Childhood Immunization Status 13.1.000

Percentage of children 2 years of age who had four diphtheria, tetanus and acellular pertussis (DTaP); three polio (IPV), one measles, mumps and rubella (MMR); three or four H influenza type B (HiB); three hepatitis B (HepB); one chicken pox (VZV); four pneumococcal conjugate (PCV); one hepatitis A (HepA); two or three rotavirus (RV); and two influenza (flu) vaccines by their second birthday

This Physician Performance Measure (Measure) and related data specifications are owned and were developed by the National Committee for Quality Assurance (NCQA). NCQA is not responsible for any use of the Measure. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures or specifications. NCQA holds a copyright in the Measure. The Measure can be reproduced and distributed, without modification, for noncommercial purposes (e.g., use by healthcare providers in connection with their practices) without obtaining approval from NCQA. Commercial use is defined as the sale, licensing, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain. All commercial uses or requests for modification must be approved by NCQA and are subject to a license at the discretion of NCQA. (C) 2012-2024 National Committee for Quality Assurance. All Rights Reserved.

Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. NCQA disclaims all liability for use or accuracy of any third-party codes contained in the specifications.

CPT(R) codes, descriptions and other data are copyright 2024. American Medical Association. All rights reserved. CPT is a trademark of the American Medical Association. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. Applicable FARS/DFARS restrictions apply to government use.

Some measure specifications contain coding from LOINC(R) (http://loinc.org). The LOINC table, LOINC codes, LOINC panels and form file, LOINC linguistic variants file, LOINC/RSNA Radiology Playbook, and LOINC/IEEE Medical Device Code Mapping Table are copyright 2004-2024 Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee, and are available at no cost under the license at http://loinc.org/terms-of-use.

Some measures use RxNorm, a standardized nomenclature and coding for clinical drugs and drug delivery devices, which is made publicly available courtesy of the U.S. National Library of Medicine (NLM), National Institutes of Health, Department of Health and Human Services. NLM is not responsible for the measures and does not endorse or recommend this or any other product.

“HL7” is the registered trademark of Health Level Seven International.

The performance Measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications. THE MEASURE AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND.
 
Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].

Infants and toddlers are particularly vulnerable to infectious diseases because their immune systems have not built up the necessary defenses to fight infection (HHS-OIDP, 2022). One study estimated that routine childhood vaccines administered in 2019 prevented 24 million diseases (Talbird et al., 2022). Another recent study estimated that routine childhood vaccinations prevented 17.8 million cases of disease and 31,000 deaths for children born in 2017, in addition to saving $13.7 billion in health care costs (Carrico et al., 2022).

Immunizing a child not only protects that child's health but also the health of the community, especially for those who are not immunized or are unable to be immunized due to other health complications (HHS-OIDP, 2022).

This measure looks for childhood vaccinations that should be completed by age 2, in accordance with the Centers for Disease Control and Prevention Advisory Committee on Immunization Practices (CDC ACIP) recommended child and adolescent immunization schedule (CDC, 2023). 

-- For the 2023–24 season, see the 2023–24 ACIP influenza vaccine recommendations (Grohskopf, 2023).

Higher score indicates better quality

Reference Type: CITATION

Reference Text: 'Carrico, J., La, E.M., Talbird, S.E., et al. (2022). Value of the Immunization Program for Children in the 2017 US Birth Cohort. Pediatrics, 150(3). doi:10.1542/peds.2021-056007'

Reference Type: CITATION

Reference Text: 'Centers for Disease Control and Prevention. (2023). Recommended Child and Adolescent Immunization Schedule for Ages 18 Years or Younger, United States. Retrieved August 23, 2023, from https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html'

Reference Type: CITATION

Reference Text: 'Grohskopf, L.A., Blanton, L.H., Ferdinands, J.M., et al. (2023). Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices — United States, 2023-24 Influenza Season. MMWR. Recommendations and Reports, 72(2), 1–25. DOI: http://dx.doi.org/10.15585/mmwr.rr7202a1'

Reference Type: CITATION

Reference Text: 'Talbird, S.E., Carrico, J., La, E.M., et al. (2022). Impact of Routine Childhood Immunization in Reducing Vaccine-Preventable Diseases in the United States. Pediatrics, 150(3). doi:10.1542/peds.2021-056013'

Reference Type: CITATION

Reference Text: 'United States Department of Health and Human Services, Office of Infectious Disease and HIV/AIDS policy (HHS-OIDP). (2022). Vaccines for Infants, Children, and Teens. Retrieved August 23, 2023, from https://www.hhs.gov/immunization/who-and-when/infants-to-teens/index.html'

Recommended vaccines: Vaccines and the schedule of vaccines as recommended by the ACIP for children two years of age. The measure may differ slightly from the ACIP recommendations because the measure focuses on immunizations that are appropriate by age 2. Also, there may be small differences when there are shortages for a particular vaccine.

The measure allows a grace period by measuring compliance with these recommendations between birth and age two.

This eCQM is a patient-based measure.
 
This version of the eCQM uses QDM version 5.6. Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.

Children who turn 2 years of age during the measurement period and have a visit during the measurement period

Equals Initial Population

Exclude children who are in hospice care for any part of the measurement period.

Exclude children with any of the following on or before the child’s second birthday:
- Severe combined immunodeficiency
- Immunodeficiency
- Human Immunodeficiency Virus (HIV)
- Lymphoreticular cancer, multiple myeloma or leukemia
- Intussusception

DTaP
Children with any of the following on or before the child’s second birthday meet criteria:
- At least four DTaP vaccinations, with different dates of service. Do not count a vaccination administered prior to 42 days after birth.
- Anaphylaxis due to the diphtheria, tetanus or pertussis vaccine.
- Encephalitis due to the diphtheria, tetanus or pertussis vaccine.

IPV
Children with either of the following on or before the child’s second birthday meet criteria:
- At least three IPV vaccinations, with different dates of service. Do not count a vaccination administered prior to 42 days after birth.
- Anaphylaxis due to the IPV vaccine.

MMR
Children with any of the following meet criteria:
- At least one MMR vaccination on or between the child’s first and second birthdays.
- Anaphylaxis due to the MMR vaccine on or before the child’s second birthday.
- All of the following anytime on or before the child’s second birthday (on the same or different date of service):
- History of measles.
- History of mumps.
- History of rubella.

HiB
Children with either of the following meet criteria on or before the child’s second birthday:
- At least three HiB vaccinations, with different dates of service. Do not count a vaccination administered prior to 42 days after birth.
- Anaphylaxis due to the HiB vaccine.

HepB
Children with any of the following on or before the child’s second birthday meet criteria:
- At least three hepatitis B vaccinations, with different dates of service.
- One of the three vaccinations can be a newborn hepatitis B vaccination during the eight-day period that begins on the date of birth and ends seven days after the date of birth. For example, if the member’s date of birth is December 1, the newborn hepatitis B vaccination must be on or between December 1 and December 8.
- Anaphylaxis due to the hepatitis B vaccine.
- History of hepatitis B illness.

