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<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><paragraph ID="immun1">Patient objected to <content ID="ImmunizationProduct_1">influenza, intradermal, quadrivalent</content> on 11/15/2015</paragraph></text>
<entry typeCode="COMP">
<!-- negationInd=true indicates substance was NOT given at this date-->
<substanceAdministration classCode="SBADM" moodCode="EVN"
negationInd="true">
<!-- ** Immunization activity ** -->
<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"/>
<id root="e6f1ba43-c0ed-4b9b-9f12-f435d8ad8f92"/>
<text>
<reference value="#immun1"/>
</text>
<!-- Indicates the status of the substanceAdministartion -->
<statusCode code="completed"/>
<effectiveTime value="20151115"/>
<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>
<code code="166" codeSystem="2.16.840.1.113883.12.292"
displayName="influenza, intradermal, quadrivalent, preservative free"
codeSystemName="CVX">
<originalText>
<reference value="#ImmunizationProduct_1"/>
</originalText>
</code>
<!-- DSTU comment relaxing lotNumber requirement -->
<!-- http://www.hl7.org/dstucomments/showdetail_comment.cfm?commentid=995 -->
<!-- <lotNumberText>1</lotNumberText> -->
</manufacturedMaterial>
<!-- Optional manufacturerOrganization
<manufacturerOrganization>
<name>Health LS - Immuno Inc.</name>
</manufacturerOrganization>-->
</manufacturedProduct>
</consumable>
<entryRelationship typeCode="RSON">
<observation classCode="OBS" moodCode="EVN">
<!-- Immunization Refusal Reason -->
<!-- Included the reason since it may be relevant to a future clinician or quality measurement -->
<templateId root="2.16.840.1.113883.10.20.22.4.53"/>
<id root="c1296315-9a6d-45a2-aac0-ee225d375409"/>
<code displayName="Patient Objection" code="PATOBJ"
codeSystemName="HL7 ActNoImmunizationReason" codeSystem="2.16.840.1.113883.5.8"/>
<statusCode code="completed"/>
</observation>
</entryRelationship>
</substanceAdministration>
</entry>
</section>
</component>