The table below provides the list of data elements used to transmit vaccine administration information to the registry. The HL7 2.5.1 immunization implementation guide informed the list. [Each element is Required (R), Required if Exists (RE), Conditional (C), Optional (O).]
| TRANSMIT STANDARD PATIENT IMMUNIZATION HISTORY REPORT | |
| Concept Name | R/RE/O |
| Patient Identifier Number | RE |
| Assigning Authority | RE |
| Patient Identifier Type Code | RE |
| Patient Name | RE |
| Mother’s Maiden Name | RE |
| Date/Time of Birth | RE |
| Sex | RE |
| Patient Address | RE |
| Phone | RE |
| Multiple Birth Indicator | RE |
| Birth Order | RE |
| Entered by | RE |
| Ordering Provider | RE |
| Vaccine Event Information Source | C (R – Vaccine is Completed or Partially Administered/O) |
| Entering Organization | RE |
| Vaccine Type | R |
| Date/time Vaccine Administered | R |
| Dose Number in Series | O |
| Number of Doses in Primary Immunization Series | O |
| Vaccine Administered | R |
| Vaccine Lot Number | R |
| Vaccine Expiration Date | R |
| Vaccine Manufacturer Name | R |
| Dose – Administered Amount of Vaccine | R |
| Administered Units (of Measure) | C (R – administered amount NOT ‘999’/O) |
| Administering Provider | R |
| Administered-at Location | R |
| Completion Status | RE |
| Route of Administration | RE |
| Administration Site | RE |
| VFC status | R |
| VIS type and Date | R |
| Adverse Reactions | O |
| Vaccination Contraindications | O |
| Vaccine Refusal | O |
| Dose Number in Series | O |
| Number of Doses in Primary Immunization Series | O |