WHO Immunization Implementation Guide
0.2.0 - ci-build
WHO Immunization Implementation Guide, published by WHO. This guide is not an authorized publication; it is the continuous build for version 0.2.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/WorldHealthOrganization/smart-immunizations/tree/123/merge and changes regularly. See the Directory of published versions
| Draft as of 2026-03-03 |
<PlanDefinition xmlns="http://hl7.org/fhir">
<id value="IMMZD2DTDTPPregnancyStartingWith4Doses"/>
<meta>
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value="http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-recommendationdefinition"/>
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<text>
<status value="extensions"/>
<div xmlns="http://www.w3.org/1999/xhtml">
<div>
<table class="grid dict">
<tr>
<th scope="row"><b>Id: </b></th>
<td style="padding-left: 4px;">IMMZD2DTDTPPregnancyStartingWith4Doses</td>
</tr>
<tr>
<th scope="row"><b>Url: </b></th>
<td style="padding-left: 4px;"><a href="PlanDefinition-IMMZD2DTDTPPregnancyStartingWith4Doses.html">IMMZ.D2.DT.DTP.Pregnancy starting with 4 doses</a></td>
</tr>
<tr>
<th scope="row"><b>Version: </b></th>
<td style="padding-left: 4px;">0.2.0</td>
</tr>
<tr>
<th scope="row"><b>Title: </b></th>
<td style="padding-left: 4px;">IMMZ.D2.DT.DTP.Pregnancy starting with 4 doses</td>
</tr>
<tr>
<th scope="row"><b>Status: </b></th>
<td style="padding-left: 4px;">draft</td>
</tr>
<tr>
<th scope="row"><b>Type: </b></th>
<td style="padding-left: 4px;">
<p style="margin-bottom: 5px;">
<b>system: </b> <span><a href="http://terminology.hl7.org/7.0.1/CodeSystem-plan-definition-type.html">http://terminology.hl7.org/CodeSystem/plan-definition-type</a></span>
</p>
<p style="margin-bottom: 5px;">
<b>code: </b> <span>eca-rule</span>
</p>
</td>
</tr>
<tr>
<th scope="row"><b>Date: </b></th>
<td style="padding-left: 4px;">2026-03-03 13:07:11+0000</td>
</tr>
<tr>
<th scope="row"><b>Publisher: </b></th>
<td style="padding-left: 4px;">WHO</td>
</tr>
<tr>
<th scope="row"><b>Description: </b></th>
<td style="padding-left: 4px;"><div><p>IMMZ.D2.DT.DTP.Pregnancy starting with 4 doses
Diphtheria and tetanus vaccination schedule in pregnant women who received 4 childhood DTP doses</p>
</div></td>
</tr>
<tr>
<th scope="row"><b>Knowledge Capability: </b></th>
<td style="padding-left: 4px;">
computable
</td>
</tr>
<tr>
<th scope="row"><b>Related Artifacts: </b></th>
<td style="padding-left: 4px;">
<p><b>References</b></p>
<ul>
<li><div><p>WHO recommendations for routine immunization - summary tables (January 2025)</p>
</div><br/><a href="null"/></li>
</ul>
</td>
</tr>
<tr>
<th scope="row"><b>Libraries: </b></th>
<td style="padding-left: 4px;">
<table class="grid-dict">
<tr>
<td><a href="Library-IMMZD2DTDTPPregnancyStartingWith4DosesLogic.html">IMMZD2DTDTPPregnancyStartingWith4DosesLogic</a></td>
</tr>
</table>
</td>
</tr>
<tr>
<th scope="row"><b>Actions: </b></th>
<td style="padding-left: 4px;">
<table class="grid-dict">
<tr>
<td>
<b> Determine if the client is due for DTP.:</b> Determine if the client is due for DTP vaccine according to the national immunization protocol.
Diphtheria and tetanus vaccination schedule in pregnant women who received 4 childhood DTP doses
<br/>
<b>If:</b>
<i>Applicability:</i>
Client is due for tetanus and diphtheria booster dose
<i>(Client is due for tetanus and diphtheria booster dose)</i>
<br/>
<b>Then:</b> <i>Definition:</i> <a href="ActivityDefinition-IMMZD2DTMR.html">IMMZD2DTMR</a><br/>
<i>Dynamic Values:</i><br/>
status: <i>('draft')</i>
<br/>
intent: <i>('proposal')</i>
<br/>
medication: <i>(Concept { codes: { Code { system: 'http://smart.who.int/immunizations/CodeSystem/IMMZ.Z', code: 'DE28', display: 'Tetanus and diphtheria-containing vaccines' } }, display: 'Tetanus and diphtheria-containing vaccines' })</i>
<br/>
</td>
</tr>
<tr>
<td>
<b> Check for Guidance for the patient regarding IMMZ.D2.DT.DTP.Pregnancy starting with 4 doses.:</b> Show Guidance for the patient regarding IMMZ.D2.DT.DTP.Pregnancy starting with 4 doses.
<br/>
<b>If:</b>
<i>Applicability:</i>
Has Guidance
<i>(Has Guidance)</i>
<br/>
<b>Then:</b> <i>Definition:</i> <a href="ActivityDefinition-IMMZD2DTCR.html">IMMZ.D2.DT.CR</a><br/>
<i>Dynamic Values:</i><br/>
status: <i>('active')</i>
<br/>
payload.contentString: <i>(Guidance)</i>
<br/>
category.coding: <i>(Code { system: 'http://terminology.hl7.org/CodeSystem/communication-category', code: 'alert' })</i>
<br/>
priority: <i>(Code { system: 'http://hl7.org/fhir/request-priority', code: 'routine' })</i>
<br/>
</td>
</tr>
</table>
</td>
</tr>
</table>
</div>
</div>
</text>
<contained>
<Library>
<id value="effective-data-requirements"/>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode">
<valueCoding>
<system
value="http://smart.who.int/immunizations/CodeSystem/IMMZ.D"/>
<code value="DE161"/>
<display value="Potential contraindications"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode">
<valueCoding>
<system
value="http://smart.who.int/immunizations/CodeSystem/IMMZ.D"/>
<code value="DE162"/>
<display value="Currently pregnant"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode">
<valueCoding>
<system
value="http://terminology.hl7.org/CodeSystem/condition-clinical"/>
<code value="active"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode">
<valueCoding>
<system
value="http://terminology.hl7.org/CodeSystem/condition-clinical"/>
<code value="recurrence"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode">
<valueCoding>
<system
value="http://terminology.hl7.org/CodeSystem/condition-clinical"/>
<code value="relapse"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode">
<valueCoding>
<system value="http://loinc.org"/>
<code value="82810-3"/>
<display value="Pregnancy status"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode">
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA15173-0"/>
<display value="Pregnant"/>
</valueCoding>
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<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="IMMZElements"/>
</extension>
<extension url="name">
<valueString value="Doses Administered to Patient"/>
</extension>
<extension url="statement">
<valueString
value="/**
* @dataElement All Doses Administered to Patient
*/
define "Doses Administered to Patient":
[Immunization] I
where I.status = 'completed'
and I.isSubpotent is not true"/>
</extension>
<extension url="displaySequence">
<valueInteger value="0"/>
</extension>
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<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="IMMZD2DTDTPElements"/>
</extension>
<extension url="name">
<valueString value="DTP Doses Administered to Patient"/>
</extension>
<extension url="statement">
<valueString
value="/*
@internal: DTP containing Doses Administered to Patient
*/
define "DTP Doses Administered to Patient":
Elements."Doses Administered to Patient" I
where
I.vaccineCode in Concepts."DTP-containing vaccines""/>
</extension>
<extension url="displaySequence">
<valueInteger value="1"/>
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<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="IMMZD2DTDTPElements"/>
</extension>
<extension url="name">
<valueString
value="DTP Primary Series Doses Administered to Patient"/>
</extension>
<extension url="statement">
<valueString
value="/*
@internal: DTP containing Doses Administered to Patient that are in the Primary series
*/
define "DTP Primary Series Doses Administered to Patient":
