HL7 Version 2.5.1 Implementation Guide for Immunization Messaging 

(Release 1.5)—Addendum 

This addendum consolidates the Implementation Guide information that clarifies the conformance 

requirements. This supplement does not specify additional requirements; it just clarifies existing ones. 

Value set requirements, general clarifications, and Immunization Implementation Guide errata are also 

provided in this addendum.

General Clarifications

In the event of a conflict between the information in the table definitions and the explanatory text of 

Segment Level definitions (i.e., the data type, the constrained value etc.), the source of truth is the table.

In all message definitions, the Software (SFT) segment has a Usage of O and a Cardinality of [0..*] 

regardless of whether or not it is explicitly listed in the Static Definition – Message Level.

In all message definitions, the Continuation Pointer (DCS) segment has a Usage of X and a Cardinality of 

[0..0] regardless of whether or not it is explicitly listed in the Static Definition – Message Level.

This document references both Coding Systems (AKA Code Sets) and Value Sets in relation to coded 

message elements (including the CE, CWE, CX, IS, ID and XCN data types). While related, these terms are 

distinct. A Coding System is an extensive, and in some cases extendable, list of values available for use in 

a message. A single Coding System may be relevant to a number of different parts of a single message. 

For example, HL7 table 0203 contains a list of Identifier Types. This table is called out as part of the CX 

data type (used in PID-3 and QPD-3) as well as the XCN data type (used in ORC-12 and RXA-10). A Coding 

System tends to be a very broad list and not all values are appropriate to use in a given message 

element. For example HL7 table 0203 contains the ID types of MR (Medical Record Number) and NPI 

(National Provider Identifier) which are appropriate for use in PID-3 and ORC-12 respectively. In 

contrast, a Value Set is a more refined list of values, taken from one or more Coding Systems, applied at 

a more granular level of the message and which contains only values appropriate for that location in the 

message. In some cases, a Value Set may have the same content as the underlying Coding System. 

Note that for coded data types (a data type of CE or CWE), the Name of Coding System 

(CE.3/CE.6/CWE.3/CWE.6) in the message should reference the Coding System, not the Value Set. Given 

the distinctions between value sets and coding system, often there is confusion as to the value to send 

in the message in the CE and CWE data types. For coded data types, the coding system in the third 

component is drawn from table HL70396. Changes to Table 0396 occur frequently. The most recent 

version of this table is available at http://www.hl7.org/special/committees/vocab/table_0396/index.cfm

which contains a list of possible values. The intended coding systems expected in coded fields are as 

follows:

Message Field Field Description Coding System for CE.3/CWE.3

ERR-2 HL7 Error Code HL70357

ERR-5 Application Error Code HL70533

IN1-2 Insurance Plan HL70072

NK1-3 Relationship HL70063

CDC - July 2015
Message Field Field Description Coding System for CE.3/CWE.3

OBX-3 Observation ID

LN which using LOINC otherwise 

some other value from HL0396

OBX-6 Units UCUM or HL70353

OBX-17 Observation Method CDCPHINVS

ORC-17 Entering Organization HL70362

PD1-11 Publicity Code HL70215

PID-10 Race CDCREC

PID-22 Ethnic Group CDCREC

QAK-3 Message Query Name CDCPHINVS

QPD-1 Message Query Name CDCPHINVS

RCP-2.2 Units HL70126

RXA-5 Administered Code

CVX when transmitting CVX codes, 

otherwise NDC, CPT, etc. as 

appropriate

RXA-7 Administered Units UCUM

RXA-9 Administration Notes NIP001

RXA-17 Manufacturer MVX when transmitting MVX codes

RXA-18 Refusal Reason NIP002

RXR-1 Route NCIT

RXR-2 Site HL70163

Various fields and data types, such as PID-5, PID-11 and ERL, contain references to “repetitions”. The 

word repetition is intended to be synonymous with the word occurrence. That is, the “first repetition” is 

not the “second occurrence”. For example if the value of PID-3 is “1234^^^AA1^MR~5678^^^AA2^DL”, 

“1234^^^AA1^MR” is the first repetition and “5678^^^AA2^DL” is the second repetition.

All response messages (profiles Z23, Z32, Z31, Z33 and Z42) should be returned synchronously. That is, 

the receiving process gives the response immediately or in a short period during which the originating

process will wait for the response. The originating process will not send a new message until a response 

has been received. A system may initiate multiple simultaneous processes if allowed, but each process 

must wait for a response to a given message before sending the next one. For query interactions, this 

behavior is controlled by the constrained value of “I” in the Query Priority (RCP-2) field. See Chapter 5 of 

the HL7 2.5.1 Base Standard for more details.

Profiles Z22, Z34 and Z44 have constrained values of ER for Accept Acknowledgement Type (MSH-15) 

and AL for Application Acknowledgement Type (MSH-16). When processing a message conformant with 

one of these profiles, the receiving system shall evaluate the message for unsupported message types, 

version ID, and processing IDs or other issues unrelated to format or content. If the message fails this 

validation, an ACK message conforming to profile Z23 shall be returned. This is consistent with “ER” in 

MSH-15. Messages which pass this initial validation are then processed and an appropriate Application 

level response message is returned. This is consistent with “AL” in MSH-16. Note that messages which 

fail the initial validation are not processed further and therefore do not have the opportunity to trigger 

an Application level response message. The receiving system only returns one message per incoming 
message. This process is diagrammed in Figure 37 (Z22 profile), Figure 41 (Z34 profile) and Figure 44 

(Z44 profile).

Chapter 2 includes a section entitled “Processing Mode” which discusses consolidation of records from 

multiple sources. However, messages conforming to the different profiles described by this guide may 

be populated with different quantities of data depending on the profile they conform to. 

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Z22 (Transmit Unsolicited Vaccine Update –VXU): The goal of a Z22 message is to send up-todate information about a vaccination event and the patient receiving the vaccine. A conformant 

message may contain a view of the entire patient vaccination history as known by the system 

originating the VXU^V04 message, but it is not required to do so. In other words, a given Z22 

conformant message may only contain a subset of all vaccinations events on the patient record, 

typically only those that have been added, updated or deleted as part of the event leading to 

the triggering of a message. The receiving system is responsible for applying business rules to 

integrate the data received but should not assume that the message being processed represents 

the entire patient vaccination history. The data within any single order group (set of one ORC 

segment, one RXA segment and associated RXR and OBX segments, if any) should represent the 

complete set of data about the vaccination event as known by the system originating the

message. A complete set of data is defined by the required (as per this implementation guide) 

and locally agreed to data elements. 

Z32 (Return complete immunization history): The goal of the Z32 is to return a complete 

immunization history in response to a query request. Conformant messages should contain a 

view of the entire patient vaccination history as known by the system that originates the 

RSP^K11 message. The receiving system may process the message as required by local rules and 

needs. Depending on the situation and construction of the receiving system data base, the 

content of the message may completely overwrite existing query response data or may need to 

be reconciled against existing data on the patient record, the latter happening when the 

receiving system is likely to contain data not known to the system originating the RSP^K11 

message. The data within any single order group (set of one ORC segment, one RXA segment 

and associated RXR and OBX segments, if any) should represent the complete set of data about

the vaccination event as known by the system originating the message. A complete set of data is 

defined by the required (as per this implementation guide) and locally agreed to data elements.

Z42 (Return Evaluated History and Forecast): The goal of a Z42 message is to return an 

evaluated history and forecast in response to a query request. It is intended to be displayed 

back to the requesting provider to inform clinical care. The evaluated history portion of the 

message contains all immunizations for the patient known to the responding system. Each of 

these will be evaluated against a set of rules, such as ACIP. The forecast portion of the message 

should be considered to be a complete representation of the patient forecast. This message is 

not intended to return all the details expected of a complete immunization history. This 

message may not include information about Lot Number or other data in a complete history, for 

instance. A Z34 query and Z32 response should be used for that purpose. The data within any 

single order group (set of one ORC segment, one RXA segment and associated RXR and OBX 

segments, if any) should represent the complete set of data about the vaccination event as 

known by the system originating the message. A complete set of data is defined by the required 

(as per this implementation guide) and locally agreed to data elements. 