VZV
Children with any of the following meet criteria:
- At least one VZV vaccination, with a date of service on or between the child’s first and second birthdays.
- Anaphylaxis due to the VZV vaccine on or before the child’s second birthday.
- History of varicella zoster (e.g., chicken pox) illness on or before the child’s second birthday.

PCV
Children with either of the following on or before the child’s second birthday meet criteria:
- At least four pneumococcal conjugate vaccinations, with different dates of service on or before the child’s second birthday. Do not count a vaccination administered prior to 42 days after birth.
- Anaphylaxis due to the pneumococcal vaccine.

HepA
Children with any of the following meet criteria:
- At least one hepatitis A vaccination, with a date of service on or between the child’s first and second birthdays.
- Anaphylaxis due to the hepatitis A vaccine on or before the child’s second birthday.
- History of hepatitis A illness on or before the child’s second birthday.

RV
Children with any of the following meet criteria:
- At least two doses of the two-dose rotavirus vaccine on different dates of service on or before the child’s second birthday. Do not count a vaccination administered prior to 42 days after birth.
- At least three doses of the three-dose rotavirus vaccine on different dates of service on or before the child’s second birthday. Do not count a vaccination administered prior to 42 days after birth.
- At least one dose of the two-dose rotavirus vaccine and at least two doses of the three-dose rotavirus vaccine, all on different dates of service, on or before the child’s second birthday. Do not count a vaccination administered prior to 42 days after birth.
- Anaphylaxis due to the rotavirus vaccine on or before the child’s second birthday.

Flu
Children with either of the following on or before their second birthday meet criteria:
- At least two influenza vaccinations, with different dates of service on or before the child’s second birthday. Do not count a vaccination administered prior to 6 months (180 days) after birth.
- One of the two vaccinations can be a Live Attenuated Influenza Vaccine (LAIV) vaccination administered on the child’s second birthday. Do not count a LAIV vaccination administered before the child’s second birthday.
- Anaphylaxis due to the influenza vaccine.

For every patient evaluated by this measure also identify payer, race, ethnicity and sex

Initial Population

AgeInYearsAt(date from 
  end of "Measurement Period"
) = 2
  and exists ( "Qualifying Encounters" )

- Denominator
  - "Initial Population"

Denominator Exclusions

Hospice."Has Hospice Services"
  or "Has Severe Combined Immunodeficiency"
  or "Has Immunodeficiency"
  or "Has HIV"
  or "Has Lymphoreticular Cancer, Multiple Myeloma or Leukemia"
  or "Has Intussusception"

Numerator

( exists ( "Four DTaP Vaccinations" )
    or exists ( "DTaP Numerator Inclusion Conditions" )
)
  and ( exists ( "Three Polio Vaccinations" )
      or exists ( "Polio Numerator Inclusion Conditions" )
  )
  and ( exists ( "One MMR Vaccination" )
      or exists ( "MMR Numerator Inclusion Conditions" )
      or ( exists ( "Measles Indicators" )
          and exists ( "Mumps Indicators" )
          and exists ( "Rubella Indicators" )
      )
  )
  and ( "Has Appropriate Number of Hib Immunizations"
      or exists ( "Hib Numerator Inclusion Conditions" )
  )
  and ( exists ( "Three Hepatitis B Vaccinations" )
      or ( exists ( "Meets HepB Vaccination Requirement" )
          or exists ( "Hepatitis B Numerator Inclusion Conditions" )
      )
  )
  and ( exists ( "One Chicken Pox Vaccination" )
      or exists ( "Varicella Zoster Numerator Inclusion Conditions" )
  )
  and ( exists ( "Four Pneumococcal Conjugate Vaccinations" )
      or exists ( "Pneumococcal Conjugate Numerator Inclusion Conditions" )
  )
  and ( exists ( "One Hepatitis A Vaccinations" )
      or exists ( "Hepatitis A Numerator Inclusion Conditions" )
  )
  and ( "Has Appropriate Number of Rotavirus Immunizations"
      or exists ( "Rotavirus Numerator Inclusion Conditions" )
  )
  and ( exists ( "Two Influenza Vaccinations" )
      or ( "Two Influenza Vaccinations Including One LAIV Vaccination" )
      or exists ( "Influenza Numerator Inclusion Conditions" )
  )

- Numerator Exclusions
  - None

- Denominator Exceptions
  - None

- Stratification
  - None

Date of First Birthday

date from Patient.birthDatetime + 1 year

Date of First Birthday to Date of Second Birthday

Interval["Date of First Birthday", "Date of Second Birthday"]

Date of Second Birthday

date from Patient.birthDatetime + 2 years

Denominator
- - "Initial Population"

Denominator Exclusions

Hospice."Has Hospice Services"
  or "Has Severe Combined Immunodeficiency"
  or "Has Immunodeficiency"
  or "Has HIV"
  or "Has Lymphoreticular Cancer, Multiple Myeloma or Leukemia"
  or "Has Intussusception"

DTaP Immunizations or Procedures

( ( ["Immunization, Administered": "DTaP Vaccine"]
    union ["Procedure, Performed": "DTaP Vaccine Administered"] ) DTaPVaccination
    where date from Global."EarliestOf" ( DTaPVaccination.relevantDatetime, DTaPVaccination.relevantPeriod ) during day of "Vaccine Administration Interval - 42 Days up to 2 Years Old"
)

DTaP Numerator Inclusion Conditions

( ["Diagnosis": "Anaphylactic Reaction to DTaP Vaccine"]
  union ["Diagnosis": "Encephalitis Due to Diphtheria, Tetanus or Pertussis Vaccine"] ) DTaPConditions
  where date from start of DTaPConditions.prevalencePeriod during day of "First Two Years"

First Two Years

Interval[date from Patient.birthDatetime, "Date of Second Birthday"]

Four DTaP Vaccinations

from
  "DTaP Immunizations or Procedures" DTaPVaccination1,
  "DTaP Immunizations or Procedures" DTaPVaccination2,
  "DTaP Immunizations or Procedures" DTaPVaccination3,
  "DTaP Immunizations or Procedures" DTaPVaccination4
  where date from Global."EarliestOf" ( DTaPVaccination2.relevantDatetime, DTaPVaccination2.relevantPeriod ) 1 day or more after date from Global."EarliestOf" ( DTaPVaccination1.relevantDatetime, DTaPVaccination1.relevantPeriod )
    and date from Global."EarliestOf" ( DTaPVaccination3.relevantDatetime, DTaPVaccination3.relevantPeriod ) 1 day or more after date from Global."EarliestOf" ( DTaPVaccination2.relevantDatetime, DTaPVaccination2.relevantPeriod )
    and date from Global."EarliestOf" ( DTaPVaccination4.relevantDatetime, DTaPVaccination4.relevantPeriod ) 1 day or more after date from Global."EarliestOf" ( DTaPVaccination3.relevantDatetime, DTaPVaccination3.relevantPeriod )
  return DTaPVaccination1