"DTP Doses Administered to Patient".seriesPrimary()"/>
</extension>
<extension url="displaySequence">
<valueInteger value="2"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="IMMZD2DTDTPEncounterElements"/>
</extension>
<extension url="name">
<valueString
value="DTP Primary Series Doses Administered to Patient"/>
</extension>
<extension url="statement">
<valueString
value="/*
@internal: DTP containing Doses Administered to Patient that are in the Primary series
*/
define "DTP Primary Series Doses Administered to Patient":
DTPElements."DTP Primary Series Doses Administered to Patient".onOrBefore(Today)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="3"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="IMMZD2DTDTPEncounterElements"/>
</extension>
<extension url="name">
<valueString
value="Number of DTP Primary Series Doses Administered"/>
</extension>
<extension url="statement">
<valueString
value="/*
@internal: Number of DTP Primary Series doses
*/
define "Number of DTP Primary Series Doses Administered":
Count("DTP Primary Series Doses Administered to Patient")"/>
</extension>
<extension url="displaySequence">
<valueInteger value="4"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="IMMZD2DTDTPEncounterElements"/>
</extension>
<extension url="name">
<valueString
value="Three DTP primary series doses were administered"/>
</extension>
<extension url="statement">
<valueString
value="/*
@input: Three DTP primary series doses were administered
@pseudocode: Count of vaccines administered (where "Vaccine type" = "DTP-containing vaccines" and "Type of dose" = "Primary series") = 3
@code: Three DTP primary series doses were administered-123
@decision: IMMZ.D2.DT.DTP.On-time start: DTP vaccination schedule, on-time start (at ≤ 12 months of age)
@decision: IMMZ.D2.DT.DTP.Delayed or interrupted series: DTP vaccination schedule for the following groups: children ≥ 1 year of age with no previous immunization, adolescents and adults with no previous immunization (including pregnant women) and supplementary immunization activities in high-risk areas, for women of reproductive age
@decision: IMMZ.D2.DT.DTP.Pregnancy: Determine whether DTP-containing vaccines are needed for pregnant women
@decision: IMMZ.D2.DT.DTP.Pregnancy starting with 3 doses: Diphtheria and tetanus vaccination schedule in pregnant women who received 3 childhood DTP doses
@decision: IMMZ.D2.DT.DTP.Pregnancy starting with 4 doses: Diphtheria and tetanus vaccination schedule in pregnant women who received 4 childhood DTP doses
*/
define "Three DTP primary series doses were administered":
"Number of DTP Primary Series Doses Administered" = 3"/>
</extension>
<extension url="displaySequence">
<valueInteger value="5"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="IMMZD2DTDTPElements"/>
</extension>
<extension url="name">
<valueString value="Td Doses Administered to Patient"/>
</extension>
<extension url="statement">
<valueString
value="/*
@internal: Td Doses Administered to Patient
*/
define "Td Doses Administered to Patient":
Elements."Doses Administered to Patient" I
where
I.vaccineCode in Concepts."Tetanus and diphtheria-containing vaccines""/>
</extension>
<extension url="displaySequence">
<valueInteger value="6"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="IMMZD2DTDTPElements"/>
</extension>
<extension url="name">
<valueString
value="Td Booster Series Doses Administered to Patient"/>
</extension>
<extension url="statement">
<valueString
value="/*
@internal: Td Booster Series Doses Administered to Patient
*/
define "Td Booster Series Doses Administered to Patient":
"Td Doses Administered to Patient".seriesBooster()"/>
</extension>
<extension url="displaySequence">
<valueInteger value="7"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="IMMZD2DTDTPEncounterElements"/>
</extension>
<extension url="name">
<valueString
value="Td Booster Series Doses Administered to Patient"/>
</extension>
<extension url="statement">
<valueString
value="/*
@internal: Td Booster Series Doses Administered to Patient
*/
define "Td Booster Series Doses Administered to Patient":
DTPElements."Td Booster Series Doses Administered to Patient".onOrBefore(Today)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="8"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="IMMZD2DTDTPEncounterElements"/>
</extension>
<extension url="name">
<valueString
value="Number of Td Booster Series Doses Administered"/>
</extension>
<extension url="statement">
<valueString
value="/*
@internal: Number of Td Booster Series Doses Administered
*/
define "Number of Td Booster Series Doses Administered":
Count("Td Booster Series Doses Administered to Patient")"/>
</extension>
<extension url="displaySequence">
<valueInteger value="9"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="IMMZD2DTDTPEncounterElements"/>
</extension>
<extension url="name">
<valueString
value="One tetanus and diphtheria booster dose was administered"/>
</extension>
<extension url="statement">
<valueString
value="/*
@input: One tetanus and diphtheria booster dose was administered
@pseudocode: Count of vaccines administered (where "Vaccine type" = "Tetanus and diphtheria-containing vaccines" and "Type of dose" = "Booster dose") = 1
@code: One tetanus and diphtheria booster dose was administered-140
@decision: IMMZ.D2.DT.DTP.On-time start: DTP vaccination schedule, on-time start (at ≤ 12 months of age)
@decision: IMMZ.D2.DT.DTP.Delayed or interrupted series: DTP vaccination schedule for the following groups: children ≥ 1 year of age with no previous immunization, adolescents and adults with no previous immunization (including pregnant women) and supplementary immunization activities in high-risk areas, for women of reproductive age
@decision: IMMZ.D2.DT.DTP.Pregnancy: Determine whether DTP-containing vaccines are needed for pregnant women
@decision: IMMZ.D2.DT.DTP.Pregnancy starting with 4 doses: Diphtheria and tetanus vaccination schedule in pregnant women who received 4 childhood DTP doses
*/
define "One tetanus and diphtheria booster dose was administered":
"Number of Td Booster Series Doses Administered" = 1"/>
</extension>
<extension url="displaySequence">
<valueInteger value="10"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="IMMZElements"/>
</extension>
<extension url="name">
<valueString value="Potential contraindications"/>
</extension>
<extension url="statement">
<valueString
value="/*
@internal: Potential contraindications observations
*/
define "Potential contraindications":
([Observation: Concepts."Potential contraindications"]).complete()"/>
</extension>
<extension url="displaySequence">
<valueInteger value="11"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="IMMZElements"/>
</extension>
<extension url="name">
<valueString value="CI Currently pregnant Observation"/>
</extension>
<extension url="statement">
<valueString
value="/*
@internal: Observation for currently pregnant
*/
define "CI Currently pregnant Observation":
"Potential contraindications" O
where O.value ~ Concepts."CI-Currently pregnant""/>
</extension>
<extension url="displaySequence">
<valueInteger value="12"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="IMMZEncounterElements"/>
</extension>
<extension url="name">
<valueString value="CI Currently pregnant Observation"/>
</extension>
<extension url="statement">
<valueString
value="/*
@internal: Observation for currently pregnant
*/
define "CI Currently pregnant Observation":
Elements."CI Currently pregnant Observation" O
where O.encounter.references(EncounterId)
