Unknown Immunization Status(C-CDA2.1).xml

<component>
    <section>
        <!-- conforms to Immunizations section with entries optional -->
        <templateId root="2.16.840.1.113883.10.20.22.2.2"/>        
        <templateId root="2.16.840.1.113883.10.20.22.2.2" extension="2015-08-01"/>
        <!-- Immunizations section with entries required -->
        <templateId root="2.16.840.1.113883.10.20.22.2.2.1"/>
        <templateId root="2.16.840.1.113883.10.20.22.2.2.1" extension="2015-08-01"/>
        <code code="11369-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"
            displayName="History of immunizations"/>
        <title>IMMUNIZATIONS</title>
        <text>
            <table border="1" width="100%">
                <thead>
                    <tr>
                        <th>Vaccine</th>
                        <th>Date</th>
                        <th>Status</th>
                    </tr>
                </thead>
                <tbody>
                    <tr ID="immun1">
                        <td> Unknown Immunization  Status</td>
                        <td>Nov 1999</td>
                        <td>Completed</td>
                    </tr>
                </tbody>
            </table>
        </text>
        <entry>
            <substanceAdministration moodCode="EVN" classCode="SBADM" negationInd="false" nullFlavor="NI">
                <!--  We selected NI for this example, C-CDA R2 may describe other appropriate nullFlavors -->
                <templateId root="2.16.840.1.113883.10.20.22.4.52"/>
                <templateId root="2.16.840.1.113883.10.20.22.4.52" extension="2015-08-01"/>
                <!--  ****   Immunization activity template    **** -->
                <id root="e6f1ba43-c0ed-4b9b-9f12-f435d8ad8f88"/>
                <!-- No information on whether the patient received a vaccination -->
                <text>
                    <reference value="#immun1"/>
                </text>
                <!-- Link to narrative stating no information on whether the patient received a vaccination -->
                <statusCode code="completed"/>
                <effectiveTime value="199911"/>
                <!-- Date which you do not know whether or not patient received a vaccination -->
                <consumable>
                    <manufacturedProduct classCode="MANU">
                        <!-- ** Immunization medication information ** -->
                        <templateId root="2.16.840.1.113883.10.20.22.4.54"/>
                        <templateId root="2.16.840.1.113883.10.20.22.4.54" extension="2014-06-09"/>
                        <manufacturedMaterial>
                            <!-- Needed to use nullFlavor of OTH since templates requires CVX in code element-->
                            <code nullFlavor="OTH">
                                <!-- Optional original text -->
                                <originalText>Vaccination</originalText>
                                <translation code="71181003" displayName="vaccine"
                                    codeSystem="2.16.840.1.113883.6.96"
                                    codeSystemName="SNOMED CT"/>
                            </code>
                        </manufacturedMaterial>
                    </manufacturedProduct>
                </consumable>
            </substanceAdministration>
        </entry>
    </section>
</component>