Four Pneumococcal Conjugate Vaccinations

from
  "Pneumococcal Conjugate Immunizations or Procedures" PneumococcalVaccination1,
  "Pneumococcal Conjugate Immunizations or Procedures" PneumococcalVaccination2,
  "Pneumococcal Conjugate Immunizations or Procedures" PneumococcalVaccination3,
  "Pneumococcal Conjugate Immunizations or Procedures" PneumococcalVaccination4
  where date from Global."EarliestOf" ( PneumococcalVaccination2.relevantDatetime, PneumococcalVaccination2.relevantPeriod ) 1 day or more after date from Global."EarliestOf" ( PneumococcalVaccination1.relevantDatetime, PneumococcalVaccination1.relevantPeriod )
    and date from Global."EarliestOf" ( PneumococcalVaccination3.relevantDatetime, PneumococcalVaccination3.relevantPeriod ) 1 day or more after date from Global."EarliestOf" ( PneumococcalVaccination2.relevantDatetime, PneumococcalVaccination2.relevantPeriod )
    and date from Global."EarliestOf" ( PneumococcalVaccination4.relevantDatetime, PneumococcalVaccination4.relevantPeriod ) 1 day or more after date from Global."EarliestOf" ( PneumococcalVaccination3.relevantDatetime, PneumococcalVaccination3.relevantPeriod )
  return PneumococcalVaccination1

Has Appropriate Number of Hib Immunizations

exists ( "Hib 3 or 4 Dose Immunizations" HibImmunization
//4 dose test
    
    let HasFourDose: Count("Hib 4 Dose Immunizations or Procedures") > 0
    where ( HasFourDose //if pt had at least one 4 dose code
        
        and Count(distinct("Hib 3 or 4 Dose Immunizations" HibVaccinations
              return date from Global."EarliestOf"(HibVaccinations.relevantDatetime, HibVaccinations.relevantPeriod)
          )
        ) >= 4 //pt must have 4 regimens (e.g., 3,3,4,4 or 4,3,4,4)
    
    )
      or ( HasFourDose is false //if pt did not have at least one 4 dose code
          
          and Count(distinct("Hib 3 or 4 Dose Immunizations" HibVaccinations
                return date from Global."EarliestOf"(HibVaccinations.relevantDatetime, HibVaccinations.relevantPeriod)
            )
          ) >= 3 //pt must have 3 regimens of 3 dose codes
      
      )
)

Has Appropriate Number of Rotavirus Immunizations

exists ( "Rotavirus 2 or 3 Dose Immunizations" RotavirusImmunization
    let HasThreeDose: Count("Rotavirus 3 Dose Immunizations or Procedures") > 0
    where ( HasThreeDose
        and Count(distinct("Rotavirus 2 or 3 Dose Immunizations" RotavirusVaccinations
              return date from Global."EarliestOf"(RotavirusVaccinations.relevantDatetime, RotavirusVaccinations.relevantPeriod)
          )
        ) >= 3
    )
      or ( HasThreeDose is false
          and Count(distinct("Rotavirus 2 or 3 Dose Immunizations" RotavirusVaccinations
                return date from Global."EarliestOf"(RotavirusVaccinations.relevantDatetime, RotavirusVaccinations.relevantPeriod)
            )
          ) >= 2
      )
)

Has HIV

exists ( ["Diagnosis": "HIV"] HIV
    where date from start of HIV.prevalencePeriod during day of "First Two Years"
)

Has Immunodeficiency

exists ( ["Diagnosis": "Disorders of the Immune System"] ImmuneDisorder
    where date from start of ImmuneDisorder.prevalencePeriod during day of "First Two Years"
)

Has Intussusception

exists ( ["Diagnosis": "Intussusception"] IntussusceptionDisorder
    where date from start of IntussusceptionDisorder.prevalencePeriod during day of "First Two Years"
)

Has Lymphoreticular Cancer, Multiple Myeloma or Leukemia

exists ( ["Diagnosis": "Malignant Neoplasm of Lymphatic and Hematopoietic Tissue"] LymphaticMalignantNeoplasm
    where date from start of LymphaticMalignantNeoplasm.prevalencePeriod during day of "First Two Years"
)

Has Severe Combined Immunodeficiency

exists ( ["Diagnosis": "Severe Combined Immunodeficiency"] SevereImmuneDisorder
    where date from start of SevereImmuneDisorder.prevalencePeriod during day of "First Two Years"
)

Hepatitis A Numerator Inclusion Conditions

( ["Diagnosis": "Hepatitis A"]
  union ["Diagnosis": "Anaphylaxis caused by vaccine product containing Hepatitis A virus antigen (disorder)"] ) HepatitisADiagnosis
  where date from start of HepatitisADiagnosis.prevalencePeriod during day of "First Two Years"

Hepatitis B Immunizations or Procedures

( ( ["Immunization, Administered": "Hepatitis B Vaccine"]
    union ["Procedure, Performed": "Hepatitis B Vaccine Administered"] ) HepatitisBVaccination
    where date from Global."EarliestOf" ( HepatitisBVaccination.relevantDatetime, HepatitisBVaccination.relevantPeriod ) during day of "First Two Years"
)

Hepatitis B Numerator Inclusion Conditions

( ["Diagnosis": "Anaphylaxis caused by vaccine product containing Hepatitis B virus antigen (disorder)"]
  union ["Diagnosis": "Hepatitis B"] ) HepBConditions
  where date from start of HepBConditions.prevalencePeriod during day of "First Two Years"

Hib 3 Dose Immunizations or Procedures

( ( ["Immunization, Administered": "Hib Vaccine (3 dose schedule)"]
    union ["Procedure, Performed": "Hib Vaccine (3 dose schedule) Administered"] ) ThreeDoseHib
    where date from Global."EarliestOf" ( ThreeDoseHib.relevantDatetime, ThreeDoseHib.relevantPeriod ) during day of "Vaccine Administration Interval - 42 Days up to 2 Years Old"
)

Hib 3 or 4 Dose Immunizations

"Hib 3 Dose Immunizations or Procedures"
  union "Hib 4 Dose Immunizations or Procedures"

Hib 4 Dose Immunizations or Procedures

( ( ["Immunization, Administered": "Hib Vaccine (4 dose schedule)"]
    union ["Procedure, Performed": "Hib Vaccine (4 dose schedule) Administered"] ) FourDoseHib
    where date from Global."EarliestOf" ( FourDoseHib.relevantDatetime, FourDoseHib.relevantPeriod ) during day of "Vaccine Administration Interval - 42 Days up to 2 Years Old"
)

Hib Numerator Inclusion Conditions

["Diagnosis": "Anaphylaxis caused by vaccine product containing only Haemophilus influenzae type b antigen (disorder)"] HibReaction
  where date from start of HibReaction.prevalencePeriod during day of "First Two Years"