Sometimes it is necessary to remove a previously submitted vaccination administration record. If the 

existing record must simply be deleted, that is it should never have been entered, then a second 
VXU^V04 message should be sent where all data in the message, including the ORC and RXA 

segments, is the same as the most recent message for the administration, except for the Action 

Code (RXA-20) which should be D. Importantly, the filler ID in ORC-3 should be the same between 

messages as this ID may be crucial to identifying the correct administration to remove. Once the 

inaccurate data has been deleted, additional independent messages (adds, refusals, etc.) can be 

sent to accurately populate the receiving system.

General Errata

Any data elements with a Usage of “X” will have a Cardinality of “[0..0]”.

Data Types 

Clarification

Location Existing Clarification

Table 4-33 None Each telecommunication use code (i.e. Phone number, email 

address, etc.) must be in its own occurrence. For example, a 

primary residence number and email address:

^PRN^PH^^^734^6777777~^NET^Internet^bjones7656@isp.com

Errata

Location Data Type Change Existing Corrected

Table 4-1 n/a Omission 

correction

The XPN_M data 

type is not 

included in the 

list of data types 

used by the IG.

XPN_M is a valid data type for this 

IG and is included with the list in 

Table 4-1.

IZ-2 Composite 

Quantity with Units 

(CQ)

Error 

correction

IZ-2: CQ-2 

(Units) shall be 

the literal value 

“RD”.

IZ-2: CQ-2.1 (Units) shall be the 

literal value “RD”.

Table 4-8 Date (DT_D) Error 

correction

Definition: 

Specifies the 

century and 

year with 

optional 

precision to 

month and day.

Precision to the month and day is 

required for the DT_D data type. 

The word “optional” should be 

disregarded.

Table 4-8 Date (DT_D) Error 

correction

Elements for 

hours, minutes, 

seconds and 

time zone offset 

have a usage of 

O but these 

elements are 

not allowed for 

Date data types.

Elements for hours, minutes, 

seconds and time zone offset shall 

no longer be listed in this table and 

shall not be sent when using the 

DT_D data type.
Location Data Type Change Existing Corrected

Table 4-8 Date (DT_D) Error 

correction

Length 4..8 Length 8

Table 4-

26

Time Stamp with 

Time Zone (TS_Z)

Error 

correction

Hours, Minutes 

and Seconds 

have a usage of 

O.

Hours, Minutes and Seconds shall 

have a usage of R. Sub-second data 

remains optional:

YYYYMMDDHHMMSS[.S[S[S[S]]]]]+/-

ZZZZ

Table 4-

29

Extended 

Composite ID 

Number and Name 

(XCN)

Error 

correction

The usage of 

Identifier Type 

Code (XCN.13) is 

O. 

The usage of Identifier Type Code 

(XCN.13) shall be C(R/X) with the 

Conditional Predicate of:

“If the XCN-1 (id number) is valued”

The Value Set shall be HL70203. The 

combination of the Identifier Type 

Code and the Assigning Authority 

(XCN.9) define a unique ID pool.

Table 4-

30

Extended 

Composite Name 

and ID Number for 

Organizations.

Omission 

correction

A value set is 

not defined for 

XON.6.

When using the XON data type, the 

Assigning Authority element 

(XON.6) uses the HD data type 

which should draw the Assigning 

Authority from the value set of 

table HL70363.

Table 4-

31

Extended Person 

Name (XPN)

Error 

correction

The usage of 

Name Type 

Code (XPN.7) is 

RE.

The usage of Name Type Code 

(XPN.7) shall be R. if the type of 

name is not known, a value of UUnspecified should be used rather 

than leaving the Name Type Code 

empty.

Table 4-

32

Extended Person 

Name - Maiden 

Name (XPN_M)

Error 

correction

The usage of 

Given Name 

(XPN_M.2) is RE.

The usage of Given Name 

(XPN_M.2) shall be O. Only the last 

name is required for the Maiden 

Name. The first name is optional.

Table 4-

33

Extended 

Telecommunication

Number (XTN)

Error 

correction

Area/City Code 

(XTN.6) and 

(Local Number) 

XTN.7 have 

lengths of 5 and 

9 respectively.

Lengths of 3 and 7 respectively are 

valid to allow for sending of a 3 digit 

area code and 7 digit local number 

without including non-numeric 

characters as required by the NM 

data type.
Profile Z22

Clarifications

Location Existing Clarification

OBX-17 CDCPHINVS is called out as the 

value set for Observation Method 

(OBX-17).

The value set for sending the funding 

eligibility Observation Method in OBX17 is

PNHV_FundingEligibilityObsMethod_IIS 

which is described in Appendix A. Only 

two values, VXC40 and VXC41 are valid 

for this field. CDCPHINVS is to be sent 

as the Coding System in OBX-17.3 as 

given in Appendix A.

ORC-3 This shall be the unique identifier 

of the sending system in a given 

transaction. In the case where 

system A sends the record to 

system B and system B then 

forwards to system C, system B 

will send its’ own unique identifier.

This statement conflicts with a 

previous statement correctly defining 

ORC-3 as the unique identifier from the 

system “where the order was filled”. 

This is the correct interpretation of 

ORC-3. The description relating to 

systems A, B and C shall be 

disregarded.

PD1-16 This field identifies the current 

status of the patient in relation to 

the sending provider organization.

The term “sending provider 

organization” refers to the 

organization that is accountable for the 

content of the message. This may be 

an EHR for a VXU^V04 message or an 

IIS for an RSP^K11 message. PD1-16 

should reflect the status of the patient 

relative to the system creating the 

message.

IZ-31 and 47 Current wording implies that 

empty repetitions of 

Administration Notes (RXA-9) are 

allowed.

The first occurrence should be either 

null or a value from the NIP001 value 

set. Any additional occurrences may be 

valued with text notes using the CE_TX 

data type if local agreement allows. 

Empty occurrences, other than the 

first, should not be sent.

Errata

Location Change Existing Corrected

Table 5-1 Error 

correction

Usage for the NTE segment is 

RE.

Exchange of NTE segments is by 

local agreement, therefore the 

usage of the NTE segment is O.

Table 5-2 Omission 

correction

Cardinality is missing for

Insurance Company ID (IN1-3), 

Plan Type (IN1-15) and 

Verification Date/Time (IN1-

29).

Insurance Company ID (IN1-3), Plan 

Type (IN1-15) have a Cardinality of 

[1..1]. Verification Date/Time (IN1-

29) has a Cardinality of [0..1].
Location Change Existing Corrected

Table 5-2 Error 

correction

The comment for Verification 

Date/Time (IN1-29) describes 

the necessary precision for the 

field.

The comment for Verification 

Date/Time (IN1-29) implies that 

the year, month and day are 

optional by virtue of using the [ ] 

characters. Per the definition of 

the TS_NZ data type, precision 

down to the day is required. 

Disregard the comment and refer 

to the definition of TS_NZ.

IN1 segment 

definition

Omission 

correction

The Set ID (IN1-1) field 

definition describes the usage 

of IN1-1 but the necessary 

Conformance Statement was 

omitted.

The following new Conformance 

Statement now applies to the IN1

segment in the Z22 profile:

IZ-69: IN1-1 (Set ID-IN1) SHALL be 

valued “1”.

IZ-17 Error 

correction

VXU^VO4^VXU_V04 VXU^V04^VXU_V04

NK1 segment 

definition

Omission 

correction

The Set ID (NK1-1) field 

definition describes the usage 

of NK1-1 but the necessary 

Conformance Statement was 

omitted.

The following new Conformance 

Statement now applies to the NK1 

segment in the Z22 profile:

IZ-70: NK1-1 (Set ID-NK1) SHALL be 

valued sequentially starting with 

the value “1”.

Table 5-7 Error 

correction

The Conditional Predicate for 

Units (OBX-6) requires that 

OBX-6 be populated if Data 

Type (OBX-2) is either “NM” or 

“SN”

The Conditional Predicate should 

only apply if Data Type (OBX-2) is 

“NM”. The “SN” data type is not 

required by any Observation ID 

defined by this IG.

IZ-21 Error 

correction

The value of OBX-2 (Value 

Type) SHALL be one of the 

following: CE, NM, ST, DT, ID or 

TS 

IZ-21 has been removed. Required 

Value Types are defined by the 

required Observation IDs (OBX-3) 

per profile (see the CDC-defined 

NIP003 table in Appendix A). By 

local agreement, OBX segments 

using other data types may be 

sent.