or O.effective.toInterval() starts same day or after Today - 9 months"/>
</extension>
<extension url="displaySequence">
<valueInteger value="13"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="IMMZElements"/>
</extension>
<extension url="name">
<valueString value="CI Currently pregnant Condition"/>
</extension>
<extension url="statement">
<valueString
value="/*
@internal: Condition for currently pregnant
*/
define "CI Currently pregnant Condition":
[Condition: Concepts."CI-Currently pregnant"]"/>
</extension>
<extension url="displaySequence">
<valueInteger value="14"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="IMMZEncounterElements"/>
</extension>
<extension url="name">
<valueString value="CI Currently pregnant Condition"/>
</extension>
<extension url="statement">
<valueString
value="/*
@internal: Condition for currently pregnant
*/
define "CI Currently pregnant Condition":
Elements."CI Currently pregnant Condition" C
where C.prevalenceInterval() includes Today"/>
</extension>
<extension url="displaySequence">
<valueInteger value="15"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="WHOElements"/>
</extension>
<extension url="name">
<valueString value="Pregnancy Status Observation"/>
</extension>
<extension url="statement">
<valueString
value="define "Pregnancy Status Observation":
[Observation: Concepts."Pregnancy status"] O
where O.status in { 'final', 'amended', 'corrected' }"/>
</extension>
<extension url="displaySequence">
<valueInteger value="16"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="WHOElements"/>
</extension>
<extension url="name">
<valueString value="Pregnant Observation"/>
</extension>
<extension url="statement">
<valueString
value="define "Pregnant Observation":
"Pregnancy Status Observation" O
where O.value ~ Concepts."Pregnant""/>
</extension>
<extension url="displaySequence">
<valueInteger value="17"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="WHOEncounterElements"/>
</extension>
<extension url="name">
<valueString value="Pregnant Observation"/>
</extension>
<extension url="statement">
<valueString
value="define "Pregnant Observation":
Elements."Pregnant Observation" O
where O.encounter.references(EncounterId)
or O.effective.toInterval() starts same day or after AsOf - 9 months"/>
</extension>
<extension url="displaySequence">
<valueInteger value="18"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="IMMZEncounterElements"/>
</extension>
<extension url="name">
<valueString value="The client is pregnant"/>
</extension>
<extension url="statement">
<valueString
value="/*
@input: The client is pregnant
@pseudocode: "Potential contraindications" = "Currently pregnant"
*/
define "The client is pregnant":
exists "CI Currently pregnant Observation"
or exists "CI Currently pregnant Condition"
or exists WE."Pregnant Observation""/>
</extension>
<extension url="displaySequence">
<valueInteger value="19"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="IMMZD2DTDTPEncounterElements"/>
</extension>
<extension url="name">
<valueString value="Client is currently pregnant"/>
</extension>
<extension url="statement">
<valueString
value="/*
@input: Client is currently pregnant
@pseudocode: "Currently pregnant" = TRUE
@code: Client is currently pregnant-27
@decision: IMMZ.D2.DT.DTP.Pregnancy: Determine whether DTP-containing vaccines are needed for pregnant women
@decision: IMMZ.D2.DT.DTP.Pregnancy starting with 3 doses: Diphtheria and tetanus vaccination schedule in pregnant women who received 3 childhood DTP doses
@decision: IMMZ.D2.DT.DTP.Pregnancy starting with 4 doses: Diphtheria and tetanus vaccination schedule in pregnant women who received 4 childhood DTP doses
*/
define "Client is currently pregnant":
Encounter."The client is pregnant""/>
</extension>
<extension url="displaySequence">
<valueInteger value="20"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="IMMZD2DTDTPPregnancyStartingWith4DosesLogic"/>
</extension>
<extension url="name">
<valueString
value="Client is due for tetanus and diphtheria booster dose Case 1"/>
</extension>
<extension url="statement">
<valueString
value="/*
@output: Client is due for tetanus and diphtheria booster dose Case 1
@pseudocode: "Immunization recommendation status" = "Due" (where "Vaccine type" = "Tetanus and diphtheria-containing vaccines")
*/
define "Client is due for tetanus and diphtheria booster dose Case 1":
Encounter."Three DTP primary series doses were administered"
and Encounter."One tetanus and diphtheria booster dose was administered"
and Encounter."Client is currently pregnant""/>
</extension>
<extension url="displaySequence">
<valueInteger value="21"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="IMMZD2DTDTPEncounterElements"/>
</extension>
<extension url="name">
<valueString
value="Two tetanus and diphtheria booster doses were administered"/>
</extension>
<extension url="statement">
<valueString
value="/*
@input: Two tetanus and diphtheria booster doses were administered
@pseudocode: Count of vaccines administered (where "Vaccine type" = "Tetanus and diphtheria-containing vaccines" and "Type of dose" = "Booster dose") = 2
@code: Two tetanus and diphtheria booster doses were administered-140
@decision: IMMZ.D2.DT.DTP.On-time start: DTP vaccination schedule, on-time start (at ≤ 12 months of age)
@decision: IMMZ.D2.DT.DTP.Delayed or interrupted series: DTP vaccination schedule for the following groups: children ≥ 1 year of age with no previous immunization, adolescents and adults with no previous immunization (including pregnant women) and supplementary immunization activities in high-risk areas, for women of reproductive age
@decision: IMMZ.D2.DT.DTP.Pregnancy: Determine whether DTP-containing vaccines are needed for pregnant women
@decision: IMMZ.D2.DT.DTP.Pregnancy starting with 3 doses: Diphtheria and tetanus vaccination schedule in pregnant women who received 3 childhood DTP doses
@decision: IMMZ.D2.DT.DTP.Pregnancy starting with 4 doses: Diphtheria and tetanus vaccination schedule in pregnant women who received 4 childhood DTP doses
*/
define "Two tetanus and diphtheria booster doses were administered":
"Number of Td Booster Series Doses Administered" = 2"/>
</extension>
<extension url="displaySequence">
<valueInteger value="22"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="IMMZD2DTDTPEncounterElements"/>
</extension>
<extension url="name">
<valueString value="Td Doses Administered to Patient"/>
</extension>
<extension url="statement">
<valueString
value="/*
@internal: Td Doses Administered to Patient
*/
define "Td Doses Administered to Patient":
DTPElements."Td Doses Administered to Patient".onOrBefore(Today)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="23"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="IMMZD2DTDTPEncounterElements"/>
</extension>
<extension url="name">
<valueString value="Date of Latest Td Dose"/>
</extension>
<extension url="statement">
<valueString
value="/*
@internal: Date of Latest Td Dose
*/
define "Date of Latest Td Dose":
date from start of "Td Doses Administered to Patient".mostRecent().occurrence.toInterval()"/>
</extension>
<extension url="displaySequence">
<valueInteger value="24"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="IMMZD2DTDTPEncounterElements"/>
</extension>
<extension url="name">
<valueString
value="The latest tetanus and diphtheria dose was administered less than 1 year ago"/>
</extension>
<extension url="statement">
<valueString
value="/*