Hospice.Has Hospice Services

exists ( ["Encounter, Performed": "Encounter Inpatient"] InpatientEncounter
    where ( InpatientEncounter.dischargeDisposition ~ "Discharge to home for hospice care (procedure)"
        or InpatientEncounter.dischargeDisposition ~ "Discharge to healthcare facility for hospice care (procedure)"
    )
      and InpatientEncounter.relevantPeriod ends during day of "Measurement Period"
)
  or exists ( ["Encounter, Performed": "Hospice Encounter"] HospiceEncounter
      where HospiceEncounter.relevantPeriod overlaps day of "Measurement Period"
  )
  or exists ( ["Assessment, Performed": "Hospice care [Minimum Data Set]"] HospiceAssessment
      where HospiceAssessment.result ~ "Yes (qualifier value)"
        and Global."NormalizeInterval" ( HospiceAssessment.relevantDatetime, HospiceAssessment.relevantPeriod ) overlaps day of "Measurement Period"
  )
  or exists ( ["Intervention, Order": "Hospice Care Ambulatory"] HospiceOrder
      where HospiceOrder.authorDatetime during day of "Measurement Period"
  )
  or exists ( ["Intervention, Performed": "Hospice Care Ambulatory"] HospicePerformed
      where Global."NormalizeInterval" ( HospicePerformed.relevantDatetime, HospicePerformed.relevantPeriod ) overlaps day of "Measurement Period"
  )
or exists ( ["Diagnosis": "Hospice Diagnosis"] HospiceCareDiagnosis
      where HospiceCareDiagnosis.prevalencePeriod overlaps day of "Measurement Period"
  )

Influenza Immunizations or Procedures

( ( ["Immunization, Administered": "Child Influenza Vaccine"]
    union ["Procedure, Performed": "Child Influenza Vaccine Administered"] ) InfluenzaAdministration
    where date from Global."EarliestOf" ( InfluenzaAdministration.relevantDatetime, InfluenzaAdministration.relevantPeriod ) during day of "Vaccine Administration Interval - 180 Days up to 2 Years Old"
)

Influenza Numerator Inclusion Conditions

["Diagnosis": "Anaphylaxis caused by vaccine product containing Influenza virus antigen (disorder)"] InfluenzaConditions
  where date from start of InfluenzaConditions.prevalencePeriod during day of "First Two Years"

Initial Population

AgeInYearsAt(date from 
  end of "Measurement Period"
) = 2
  and exists ( "Qualifying Encounters" )

LAIV Vaccinations

( ( ["Immunization, Administered": "Influenza Virus LAIV Vaccine"]
    union ["Procedure, Performed": "Influenza Virus LAIV Vaccine Administered"] ) InfluenzaAdministration
    where date from Global."EarliestOf" ( InfluenzaAdministration.relevantDatetime, InfluenzaAdministration.relevantPeriod ) during day of Interval["Date of Second Birthday", "Date of Second Birthday"]
)

Measles Indicators

["Diagnosis": "Measles"] MeaslesDiagnosis
  where date from start of MeaslesDiagnosis.prevalencePeriod during day of "First Two Years"

Meets HepB Vaccination Requirement

from
  "Hepatitis B Immunizations or Procedures" HepatitisBVaccination1,
  "Hepatitis B Immunizations or Procedures" HepatitisBVaccination2,
  "NewBorn Vaccine Requirement" NewBornVaccine3
  where date from Global."EarliestOf" ( HepatitisBVaccination2.relevantDatetime, HepatitisBVaccination2.relevantPeriod ) 1 day or more after date from Global."EarliestOf" ( HepatitisBVaccination1.relevantDatetime, HepatitisBVaccination1.relevantPeriod )
    and date from Global."EarliestOf" ( HepatitisBVaccination1.relevantDatetime, HepatitisBVaccination1.relevantPeriod ) 1 day or more after date from Global."EarliestOf" ( NewBornVaccine3.relevantDatetime, NewBornVaccine3.relevantPeriod )
    and date from Global."EarliestOf" ( HepatitisBVaccination2.relevantDatetime, HepatitisBVaccination2.relevantPeriod ) 1 day or more after date from Global."EarliestOf" ( NewBornVaccine3.relevantDatetime, NewBornVaccine3.relevantPeriod )
  return HepatitisBVaccination1

MMR Numerator Inclusion Conditions

["Diagnosis": "Anaphylaxis caused by vaccine product containing Measles morbillivirus and Mumps orthorubulavirus and Rubella virus antigens (disorder)"] MMRConditions
  where date from start of MMRConditions.prevalencePeriod during day of "First Two Years"

Mumps Indicators

["Diagnosis": "Mumps"] MumpsDiagnosis
  where date from start of MumpsDiagnosis.prevalencePeriod during day of "First Two Years"

NewBorn Vaccine Requirement

["Procedure, Performed": "Introduction of Serum, Toxoid and Vaccine into Muscle, Percutaneous Approach"] NewBornVaccine
  where date from Global."EarliestOf" ( NewBornVaccine.relevantDatetime, NewBornVaccine.relevantPeriod ) during day of Interval[date from Patient.birthDatetime, date from Patient.birthDatetime + 7 days]

Numerator

( exists ( "Four DTaP Vaccinations" )
    or exists ( "DTaP Numerator Inclusion Conditions" )
)
  and ( exists ( "Three Polio Vaccinations" )
      or exists ( "Polio Numerator Inclusion Conditions" )
  )
  and ( exists ( "One MMR Vaccination" )
      or exists ( "MMR Numerator Inclusion Conditions" )
      or ( exists ( "Measles Indicators" )
          and exists ( "Mumps Indicators" )
          and exists ( "Rubella Indicators" )
      )
  )
  and ( "Has Appropriate Number of Hib Immunizations"
      or exists ( "Hib Numerator Inclusion Conditions" )
  )
  and ( exists ( "Three Hepatitis B Vaccinations" )
      or ( exists ( "Meets HepB Vaccination Requirement" )
          or exists ( "Hepatitis B Numerator Inclusion Conditions" )
      )
  )
  and ( exists ( "One Chicken Pox Vaccination" )
      or exists ( "Varicella Zoster Numerator Inclusion Conditions" )
  )
  and ( exists ( "Four Pneumococcal Conjugate Vaccinations" )
      or exists ( "Pneumococcal Conjugate Numerator Inclusion Conditions" )
  )
  and ( exists ( "One Hepatitis A Vaccinations" )
      or exists ( "Hepatitis A Numerator Inclusion Conditions" )
  )
  and ( "Has Appropriate Number of Rotavirus Immunizations"
      or exists ( "Rotavirus Numerator Inclusion Conditions" )
  )
  and ( exists ( "Two Influenza Vaccinations" )
      or ( "Two Influenza Vaccinations Including One LAIV Vaccination" )
      or exists ( "Influenza Numerator Inclusion Conditions" )
  )

One Chicken Pox Vaccination

( ( ["Immunization, Administered": "Varicella Zoster Vaccine (VZV)"]
    union ["Procedure, Performed": "Varicella Zoster Vaccine (VZV) Administered"] ) ChickenPoxVaccination
    where date from Global."EarliestOf" ( ChickenPoxVaccination.relevantDatetime, ChickenPoxVaccination.relevantPeriod ) during day of "Date of First Birthday to Date of Second Birthday"
)

One Hepatitis A Vaccinations

( ( ["Immunization, Administered": "Hepatitis A Vaccine"]
    union ["Procedure, Performed": "Hepatitis A Vaccine Administered"] ) HepatitisAVaccination
    where date from Global."EarliestOf" ( HepatitisAVaccination.relevantDatetime, HepatitisAVaccination.relevantPeriod ) during day of "Date of First Birthday to Date of Second Birthday"
)