IZ-36 Error 

correction

If OBX-3.1 is “69764-9” and 

OBX-2 is “CE” then the value 

set for OBX-5 shall be 

cdcgs1vis. 

If OBX-3.1 is “69764-9” and OBX-2 

is “CE” then the value set for OBX-5 

shall be PHVS_VISBarcodes_IIS. 

Note that PHVS_VISBarcodes_IIS 

uses values from the cdcgs1vis 

Coding System.
Location Change Existing Corrected

OBX segment 

definition

Error 

correction

Set ID (OBX-1) Definition: This 

field contains the sequence 

number. The first instance shall 

be set to 1 and each 

subsequent instance shall be 

the next number in sequence. 

Numbering is not restarted 

within a message. That is, if a 

message had 3 order groups 

and each had 3 OBX, the last 

OBX in the message would 

have value of 9 for this field.

In addition to the current 

description, the Set ID is also 

allowed to restart within a 

message, between order groups. 

This is, if a message had 3 order 

groups and each had 3 OBX, all 

three order groups would contain 

OBX segments with Set IDs of 1, 2 

and 3. Either approach, restarting 

or not restarting per order group, is 

allowed.

IZ-45 Error 

correction

IZ-45: If RXA-20 is valued “NA” 

or “RE” then ORC-3 SHALL be 

valued “9999”.

IZ-45: If RXA-20 is valued “NA” or 

“RE” then ORC-3.1 SHALL be valued 

“9999”.

Table 5-10 Error 

correction

Data Type for Protection 

Indicator Date (PD1-13), 

Immunization Registry Status 

Effective Date (PD1-17) and 

Publicity Code Effective Date 

(PD1-18) is DT_T in Table 5-10 

and DT in the subsequent 

description section.

Data Type for Protection Indicator 

Date (PD1-13), Immunization 

Registry Status Effective Date (PD1-

17) and Publicity Code Effective 

Date (PD1-18) is DT_D.

Table 5-11 Error 

correction

The Usage and Cardinality of 

Administrative Sex (PID-8) are 

RE and [0..1].

The Usage and Cardinality of 

Administrative Sex (PID-8) are R 

and [1..1]. If a sex is not definitively 

known, use the value U-Unknown 

from HL70001.

Table 5-11 Error 

correction

The Value Set of Race (PID-10) 

is HL70005.

The Value Set of Race (PID-10) is 

CDCREC. The coding system shall 

be CDCREC from the most recent 

version of HL70396. The values 

listed in Appendix A for HL70005 

are still valid for CDCREC.

Table 5-12 Error 

correction

The length of Give Sub-ID 

Counter (RXA-1) and 

Administration Sub-ID Counter 

(RXA-2) is 4.

The length of Give Sub-ID Counter 

(RXA-1) and Administration Sub-ID 

Counter (RXA-2) is 1 per 

constraints on the values of those 

two fields.

Table 5-12 Error 

correction

The Usage of Administered 

Units (RXA-7) is C(R/O).

The Usage of Administered Units 

(RXA-7) is C(R/X).

Table 5-12 Error 

correction

The Value Set of 

Administration Notes (RXA-9) is 

NIP 0001.

The Value Set of Administration 

Notes (RXA-9) is NIP001.
Location Change Existing Corrected

IZ-47 Error 

correction

If RA-20 is NOT valued "CP" or 

"PA" then the first occurrence 

of RXA-9.1 (admin notes) 

SHALL be empty and the 

following repetitions should be 

empty or valued with text 

notes.

If RXA-20 is NOT valued "CP" or 

"PA" then the first occurrence of 

RXA-9.1 (admin notes) SHALL be 

empty and the following 

occurrences should be empty or 

valued with text notes.

IZ-49 Error 

correction

IZ-49: If RXA-5.3 is valued 

“998” then RXA-6 shall be 

valued “999”.

IZ-49: If RXA-5.1 is valued “998” 

then RXA-6 shall be valued “999”.

RXA segment 

definition

Error 

correction

IZ-50: If the first instance of 

RXA-9.1 is not valued “00” then 

RXA-6 (administered amount) 

SHALL be valued “999”

IZ-50 is no longer enforced and 

shall be disregarded. Scenarios 

exist where RXA-9.1 may be a value 

other than “00” but an 

administered amount may be 

known and should be sent.

Profile Z23

Errata

Location Change Existing Corrected

IZ-51 Error 

correction

MSH-9 (Message Type) SHALL 

contain the constant value 

“ACK^VO4^ACK”

MSH-9 (Message Type) SHALL 

contain the constant value 

“ACK^V04^ACK” or “ACK^Q11^ACK” 

depending on the type of message 

triggering the ACK response 

message.

Profile Z34

Clarifications

Location Existing Clarification

RCP-2 Quantity Limited 

Request

Definition: This field contains the 

maximum length of the response 

that can be accepted by the 

requesting system. Valid entries are 

numerical values (in the first 

component) given in the units 

specified in the second component. 

Default is LI (lines). The expected 

type is records, so the second 

component is constrained to RD.

The value sent in RCP-2.1 represents 

the maximum number of client 

(patient) records that should be 

returned in the response message. 

There is no maximum number of 

immunization records for the client 

in the response message.

Given that RCP-2.2 is constrained to 

“RD&records&HL70126”, the default 

value specified in the text is not 

relevant.
Errata

Location Change Existing Corrected

Table 7-4 Error 

correction

HL70362 is called out as the 

Value Set for Sending 

Responsible Organization (MSH22) and Receiving Responsible 

Organization (MSH-23).

The Value Sets to use in Sending 

Responsible Organization (MSH-22) 

and Receiving Responsible 

Organization (MSH-23) are defined 

in the XON data type. HL70362 does 

not apply to these fields.

Table 7-5 Omission 

correction

QPD fields 3 through 11 lack an 

explicit Cardinality.

PatientList (QPD-3) has a Cardinality 

of [0..*]. QPD fields 4 through 11 

have a Cardinality of [0..1].

Table 7-5 Omission 

correction

Patient Sex (QPD-7) does not 

have a Value Set defined.

Patient Sex (QPD-7) uses the value 

set HL70001.

Table 7-5 Omission 

correction

Patient Multiple Birth Indicator 

(QPD-10) does not have a Value 

Set defined.

Patient Multiple Birth Indicator 

(QPD-10) uses the value set 

HL70136.

Table 7-5 Error 

correction

Usage of Client Last Updated 

Date (QPD-12) and Client Last 

Update Facility (QPD-13) are RE.

Usage of Client Last Updated Date 

(QPD-12) and Client Last Update 

Facility (QPD-13) are O.

QPD 

segment 

definition

Omission 

correction

The comment for Message 

Query Name (QPD-1) in Table 7-

5 constrains the value of the 

field, but the necessary 

Conformance Statement was 

omitted.

The following new Conformance 

Statement now applies to the QPD 

segment in the Z34 profile:

IZ-67: QPD-1 (Message Query Name) 

SHALL be valued "Z34^Request 

Immunization History^CDCPHINVS”.

Note that the value of QPD-1.2 in IZ67 varies from comment in Table 7-

5. The value in the Conformance 

Statement is the correct value.

Profile Z32

Clarifications

Location Existing Clarification

IZ-31 and 47 Current wording implies that 

empty repetitions of 

Administration Notes (RXA-9) are 

allowed.

The first occurrence should be either 

null or a value from the NIP001 value 

set. Any additional occurrences may be 

valued with text notes using the CE_TX 

data type if local agreement allows. 

Empty occurrences, other than the 

first, should not be sent.
Location Existing Clarification

OBX-17 CDCPHINVS is called out as the 

value set for Observation Method 

(OBX-17).

The value set for sending the funding 

eligibility Observation Method in OBX17 is

PNHV_FundingEligibilityObsMethod_IIS 

which is described in Appendix A. Only 

two values, VXC40 and VXC41 are valid 

for this field. The Coding System to be 

send in OBX-17.3 is CDCPHINVS as 

given in Appendix A.

Errata

Location Change Existing Corrected

Table 8-1 Error 

correction

Usage for the NTE segment is 

RE.

Exchange of NTE segments is by 

local agreement, therefore the 

usage of the NTE segment is O.

Table 8-2 Error 

correction

The Cardinality of Error Location 

(ERR-2) has a footnote.

