: inherit"/> Documentation for this format</a></td></tr></table><h2>Contained Resources</h2><hr/><p class="res-header-id"><b>ValueSet  #v2-0001</b></p><a name="Questionnaire-ICVPModel/v2-0001"> </a><a name="hcQuestionnaire-ICVPModel/v2-0001"> </a><a name="Questionnaire-ICVPModel/v2-0001-en-US"> </a><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Language: en</p><p style="margin-bottom: 0px">Profile: <a href="http://hl7.org/fhir/R4/shareablevalueset.html">Shareable ValueSet</a></p></div><ul><li>Include all codes defined in <a href="http://terminology.hl7.org/3.1.0/CodeSystem-v2-0001.html"><code>http://terminology.hl7.org/CodeSystem/v2-0001</code></a></li></ul><hr/><p class="res-header-id"><b>ValueSet  #v3-Country</b></p><a name="Questionnaire-ICVPModel/v3-Country"> </a><a name="hcQuestionnaire-ICVPModel/v3-Country"> </a><a name="Questionnaire-ICVPModel/v3-Country-en-US"> </a><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Language: en</p></div><ul><li>Include codes from<a href="http://terminology.hl7.org/6.0.2/CodeSystem-ISO3166Part1.html"><code>urn:iso:std:iso:3166</code></a> where code  matches (by regex) [A-Z]{3}</li></ul><hr/><p class="res-header-id"><b>ValueSet  #ICVPDiseaseTargeted</b></p><a name="Questionnaire-ICVPModel/ICVPDiseaseTargeted"> </a><a name="hcQuestionnaire-ICVPModel/ICVPDiseaseTargeted"> </a><a name="Questionnaire-ICVPModel/ICVPDiseaseTargeted-en-US"> </a><ul><li>Include these codes as defined in <a href="http://smart.who.int/ts/0.1.0/CodeSystem-ICD11.html"><code>http://id.who.int/icd/release/11/mms</code></a><table class="none"><tr><td style="white-space:nowrap"><b>Code</b></td><td><b>Display</b></td><td><b>Definition</b></td></tr><tr><td><a href="http://smart.who.int/ts/0.1.0/CodeSystem-ICD11.html#ICD11-1D47">1D47</a></td><td>Yellow fever</td><td>Yellow fever</td></tr><tr><td><a href="http://smart.who.int/ts/0.1.0/CodeSystem-ICD11.html#ICD11-1C81">1C81</a></td><td>Poliomyelitis</td><td>Poliomyelitis</td></tr></table></li></ul><hr/><p class="res-header-id"><b>ValueSet  #ICVPVaccineCodes</b></p><a name="Questionnaire-ICVPModel/ICVPVaccineCodes"> </a><a name="hcQuestionnaire-ICVPModel/ICVPVaccineCodes"> </a><a name="Questionnaire-ICVPModel/ICVPVaccineCodes-en-US"> </a><ul><li>Include these codes as defined in <a href="http://smart.who.int/ts/0.1.0/CodeSystem-ICD11.html"><code>http://id.who.int/icd/release/11/mms</code></a><table class="none"><tr><td style="white-space:nowrap"><b>Code</b></td><td><b>Display</b></td><td><b>Definition</b></td></tr><tr><td><a href="http://smart.who.int/ts/0.1.0/CodeSystem-ICD11.html#ICD11-XM0N24">XM0N24</a></td><td>Yellow fever vaccines</td><td>Yellow fever vaccine</td></tr><tr><td><a href="http://smart.who.int/ts/0.1.0/CodeSystem-ICD11.html#ICD11-XM3418">XM3418</a></td><td>Yellow fever, live attenuated</td><td>Yellow fever, live attenuated</td></tr><tr><td><a href="http://smart.who.int/ts/0.1.0/CodeSystem-ICD11.html#ICD11-XM0N50">XM0N50</a></td><td>Poliomyelitis vaccines</td><td>Poliomyelitis vaccines</td></tr><tr><td><a href="http://smart.who.int/ts/0.1.0/CodeSystem-ICD11.html#ICD11-XM1LX9">XM1LX9</a></td><td>Diphtheria, hemophilus influenzae B, pertussis, poliomyelitis, tetanus vaccines</td><td>Diphtheria, hemophilus influenzae B, pertussis, poliomyelitis, tetanus vaccines</td></tr><tr><td><a href="http://smart.who.int/ts/0.1.0/CodeSystem-ICD11.html#ICD11-XM09Q7">XM09Q7</a></td><td>Diphtheria, pertussis, poliomyelitis, tetanus vaccines</td><td>Diphtheria, pertussis, poliomyelitis, tetanus vaccines</td></tr><tr><td><a href="http://smart.who.int/ts/0.1.0/CodeSystem-ICD11.html#ICD11-XM0LT9">XM0LT9</a></td><td>Diphtheria, pertussis, poliomyelitis, tetanus, hepatitis B vaccines</td><td>Diphtheria, pertussis, poliomyelitis, tetanus, hepatitis B vaccines</td></tr><tr><td><a href="http://smart.who.int/ts/0.1.0/CodeSystem-ICD11.html#ICD11-XM8AW1">XM8AW1</a></td><td>Diphtheria, poliomyelitis, tetanus vaccines</td><td>Diphtheria, poliomyelitis, tetanus vaccines</td></tr><tr><td><a