One MMR Vaccination

( ( ["Immunization, Administered": "Measles, Mumps and Rubella (MMR) Vaccine"]
    union ["Procedure, Performed": "Measles, Mumps and Rubella (MMR) Vaccine Administered"] ) MMRVaccination
    where date from Global."EarliestOf" ( MMRVaccination.relevantDatetime, MMRVaccination.relevantPeriod ) during day of "Date of First Birthday to Date of Second Birthday"
)

Pneumococcal Conjugate Immunizations or Procedures

( ( ["Immunization, Administered": "Pneumococcal Conjugate Vaccine"]
    union ["Procedure, Performed": "Pneumococcal Conjugate Vaccine Administered"] ) PneumococcalVaccination
    where date from Global."EarliestOf" ( PneumococcalVaccination.relevantDatetime, PneumococcalVaccination.relevantPeriod ) during day of "Vaccine Administration Interval - 42 Days up to 2 Years Old"
)

Pneumococcal Conjugate Numerator Inclusion Conditions

["Diagnosis": "Anaphylaxis caused by vaccine product containing Streptococcus pneumoniae antigen (disorder)"] PneumococcalReaction
  where date from start of PneumococcalReaction.prevalencePeriod during day of "First Two Years"

Polio Immunizations or Procedures

( ( ["Immunization, Administered": "Inactivated Polio Vaccine (IPV)"]
    union ["Procedure, Performed": "Inactivated Polio Vaccine (IPV) Administered"] ) PolioVaccination
    where date from Global."EarliestOf" ( PolioVaccination.relevantDatetime, PolioVaccination.relevantPeriod ) during day of "Vaccine Administration Interval - 42 Days up to 2 Years Old"
)

Polio Numerator Inclusion Conditions

["Diagnosis": "Anaphylaxis caused by vaccine product containing human poliovirus antigen (disorder)"] PolioConditions
  where date from start of PolioConditions.prevalencePeriod during day of "First Two Years"

Qualifying Encounters

( ["Encounter, Performed": "Office Visit"]
  union ["Encounter, Performed": "Home Healthcare Services"]
  union ["Encounter, Performed": "Preventive Care, Established Office Visit, 0 to 17"]
  union ["Encounter, Performed": "Preventive Care Services, Initial Office Visit, 0 to 17"]
  union ["Encounter, Performed": "Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician or other qualified health care professional"]
  union ["Encounter, Performed": "Virtual Encounter"]
  union ["Encounter, Performed": "Telephone Visits"] ) ValidEncounters
  where ValidEncounters.relevantPeriod during day of "Measurement Period"

Rotavirus 2 Dose Immunizations or Procedures

( ( ["Immunization, Administered": "rotavirus, live, monovalent vaccine"]
    union ["Procedure, Performed": "Rotavirus Vaccine (2 dose schedule) Administered"] ) TwoDoseRotavirus
    where date from Global."EarliestOf" ( TwoDoseRotavirus.relevantDatetime, TwoDoseRotavirus.relevantPeriod ) during day of "Vaccine Administration Interval - 42 Days up to 2 Years Old"
)

Rotavirus 2 or 3 Dose Immunizations

"Rotavirus 2 Dose Immunizations or Procedures"
  union "Rotavirus 3 Dose Immunizations or Procedures"

Rotavirus 3 Dose Immunizations or Procedures

( ( ["Immunization, Administered": "Rotavirus Vaccine (3 dose schedule)"]
    union ["Procedure, Performed": "Rotavirus Vaccine (3 dose schedule) Administered"] ) ThreeDoseRotavirus
    where date from Global."EarliestOf" ( ThreeDoseRotavirus.relevantDatetime, ThreeDoseRotavirus.relevantPeriod ) during day of "Vaccine Administration Interval - 42 Days up to 2 Years Old"
)

Rotavirus Numerator Inclusion Conditions

( ["Diagnosis": "Anaphylaxis caused by rotavirus vaccine (disorder)"] RotavirusConditions
    where date from start of RotavirusConditions.prevalencePeriod during day of "First Two Years"
)

Rubella Indicators

["Diagnosis": "Rubella"] RubellaDiagnosis
  where date from start of RubellaDiagnosis.prevalencePeriod during day of "First Two Years"

SDE Ethnicity

["Patient Characteristic Ethnicity": "Ethnicity"]

SDE Payer

["Patient Characteristic Payer": "Payer Type"]

SDE Race
- - ["Patient Characteristic Race": "Race"]

SDE Sex

["Patient Characteristic Sex": "ONC Administrative Sex"]

Three Hepatitis B Vaccinations

from
  "Hepatitis B Immunizations or Procedures" HepatitisBVaccination1,
  "Hepatitis B Immunizations or Procedures" HepatitisBVaccination2,
  "Hepatitis B Immunizations or Procedures" HepatitisBVaccination3
  where date from Global."EarliestOf" ( HepatitisBVaccination2.relevantDatetime, HepatitisBVaccination2.relevantPeriod ) 1 day or more after date from Global."EarliestOf" ( HepatitisBVaccination1.relevantDatetime, HepatitisBVaccination1.relevantPeriod )
    and date from Global."EarliestOf" ( HepatitisBVaccination3.relevantDatetime, HepatitisBVaccination3.relevantPeriod ) 1 day or more after date from Global."EarliestOf" ( HepatitisBVaccination2.relevantDatetime, HepatitisBVaccination2.relevantPeriod )
  return HepatitisBVaccination1

Three Polio Vaccinations

from
  "Polio Immunizations or Procedures" PolioVaccination1,
  "Polio Immunizations or Procedures" PolioVaccination2,
  "Polio Immunizations or Procedures" PolioVaccination3
  where date from Global."EarliestOf" ( PolioVaccination2.relevantDatetime, PolioVaccination2.relevantPeriod ) 1 day or more after date from Global."EarliestOf" ( PolioVaccination1.relevantDatetime, PolioVaccination1.relevantPeriod )
    and date from Global."EarliestOf" ( PolioVaccination3.relevantDatetime, PolioVaccination3.relevantPeriod ) 1 day or more after date from Global."EarliestOf" ( PolioVaccination2.relevantDatetime, PolioVaccination2.relevantPeriod )
  return PolioVaccination1

Two Influenza Vaccinations

from
  "Influenza Immunizations or Procedures" FluVaccination1,
  "Influenza Immunizations or Procedures" FluVaccination2
  where date from Global."EarliestOf" ( FluVaccination2.relevantDatetime, FluVaccination2.relevantPeriod ) 1 day or more after date from Global."EarliestOf" ( FluVaccination1.relevantDatetime, FluVaccination1.relevantPeriod )
  return FluVaccination1

Two Influenza Vaccinations Including One LAIV Vaccination

exists "LAIV Vaccinations"
  and exists "Influenza Immunizations or Procedures"

Vaccine Administration Interval - 180 Days up to 2 Years Old

Interval[date from Patient.birthDatetime + 180 days, "Date of Second Birthday"]