The footnote does not apply to the 

ERR segment for any profile other 

than the Z23 profile. The underlying 

HL7 Base Standard does not allow 

the ERR segment to repeat in an 

RSP^K11 message.

Table 8-2 Error 

correction

Length for Severity (ERR-4) is 

“1..1”.

Length for ERR-4 is 1.

Table 8-3 Omission 

correction

Cardinality is missing for 

Insurance Company ID (IN1-3), 

Plan Type (IN1-15) and 

Verification Date/Time (IN1-29).

Insurance Company ID (IN1-3), Plan 

Type (IN1-15) have a Cardinality of 

[1..1]. Verification Date/Time (IN1-

29) has a Cardinality of [0..1].

Table 8-3 Error 

correction

The comment for Verification 

Date/Time (IN1-29) describes 

the necessary precision for the 

field.

The comment for Verification 

Date/Time (IN1-29) implies that the 

year, month and day are optional by 

virtue of using the [ ] characters. Per 

the definition of the TS_NZ data 

type, precision down to the day is 

required. Disregard the comment 

and refer to the definition of TS_NZ.

IN1 segment 

definition

Omission 

correction

The Set ID (IN1-1) field 

definition describes the usage of 

IN1-1 but the necessary 

Conformance Statement was 

omitted.

The following new Conformance 

Statement now applies to the IN1 

segment in the Z32 profile:

IZ-69: IN1-1 (Set ID-IN1) SHALL be 

valued “1”.

Table 8-4 Error 

correction

Usage for Delayed 

Acknowledgement Type (MSA-5)

is O.

Usage for Delayed 

Acknowledgement Type (MSA-5) is 

“X”.
Location Change Existing Corrected

Table 8-5 Error 

correction

The Cardinality of Accept 

Acknowledgement Type (MSH15) is [0..1] and the Constraint is 

“ER”.

The Cardinality of Accept 

Acknowledgement Type (MSH-15) is 

[1..1] to match the Usage of R and 

the Constraint is “NE” to match IZ53.

Table 8-5 Error 

correction

The Cardinality of Application

Acknowledgement Type (MSH16) is [0..1] and the Constraint is 

“AL”.

The Cardinality of Application 

Acknowledgement Type (MSH-16) is 

[1..1] to match the Usage of R and 

the Constraint is “NE” to match IZ52.

Table 8-5 Error 

correction

Usage for Country Code (MSH17), Character Set (MSH-18), 

Principal Language of Message 

(MSH-19) and Alternate 

Character Set Handling Scheme 

(MSH-20) is X.

Usage for Country Code (MSH-17), 

Character Set (MSH-18), Principal 

Language of Message (MSH-19) and 

Alternate Character Set Handling 

Scheme (MSH-20) is O.

Table 8-5 Error 

correction

HL70362 is called out as the 

Value Set for Sending 

Responsible Organization (MSH22) and Receiving Responsible 

Organization (MSH-23).

The Value Sets to use in Sending 

Responsible Organization (MSH-22) 

and Receiving Responsible 

Organization (MSH-23) are defined 

in the XON data type. HL70362 does 

not apply to these fields.

NK1 segment 

definition

Omission 

correction

The Set ID (NK1-1) field 

definition describes the usage of 

NK1-1 but the necessary 

Conformance Statement was 

omitted.

The following new Conformance 

Statement now applies to the NK1 

segment in the Z32 profile:

IZ-70: NK1-1 (Set ID-NK1) SHALL be 

valued sequentially starting with the 

value “1”.

Table 8-8 Error 

correction

The Conditional Predicate for 

Units (OBX-6) requires that OBX6 be populated if Data Type 

(OBX-2) is either “NM” or “SN”

The Conditional Predicate should 

only apply if Data Type (OBX-2) is 

“NM”. The “SN” data type is not 

required by an Observation IDs 

defined by this IG.

OBX segment 

definition

Omission 

correction

IZ-44 is not listed as an 

applicable Conformance 

Statement.

IZ-44 applies to the OBX segment in 

the Z32 profile.

IZ-21 Error 

correction

The value of OBX-2 (Value Type) 

SHALL be one of the following: 

CE, NM, ST, DT, ID or TS

IZ-21 has been removed. Required 

Value Types are defined by the 

required Observation IDs (OBX-3) 

per profile (see the CDC-defined 

NIP003 table in Appendix A). By local 

agreement, OBX segments using 

other data types may be sent.
Location Change Existing Corrected

IZ-36 Error 

correction

If OBX-3.1 is “69764-9” and 

OBX-2 is “CE” then the value set 

for OBX-5 shall be cdcgs1vis.

If OBX-3.1 is “69764-9” and OBX-2 is 

“CE” then the value set for OBX-5 

shall be PHVS_VISBarcodes_IIS. Note 

that PHVS_VISBarcodes_IIS uses 

values from the cdcgs1vis Coding 

System.

ORC segment 

definition

Omission 

correction

IZ-45 is not listed as an 

applicable Conformance 

Statement.

IZ-45 applies to the ORC segment in 

the Z32 profile.

Table 8-12 Error 

correction

The Usage and Cardinality of 

Administrative Sex (PID-8) are 

RE and [0..1].

The Usage and Cardinality of 

Administrative Sex (PID-8) are R and 

[1..1]. If a sex is not definitively 

known, use the value U-Unknown 

from HL70001.

Table 8-12 Error 

correction

The Value Set of Race (PID-10) is 

HL70005.

The Value Set of Race (PID-10) is 

CDCREC. The coding system shall be 

CDCREC from the most recent 

version of HL70396. The values 

listed in Appendix A for HL70005 are 

still valid for CDCREC.

Table 8-13 Error 

correction

The Usage and Cardinality of 

Query Response Status (QAK-2) 

are RE and [0..1].

The Usage and Cardinality of Query 

Response Status (QAK-2) are R and 

[1..1].

Table 8-13 Omission 

correction

Query Response Status (QAK-2) 

has no Value Set.

The Value Set for Query Response 

Status (QAK-2) shall be HL70208.

Table 8-14 Omission 

correction

QPD fields 3 through 11 lack an 

explicit Cardinality.

PatientList (QPD-3) has a Cardinality 

of [0..*]. QPD fields 4 through 11 

have a Cardinality of [0..1].

Table 8-14 Error 

correction

Data type of 

PatientMotherMaidenName 

(QPD-5) is XPN.

Data type of 

PatientMotherMaidenName (QPD5) is XPN_M to match the data type 

in PID segments.

Table 8-14 Omission 

correction

Patient Sex (QPD-7) does not 

have a Value Set defined.

Patient Sex (QPD-7) uses the value 

set HL70001.

Table 8-14 Omission 

correction

Patient Multiple Birth Indicator 

(QPD-10) does not have a Value 

Set defined.

Patient Multiple Birth Indicator 

(QPD-10) uses the value set 

HL70136.

Table 8-14 Error 

correction

Usage of Client Last Updated 

Date (QPD-12) and Client Last 

Update Facility (QPD-13) are RE.

Usage of Client Last Updated Date 

(QPD-12) and Client Last Update 

Facility (QPD-13) are O.
Location Change Existing Corrected

QPD 

segment 

definition

Omission 

correction

The comment for Message 

Query Name (QPD-1) in Table 8-

14 constrains the value of the 

field, but the necessary 

Conformance Statement was 

omitted.

The following new Conformance 

Statement now applies to the QPD 

segment in the Z32 profile:

IZ-67: QPD-1 (Message Query Name) 

SHALL be valued "Z34^Request 

Immunization History^CDCPHINVS”.

Note that the value of QPD-1.2 in IZ67 varies from comment in Table 8-

14. The value in the Conformance 

Statement is the correct value.

Table 8-15 Error 

correction

The length of Give Sub-ID 

Counter (RXA-1) and 

Administration Sub-ID Counter 

(RXA-2) is 4.

The length of Give Sub-ID Counter 

(RXA-1) and Administration Sub-ID 

Counter (RXA-2) is 1 per constraints 

on the values of those two fields.

Table 8-15 Error 

correction

The Usage of Administered Units 

(RXA-7) is C(R/O).

The Usage of Administered Units 

(RXA-7) is C(R/X).

Table 8-15 Error 

correction

The Value Set of Administration 

Notes (RXA-9) is NIP 0001.