@input: The latest tetanus and diphtheria dose was administered less than 1 year ago
@pseudocode: Today's date − latest "Date and time of vaccination" (where "Vaccine type" = "Tetanus and diphtheria-containing vaccines") < 1 year
@code: The latest tetanus and diphtheria dose was administered less than 1 year ago-131
@decision: IMMZ.D2.DT.DTP.Delayed or interrupted series: DTP vaccination schedule for the following groups: children ≥ 1 year of age with no previous immunization, adolescents and adults with no previous immunization (including pregnant women) and supplementary immunization activities in high-risk areas, for women of reproductive age
@decision: IMMZ.D2.DT.DTP.Pregnancy starting with 3 doses: Diphtheria and tetanus vaccination schedule in pregnant women who received 3 childhood DTP doses
@decision: IMMZ.D2.DT.DTP.Pregnancy starting with 4 doses: Diphtheria and tetanus vaccination schedule in pregnant women who received 4 childhood DTP doses
*/
define "The latest tetanus and diphtheria dose was administered less than 1 year ago":
"Date of Latest Td Dose" is not null
and duration in years between "Date of Latest Td Dose" and Today < 1"/>
</extension>
<extension url="displaySequence">
<valueInteger value="25"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="IMMZD2DTDTPEncounterElements"/>
</extension>
<extension url="name">
<valueString
value="The latest tetanus and diphtheria dose was administered more than 1 year ago"/>
</extension>
<extension url="statement">
<valueString
value="/*
@input: The latest tetanus and diphtheria dose was administered more than 1 year ago
@pseudocode: Today's date − latest "Date and time of vaccination" (where "Vaccine type" = "Tetanus and diphtheria-containing vaccines") ≥ 1 year
@code: The latest tetanus and diphtheria dose was administered more than 1 year ago-131
@decision: IMMZ.D2.DT.DTP.Delayed or interrupted series: DTP vaccination schedule for the following groups: children ≥ 1 year of age with no previous immunization, adolescents and adults with no previous immunization (including pregnant women) and supplementary immunization activities in high-risk areas, for women of reproductive age
@decision: IMMZ.D2.DT.DTP.Pregnancy starting with 3 doses: Diphtheria and tetanus vaccination schedule in pregnant women who received 3 childhood DTP doses
@decision: IMMZ.D2.DT.DTP.Pregnancy starting with 4 doses: Diphtheria and tetanus vaccination schedule in pregnant women who received 4 childhood DTP doses
*/
define "The latest tetanus and diphtheria dose was administered more than 1 year ago":
not("The latest tetanus and diphtheria dose was administered less than 1 year ago")"/>
</extension>
<extension url="displaySequence">
<valueInteger value="26"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="IMMZD2DTDTPPregnancyStartingWith4DosesLogic"/>
</extension>
<extension url="name">
<valueString
value="Client is due for tetanus and diphtheria booster dose Case 2"/>
</extension>
<extension url="statement">
<valueString
value="/*
@output: Client is due for tetanus and diphtheria booster dose Case 2
@pseudocode: "Immunization recommendation status" = "Due" (where "Vaccine type" = "Tetanus and diphtheria-containing vaccines")
*/
define "Client is due for tetanus and diphtheria booster dose Case 2":
Encounter."Three DTP primary series doses were administered"
and Encounter."Two tetanus and diphtheria booster doses were administered"
and Encounter."The latest tetanus and diphtheria dose was administered more than 1 year ago""/>
</extension>
<extension url="displaySequence">
<valueInteger value="27"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="IMMZD2DTDTPPregnancyStartingWith4DosesLogic"/>
</extension>
<extension url="name">
<valueString
value="Client is due for tetanus and diphtheria booster dose"/>
</extension>
<extension url="statement">
<valueString
value="/*
@output: Client is due for tetanus and diphtheria booster dose
@pseudocode: "Immunization recommendation status" = "Due" (where "Vaccine type" = "Tetanus and diphtheria-containing vaccines")
*/
define "Client is due for tetanus and diphtheria booster dose":
"Client is due for tetanus and diphtheria booster dose Case 1"
or "Client is due for tetanus and diphtheria booster dose Case 2""/>
</extension>
<extension url="displaySequence">
<valueInteger value="28"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="IMMZD2DTDTPPregnancyStartingWith4DosesLogic"/>
</extension>
<extension url="name">
<valueString
value="Client is due for tetanus and diphtheria booster dose Guidance"/>
</extension>
<extension url="statement">
<valueString
value="/*
@output: Client is due for tetanus and diphtheria booster dose Guidance
@guidance = Should vaccinate client with second tetanus and diphtheria booster dose as three DTP primary series doses and one tetanus and diphtheria booster dose were administered and client is currently pregnant.
Check for contraindications.
@guidance = Should vaccinate client with third tetanus and diphtheria booster dose as the latest tetanus and diphtheria dose was administered more than 1 year ago. This dose should be administered at least 1 year after second booster dose or during next pregnancy.
Check for contraindications.
*/
define "Client is due for tetanus and diphtheria booster dose Guidance":
case
when "Client is due for tetanus and diphtheria booster dose Case 1" then 'Should vaccinate client with second tetanus and diphtheria booster dose as three DTP primary series doses and one tetanus and diphtheria booster dose were administered and client is currently pregnant.
Check for contraindications.'
when "Client is due for tetanus and diphtheria booster dose Case 2" then 'Should vaccinate client with third tetanus and diphtheria booster dose as the latest tetanus and diphtheria dose was administered more than 1 year ago. This dose should be administered at least 1 year after second booster dose or during next pregnancy.
Check for contraindications.'
else ''
end"/>
</extension>
<extension url="displaySequence">
<valueInteger value="29"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="IMMZD2DTDTPPregnancyStartingWith4DosesLogic"/>
</extension>
<extension url="name">
<valueString
value="Client is not due for tetanus and diphtheria booster dose"/>
</extension>
<extension url="statement">
<valueString
value="/*
@output: Client is not due for tetanus and diphtheria booster dose
@pseudocode: "Immunization recommendation status" = "Not due" (where "Vaccine type" = "Tetanus and diphtheria-containing vaccines")
*/
define "Client is not due for tetanus and diphtheria booster dose":
Encounter."Three DTP primary series doses were administered"
and Encounter."Two tetanus and diphtheria booster doses were administered"
and Encounter."The latest tetanus and diphtheria dose was administered less than 1 year ago""/>
</extension>
<extension url="displaySequence">
<valueInteger value="30"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="IMMZD2DTDTPPregnancyStartingWith4DosesLogic"/>
</extension>
<extension url="name">
<valueString
value="Client is not due for tetanus and diphtheria booster dose Guidance"/>
</extension>
<extension url="statement">
<valueString
value="/*
@output: Client is not due for tetanus and diphtheria booster dose Guidance
@guidance: Should not vaccinate client with third tetanus and diphtheria booster dose as the latest tetanus and booster dose was administered less than 1 year ago. This dose should be administered at least 1 year after second booster dose or during next pregnancy.