Vaccine Administration Interval - 42 Days up to 2 Years Old

Interval[date from Patient.birthDatetime + 42 days, "Date of Second Birthday"]

Varicella Zoster Numerator Inclusion Conditions

( ["Diagnosis": "Varicella Zoster"]
  union ["Diagnosis": "Anaphylaxis caused by vaccine containing Human alphaherpesvirus 3 antigen (disorder)"] ) VaricellaZoster
  where date from start of VaricellaZoster.prevalencePeriod during day of "First Two Years"

Global.Earliest(period Interval<DateTime>)

if ( HasStart(period)) then start of period 
  else 
end of period

Global.EarliestOf(pointInTime DateTime, period Interval<DateTime>)
- - Earliest(NormalizeInterval(pointInTime, period))

Global.HasStart(period Interval<DateTime>)

not ( start of period is null
    or start of period = minimum DateTime
)

Global.NormalizeInterval(pointInTime DateTime, period Interval<DateTime>)

if pointInTime is not null then Interval[pointInTime, pointInTime]
  else if period is not null then period 
  else null as Interval<DateTime>

code "Anaphylaxis caused by rotavirus vaccine (disorder)" ("SNOMEDCT Code (428331000124103)")
code "Anaphylaxis caused by vaccine containing Human alphaherpesvirus 3 antigen (disorder)" ("SNOMEDCT Code (471341000124104)")
code "Anaphylaxis caused by vaccine product containing Hepatitis A virus antigen (disorder)" ("SNOMEDCT Code (471311000124103)")
code "Anaphylaxis caused by vaccine product containing Hepatitis B virus antigen (disorder)" ("SNOMEDCT Code (428321000124101)")
code "Anaphylaxis caused by vaccine product containing human poliovirus antigen (disorder)" ("SNOMEDCT Code (471321000124106)")
code "Anaphylaxis caused by vaccine product containing Influenza virus antigen (disorder)" ("SNOMEDCT Code (471361000124100)")
code "Anaphylaxis caused by vaccine product containing Measles morbillivirus and Mumps orthorubulavirus and Rubella virus antigens (disorder)" ("SNOMEDCT Code (471331000124109)")
code "Anaphylaxis caused by vaccine product containing only Haemophilus influenzae type b antigen (disorder)" ("SNOMEDCT Code (433621000124101)")
code "Anaphylaxis caused by vaccine product containing Streptococcus pneumoniae antigen (disorder)" ("SNOMEDCT Code (471141000124102)")
code "Discharge to healthcare facility for hospice care (procedure)" ("SNOMEDCT Code (428371000124100)")
code "Discharge to home for hospice care (procedure)" ("SNOMEDCT Code (428361000124107)")
code "Hospice care [Minimum Data Set]" ("LOINC Code (45755-6)")
code "Introduction of Serum, Toxoid and Vaccine into Muscle, Percutaneous Approach" ("ICD10PCS Code (3E0234Z)")
code "Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician or other qualified health care professional" ("CPT Code (99211)")
code "rotavirus, live, monovalent vaccine" ("CVX Code (119)")
code "Yes (qualifier value)" ("SNOMEDCT Code (373066001)")
valueset "Anaphylactic Reaction to DTaP Vaccine" (2.16.840.1.113883.3.464.1003.199.12.1031)
valueset "Child Influenza Vaccine" (2.16.840.1.113883.3.464.1003.196.12.1218)
valueset "Child Influenza Vaccine Administered" (2.16.840.1.113883.3.464.1003.110.12.1044)
valueset "Disorders of the Immune System" (2.16.840.1.113883.3.464.1003.120.12.1001)
valueset "DTaP Vaccine" (2.16.840.1.113883.3.464.1003.196.12.1214)
valueset "DTaP Vaccine Administered" (2.16.840.1.113883.3.464.1003.110.12.1022)
valueset "Encephalitis Due to Diphtheria, Tetanus or Pertussis Vaccine" (2.16.840.1.113883.3.464.1003.1164)
valueset "Encounter Inpatient" (2.16.840.1.113883.3.666.5.307)
valueset "Ethnicity" (2.16.840.1.114222.4.11.837)
valueset "Hepatitis A" (2.16.840.1.113883.3.464.1003.110.12.1024)
valueset "Hepatitis A Vaccine" (2.16.840.1.113883.3.464.1003.196.12.1215)
valueset "Hepatitis A Vaccine Administered" (2.16.840.1.113883.3.464.1003.110.12.1041)
valueset "Hepatitis B" (2.16.840.1.113883.3.67.1.101.1.269)
valueset "Hepatitis B Vaccine" (2.16.840.1.113883.3.464.1003.196.12.1216)
valueset "Hepatitis B Vaccine Administered" (2.16.840.1.113883.3.464.1003.110.12.1042)
valueset "Hib Vaccine (3 dose schedule)" (2.16.840.1.113883.3.464.1003.110.12.1083)
valueset "Hib Vaccine (3 dose schedule) Administered" (2.16.840.1.113883.3.464.1003.110.12.1084)
valueset "Hib Vaccine (4 dose schedule)" (2.16.840.1.113883.3.464.1003.110.12.1085)
valueset "Hib Vaccine (4 dose schedule) Administered" (2.16.840.1.113883.3.464.1003.110.12.1086)
valueset "HIV" (2.16.840.1.113883.3.464.1003.120.12.1003)
valueset "Home Healthcare Services" (2.16.840.1.113883.3.464.1003.101.12.1016)
valueset "Hospice Care Ambulatory" (2.16.840.1.113883.3.526.3.1584)
valueset "Hospice Diagnosis" (2.16.840.1.113883.3.464.1003.1165)
valueset "Hospice Encounter" (2.16.840.1.113883.3.464.1003.1003)
valueset "Inactivated Polio Vaccine (IPV)" (2.16.840.1.113883.3.464.1003.196.12.1219)
valueset "Inactivated Polio Vaccine (IPV) Administered" (2.16.840.1.113883.3.464.1003.110.12.1045)
valueset "Influenza Virus LAIV Vaccine" (2.16.840.1.113883.3.464.1003.110.12.1087)
valueset "Influenza Virus LAIV Vaccine Administered" (2.16.840.1.113883.3.464.1003.110.12.1088)
valueset "Intussusception" (2.16.840.1.113883.3.464.1003.199.12.1056)
valueset "Malignant Neoplasm of Lymphatic and Hematopoietic Tissue" (2.16.840.1.113883.3.464.1003.108.12.1009)
valueset "Measles" (2.16.840.1.113883.3.464.1003.110.12.1053)
valueset "Measles, Mumps and Rubella (MMR) Vaccine" (2.16.840.1.113883.3.464.1003.196.12.1224)
valueset "Measles, Mumps and Rubella (MMR) Vaccine Administered" (2.16.840.1.113883.3.464.1003.110.12.1031)
valueset "Mumps" (2.16.840.1.113883.3.464.1003.110.12.1032)
valueset "Office Visit" (2.16.840.1.113883.3.464.1003.101.12.1001)
valueset "ONC Administrative Sex" (2.16.840.1.113762.1.4.1)
valueset "Payer Type" (2.16.840.1.114222.4.11.3591)
valueset "Pneumococcal Conjugate Vaccine" (2.16.840.1.113883.3.464.1003.196.12.1221)
valueset "Pneumococcal Conjugate Vaccine Administered" (2.16.840.1.113883.3.464.1003.110.12.1046)
valueset "Preventive Care Services, Initial Office Visit, 0 to 17" (2.16.840.1.113883.3.464.1003.101.12.1022)
valueset "Preventive Care, Established Office Visit, 0 to 17" (2.16.840.1.113883.3.464.1003.101.12.1024)
valueset "Race" (2.16.840.1.114222.4.11.836)
valueset "Rotavirus Vaccine (2 dose schedule) Administered" (2.16.840.1.113883.3.464.1003.110.12.1048)
valueset "Rotavirus Vaccine (3 dose schedule)" (2.16.840.1.113883.3.464.1003.196.12.1223)
valueset "Rotavirus Vaccine (3 dose schedule) Administered" (2.16.840.1.113883.3.464.1003.110.12.1047)
valueset "Rubella" (2.16.840.1.113883.3.464.1003.110.12.1037)
valueset "Severe Combined Immunodeficiency" (2.16.840.1.113883.3.464.1003.120.12.1007)
valueset "Telephone Visits" (2.16.840.1.113883.3.464.1003.101.12.1080)
valueset "Varicella Zoster" (2.16.840.1.113883.3.464.1003.110.12.1039)
valueset "Varicella Zoster Vaccine (VZV)" (2.16.840.1.113883.3.464.1003.196.12.1170)
valueset "Varicella Zoster Vaccine (VZV) Administered" (2.16.840.1.113883.3.464.1003.110.12.1040)
valueset "Virtual Encounter" (2.16.840.1.113883.3.464.1003.101.12.1089)

