Panorama Bulletin 0024
WHERE DO I DOCUMENT IN PANORAMA?
2015-09-09
Revised
 Immunization providers will use the features in Panorama to document immunization-relevant details (such as the Immunizations - Special
Considerations function).
 A standardized approach to the documentation of these details should prevent extraneous clinical notes, prevent redundancy of information,
protect sensitive information, enhance client privacy, and provide timely access to pertinent immunization information.
 Remember to check Bulletins, Policies, and the User Guides for more information or consult your Super User or supervisor if you still have
questions after reviewing this reference.
 Bulletin 0022 has information about publicly funded vaccine eligibility and risk factors used in Panorama.
Topic
Information to be
Documented
(issues relating to
documentation)
1.
Refusal of
individual
antigen(s) or
vaccine
agent(s)
2.
Refusal of all
vaccine
agents
Refusals
3.
Refusal
migrated
from SIMS as
a Special
Consideration
> Exemption>
Refusal
Consent
Directive
Risk Factors
Client Warnings
Deferrals
Immunization
Details
Grant or
Refusal
Factor
Warning
Deferral
Reason
Comments
 Refusal –
Only 1 drop
down
choice.
(vaccine will
still forecast)
 Refusal –
Only 1 drop
down
choice.
(vaccine will
still
forecast))
Special Considerations
Consideration Type
Reason
Source
See Panorama Policy
- Documentation of
Immunization Refusal
if client requests no
reminders
End date the Client
Warning but only if
warning only applies
to this particular
vaccine.
If this is a second
refusal (e.g. HPV in
Grade 8) then enter a
comment in the preexisting exemption.
Note: If a duplicate SC
exists, refer to revised
bulletin 0027.
 Contraindication
 Precaution
 Exemption
End date if
conversation with
client has occurred
and the client is now
accepting.
If this is a second
refusal (e.g. HPV in G.
8) then do not enddate or update the
date field and enter a
comment in the preexisting exemption.
If adding end date
then document
reason as “No
longer applicable”
Verbal
report
1
Topic
Information to be
Documented
(issues relating to
documentation)
Consent
Directive
Risk Factors
Client Warnings
Deferrals
Immunization
Details
Grant or
Refusal
Factor
Warning
Deferral
Reason
Comments
Special Considerations
Consideration Type
Reason
Source
 Contraindication
4.
Refusals
5.
Vaccine
Eligibility
by Risk
Factor
Category
Client now
accepting a
previously
refused
vaccine
Child eligible
for early HB
based on
parental
immigration
 Grant
Enter
vaccine
provided
 Precaution
 Exemption
End date if
conversation with
client has occurred
No longer
applicable
Verbal
report,
written
documenta
tion
 Special Population
- Children of
Immigrants Hepatitis B
6.
Infant HB
postexposure
prophylaxis in
hospital
 Post-exposure Infant Born to
HBsAg+ Mom or High
Risk for HB - Greater
than or equal to 2000
grams
OR
 Post-exposure Infant Born to
HBsAg+ Mom or High
Risk for HB - Less
than 2000 grams
7.
Tdap given to
the
parent/caregi
ver of a
newborn < 5
yrs from last
Td
 Special Population
- Parents/Caregivers
of Newborns
 Document only for
infants who received
HBIg: "Serologic
testing for Hepatitis B
antibody and antigen
is required at least 4
weeks after
completion of HB
vaccine series [CIG]."
2
Topic
Information to be
Documented
(issues relating to
documentation)
8.
Vaccine
Eligibility
by Risk
Factor
Category
9.
People born
since January
1, 1982 who