Check for any other vaccines due and inform the caregiver of when to come back for third tetanus and diphtheria booster dose.
*/
define "Client is not due for tetanus and diphtheria booster dose Guidance":
'Should not vaccinate client with third tetanus and diphtheria booster dose as the latest tetanus and booster dose was administered less than 1 year ago. This dose should be administered at least 1 year after second booster dose or during next pregnancy.
Check for any other vaccines due and inform the caregiver of when to come back for third tetanus and diphtheria booster dose.'"/>
</extension>
<extension url="displaySequence">
<valueInteger value="31"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="IMMZD2DTDTPEncounterElements"/>
</extension>
<extension url="name">
<valueString
value="Three tetanus and diphtheria booster doses were administered"/>
</extension>
<extension url="statement">
<valueString
value="/*
@input: Three tetanus and diphtheria booster doses were administered
@pseudocode: Count of vaccines administered (where "Vaccine type" = "Tetanus and diphtheria-containing vaccines" and "Type of dose" = "Booster dose") = 3
@code: Three tetanus and diphtheria booster doses were administered-140
@decision: IMMZ.D2.DT.DTP.On-time start: DTP vaccination schedule, on-time start (at ≤ 12 months of age)
@decision: IMMZ.D2.DT.DTP.Pregnancy: Determine whether DTP-containing vaccines are needed for pregnant women
@decision: IMMZ.D2.DT.DTP.Pregnancy starting with 3 doses: Diphtheria and tetanus vaccination schedule in pregnant women who received 3 childhood DTP doses
@decision: IMMZ.D2.DT.DTP.Pregnancy starting with 4 doses: Diphtheria and tetanus vaccination schedule in pregnant women who received 4 childhood DTP doses
*/
define "Three tetanus and diphtheria booster doses were administered":
"Number of Td Booster Series Doses Administered" = 3"/>
</extension>
<extension url="displaySequence">
<valueInteger value="32"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="IMMZD2DTDTPPregnancyStartingWith4DosesLogic"/>
</extension>
<extension url="name">
<valueString
value="Tetanus and diphtheria immunization schedule is complete"/>
</extension>
<extension url="statement">
<valueString
value="/*
@output: Tetanus and diphtheria immunization schedule is complete
@pseudocode: "Immunization recommendation status" = "Complete" (where "Vaccine type" = "Tetanus and diphtheria-containing vaccines")
*/
define "Tetanus and diphtheria immunization schedule is complete":
Encounter."Three DTP primary series doses were administered"
and Encounter."Three tetanus and diphtheria booster doses were administered""/>
</extension>
<extension url="displaySequence">
<valueInteger value="33"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="IMMZD2DTDTPPregnancyStartingWith4DosesLogic"/>
</extension>
<extension url="name">
<valueString
value="Tetanus and diphtheria immunization schedule is complete Guidance"/>
</extension>
<extension url="statement">
<valueString
value="/*
@output: Tetanus and diphtheria immunization schedule is complete Guidance
@guidance: Tetanus and diphtheria immunization schedule is complete. Three DTP primary series doses and three tetanus and diphtheria booster doses were administered.
Check for any other vaccines due.
*/
define "Tetanus and diphtheria immunization schedule is complete Guidance":
'Tetanus and diphtheria immunization schedule is complete. Three DTP primary series doses and three tetanus and diphtheria booster doses were administered.
Check for any other vaccines due.'"/>
</extension>
<extension url="displaySequence">
<valueInteger value="34"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="IMMZD2DTDTPPregnancyStartingWith4DosesLogic"/>
</extension>
<extension url="name">
<valueString value="Guidance"/>
</extension>
<extension url="statement">
<valueString
value="/*
@dynamicValue: Guidance
*/
define "Guidance":
case
when "Client is due for tetanus and diphtheria booster dose" then "Client is due for tetanus and diphtheria booster dose Guidance"
when "Client is not due for tetanus and diphtheria booster dose" then "Client is not due for tetanus and diphtheria booster dose Guidance"
when "Tetanus and diphtheria immunization schedule is complete" then "Tetanus and diphtheria immunization schedule is complete Guidance"
else ''
end"/>
</extension>
<extension url="displaySequence">
<valueInteger value="35"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="IMMZD2DTDTPPregnancyStartingWith4DosesLogic"/>
</extension>
<extension url="name">
<valueString value="Has Guidance"/>
</extension>
<extension url="statement">
<valueString
value="define "Has Guidance":
"Guidance" is not null and "Guidance" != ''"/>
</extension>
<extension url="displaySequence">
<valueInteger value="36"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="IMMZCommon"/>
</extension>
<extension url="name">
<valueString value="onOrBefore"/>
</extension>
<extension url="statement">
<valueString
value="/**
* @description: Gets immunizations on or before a date
*/
define fluent function onOrBefore(immunizations List<Immunization>, beforeDate Date):
immunizations I where
I.occurrence.toInterval() same day or before beforeDate"/>
</extension>
<extension url="displaySequence">
<valueInteger value="37"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="IMMZCommon"/>
</extension>
<extension url="name">
<valueString value="seriesPrimary"/>
</extension>
<extension url="statement">
<valueString
value="/**
* @description: Gets the doses from the primary series
*/
define fluent function seriesPrimary(immunizations List<Immunization>):
immunizations I where
exists( I.protocolApplied pa where pa.series = 'Primary series' )"/>
</extension>
<extension url="displaySequence">
<valueInteger value="38"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="FHIRHelpers"/>
</extension>
<extension url="name">
<valueString value="ToString"/>
</extension>
<extension url="statement">
<valueString
value="define function ToString(value string): value.value"/>
</extension>
<extension url="displaySequence">
<valueInteger value="39"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="FHIRHelpers"/>
</extension>
<extension url="name">
<valueString value="ToString"/>
</extension>
<extension url="statement">
<valueString
value="define function ToString(value ImmunizationStatus): value.value"/>
</extension>
<extension url="displaySequence">
<valueInteger value="40"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="FHIRHelpers"/>
</extension>
<extension url="name">
<valueString value="ToBoolean"/>
</extension>
<extension url="statement">
<valueString
value="define function ToBoolean(value boolean): value.value"/>
</extension>
<extension url="displaySequence">
<valueInteger value="41"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="FHIRHelpers"/>
</extension>
<extension url="name">
<valueString value="ToConcept"/>
</extension>
<extension url="statement">
<valueString
value="define function ToConcept(concept FHIR.CodeableConcept):
if concept is null then
null
else
System.Concept {
codes: concept.coding C return ToCode(C),
display: concept.text.value
}"/>
</extension>
<extension url="displaySequence">
<valueInteger value="42"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="FHIRHelpers"/>
</extension>
<extension url="name">
<valueString value="ToCode"/>
</extension>
<extension url="statement">
<valueString
value="define function ToCode(coding FHIR.Coding):
if coding is null then
null
else
System.Code {
code: coding.code.value,
system: coding.system.value,
version: coding.version.value,
display: coding.display.value
}"/>
</extension>
<extension url="displaySequence">
<valueInteger value="43"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="IMMZCommon"/>
</extension>
<extension url="name">
<valueString value="seriesBooster"/>
</extension>
<extension url="statement">
<valueString
value="/**
* @description: Gets the doses from the Booster series
*/
define fluent function seriesBooster(immunizations List<Immunization>):
immunizations I where
exists( I.protocolApplied pa where pa.series = 'Booster dose' )"/>
</extension>
<extension url="displaySequence">
<valueInteger value="44"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="WHOCommon"/>
</extension>
<extension url="name">
<valueString value="complete"/>
</extension>
<extension url="statement">
<valueString
value="define fluent function complete(observations List<Observation>):
observations O where O.status in { 'final', 'amended', 'corrected' }"/>
</extension>
<extension url="displaySequence">
<valueInteger value="45"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="FHIRHelpers"/>
</extension>
<extension url="name">
<valueString value="ToString"/>
</extension>
<extension url="statement">
<valueString
value="define function ToString(value ObservationStatus): value.value"/>
</extension>
<extension url="displaySequence">
<valueInteger value="46"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="WHOCommon"/>
</extension>
<extension url="name">
<valueString value="references"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Returns true if the given reference is to the given resourceId
@comment: Returns true if the `resourceId` parameter exactly equals the tail of the given reference.