href="http://smart.who.int/ts/0.1.0/CodeSystem-ICD11.html#ICD11-XM01H1">XM01H1</a></td><td>Hemophilus influenzae B and poliomyelitis vaccines</td><td>Hemophilus influenzae B and poliomyelitis vaccines</td></tr><tr><td><a href="http://smart.who.int/ts/0.1.0/CodeSystem-ICD11.html#ICD11-XM21E6">XM21E6</a></td><td>Diphtheria tetanus, acellular pertussis, inactivated polio virus, haemophilus Influenzae type B vaccines</td><td>Diphtheria tetanus, acellular pertussis, inactivated polio virus, haemophilus Influenzae type B vaccines</td></tr><tr><td><a href="http://smart.who.int/ts/0.1.0/CodeSystem-ICD11.html#ICD11-XM84S1">XM84S1</a></td><td>Diphtheria, hepatitis B, tetanus, acellular pertussis, inactivated polio virus, haemophilus Influenzae type B vaccines</td><td>Diphtheria, hepatitis B, tetanus, acellular pertussis, inactivated polio virus, haemophilus Influenzae type B vaccines</td></tr><tr><td><a href="http://smart.who.int/ts/0.1.0/CodeSystem-ICD11.html#ICD11-XM9JP8">XM9JP8</a></td><td>Diphtheria, tetanus, acellular pertussis, inactivated polio virus vaccines</td><td>Diphtheria, tetanus, acellular pertussis, inactivated polio virus vaccines</td></tr><tr><td><a href="http://smart.who.int/ts/0.1.0/CodeSystem-ICD11.html#ICD11-XM5V19">XM5V19</a></td><td>Poliomyelitis, trivalent, inactivated, whole virus</td><td>Poliomyelitis, trivalent, inactivated, whole virus</td></tr><tr><td><a href="http://smart.who.int/ts/0.1.0/CodeSystem-ICD11.html#ICD11-XM79H3">XM79H3</a></td><td>Poliomyelitis oral, bivalent, live attenuated</td><td>Poliomyelitis oral, bivalent, live attenuated</td></tr><tr><td><a href="http://smart.who.int/ts/0.1.0/CodeSystem-ICD11.html#ICD11-XM0VX8">XM0VX8</a></td><td>Poliomyelitis oral, monovalent live attenuated</td><td>Poliomyelitis oral, monovalent live attenuated</td></tr><tr><td><a href="http://smart.who.int/ts/0.1.0/CodeSystem-ICD11.html#ICD11-XM0KZ1">XM0KZ1</a></td><td>Poliomyelitis oral, trivalent, live attenuated</td><td>Poliomyelitis oral, trivalent, live attenuated</td></tr></table></li></ul><hr/><p class="res-header-id"><b>ValueSet  #doseNumber</b></p><a name="Questionnaire-ICVPModel/doseNumber"> </a><a name="hcQuestionnaire-ICVPModel/doseNumber"> </a><a name="Questionnaire-ICVPModel/doseNumber-en-US"> </a><ul><li>Include all codes defined in <a href="CodeSystem-doseNumber.html"><code>http://smart.who.int/icvp/CodeSystem/doseNumber</code></a></li></ul><hr/><p class="res-header-id"><b>ValueSet  #DVCRelationshipStatus</b></p><a name="Questionnaire-ICVPModel/DVCRelationshipStatus"> </a><a name="hcQuestionnaire-ICVPModel/DVCRelationshipStatus"> </a><a name="Questionnaire-ICVPModel/DVCRelationshipStatus-en-US"> </a><ul><li>Include all codes defined in <a href="CodeSystem-DVCRelationshipStatus.html"><code>http://smart.who.int/icvp/CodeSystem/DVCRelationshipStatus</code></a></li></ul></div>
  </text>
  <contained>
    <ValueSet>
      <id value="v2-0001"/>
      <meta>
        <profile
                 value="http://hl7.org/fhir/StructureDefinition/shareablevalueset"/>
      </meta>
      <language value="en"/>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status">
        <valueCode value="external"/>
      </extension>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm">
        <valueInteger value="0"/>
      </extension>
      <url value="http://terminology.hl7.org/ValueSet/v2-0001"/>
      <version value="2.9"/>
      <name value="v2.0001"/>
      <title value="v2 SEX"/>
      <status value="active"/>
      <experimental value="false"/>
      <publisher value="HL7, Inc"/>
      <contact>
        <telecom>
          <system value="url"/>
          <value value="http://hl7.org"/>
        </telecom>
      </contact>
      <description
                   value="FHIR Value set/code system definition for HL7 v2 table 0001 ( SEX)"/>
      <immutable value="true"/>
      <compose>
        <include>
          <system value="http://terminology.hl7.org/CodeSystem/v2-0001"/>
        </include>