The Value Set of Administration 

Notes (RXA-9) is NIP001.

RXA segment 

definition

Error 

correction

IZ-50: If the first instance of 

RXA-9.1 is not valued “00” then 

RXA-6 (administered amount) 

SHALL be valued “999”

IZ-50 is no longer enforced and shall 

be disregarded. Scenarios exist 

where RXA-9.1 may be a value other 

than “00” but an administered 

amount may be known and should 

be sent.

Profile Z31

Errata

Location Change Existing Corrected

Table 9-1 Error 

correction

Usage for the PD1 segment is 

RE.

Usage for the PD1 segment is O.

Table 9-4 Error 

correction

The Cardinality of Accept 

Acknowledgement Type (MSH15) is [0..1] and the Constraint is 

“ER”.

The Cardinality of Accept 

Acknowledgement Type (MSH-15) is 

[1..1] to match the Usage of R and 

the Constraint is “NE” to match IZ53.

Table 9-4 Error 

correction

The Cardinality of Application 

Acknowledgement Type (MSH16) is [0..1] and the Constraint is 

“AL”.

The Cardinality of Application 

Acknowledgement Type (MSH-16) is 

[1..1] to match the Usage of R and 

the Constraint is “NE” to match IZ52.
Location Change Existing Corrected

Table 9-4 Error 

correction

Usage for Country Code (MSH17), Character Set (MSH-18), 

Principal Language of Message 

(MSH-19) and Alternate 

Character Set Handling Scheme 

(MSH-20) is X.

Usage for Country Code (MSH-17), 

Character Set (MSH-18), Principal 

Language of Message (MSH-19) and 

Alternate Character Set Handling 

Scheme (MSH-20) is O.

Table 9-4 Error 

correction

HL70362 is called out as the 

Value Set for Sending 

Responsible Organization (MSH22) and Receiving Responsible 

Organization (MSH-23).

The Value Sets to use in Sending 

Responsible Organization (MSH-22) 

and Receiving Responsible 

Organization (MSH-23) are defined 

in the XON data type. HL70362 does 

not apply to these fields.

NK1 segment 

definition

Omission 

correction

The Set ID (NK1-1) field 

definition describes the usage of 

NK1-1 but the necessary 

Conformance Statement was 

omitted.

The following new Conformance 

Statement now applies to the NK1 

segment in the Z31 profile:

IZ-70: NK1-1 (Set ID-NK1) SHALL be 

valued sequentially starting with the 

value “1”.

QAK segment

definition

Omission

correction

The Z31 profile is currently 

missing the Segment Level 

definition of the QAK segment.

Refer to the QAK Segment Level 

definition for the Z32 profile.

Table 9-6 Omission 

correction

QPD fields 3 through 11 lack an 

explicit Cardinality.

PatientList (QPD-3) has a Cardinality 

of [0..*]. QPD fields 4 through 11 

have a Cardinality of [0..1].

Table 9-6 Error 

correction

Data type of 

PatientMotherMaidenName 

(QPD-5) is XPN.

Data type of 

PatientMotherMaidenName (QPD5) is XPN_M to match the data type 

in PID segments.

Table 9-6 Omission 

correction

Patient Sex (QPD-7) does not 

have a Value Set defined.

Patient Sex (QPD-7) uses the value 

set HL70001.

Table 9-6 Omission 

correction

Patient Multiple Birth Indicator 

(QPD-10) does not have a Value 

Set defined.

Patient Multiple Birth Indicator 

(QPD-10) uses the value set 

HL70136.

Table 9-6 Error 

correction

Usage of Client Last Updated 

Date (QPD-12) and Client Last 

Update Facility (QPD-13) are RE.

Usage of Client Last Updated Date 

(QPD-12) and Client Last Update 

Facility (QPD-13) are O.

QPD 

segment 

definition

Omission 

correction

The comment for Message 

Query Name (QPD-1) in Table 9-

6 constrains the value of the 

field, but the necessary 

Conformance Statement was 

omitted.

The following new Conformance 

Statement now applies to the QPD 

segment in the Z31 profile:

IZ-67: QPD-1 (Message Query Name) 

SHALL be valued "Z34^Request 

Immunization History^CDCPHINVS”.

Note that the value of QPD-1.2 in IZ67 varies from comment in Table 9-

6. The value in the Conformance 

Statement is the correct value.
Location Change Existing Corrected

Table 9-7 Error 

correction

The Usage and Cardinality of 

Administrative Sex (PID-8) are 

RE and [0..1].

The Usage and Cardinality of 

Administrative Sex (PID-8) are R and 

[1..1]. If a sex is not definitively 

known, use the value U-Unknown 

from HL70001.

Table 9-7 Error 

correction

The Value Set of Race (PID-10) is 

HL70005.

The Value Set of Race (PID-10) is 

CDCREC. The coding system shall be 

CDCREC from the most recent 

version of HL70396. The values 

listed in Appendix A for HL70005 are 

still valid for CDCREC.

Table-9-7 Error 

correction

Value Set for Ethnic Group (PID22) references HL70189. Value Set for Ethnic Group (PID-22) 

shall be CDCREC. The coding system 

shall be CDCREC from the most 

recent version of HL70396.

IZ-46 Error 

correction

IZ-46 is present in the document 

with multiple different texts 

including the text below in 

profile Z31:

IZ-46: PID-1 SHALL be a positive 

integer.

IZ-46 is replaced in profile Z31 with 

the following conformance 

statement:

IZ-72: PID-1 (Set ID-PID) SHALL be 

valued sequentially starting with the 

value “1”.

Profile Z33

Errata

Location Change Existing Corrected

Table 10-5 Error 

correction

The Cardinality of Accept 

Acknowledgement Type (MSH15) is [0..1]

The Cardinality of Accept 

Acknowledgement Type (MSH-15) is 

[1..1] to match the Usage of R.

Table 10-5 Error 

correction

The Cardinality of Application 

Acknowledgement Type (MSH16) is [0..1]

The Cardinality of Application 

Acknowledgement Type (MSH-16) is 

[1..1] to match the Usage of R.

Table 10-5 Error 

correction

Usage for Country Code (MSH17), Character Set (MSH-18), 

Principal Language of Message 

(MSH-19) and Alternate 

Character Set Handling Scheme 

(MSH-20) is X.

Usage for Country Code (MSH-17), 

Character Set (MSH-18), Principal 

Language of Message (MSH-19) and 

Alternate Character Set Handling 

Scheme (MSH-20) is O.

Table 10-5 Error 

correction

HL70362 is called out as the 

Value Set for Sending 

Responsible Organization (MSH22) and Receiving Responsible 

Organization (MSH-23).

The Value Sets to use in Sending 

Responsible Organization (MSH-22) 

and Receiving Responsible 

Organization (MSH-23) are defined 

in the XON data type. HL70362 does 

not apply to these fields.
Location Change Existing Corrected

QAK segment

definition

Omission

correction

The Z33 profile is currently 

missing the Segment Level 

definition of the QAK segment.

Refer to the QAK Segment Level 

definition for the Z32 profile.

Table 10-6 Omission 

correction

QPD fields 3 through 11 lack an 

explicit Cardinality.

PatientList (QPD-3) has a Cardinality 

of [0..*]. QPD fields 4 through 11 

have a Cardinality of [0..1].

Table 10-6 Error 

correction

Data type of 

PatientMotherMaidenName 

(QPD-5) is XPN.

Data type of 

PatientMotherMaidenName (QPD5) is XPN_M to match the data type 

in PID segments.

Table 10-6 Omission 

correction

Patient Sex (QPD-7) does not 

have a Value Set defined.

Patient Sex (QPD-7) uses the value 

set HL70001.

Table 10-6 Omission 

correction

Patient Multiple Birth Indicator 

(QPD-10) does not have a Value 

Set defined.

Patient Multiple Birth Indicator 

(QPD-10) uses the value set 

HL70136.

Table 10-6 Error 

correction

Usage of Client Last Updated 

Date (QPD-12) and Client Last 

Update Facility (QPD-13) are RE.

Usage of Client Last Updated Date 

(QPD-12) and Client Last Update 

Facility (QPD-13) are O.

QPD 

segment 

definition

Omission 

correction

The comment for Message 

Query Name (QPD-1) in Table 

10-6 constrains the value of the 

field, but the necessary 

Conformance Statement was 

omitted.