NOTE: This function assumes resources from the same source server.
*/
define fluent function references(reference FHIR.Reference, resourceId String):
resourceId = Last(Split(reference.reference, '/'))"/>
</extension>
<extension url="displaySequence">
<valueInteger value="47"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="WHOCommon"/>
</extension>
<extension url="name">
<valueString value="prevalenceInterval"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Returns an interval representing the normalized prevalence period of a given Condition resource.
@comment: Uses the toInterval and toAbatementInterval functions to determine the widest potential interval from
onset to abatement as specified in the given Condition.
*/
define fluent function prevalenceInterval(condition Condition):
if condition.clinicalStatus ~ "active"
or condition.clinicalStatus ~ "recurrence"
or condition.clinicalStatus ~ "relapse" then
Interval[start of condition.onset.toInterval(), end of condition.abatementInterval()]
else
(end of condition.abatementInterval()) abatementDate
return
if abatementDate is null then
Interval[start of condition.onset.toInterval(), abatementDate)
else
Interval[start of condition.onset.toInterval(), abatementDate]"/>
</extension>
<extension url="displaySequence">
<valueInteger value="48"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="WHOCommon"/>
</extension>
<extension url="name">
<valueString value="abatementInterval"/>
</extension>
<extension url="statement">
<valueString
value="// Was getting error on this for this particular choice set not being found
/*
@description: Returns an interval representing the normalized Abatement of a given Condition resource.
@comment: NOTE: Due to the complexity of determining an interval from a String, this function will throw
a run-time exception if used with a Condition instance that has a String as the abatement value.
*/
define fluent function abatementInterval(condition Condition):
if condition.abatement is FHIR.dateTime then
Interval[FHIRHelpers.ToDateTime(condition.abatement as FHIR.dateTime), FHIRHelpers.ToDateTime(condition.abatement as FHIR.dateTime)]
else if condition.abatement is FHIR.Period then
FHIRHelpers.ToInterval(condition.abatement as FHIR.Period)
else if condition.abatement is FHIR.string then
Message(null as Interval<DateTime>, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a String value is not supported')
else if condition.abatement is FHIR.Age then
Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(condition.abatement as FHIR.Age),
FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(condition.abatement as FHIR.Age) + 1 year)
else if condition.abatement is FHIR.Range then
Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((condition.abatement as FHIR.Range).low),
FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((condition.abatement as FHIR.Range).high) + 1 year)
else if condition.abatement is FHIR.boolean then
Interval[end of condition.onset.toInterval(), condition.recordedDate)
else
null"/>
</extension>
<extension url="displaySequence">
<valueInteger value="49"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="FHIRHelpers"/>
</extension>
<extension url="name">
<valueString value="ToDateTime"/>
</extension>
<extension url="statement">
<valueString
value="define function ToDateTime(value dateTime): value.value"/>
</extension>
<extension url="displaySequence">
<valueInteger value="50"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="FHIRHelpers"/>
</extension>
<extension url="name">
<valueString value="ToInterval"/>
</extension>
<extension url="statement">
<valueString
value="define function ToInterval(period FHIR.Period):
if period is null then
null
else
if period."start" is null then
Interval(period."start".value, period."end".value]
else
Interval[period."start".value, period."end".value]"/>
</extension>
<extension url="displaySequence">
<valueInteger value="51"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="FHIRHelpers"/>
</extension>
<extension url="name">
<valueString value="ToDate"/>
</extension>
<extension url="statement">
<valueString
value="define function ToDate(value date): value.value"/>
</extension>
<extension url="displaySequence">
<valueInteger value="52"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="FHIRHelpers"/>
</extension>
<extension url="name">
<valueString value="ToQuantity"/>
</extension>
<extension url="statement">
<valueString
value="define function ToQuantity(quantity FHIR.Quantity):
case
when quantity is null then null
when quantity.value is null then null
when quantity.comparator is not null then
Message(null, true, 'FHIRHelpers.ToQuantity.ComparatorQuantityNotSupported', 'Error', 'FHIR Quantity value has a comparator and cannot be converted to a System.Quantity value.')