      </compose>
    </ValueSet>
  </contained>
  <contained>
    <ValueSet>
      <id value="v3-Country"/>
      <language value="en"/>
      <text>
        <status value="generated"/>
        <div xml:lang="en" xmlns="http://www.w3.org/1999/xhtml" lang="en"><p class="res-header-id"><b>Generated Narrative: ValueSet v3-Country</b></p><a name="v3-Country"> </a><a name="hcv3-Country"> </a><a name="v3-Country-en-US"> </a><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Language: en</p></div><ul><li>Include codes from<a href="CodeSystem-ISO3166Part1.html"><code>urn:iso:std:iso:3166</code></a> where code  matches (by regex) [A-Z]{3}</li></ul></div>
      </text>
      <url value="http://terminology.hl7.org/ValueSet/v3-Country"/>
      <identifier>
        <system value="urn:ietf:rfc:3986"/>
        <value value="urn:oid:2.16.840.1.113883.1.11.171"/>
      </identifier>
      <version value="3.0.0"/>
      <name value="Country"/>
      <title value="Country"/>
      <status value="active"/>
      <experimental value="false"/>
      <date value="2014-03-26"/>
      <publisher value="Health Level Seven International"/>
      <contact>
        <telecom>
          <system value="url"/>
          <value value="http://hl7.org"/>
        </telecom>
        <telecom>
          <system value="email"/>
          <value value="hq@HL7.org"/>
        </telecom>
      </contact>
      <description
                   value="Countries of the world. ISO 3166, part 1, alpha-3 set."/>
      <copyright
                 value="This material derives from the HL7 Terminology THO. THO is copyright ©1989+ Health Level Seven International and is made available under the CC0 designation. For more licensing information see: https://terminology.hl7.org/license.html"/>
      <compose>
        <include>
          <system value="urn:iso:std:iso:3166"/>
          <filter>
            <property value="code"/>
            <op value="regex"/>
            <value value="[A-Z]{3}"/>
          </filter>
        </include>
      </compose>
    </ValueSet>
  </contained>
  <contained>
    <ValueSet>
      <id value="ICVPDiseaseTargeted"/>
      <url value="http://smart.who.int/icvp/ValueSet/ICVPDiseaseTargeted"/>
      <name value="ICVPDiseaseTargeted"/>
      <title value="ICVP Disease Targeted"/>
      <status value="draft"/>
      <description value="Value set for yellow fever and polio only"/>
      <compose>
        <include>
          <system value="http://id.who.int/icd/release/11/mms"/>
          <concept>
            <code value="1D47"/>
            <display value="Yellow fever"/>
          </concept>
          <concept>
            <code value="1C81"/>
            <display value="Poliomyelitis"/>
          </concept>
        </include>
      </compose>
    </ValueSet>
  </contained>
  <contained>
    <ValueSet>
      <id value="ICVPVaccineCodes"/>
      <url value="http://smart.who.int/icvp/ValueSet/ICVPVaccineCodes"/>
      <name value="ICVPVaccineCodes"/>
      <title value="ICVP - Vaccine Codes"/>
      <status value="draft"/>
      <description value="This value set includes codes from ICVP"/>
      <compose>
        <include>
          <system value="http://id.who.int/icd/release/11/mms"/>
          <concept>
            <code value="XM0N24"/>
            <display value="Yellow fever vaccines"/>
          </concept>
          <concept>
            <code value="XM3418"/>
            <display value="Yellow fever, live attenuated"/>
          </concept>
          <concept>
            <code value="XM0N50"/>
            <display value="Poliomyelitis vaccines"/>
          </concept>
          <concept>
            <code value="XM1LX9"/>
            <display
                     value="Diphtheria, hemophilus influenzae B, pertussis, poliomyelitis, tetanus vaccines"/>
          </concept>
          <concept>
            <code value="XM09Q7"/>
            <display
                     value="Diphtheria, pertussis, poliomyelitis, tetanus vaccines"/>