The following new Conformance 

Statement now applies to the QPD 

segment in the Z33 profile:

IZ-71: QPD-1 (Message Query Name) 

SHALL be valued "Z34^Request 

Immunization History^CDCPHINVS" 

or "Z44^Request Evaluated History 

and Forecast^CDCPHINVS" 

depending on the query profile 

received.

Note that the value of QPD-1.2 in IZ71 varies from comment in Table 10-

6. The value in the Conformance 

Statement is the correct value.

Profile Z44

Errata

Location Change Existing Corrected

Tables 11-4 

and 11-5 

Error 

correction

The Z44 profile does not include 

the MSA and ERR segments, yet 

a Segment Level definition is 

included for both segments.

Disregard the MSA and ERR 

Segment Level definitions for the 

Z44 profile.

Table 11-6 Error 

correction

The Cardinality of Accept 

Acknowledgement Type (MSH15) is [0..1]

The Cardinality of Accept 

Acknowledgement Type (MSH-15) is 

[1..1] to match the Usage of R.
Location Change Existing Corrected

Table 11-6 Error 

correction

The Cardinality of Application 

Acknowledgement Type (MSH16) is [0..1]

The Cardinality of Application 

Acknowledgement Type (MSH-16) is 

[1..1] to match the Usage of R.

Table 11-6 Error 

correction

Usage for Country Code (MSH17), Character Set (MSH-18), 

Principal Language of Message 

(MSH-19) and Alternate 

Character Set Handling Scheme 

(MSH-20) is X.

Usage for Country Code (MSH-17), 

Character Set (MSH-18), Principal 

Language of Message (MSH-19) and 

Alternate Character Set Handling 

Scheme (MSH-20) is O.

Table 11-6 Error 

correction

HL70362 is called out as the 

Value Set for Sending 

Responsible Organization (MSH22) and Receiving Responsible 

Organization (MSH-23).

The Value Sets to use in Sending 

Responsible Organization (MSH-22) 

and Receiving Responsible 

Organization (MSH-23) are defined 

in the XON data type. HL70362 does 

not apply to these fields.

Table 11-7 Omission 

correction

QPD fields 3 through 11 lack an 

explicit Cardinality.

PatientList (QPD-3) has a Cardinality 

of [0..*]. QPD fields 4 through 11 

have a Cardinality of [0..1].

Table 11-7 Error 

correction

The value of MessageQeryName 

(QPD-1) is defined as:

Z34^Request Complete 

Immunization 

History^CDCPHINVS

The value of MessageQeryName 

(QPD-1) is defined as:

Z44^Request Evaluated History and 

Forecast^CDCPHINVS

Table 11-7 Error 

correction

Data type of 

PatientMotherMaidenName 

(QPD-5) is XPN.

Data type of 

PatientMotherMaidenName (QPD5) is XPN_M to match the data type 

in PID segments.

Table 11-7 Omission 

correction

Patient Sex (QPD-7) does not 

have a Value Set defined.

Patient Sex (QPD-7) uses the value 

set HL70001.

Table 11-7 Omission 

correction

Patient Multiple Birth Indicator 

(QPD-10) does not have a Value 

Set defined.

Patient Multiple Birth Indicator 

(QPD-10) uses the value set 

HL70136.

Table 11-7 Error 

correction

Usage of Client Last Updated 

Date (QPD-12) and Client Last 

Update Facility (QPD-13) are RE.

Usage of Client Last Updated Date 

(QPD-12) and Client Last Update 

Facility (QPD-13) are O.

QPD 

segment 

definition

Omission 

correction

The comment for Message 

Query Name (QPD-1) in Table 

11-7 constrains the value of the 

field, but the necessary 

Conformance Statement was 

omitted.

The following new Conformance 

Statement now applies to the QPD 

segment in the Z44 profile:

IZ-68: QPD-1 (Message Query Name) 

SHALL be valued "Z44^Request 

Evaluated History and 

Forecast^CDCPHINVS".

Table 11-8 Error 

correction

Data type of Mother’s Maiden 

Name is XPN_MDN.

Data type of Mother’s Maiden Name 

is XPN_M.
Location Change Existing Corrected

Table 11-9 Omission 

correction

The comment for Query Priority 

(RCP-1) in Table 11-9 constrains 

the value of the field, but the 

necessary Conformance 

Statement was omitted.

The following Conformance 

Statement now applies to the RCP 

segment in the Z44 profile:

IZ-27: Constrain RCP-1 (Query 

Priority) to “I”. 

Profile Z42

Clarifications

Location Existing Clarification

ORC segment definition A single ORC segment is defined for 

use with both the evaluated history 

and forecast sections of the 

message.

The population of the ORC segment 

will vary for evaluated history and 

forecast groups. For Forecast 

segments, Filler Order Number 

(ORC-3) is still required and is 

subject to Conformance Statement 

IZ-45. Placer Order Number (ORC-2) 

and Entering Organization (ORC-17) 

both have a usage of RE but are not 

expected for forecast ORC 

segments.

IZ-31 and 47 Current wording implies that empty 

repetitions of Administration Notes 

(RXA-9) are allowed.

The first occurrence should be either 

null or a value from the NIP001 

value set. Any additional 

occurrences may be valued with text 

notes using the CE_TX data type if 

local agreement allows. Empty 

occurrences, other than the first, 

should not be sent.

Errata

Location Change Existing Corrected

Table 12-1 Error 

correction

The ORC segment has a usage of 

O.

The ORC segment has a usage of R 

and a Cardinality of [1..1].

Static 

Definition – 

Segment 

Level

Omission 

correction

The ERR and MSA segments are 

part of the Z42 message profile 

but are not described.

Refer to the Segment Level 

definitions in the Z32 profile for the 

ERR and MSA segments.

Table 12-2 Error 

correction

The Cardinality of Accept 

Acknowledgement Type (MSH15) is [0..1]

The Cardinality of Accept 

Acknowledgement Type (MSH-15) is 

[1..1] to match the Usage of R.

Table 12-2 Error 

correction

The Cardinality of Application 

Acknowledgement Type (MSH16) is [0..1] and the Constraint is 

“AL”.

The Cardinality of Application 

Acknowledgement Type (MSH-16) is 

[1..1] to match the Usage of R and 

the Constraint is “NE” to match IZ52.
Location Change Existing Corrected

Table 12-2 Error 

correction

Usage for Country Code (MSH17), Character Set (MSH-18), 

Principal Language of Message 

(MSH-19) and Alternate 

Character Set Handling Scheme 

(MSH-20) is X.

Usage for Country Code (MSH-17), 

Character Set (MSH-18), Principal 

Language of Message (MSH-19) and 

Alternate Character Set Handling 

Scheme (MSH-20) is O.

Table 12-2 Error 

correction

The Value Sets to use in Sending 

Responsible Organization (MSH22) and Receiving Responsible 

Organization (MSH-23) are 

defined in the XON data type. 

HL70362 does not apply to 

these fields.

The Value Sets to use in Sending 

Responsible Organization (MSH-22) 

and Receiving Responsible 

Organization (MSH-23) are defined 

in the XON data type. HL70362 does 

not apply to these fields.

IZ-55 Error 

correction

Conformance Statement IZ-55 is 

applied to the Z42 profile, 

constraining Message Type 

(MSH-9) to 

“QBP^Q11^QBP_Q11”.

IZ-55 does not apply and is replaced 

by IZ-59 which constrains Message 

Type (MSH-9) to 

“RSP^K11^RSP_K11” as is 

appropriate for the profile.

Table 12-3 Error 

correction

The Conditional Predicate for 

Units (OBX-6) requires that OBX6 be populated if Data Type 

(OBX-2) is either “NM” or “SN”

The Conditional Predicate should 

only apply if Data Type (OBX-2) is 

“NM”. The “SN” data type is not 

required by an Observation IDs 

defined by this IG.

IZ-21 Error 

correction

The value of OBX-2 (Value Type) 

SHALL be one of the following: 

CE, NM, ST, DT, ID or TS

IZ-21 has been removed. Required 

Value Types are defined by the 

required Observation IDs (OBX-3) 

per profile (see the CDC-defined 

NIP003 table in Appendix A). By local 

agreement, OBX segments using 

other data types may be sent.