"Assessment, Performed: Hospice care [Minimum Data Set]" using "Hospice care [Minimum Data Set] (LOINC Code 45755-6)"
"Diagnosis: Anaphylactic Reaction to DTaP Vaccine" using "Anaphylactic Reaction to DTaP Vaccine (2.16.840.1.113883.3.464.1003.199.12.1031)"
"Diagnosis: Anaphylaxis caused by rotavirus vaccine (disorder)" using "Anaphylaxis caused by rotavirus vaccine (disorder) (SNOMEDCT Code 428331000124103)"
"Diagnosis: Anaphylaxis caused by vaccine containing Human alphaherpesvirus 3 antigen (disorder)" using "Anaphylaxis caused by vaccine containing Human alphaherpesvirus 3 antigen (disorder) (SNOMEDCT Code 471341000124104)"
"Diagnosis: Anaphylaxis caused by vaccine product containing Hepatitis A virus antigen (disorder)" using "Anaphylaxis caused by vaccine product containing Hepatitis A virus antigen (disorder) (SNOMEDCT Code 471311000124103)"
"Diagnosis: Anaphylaxis caused by vaccine product containing Hepatitis B virus antigen (disorder)" using "Anaphylaxis caused by vaccine product containing Hepatitis B virus antigen (disorder) (SNOMEDCT Code 428321000124101)"
"Diagnosis: Anaphylaxis caused by vaccine product containing human poliovirus antigen (disorder)" using "Anaphylaxis caused by vaccine product containing human poliovirus antigen (disorder) (SNOMEDCT Code 471321000124106)"
"Diagnosis: Anaphylaxis caused by vaccine product containing Influenza virus antigen (disorder)" using "Anaphylaxis caused by vaccine product containing Influenza virus antigen (disorder) (SNOMEDCT Code 471361000124100)"
"Diagnosis: Anaphylaxis caused by vaccine product containing Measles morbillivirus and Mumps orthorubulavirus and Rubella virus antigens (disorder)" using "Anaphylaxis caused by vaccine product containing Measles morbillivirus and Mumps orthorubulavirus and Rubella virus antigens (disorder) (SNOMEDCT Code 471331000124109)"
"Diagnosis: Anaphylaxis caused by vaccine product containing only Haemophilus influenzae type b antigen (disorder)" using "Anaphylaxis caused by vaccine product containing only Haemophilus influenzae type b antigen (disorder) (SNOMEDCT Code 433621000124101)"
"Diagnosis: Anaphylaxis caused by vaccine product containing Streptococcus pneumoniae antigen (disorder)" using "Anaphylaxis caused by vaccine product containing Streptococcus pneumoniae antigen (disorder) (SNOMEDCT Code 471141000124102)"
"Diagnosis: Disorders of the Immune System" using "Disorders of the Immune System (2.16.840.1.113883.3.464.1003.120.12.1001)"
"Diagnosis: Encephalitis Due to Diphtheria, Tetanus or Pertussis Vaccine" using "Encephalitis Due to Diphtheria, Tetanus or Pertussis Vaccine (2.16.840.1.113883.3.464.1003.1164)"
"Diagnosis: Hepatitis A" using "Hepatitis A (2.16.840.1.113883.3.464.1003.110.12.1024)"
"Diagnosis: Hepatitis B" using "Hepatitis B (2.16.840.1.113883.3.67.1.101.1.269)"
"Diagnosis: HIV" using "HIV (2.16.840.1.113883.3.464.1003.120.12.1003)"
"Diagnosis: Hospice Diagnosis" using "Hospice Diagnosis (2.16.840.1.113883.3.464.1003.1165)"
"Diagnosis: Intussusception" using "Intussusception (2.16.840.1.113883.3.464.1003.199.12.1056)"
"Diagnosis: Malignant Neoplasm of Lymphatic and Hematopoietic Tissue" using "Malignant Neoplasm of Lymphatic and Hematopoietic Tissue (2.16.840.1.113883.3.464.1003.108.12.1009)"
"Diagnosis: Measles" using "Measles (2.16.840.1.113883.3.464.1003.110.12.1053)"
"Diagnosis: Mumps" using "Mumps (2.16.840.1.113883.3.464.1003.110.12.1032)"
"Diagnosis: Rubella" using "Rubella (2.16.840.1.113883.3.464.1003.110.12.1037)"
"Diagnosis: Severe Combined Immunodeficiency" using "Severe Combined Immunodeficiency (2.16.840.1.113883.3.464.1003.120.12.1007)"
"Diagnosis: Varicella Zoster" using "Varicella Zoster (2.16.840.1.113883.3.464.1003.110.12.1039)"
"Encounter, Performed: Encounter Inpatient" using "Encounter Inpatient (2.16.840.1.113883.3.666.5.307)"
"Encounter, Performed: Home Healthcare Services" using "Home Healthcare Services (2.16.840.1.113883.3.464.1003.101.12.1016)"
"Encounter, Performed: Hospice Encounter" using "Hospice Encounter (2.16.840.1.113883.3.464.1003.1003)"
"Encounter, Performed: Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician or other qualified health care professional" using "Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician or other qualified health care professional (CPT Code 99211)"
"Encounter, Performed: Office Visit" using "Office Visit (2.16.840.1.113883.3.464.1003.101.12.1001)"
"Encounter, Performed: Preventive Care Services, Initial Office Visit, 0 to 17" using "Preventive Care Services, Initial Office Visit, 0 to 17 (2.16.840.1.113883.3.464.1003.101.12.1022)"
"Encounter, Performed: Preventive Care, Established Office Visit, 0 to 17" using "Preventive Care, Established Office Visit, 0 to 17 (2.16.840.1.113883.3.464.1003.101.12.1024)"
"Encounter, Performed: Telephone Visits" using "Telephone Visits (2.16.840.1.113883.3.464.1003.101.12.1080)"
"Encounter, Performed: Virtual Encounter" using "Virtual Encounter (2.16.840.1.113883.3.464.1003.101.12.1089)"