          </concept>
          <concept>
            <code value="XM0LT9"/>
            <display
                     value="Diphtheria, pertussis, poliomyelitis, tetanus, hepatitis B vaccines"/>
          </concept>
          <concept>
            <code value="XM8AW1"/>
            <display value="Diphtheria, poliomyelitis, tetanus vaccines"/>
          </concept>
          <concept>
            <code value="XM01H1"/>
            <display
                     value="Hemophilus influenzae B and poliomyelitis vaccines"/>
          </concept>
          <concept>
            <code value="XM21E6"/>
            <display
                     value="Diphtheria tetanus, acellular pertussis, inactivated polio virus, haemophilus Influenzae type B vaccines"/>
          </concept>
          <concept>
            <code value="XM84S1"/>
            <display
                     value="Diphtheria, hepatitis B, tetanus, acellular pertussis, inactivated polio virus, haemophilus Influenzae type B vaccines"/>
          </concept>
          <concept>
            <code value="XM9JP8"/>
            <display
                     value="Diphtheria, tetanus, acellular pertussis, inactivated polio virus vaccines"/>
          </concept>
          <concept>
            <code value="XM5V19"/>
            <display
                     value="Poliomyelitis, trivalent, inactivated, whole virus"/>
          </concept>
          <concept>
            <code value="XM79H3"/>
            <display value="Poliomyelitis oral, bivalent, live attenuated"/>
          </concept>
          <concept>
            <code value="XM0VX8"/>
            <display value="Poliomyelitis oral, monovalent live attenuated"/>
          </concept>
          <concept>
            <code value="XM0KZ1"/>
            <display value="Poliomyelitis oral, trivalent, live attenuated"/>
          </concept>
        </include>
      </compose>
    </ValueSet>
  </contained>
  <contained>
    <ValueSet>
      <id value="doseNumber"/>
      <url value="http://smart.who.int/icvp/ValueSet/doseNumber"/>
      <name value="doseNumber"/>
      <title value="Dose Number"/>
      <status value="draft"/>
      <description value="Dose Number value set"/>
      <compose>
        <include>
          <system value="http://smart.who.int/icvp/CodeSystem/doseNumber"/>
        </include>
      </compose>
    </ValueSet>
  </contained>
  <contained>
    <ValueSet>
      <id value="DVCRelationshipStatus"/>
      <url value="http://smart.who.int/icvp/ValueSet/DVCRelationshipStatus"/>
      <name value="DVCRelationshipStatus"/>
      <title value="Relationship Status for Contact in Patient"/>
      <status value="draft"/>
      <description value="Relationship Status for Contact in Patient"/>
      <compose>
        <include>
          <system
                  value="http://smart.who.int/icvp/CodeSystem/DVCRelationshipStatus"/>
        </include>
      </compose>
    </ValueSet>
  </contained>
  <url
       value="http://smart.who.int/icvp/Questionnaire/Questionnaire-ICVPModel"/>
  <version value="0.1.0"/>
  <title value="ICVP Model Questionnaire"/>
  <status value="draft"/>
  <date value="2024-12-11T15:43:16+00:00"/>
  <publisher value="WHO"/>
  <contact>
    <name value="WHO"/>
    <telecom>
      <system value="url"/>
      <value value="http://who.int"/>
    </telecom>
  </contact>
  <description value="Questionnaire for ICVP Logical Model"/>
  <item>
    <linkId value="name"/>
    <text value="Full Name of the client"/>
    <type value="string"/>
    <required value="true"/>
    <repeats value="false"/>
  </item>
  <item>
    <linkId value="dob"/>
    <text value="Date of Birth"/>
    <type value="date"/>
    <required value="true"/>
    <repeats value="false"/>
  </item>
  <item>
    <linkId value="sex"/>
    <text value="Sex"/>
    <type value="choice"/>
    <required value="false"/>
    <repeats value="false"/>
    <answerValueSet value="http://terminology.hl7.org/ValueSet/v2-0001"/>
  </item>
  <item>