live in
Keewatin
Yatthé,
Athabasca or
Mamawetan
Churchill
River health
authorities or
on reserves
in
Saskatchewa
n (excluding
Creighton, Air
Ronge and La
Ronge)
Household/se
xual/ close
contacts of
an individual
with acute or
chronic HB
10. Sexual
partners and
household
contacts of
individuals
who use illicit
drugs
11. Client with
multiple
sexual
partners
Consent
Directive
Risk Factors
Client Warnings
Deferrals
Immunization
Details
Grant or
Refusal
Factor
Warning
Deferral
Reason
Comments
Special Considerations
Consideration Type
Reason
Source
 Special Population
- Hepatitis A Program
- Targeted
Community
 Contact - Hepatitis
B
 Document:
"Post- vaccination
testing for HB
antibody is
recommended 1 to 6
months after series
complete."
 Special Population
– Potential Exposure
– Hepatitis B
 Special Population
– Potential Exposure
– Hepatitis B
3
Topic
Information to be
Documented
(issues relating to
documentation)
12. Percutaneous
or mucosal
exposure
(sexual
assault, bite,
etc.)
Vaccine
Eligibility
by Risk
Factor
Category
Consent
Directive
Risk Factors
Client Warnings
Deferrals
Immunization
Details
Grant or
Refusal
Factor
Warning
Deferral
Reason
Comments
 Post-exposure Blood and body
fluids.
Note: The Forecaster
is not currently
engaged for HB for
this risk factor but
will validate and
forecast once a series
has been initiated).
Special Considerations
Consideration Type
Reason
Source
 Document:
"Post- vaccination
testing for HB
antibody is
recommended 1 to 6
months after series
complete."
 If vaccine series is
not initiated at initial
contact a Client
Warning could be
added: “Client is
eligible for HB
vaccine.”
Note: 2 doses are
required to be
considered
immune, so
complete series
then document
(Special
population - Nonresponder Specify) only if
testing done after
2nd dose indicates
non-immune.
13. Woman of
childbearing
age with nonimmune
varicella
serology after
1st Var dose
14. Student
attending or
accepted into
a postsecondary
health care
program
 Occupation Health Care - Student
15. Employee of
RHA/SCA or
FNJ
 Occupation Health Care RHA/SCA/FNJ
Employee
4
Topic
Vaccine
Eligibility
by Risk
Factor
Category
Eligible
vaccine
not
administer
ed with
previous
valid
consent
grant
document
ed
(If no
previous
consent
grant –
document
as a
refusal)
Information to be
Documented
(issues relating to
documentation)
16. Employee of
a private care
home or a
private
practice
(dentists,
physio,
private
nursing
service)
17. Parent not
wanting all
recommende
d vaccines
given on the
same day
Consent
Directive
Risk Factors
Client Warnings
Deferrals
Immunization
Details
Grant or
Refusal
Factor
Warning
Deferral
Reason
Comments
Reason
Source
Parent/
Guardian/
Client Deferral
Nursing Clinical
Decision
19. Child
resistant to
immunization
Parent/
Guardian/
Client Deferral
20. Too ill to
receive
vaccine today
Serious illness temporary
22. Vaccine
unavailable
Consideration Type
 Occupation Health Care - NonRHA Employee
18. Nurse felt
that couldn't
safely
administer all
vaccines the
client is
eligible for
today
21. Nurse needs
to consult
MHO before
administratio
n of vaccine
Special Considerations
Create a Client
Warning. Add MHO’s
recommendations.
Referred to
MHO
Vaccine Supply
issues
5
Topic
Information to be
Documented
(issues relating to
documentation)
Consent
Directive
Risk Factors
Client Warnings
Deferrals
Immunization
Details
Grant or
Refusal
Factor
Warning
Deferral
Reason
Comments