OBX segment 

definition

Omission 

correction

IZ-44 is not listed as an 

applicable Conformance 

Statement.

IZ-44 applies to the OBX segment in 

the Z42 profile.

ORC segment 

definition

Omission 

correction

IZ-45 is not listed as an 

applicable Conformance 

Statement.

IZ-45 applies to the ORC segment in 

the Z42 profile.

Table 12-6 Error 

correction

The Usage and Cardinality of 

Administrative Sex (PID-8) are 

RE and [0..1].

The Usage and Cardinality of 

Administrative Sex (PID-8) are R and 

[1..1]. If a sex is not definitively 

known, use the value U-Unknown 

from HL70001.
Location Change Existing Corrected

Table 12-6 Error 

correction

The Value Set of Race (PID-10) is 

HL70005.

The Value Set of Race (PID-10) is 

CDCREC. The coding system shall be 

CDCREC from the most recent 

version of HL70396. The values 

listed in Appendix A for HL70005 are 

still valid for CDCREC.

Table 12-7 Error 

correction

The Usage and Cardinality of 

Query Response Status (QAK-2) 

are RE and [0..1].

The Usage and Cardinality of Query 

Response Status (QAK-2) are R and 

[1..1].

Table 12-7 Omission Query Response Status (QAK-2) 

has no Value Set.

The Value Set for Query Response 

Status (QAK-2) shall be HL70208.

Table 12-8 Omission 

correction

QPD fields 3 through 11 lack an 

explicit Cardinality.

PatientList (QPD-3) has a Cardinality 

of [0..*]. QPD fields 4 through 11 

have a Cardinality of [0..1].

Table 12-8 Error 

correction

The value of MessageQeryName 

(QPD-1) is defined as:

Z34^Request Complete 

Immunization 

History^CDCPHINVS

The value of MessageQeryName 

(QPD-1) is defined as:

Z44^Request Evaluated History and 

Forecast^CDCPHINVS

Table 12-8 Error 

correction

Data type of 

PatientMotherMaidenName 

(QPD-5) is XPN.

Data type of 

PatientMotherMaidenName (QPD5) is XPN_M to match the data type 

in PID segments.

Table 12-8 Omission 

correction

Patient Sex (QPD-7) does not 

have a Value Set defined.

Patient Sex (QPD-7) uses the value 

set HL70001.

Table 12-8 Omission 

correction

Patient Multiple Birth Indicator 

(QPD-10) does not have a Value 

Set defined.

Patient Multiple Birth Indicator 

(QPD-10) uses the value set 

HL70136.

Table 12-8 Error 

correction

Usage of Client Last Updated 

Date (QPD-12) and Client Last 

Update Facility (QPD-13) are RE.

Usage of Client Last Updated Date 

(QPD-12) and Client Last Update 

Facility (QPD-13) are O.

QPD 

segment 

definition

Omission 

correction

The comment for Message 

Query Name (QPD-1) in Table 

12-8 constrains the value of the 

field, but the necessary 

Conformance Statement was 

omitted.

The following new Conformance 

Statement now applies to the QPD 

segment in the Z44 profile:

IZ-68: QPD-1 (Message Query Name) 

SHALL be valued "Z44^Request 

Evaluated History and 

Forecast^CDCPHINVS".

Table 12-9 Error 

correction

The length of Give Sub-ID 

Counter (RXA-1) and 

Administration Sub-ID Counter 

(RXA-2) is 4.

The length of Give Sub-ID Counter 

(RXA-1) and Administration Sub-ID 

Counter (RXA-2) is 1 per constraints 

on the values of those two fields.

Table 12-9 Error 

correction

The Usage of Administered Units 

(RXA-7) is C(R/O).

The Usage of Administered Units 

(RXA-7) is C(R/X).

Table 12-9 Error 

correction

The Value Set of Administration 

Notes (RXA-9) is NIP 0001.

The Value Set of Administration 

Notes (RXA-9) is NIP001.
Location Change Existing Corrected

RXA segment 

definition

Error 

correction

IZ-50: If the first instance of 

RXA-9.1 is not valued “00” then 

RXA-6 (administered amount) 

SHALL be valued “999”

IZ-50 is no longer enforced and shall 

be disregarded. Scenarios exist 

where RXA-9.1 may be a value other 

than “00” but an administered 

amount may be known and should 

be sent.

Value Sets

Clarifications

Location Existing Clarification

HL-defined Table 0136 

– Yes/No indicator

A discussion of the use of Null and 

Empty fields in HL7 is included in 

this section.

The discussion of null and empty 

fields is contained in Chapter 3. 

Information contained in the 

definition of Table 0136 shall be 

disregarded. 

CDC-defined NIP003 –

Observation Identifiers

The table documents co-constraints 

for OBX-2 and OBX-5 when a 

particular LOINC code is sent in OBX3.

While not all LOINC codes are 

appropriate to use in every profile, 

when a compliant system builds a 

message containing one of these 

LOINC codes they shall abide by the 

co-constraints outlined in the table.

CDC-defined NIP003 –

Observation Identifiers

Column Header - Corresponding 

data type (indicate in OBX-2)

Data within this column is a mixture 

of base HL7 data types (CE, DT, etc.) 

and data type flavors defined by the 

implementation guide (TS_NZ). 

When a guide specific flavor is 

specified, OBX-2 of the message 

should be populated with the base 

HL7 data type for that flavor. For 

example, if DT_D is listed in the 

table, OBX-2 will be populated with 

DT.

Errata

Location Change Existing Corrected

HL7-defined Table 

0125 – Value Type

Error 

correction

The data types CE_TX, DT_D, 

TS_M, TS_NZ and TS_Z are 

included as valid values in the 

HL70125 code set.

HL70125 defines codes valid 

for inclusion in OBX-2. While 

these data types are used by 

the IG, they should not be 

messaged in OBX-2 and shall 

not be considered value for 

table HL70125.
Location Change Existing Corrected

HL7-defined Table 

0357 – Message Error 

Status Codes

Omission 

correction

Table 0357 doesn’t currently 

have a code that can be used to 

indicate an application error.

A new code is added to HL7-

defined table 0357. 

Status Code: 999

Status Text: Application 

error

Description: Any application 

generated error. ERR-5 and 

ERR-8 will contain additional 

information on the nature of 

the error. This error is 

unrelated to the message 

structure but indicates that 

the system cannot use the 

data.

When incorporating this 

code into ERR-3, the 

appropriate coding system to 

use in ERR-3.3 is “HL70357”. 

This guide is extending HL7 

table 0357 to include this 

value. Future versions of HL7 

will contain this code and 

future releases of this guide 

will manage value sets using 

a more structured method.

CDC-defined NIP003 –

Observation 

Identifiers 

Error 

correction

LOINC code 59778-1 has the 

wrong data associated with it.

LOINC code 59778-1 is 

defined as follows:

Description: Date when 

overdue 

Corresponding data type:

DT_D

Corresponding observation 

value example: 19980522
Location Change Existing Corrected

CDC-defined NIP003 –

Observation 

Identifiers 

Error 

correction

Several LOINC codes have an 

incorrect Data Type (OBX-2) 

associated with them. 

The following LOINC codes 

should use the DT_D data 

type flavor when populating 

OBX-5. Keep in mind that per 

the clarification above, OBX2 of the message will be DT.

30946-8 

30944-3 

30980-7 

30981-5 

59777-3 

59778-1 

29768-9 

29769-7 

46250-7

PHIN_VISBarcodes_IIS Error

Correction

The coding system is specified 

as cdcgs1vis.

cdcgs1vis is not a valid entry 

in HL7 table 0396. The 

correct coding system to use 

is CDCPHINVS.

Immunization Profile 

Identifiers

Omission 

correction

The Value Set for MSH-21 

(2.16.840.1.114222.4.11.3291) 

does not contain the value for 

use with the Z22 or Z23 

profiles.

See below for the additional 

lines for the value set table.

Additional codes have been added to the Immunization Profile Identifiers – IIS Value Set (OID 

2.16.840.1.114222.4.11.3291)

Concept Code Concept Name Definition HL7 Table 0396 Code

Z22 Send Unsolicited Update Send Immunization History CDCPHINVS

Z23 Return ACK Return Acknowledgement CDCPHINVS

Updates have been made to the codes for User-defined Table 0064 – Financial Class. These codes are 

used when sending client eligibility for a funding program. Note that when an event could meet more 

than one eligibility, selection is based on priority and that eligibilities are mutually exclusive.