when quantity.system is null or quantity.system.value = 'http://unitsofmeasure.org'
or quantity.system.value = 'http://hl7.org/fhirpath/CodeSystem/calendar-units' then
System.Quantity { value: quantity.value.value, unit: ToCalendarUnit(Coalesce(quantity.code.value, quantity.unit.value, '1')) }
else
Message(null, true, 'FHIRHelpers.ToQuantity.InvalidFHIRQuantity', 'Error', 'Invalid FHIR Quantity code: ' & quantity.unit.value & ' (' & quantity.system.value & '|' & quantity.code.value & ')')
end"/>
</extension>
<extension url="displaySequence">
<valueInteger value="53"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="FHIRHelpers"/>
</extension>
<extension url="name">
<valueString value="ToCalendarUnit"/>
</extension>
<extension url="statement">
<valueString
value="define function ToCalendarUnit(unit System.String):
case unit
when 'ms' then 'millisecond'
when 's' then 'second'
when 'min' then 'minute'
when 'h' then 'hour'
when 'd' then 'day'
when 'wk' then 'week'
when 'mo' then 'month'
when 'a' then 'year'
else unit
end"/>
</extension>
<extension url="displaySequence">
<valueInteger value="54"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="WHOCommon"/>
</extension>
<extension url="name">
<valueString value="mostRecent"/>
</extension>
<extension url="statement">
<valueString
value="define fluent function mostRecent(immunizations List<Immunization>):
Last(
immunizations I
sort by start of occurrence.toInterval()
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="55"/>
</extension>
</extension>
<name value="EffectiveDataRequirements"/>
<status value="active"/>
<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/library-type"/>
<code value="module-definition"/>
</coding>
</type>
<relatedArtifact>
<type value="depends-on"/>
<display value="FHIR model information"/>
<resource
value="http://fhir.org/guides/cqf/common/Library/FHIR-ModelInfo|4.0.1"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library Encounter"/>
<resource
value="http://smart.who.int/immunizations/Library/IMMZD2DTDTPEncounterElements"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library Common"/>
<resource
value="http://smart.who.int/immunizations/Library/IMMZCommon"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library WC"/>
<resource
value="http://smart.who.int/immunizations/Library/WHOCommon"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library DTPElements"/>
<resource
value="http://smart.who.int/immunizations/Library/IMMZD2DTDTPElements"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library FHIRHelpers"/>
<resource
value="http://fhir.org/guides/cqf/common/Library/FHIRHelpers|4.0.1"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library Elements"/>
<resource
value="http://smart.who.int/immunizations/Library/IMMZElements"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library FHIRHelpers"/>
<resource
value="http://fhir.org/guides/cqf/common/Library/FHIRHelpers|4.0.1"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library Concepts"/>
<resource
value="http://smart.who.int/immunizations/Library/IMMZConcepts"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library Encounter"/>
<resource
value="http://smart.who.int/immunizations/Library/IMMZEncounterElements"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library Elements"/>
<resource
value="http://smart.who.int/immunizations/Library/IMMZElements"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library WC"/>
<resource
value="http://smart.who.int/immunizations/Library/WHOCommon"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library Concepts"/>
<resource
value="http://smart.who.int/immunizations/Library/IMMZConcepts"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library WE"/>
<resource
value="http://smart.who.int/immunizations/Library/WHOEncounterElements"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library Elements"/>
<resource
value="http://smart.who.int/immunizations/Library/WHOElements"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library Concepts"/>
<resource
value="http://smart.who.int/immunizations/Library/WHOConcepts"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library Common"/>
<resource
value="http://smart.who.int/immunizations/Library/WHOCommon"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library WC"/>
<resource
value="http://smart.who.int/immunizations/Library/WHOCommon"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Code system IMMZD"/>
<resource
value="http://smart.who.int/immunizations/CodeSystem/IMMZ.D"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Code system ConditionClinicalStatusCodes"/>
<resource
value="http://terminology.hl7.org/CodeSystem/condition-clinical"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Code system LOINC"/>
<resource value="http://loinc.org"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set DTP-containing vaccines"/>
<resource
value="http://smart.who.int/immunizations/ValueSet/IMMZ.Z.DE24"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display
value="Value set Tetanus and diphtheria-containing vaccines"/>
<resource
value="http://smart.who.int/immunizations/ValueSet/IMMZ.Z.DE28"/>
</relatedArtifact>
<parameter>
<name value="Today"/>
<use value="in"/>
<min value="0"/>
<max value="1"/>
<type value="date"/>
</parameter>
<parameter>
<name value="EncounterId"/>
<use value="in"/>
<min value="0"/>
<max value="1"/>
<type value="string"/>
</parameter>
<parameter>
<name value="AsOf"/>
<use value="in"/>
<min value="0"/>
<max value="1"/>
<type value="date"/>
</parameter>
<parameter>
<name value="Guidance"/>
<use value="out"/>
<min value="0"/>
<max value="1"/>
<type value="string"/>
</parameter>
<parameter>
<name value="Client is due for tetanus and diphtheria booster dose"/>
<use value="out"/>
<min value="0"/>
<max value="1"/>
<type value="boolean"/>
</parameter>
<parameter>
<name value="Has Guidance"/>
<use value="out"/>
<min value="0"/>
<max value="1"/>
<type value="boolean"/>
</parameter>
<dataRequirement>
<type value="Immunization"/>
<profile
value="http://hl7.org/fhir/StructureDefinition/Immunization"/>
<mustSupport value="status"/>
<mustSupport value="isSubpotent"/>
</dataRequirement>
<dataRequirement>
<type value="Immunization"/>
<profile
value="http://hl7.org/fhir/StructureDefinition/Immunization"/>
<mustSupport value="status"/>
<mustSupport value="isSubpotent"/>
<mustSupport value="vaccineCode"/>
</dataRequirement>
<dataRequirement>
<type value="Immunization"/>
<profile
value="http://hl7.org/fhir/StructureDefinition/Immunization"/>
<mustSupport value="status"/>
<mustSupport value="isSubpotent"/>
<mustSupport value="vaccineCode"/>
</dataRequirement>
<dataRequirement>
<type value="Observation"/>
<profile value="http://hl7.org/fhir/StructureDefinition/Observation"/>
<mustSupport value="code"/>
<codeFilter>
<path value="code"/>
<code>
<system
value="http://smart.who.int/immunizations/CodeSystem/IMMZ.D"/>
<code value="DE161"/>
<display value="Potential contraindications"/>
</code>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Observation"/>
<profile value="http://hl7.org/fhir/StructureDefinition/Observation"/>
<mustSupport value="code"/>
<mustSupport value="value"/>
<codeFilter>
<path value="code"/>
<code>
<system
value="http://smart.who.int/immunizations/CodeSystem/IMMZ.D"/>
<code value="DE161"/>
<display value="Potential contraindications"/>
</code>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Observation"/>
<profile value="http://hl7.org/fhir/StructureDefinition/Observation"/>
<mustSupport value="code"/>
<mustSupport value="value"/>
<mustSupport value="encounter"/>
<mustSupport value="effective"/>
<codeFilter>
<path value="code"/>
<code>
<system
value="http://smart.who.int/immunizations/CodeSystem/IMMZ.D"/>
<code value="DE161"/>
<display value="Potential contraindications"/>
</code>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Condition"/>
<profile value="http://hl7.org/fhir/StructureDefinition/Condition"/>
