FHIR 3.0 ImmunizationRecommendation modeling is consistent with information provided by clinical decision support for immunization forecasting. (Definition: A patient's point-in-time immunization and recommendation (i.e. forecasting a patient's immunization eligibility according to a published schedule) with optional supporting justification.- [[1]]. There is no concept comparable to MedicationRequest which includes an .intent metadata element allowing reference to "proposal" consistent with clinical decision support forecasting, "plan" consistent with a recommendation a clinician provides to a patient, and "order" consistent with an order placed in EHRs or other clinical software. This is an important distinction since in some practices, the physician sends a prescription (order) to a pharmacy for the patient to pick up, bring back to the practice for it to be administered. Thus, Immunization, Order should have a ImmunizationRecommendation.intent to indicate the "order" which is distinct from an ImmunizationRecommendation.intent proposal for forecasting and ImmunizationRecommendation.plan for a recommendation to a patient which may or may not be heeded.

Recommend addition of .intent metadata consistent with MedicationRequest, ProcedureRequest and ReferralRequest to manage CDS, recommendations from providers to patients and orders placed in clinical software.