Code Label Definition

V01 Not VFC eligible Client does not qualify for VFC because they do not have one of the 

statuses below. (V02-V05)

V02 VFC eligible –

Medicaid/Medicaid Managed 

Care

All of the following are true:

•

•

•

Client is currently eligible for Medicaid or Medicaid 

managed care

Client is < 19 years old

The type of vaccine administered is eligible for VFC funding
Code Label Definition

V03 VFC eligible – Uninsured All of the following are true:

•

•

•

Client does not have health insurance

Client is < 19 years old

The type of vaccine administered is eligible for VFC funding

V04 VFC eligible – American 

Indian/Alaska native

All of the following are true:

•

•

•

Client is a member of a federally recognized tribe

Client is < 19 years old

The type of vaccine administered is eligible for VFC funding

V05 VFC eligible – underinsured at 

FQHC/RHC/deputized 

provider

All of the following are true:

•

•

•

•

Client has insurance but insurance does not cover vaccines, 

limits the vaccines covered or caps vaccine coverage at a 

certain amount

Client is receiving care at an FQHC, RHC or deputized 

provider

Client is < 19 years old

The type of vaccine administered is eligible for VFC funding

V22 CHIP Client is eligible for the CHIP program, a separate state health 

insurance that is NOT a Medicaid expansion program

V23 317 Client is eligible to receive vaccines under the state/program 

immunization policy and the vaccine administered is eligible for 317 

funding

V24 Medicare Client is enrolled in Medicare

V25 State program eligibility Client is eligible for a state vaccine program

*** Specific state codes Client is eligible for a specific state vaccine program (may be used 

instead of V25)

Updates have been made to the codes for Immunization Funding Source 

(PHVS_ImmunizationFundingSource_IIS (2.16.840.1.114222.4.11.3287)). These codes indicate the 

inventory stock (i.e., Public or Private – with a two-stock storage model; Public VFC, Public non-VFC, 

Private – with a three-stock storage model) from which each vaccine dose was taken. For publicly 

purchased vaccine, an IIS will use either VXC50 code (i.e., public) or the combination of VXC51 (i.e., 

Public VFC) and VXC52 (i.e., Public non-VFC) codes to record the inventory stock for publicly purchased 

vaccines.

Code Label Definition

PHC70 Private Vaccine stock used was privately funded

VXC50 Public Vaccine stock used was publicly funded

VXC51 Public VFC Vaccine stock used was publicly funded by the VFC program

VXC52 Public non-VFC Vaccine stock used was publicly funded by a non-VFC program
Appendix B

Clarifications

Location Existing Clarification

VXU 

Example #7

Send Information 

About Vaccine 

Information 

Statement (VIS) 

section refers the 

use of the Global 

Document Type 

Identifier (GDTI)

Two methods exist to transmit information in an HL7 message 

describing the VIS document(s) presented to patients or the 

legal guardians. The first involves the use of 2D VIS barcode 

data strings, “VIS Fully-encoded text string”, while the second 

involves the identification of the vaccine type or group along 

with the VIS publication date. The use of the VIS Fully-encoded 

text string is highly recommended when messaging VIS 

information. The alternative of using the vaccine type, 

publication date and presentation date LOINC codes is 

problematic and fails in several use cases including when 

sending manufacturer specific VIS information (such as for HPV) 

or when sending the Multiple Vaccines VIS document. It is 

anticipated that this second method will be retired in a future 

release of the implementation guide. (Note: Scanning does 

not need to be used for this first method to work.) 

The 13 digit Global Document Type Identifier (GDTI) is used to 

identify a document type while the 24 digit VIS Fully-encoded 

text string begins with “253” and includes the GDTI as well as 

the publication date. The VIS Fully-encoded text string 

represents a particular version of the VIS document. The 

Implementation Guide currently says that the publication date 

may be inferred from the fully encoded GDTI. The term “fully 

encoded GDTI” here refers to the VIS Fully-encoded text string 

(24 digits) and not the 13 digit GDTI. As stated, it is the VIS 

Fully-encoded text string and not the GDTI that should be sent 

in OBX-5. The GDTI, Fully-encoded text string, and Edition Date 

are available in the VIS Lookup Table 

(http://www.cdc.gov/vaccines/programs/iis/code-sets/visbarcode-lookup-table.html).

Evaluated 

History and 

Forecast 

example

The example 

message for 

Evaluated History 

and Forecast 

includes only a single 

recommendation.

When sending multiple recommendations in a single query 

response message, the recommendations are sent using a 

single ORC/RXA pair followed by multiple sets of related OBX 

segments (grouped via the Sub-ID in OBX-4) for each 

recommendation.

See below for an example message with multiple forecasts.

Sample message for multiple recommendations:

MSH|^~\&|MYIIS|StatePH|MyEHR|DCS|20150131145233-

0500||RSP^K11^RSP_K11|3533469|P|2.5.1|||NE|NE|||||Z42^CDCPHINVS|DCS^^^^^DCS^XX^^^6439

432|StatePH

MSA|AA|793543
QAK|37374859|OK|Z44^request evaluated Immunization history^CDCPHINVS

QPD|Z44^Request Evaluated History and Forecast^CDCPHINVS 

|37374859|123456^^^MYEHR^MR|Child^Bobbie^Q^^^^L|Que^Suzy^^^^^M|20110214|M|10 East 

Main St^^Myfaircity^GA^^^L

PID|1||123456^^^MYEHR^MR~34500907^^^MyIIS^SR|| Child^Bobbie^Q^^^^L||20110214|M|||10 

East Main St^^Myfaircity^GA^^^L

<...patient history...>

ORC|RE|8788^IIS|197023^IIS

RXA|0|1|20150131|20150131|998^no vaccine admin^CVX|999||||||||||||||NA

OBX|22|CE|30956-7^vaccine type^LN|1|03^MMR^CVX||||||F|||20150131

OBX|23|CE|59779-9^Immunization Schedule 

used^LN|1|VXC16^ACIP^CDCPHINVS||||||F|||20150131

OBX|24|DT|30980-7^Date vaccination due^LN|1|20150214||||||F|||20150131

OBX|25|CE|30956-7^vaccine type^LN|2|10^IPV^CVX||||||F|||20150131

OBX|26|CE|59779-9^Immunization Schedule 

used^LN|2|VXC16^ACIP^CDCPHINVS||||||F|||20150131

OBX|27|DT|30980-7^Date vaccination due^LN|2|20150214||||||F|||20150131

OBX|28|CE|30956-7^vaccine type^LN|3|107^DTAP^CVX||||||F|||20150131

OBX|29|CE|59779-9^Immunization Schedule 

used^LN|3|VXC16^ACIP^CDCPHINVS||||||F|||20150131

OBX|30|DT|30980-7^Date vaccination due^LN|3|20150214||||||F|||20150131

Errata

Location Change Existing Corrected

VXU Example 

#8

Error 

correction

The amount given should be 0. The amount given should be 999.

Evaluated 

History and 

Forecast 

example 

(Important 

Notes)

Error 

correction

The observation sub-id holds to 

one value for each related set of 

observations under the vaccine 

group OBX.

The observation Sub-ID must be 

unique for each related set of 

observations under a given vaccine 

order group. Sub-IDs may be re-used 

between order groups in the 

message.
Location Change Existing Corrected

Evaluated 

History and 

Forecast 

example

Error 

correction

The basic structure for the 

recommendation in the 

message is:

ORC-order segment

RXA-vaccine, CVX-Unspecified 

formulation (no dose given)

OBX-the schedule

OBX-the series used

OBX-dose number in the series

OBX-number of doses in the 

series

OBX-earliest next dose due

OBX-recommended next dose 

due

OBX-overdue next dose due

OBX-series status

The basic structure for the 

recommendation in the message is:

ORC-order segment

RXA-vaccine, CVX-No Vaccine 

Administered (998)

OBX-the vaccine group

OBX-the schedule

OBX-the series used

OBX-dose number in the series

OBX-number of doses in the series

OBX-earliest next dose due

OBX-recommended next dose due

OBX-overdue next dose due

OBX-series status