<mustSupport value="code"/>
<codeFilter>
<path value="code"/>
<code>
<system
value="http://smart.who.int/immunizations/CodeSystem/IMMZ.D"/>
<code value="DE162"/>
<display value="Currently pregnant"/>
</code>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Patient"/>
<profile value="http://hl7.org/fhir/StructureDefinition/Patient"/>
</dataRequirement>
<dataRequirement>
<type value="Condition"/>
<profile value="http://hl7.org/fhir/StructureDefinition/Condition"/>
<mustSupport value="code"/>
<codeFilter>
<path value="code"/>
<code>
<system
value="http://smart.who.int/immunizations/CodeSystem/IMMZ.D"/>
<code value="DE162"/>
<display value="Currently pregnant"/>
</code>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Observation"/>
<profile value="http://hl7.org/fhir/StructureDefinition/Observation"/>
<mustSupport value="code"/>
<mustSupport value="status"/>
<codeFilter>
<path value="code"/>
<code>
<system value="http://loinc.org"/>
<code value="82810-3"/>
<display value="Pregnancy status"/>
</code>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Observation"/>
<profile value="http://hl7.org/fhir/StructureDefinition/Observation"/>
<mustSupport value="code"/>
<mustSupport value="status"/>
<mustSupport value="value"/>
<codeFilter>
<path value="code"/>
<code>
<system value="http://loinc.org"/>
<code value="82810-3"/>
<display value="Pregnancy status"/>
</code>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Observation"/>
<profile value="http://hl7.org/fhir/StructureDefinition/Observation"/>
<mustSupport value="code"/>
<mustSupport value="status"/>
<mustSupport value="value"/>
<mustSupport value="encounter"/>
<mustSupport value="effective"/>
<codeFilter>
<path value="code"/>
<code>
<system value="http://loinc.org"/>
<code value="82810-3"/>
<display value="Pregnancy status"/>
</code>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Immunization"/>
<profile
value="http://hl7.org/fhir/StructureDefinition/Immunization"/>
<mustSupport value="status"/>
<mustSupport value="isSubpotent"/>
<mustSupport value="vaccineCode"/>
</dataRequirement>
<dataRequirement>
<type value="Immunization"/>
<profile
value="http://hl7.org/fhir/StructureDefinition/Immunization"/>
<mustSupport value="status"/>
<mustSupport value="isSubpotent"/>
<mustSupport value="vaccineCode"/>
</dataRequirement>
<dataRequirement>
<type value="Immunization"/>
<profile
value="http://hl7.org/fhir/StructureDefinition/Immunization"/>
<mustSupport value="status"/>
<mustSupport value="isSubpotent"/>
<mustSupport value="vaccineCode"/>
</dataRequirement>
<dataRequirement>
<type value="Immunization"/>
<profile
value="http://hl7.org/fhir/StructureDefinition/Immunization"/>
<mustSupport value="status"/>
<mustSupport value="isSubpotent"/>
<mustSupport value="vaccineCode"/>
</dataRequirement>
<dataRequirement>
<type value="Immunization"/>
<profile
value="http://hl7.org/fhir/StructureDefinition/Immunization"/>
<mustSupport value="status"/>
<mustSupport value="isSubpotent"/>
<mustSupport value="vaccineCode"/>
</dataRequirement>
</Library>
</contained>
<extension
url="http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-knowledgeCapability">
<valueCode value="computable"/>
</extension>
<extension
url="http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-effectiveDataRequirements">
<valueCanonical value="#effective-data-requirements"/>
</extension>
<url
value="http://smart.who.int/immunizations/PlanDefinition/IMMZD2DTDTPPregnancyStartingWith4Doses"/>
<version value="0.2.0"/>
<name value="IMMZD2DTDTPPregnancyStartingWith4Doses"/>
<title value="IMMZ.D2.DT.DTP.Pregnancy starting with 4 doses"/>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/plan-definition-type"/>
<code value="eca-rule"/>
</coding>
</type>
<status value="draft"/>
<experimental value="false"/>
<date value="2026-03-03T13:07:11+00:00"/>
<publisher value="WHO"/>
<contact>
<name value="WHO"/>
<telecom>
<system value="url"/>
<value value="http://who.int"/>
</telecom>
</contact>
<description
value="IMMZ.D2.DT.DTP.Pregnancy starting with 4 doses
Diphtheria and tetanus vaccination schedule in pregnant women who received 4 childhood DTP doses"/>
<relatedArtifact>
<type value="citation"/>
<citation
value="WHO recommendations for routine immunization - summary tables (January 2025)"/>
</relatedArtifact>
<library
value="http://smart.who.int/immunizations/Library/IMMZD2DTDTPPregnancyStartingWith4DosesLogic"/>
<action>
<extension
url="http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-rationale">
<valueMarkdown
value="Pregnant women who received 4 tetanus-containing vaccines doses during childhood or pre-adulthood
need only 1 booster dose, which should be given at the first opportunity. To provide lifelong protection, a sixth
dose would be needed at least 1 year after the fifth dose, or during the next pregnancy. From 7 years of age,
only tetanus toxoid with reduced diphtheria toxoid (Td) combinations should be used. Age-appropriate combinations-containing
pertussis vaccine with reduced diphtheria toxoid are also available. Only acellular pertussis (aP)-containing vaccines should
be used for vaccination of persons aged 7 years and older."/>
</extension>
<title value="Determine if the client is due for DTP."/>
<description
value="Determine if the client is due for DTP vaccine according to the national immunization protocol.
Diphtheria and tetanus vaccination schedule in pregnant women who received 4 childhood DTP doses"/>
<condition>
<kind value="applicability"/>
<expression>
<description
value="Client is due for tetanus and diphtheria booster dose"/>
<language value="text/cql-identifier"/>
<expression
value="Client is due for tetanus and diphtheria booster dose"/>
</expression>
</condition>
<definitionCanonical
value="http://smart.who.int/immunizations/ActivityDefinition/IMMZD2DTMR"/>
<dynamicValue>
<path value="status"/>
<expression>
<language value="text/cql-expression"/>
<expression value="'draft'"/>
</expression>
</dynamicValue>
<dynamicValue>
<path value="intent"/>
<expression>
<language value="text/cql-expression"/>
<expression value="'proposal'"/>
</expression>
</dynamicValue>
<dynamicValue>
<path value="medication"/>
<expression>
<language value="text/cql-expression"/>
<expression
value="Concept { codes: { Code { system: 'http://smart.who.int/immunizations/CodeSystem/IMMZ.Z', code: 'DE28', display: 'Tetanus and diphtheria-containing vaccines' } }, display: 'Tetanus and diphtheria-containing vaccines' }"/>
</expression>
</dynamicValue>
</action>
<action>
<title
value="Check for Guidance for the patient regarding IMMZ.D2.DT.DTP.Pregnancy starting with 4 doses."/>
<description
value="Show Guidance for the patient regarding IMMZ.D2.DT.DTP.Pregnancy starting with 4 doses."/>
<condition>
<kind value="applicability"/>
<expression>
<description value="Has Guidance"/>
<language value="text/cql-identifier"/>
<expression value="Has Guidance"/>
</expression>
</condition>
<definitionCanonical
value="http://smart.who.int/immunizations/ActivityDefinition/IMMZD2DTCR"/>
<dynamicValue>
<path value="status"/>
<expression>
<language value="text/cql-expression"/>
<expression value="'active'"/>
</expression>
</dynamicValue>
<dynamicValue>
<path value="payload.contentString"/>
<expression>
<language value="text/cql-identifier"/>
<expression value="Guidance"/>
</expression>
</dynamicValue>
<dynamicValue>
<path value="category.coding"/>
<expression>
<description value="Category of communication"/>
<language value="text/cql-expression"/>
<expression
value="Code { system: 'http://terminology.hl7.org/CodeSystem/communication-category', code: 'alert' }"/>
</expression>
</dynamicValue>
<dynamicValue>
<path value="priority"/>
<expression>
<description value="Alert priority"/>
<language value="text/cql-expression"/>
<expression
value="Code { system: 'http://hl7.org/fhir/request-priority', code: 'routine' }"/>
</expression>
</dynamicValue>
</action>
</PlanDefinition>