"Immunization, Administered: Child Influenza Vaccine" using "Child Influenza Vaccine (2.16.840.1.113883.3.464.1003.196.12.1218)"
"Immunization, Administered: DTaP Vaccine" using "DTaP Vaccine (2.16.840.1.113883.3.464.1003.196.12.1214)"
"Immunization, Administered: Hepatitis A Vaccine" using "Hepatitis A Vaccine (2.16.840.1.113883.3.464.1003.196.12.1215)"
"Immunization, Administered: Hepatitis B Vaccine" using "Hepatitis B Vaccine (2.16.840.1.113883.3.464.1003.196.12.1216)"
"Immunization, Administered: Hib Vaccine (3 dose schedule)" using "Hib Vaccine (3 dose schedule) (2.16.840.1.113883.3.464.1003.110.12.1083)"
"Immunization, Administered: Hib Vaccine (4 dose schedule)" using "Hib Vaccine (4 dose schedule) (2.16.840.1.113883.3.464.1003.110.12.1085)"
"Immunization, Administered: Inactivated Polio Vaccine (IPV)" using "Inactivated Polio Vaccine (IPV) (2.16.840.1.113883.3.464.1003.196.12.1219)"
"Immunization, Administered: Influenza Virus LAIV Vaccine" using "Influenza Virus LAIV Vaccine (2.16.840.1.113883.3.464.1003.110.12.1087)"
"Immunization, Administered: Measles, Mumps and Rubella (MMR) Vaccine" using "Measles, Mumps and Rubella (MMR) Vaccine (2.16.840.1.113883.3.464.1003.196.12.1224)"
"Immunization, Administered: Pneumococcal Conjugate Vaccine" using "Pneumococcal Conjugate Vaccine (2.16.840.1.113883.3.464.1003.196.12.1221)"
"Immunization, Administered: Rotavirus Vaccine (3 dose schedule)" using "Rotavirus Vaccine (3 dose schedule) (2.16.840.1.113883.3.464.1003.196.12.1223)"
"Immunization, Administered: rotavirus, live, monovalent vaccine" using "rotavirus, live, monovalent vaccine (CVX Code 119)"
"Immunization, Administered: Varicella Zoster Vaccine (VZV)" using "Varicella Zoster Vaccine (VZV) (2.16.840.1.113883.3.464.1003.196.12.1170)"
"Intervention, Order: Hospice Care Ambulatory" using "Hospice Care Ambulatory (2.16.840.1.113883.3.526.3.1584)"
"Intervention, Performed: Hospice Care Ambulatory" using "Hospice Care Ambulatory (2.16.840.1.113883.3.526.3.1584)"
"Patient Characteristic Ethnicity: Ethnicity" using "Ethnicity (2.16.840.1.114222.4.11.837)"
"Patient Characteristic Payer: Payer Type" using "Payer Type (2.16.840.1.114222.4.11.3591)"
"Patient Characteristic Race: Race" using "Race (2.16.840.1.114222.4.11.836)"
"Patient Characteristic Sex: ONC Administrative Sex" using "ONC Administrative Sex (2.16.840.1.113762.1.4.1)"
"Procedure, Performed: Child Influenza Vaccine Administered" using "Child Influenza Vaccine Administered (2.16.840.1.113883.3.464.1003.110.12.1044)"
"Procedure, Performed: DTaP Vaccine Administered" using "DTaP Vaccine Administered (2.16.840.1.113883.3.464.1003.110.12.1022)"
"Procedure, Performed: Hepatitis A Vaccine Administered" using "Hepatitis A Vaccine Administered (2.16.840.1.113883.3.464.1003.110.12.1041)"
"Procedure, Performed: Hepatitis B Vaccine Administered" using "Hepatitis B Vaccine Administered (2.16.840.1.113883.3.464.1003.110.12.1042)"
"Procedure, Performed: Hib Vaccine (3 dose schedule) Administered" using "Hib Vaccine (3 dose schedule) Administered (2.16.840.1.113883.3.464.1003.110.12.1084)"
"Procedure, Performed: Hib Vaccine (4 dose schedule) Administered" using "Hib Vaccine (4 dose schedule) Administered (2.16.840.1.113883.3.464.1003.110.12.1086)"
"Procedure, Performed: Inactivated Polio Vaccine (IPV) Administered" using "Inactivated Polio Vaccine (IPV) Administered (2.16.840.1.113883.3.464.1003.110.12.1045)"
"Procedure, Performed: Influenza Virus LAIV Vaccine Administered" using "Influenza Virus LAIV Vaccine Administered (2.16.840.1.113883.3.464.1003.110.12.1088)"
"Procedure, Performed: Introduction of Serum, Toxoid and Vaccine into Muscle, Percutaneous Approach" using "Introduction of Serum, Toxoid and Vaccine into Muscle, Percutaneous Approach (ICD10PCS Code 3E0234Z)"
"Procedure, Performed: Measles, Mumps and Rubella (MMR) Vaccine Administered" using "Measles, Mumps and Rubella (MMR) Vaccine Administered (2.16.840.1.113883.3.464.1003.110.12.1031)"
"Procedure, Performed: Pneumococcal Conjugate Vaccine Administered" using "Pneumococcal Conjugate Vaccine Administered (2.16.840.1.113883.3.464.1003.110.12.1046)"
"Procedure, Performed: Rotavirus Vaccine (2 dose schedule) Administered" using "Rotavirus Vaccine (2 dose schedule) Administered (2.16.840.1.113883.3.464.1003.110.12.1048)"
"Procedure, Performed: Rotavirus Vaccine (3 dose schedule) Administered" using "Rotavirus Vaccine (3 dose schedule) Administered (2.16.840.1.113883.3.464.1003.110.12.1047)"
"Procedure, Performed: Varicella Zoster Vaccine (VZV) Administered" using "Varicella Zoster Vaccine (VZV) Administered (2.16.840.1.113883.3.464.1003.110.12.1040)"

["Patient Characteristic Ethnicity": "Ethnicity"]

["Patient Characteristic Payer": "Payer Type"]

```
["Patient Characteristic Race": "Race"]
```

["Patient Characteristic Sex": "ONC Administrative Sex"]

Childhood Immunization Status

Table of Contents

Population Criteria

Definitions

Functions

Terminology

Data Criteria (QDM Data Elements)

Supplemental Data Elements

Risk Adjustment Variables