    <linkId value="nationality"/>
    <text value="Nationality"/>
    <type value="choice"/>
    <required value="false"/>
    <repeats value="false"/>
    <answerValueSet value="http://terminology.hl7.org/ValueSet/v3-Country"/>
  </item>
  <item>
    <linkId value="nid"/>
    <text value="National Identification Document"/>
    <type value="string"/>
    <required value="false"/>
    <repeats value="false"/>
  </item>
  <item>
    <linkId value="guardian"/>
    <text value="Parent or Guardian Details"/>
    <type value="group"/>
    <required value="false"/>
    <repeats value="false"/>
    <item>
      <linkId value="guardianName"/>
      <text value="Name of Parent or Guardian"/>
      <type value="string"/>
      <required value="false"/>
      <repeats value="false"/>
    </item>
    <item>
      <linkId value="guardianRelationship"/>
      <text value="Relationship Status"/>
      <type value="choice"/>
      <required value="false"/>
      <repeats value="false"/>
      <answerValueSet value="#DVCRelationshipStatus"/>
    </item>
  </item>
  <item>
    <linkId value="vaccinDetails"/>
    <text value="Vaccine Certificate Details"/>
    <type value="group"/>
    <required value="true"/>
    <repeats value="true"/>
    <item>
      <linkId value="doseNumber"/>
      <text value="Dose Number"/>
      <type value="choice"/>
      <required value="true"/>
      <repeats value="false"/>
      <answerValueSet value="#doseNumber"/>
    </item>
    <item>
      <linkId value="disease"/>
      <text
            value="Name of disease of condition vaccinated or received prophylaxis against"/>
      <type value="choice"/>
      <required value="true"/>
      <repeats value="false"/>
      <answerValueSet value="#ICVPDiseaseTargeted"/>
    </item>
    <item>
      <linkId value="vaccineClassification"/>
      <text value="Vaccine or Prophylaxis classification code"/>
      <type value="choice"/>
      <required value="true"/>
      <repeats value="false"/>
      <answerValueSet value="#ICVPVaccineCodes"/>
    </item>
    <item>
      <linkId value="vaccineTradeItem"/>
      <text value="Vaccine Trade Item"/>
      <type value="string"/>
      <required value="false"/>
      <repeats value="false"/>
    </item>
    <item>
      <linkId value="date"/>
      <text value="Date of Vaccination"/>
      <type value="date"/>
      <required value="true"/>
      <repeats value="false"/>
    </item>
    <item>
      <linkId value="clinicianName"/>
      <text value="Name of supervising clinician"/>
      <type value="string"/>
      <required value="false"/>
      <repeats value="false"/>
    </item>
    <item>
      <linkId value="issuer"/>
      <text
            value="Relevant authoring reponsible for issuing the certificate, or for overseeing the administration center"/>
      <type value="string"/>
      <required value="false"/>
      <repeats value="false"/>
    </item>
    <item>
      <linkId value="manufacturerId"/>
      <text value="Manufacturer ID"/>
      <type value="string"/>
      <required value="false"/>
      <repeats value="false"/>
    </item>
    <item>
      <linkId value="manufacturer"/>
      <text value="Name of Manufacturer of Vaccine"/>
      <type value="string"/>
      <required value="true"/>
      <repeats value="false"/>
    </item>
    <item>
      <linkId value="batchNo"/>
      <text value="Batch Number"/>
      <type value="string"/>
      <required value="true"/>
      <repeats value="false"/>
    </item>
    <item>
      <linkId value="validityPeriod"/>
      <text value="Certificate Validity Period"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="false"/>
      <item>
        <linkId value="startDate"/>
        <text value="From"/>
        <type value="date"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
      <item>
        <linkId value="endDate"/>
        <text value="To"/>
        <type value="date"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
    </item>
  </item>
</Questionnaire>