23. Verbal report
of varicella
for client
born since
January 1,
2003 and/or
who is in
grade 6 and
has a “Special
Consideration
– Precaution”
migrated
from SIMS
Varicella
Disease
Offer
Vaccine:
If consents:
 Grant
Enter
vaccine
provided
If refuses:
 Refusal
Parent/
Guardian/
Client
Refusal
(vaccine will
still forecast)

Delete the Client
Warning if
pertains solely to
varicella OR
Update if
pertains to more
than one antigen
by deleting
varicella related
information from
the “message”
box. Select
“Other health
care provider
reported no
longer
applicable” as
Reason.
Special Considerations
Consideration Type
Reason
Source
Add “Effective To” date to end this “Special Consideration
– Precaution”
 Delete the “Special Consideration – Precaution” and
enter Exemption as indicated below.
(History
migrated
from
SIMS)

Contraindication
 Precaution
24. Verbal report
of varicella
for client
born before
January 1,
2003 with a
“Special
Consideration
– Precaution”
migrated
from SIMS
Documented
Verbal
Immunity
report
Note: “Effective From” date defaults to today’s date.
Update with the most appropriate date (e.g. from
warning, lab result, record) only if services planned or
presents for service.
 If client requests to be immunized in the future:

Requires serology to confirm immunity status

Document as follows:
o Immune - update the “Special
Consideration-Exemption” response to Lab
Report.
o Non-immune - add “Effective To” date to
end this “Special Consideration –
Exemption ”
 Exemption
Delete the Client
Warning if pertains
solely to varicella OR
update if pertains to
more than one
antigen by deleting
varicella related
information
6
Topic
Varicella
Disease
(History
migrated
from
SIMS)
Information to be
Documented
(issues relating to
documentation)
Consent
Directive
Risk Factors
Client Warnings
Deferrals
Immunization
Details
Grant or
Refusal
Factor
Warning
Deferral
Reason
Comments
Delete Client Warning
indicating there is a
SIMS titre in Imms
History Interpretation
26. Serological
evidence of
measles,
mumps,
rubella,
Hepatitis A,
or Hepatitis B
immunity
Reason
Source
 Precaution
Documented
Immunity
Lab report
Documented
Immunity
Lab report
 Exemption
Documented
Immunity
Lab report
 Contraindication
Severely
immunocomprise
d
(Document for all
live vaccines MMR, Var, Rota,
FluMist, oral
typhoid, YF, OPV,
& BCG)
 Exemption
 Contraindication
 Precaution
 Exemption
 Contraindication
 Chronic Medical
Condition - Liver
Disease – Hepatitis B
History of
Disease
(nonvaricella)
28. Client with
HIV
Consideration Type
 Contraindication
25. Laboratory
confirmed
case of
varicella
disease
27. Client with
chronic HB
infection or
immunity due
to natural
infection
Special Considerations

Immunocompromise
d – HIV
 Precaution
 Document this
warning:
"DO NOT GIVE ANY
LIVE VACCINE(S). Call
(PHONE NUMBER) to
review the specific
immunization
schedule for this
individual.”
Written
doc.
Lab report
 Precaution
 Exemption
29. Client with
laboratory
confirmed
Hepatitis C
infection
 Chronic Medical
Condition - Liver
Disease – Hepatitis C
7
Topic
Information to be
Documented
(issues relating to
documentation)
30. Infant born to
mother with
HIV infection
Consent
Directive
Risk Factors
Client Warnings
Deferrals
Immunization
Details
Grant or
Refusal
Factor
Warning
Deferral
Reason
Comments
 Document this
warning:
"DO NOT GIVE ANY
LIVE VACCINES. Call
(PHONE NUMBER) to
review the specific
immunization
schedule for this
individual.”
Special Considerations
Consideration Type
Contraindication
Reason
Source
Suspicious family
or medical history
for
immunodeficiency
disorders
(Document for all
live vaccines MMR, Var, Rota,
FluMist, oral
typhoid, YF, OPV,
& BCG)
Written
documenta
tion
Verbal
report
 Precaution
 Exemption
Medical
Conditions
31. Authorization
from ID
Specialist or
Positive
Living
Program to
proceed with
Rot-1 for
infant
(preliminary
test from
NML is
negative)
32. Authorization
from ID
Specialist or
Positive
Living
Program to
proceed with
live vaccines
for infant
(e.g., two
negative tests
from NML)
 Make a new
warning,
“Authorization to
proceed with Rot-1
received on {date}”.
 End-date Special Consideration - Contraindication
pertaining to Rot-1 by adding an “Effective To” date
 Add “Effective To”
date (using today’s
date) to end date the
warning. Select reason
as “Retesting shows
no longer applicable”
 End-date Special Consideration - Contraindication
pertaining to all live vaccines by adding an “Effective To”
date.

Document “Authorization to proceed with live
vaccines {specify} received {date}” to comment
section.
8
Topic
Information to be
Documented
(issues relating to
documentation)
Consent
Directive
Risk Factors
Client Warnings
Deferrals
Immunization
Details
Grant or
Refusal
Factor
Warning
Deferral
Reason
Comments
 Document this
warning:
"DO NOT GIVE ANY
LIVE VACCINES. Call
(PHONE NUMBER) to
review the specific
immunization
schedule for this
individual.”
33. Person with a
Primary
Immunodefici
ency disorder
(as noted in
CIG)
Special Considerations
Consideration Type
Contraindication
Reason
Source
Suspicious family
or medical history
for
immunodeficiency
disorders
(Document for all
live vaccines MMR, Var, Rota,
FluMist, oral
typhoid, YF, OPV,
& BCG)
Written
documenta
tion
Verbal
report
 Precaution
 Exemption
Medical
Conditions
34. Immunocompromised
–Due to
Treatment

Immunocompromise
d - Treatment Specify
NOTE:
Depending on the
client’s
treatmentspecific details
either a
Contraindication
and/or a
Precaution may
apply to specified
vaccines.
Contraindication
←See NOTE
 Precaution
←See NOTE
Severely
immunocomprise
d. Comment
section may be
used for charting.
(Document for all
live vaccines MMR, Var, Rota,
FluMist, oral
typhoid, YF, OPV,
& BCG)
Immunosuppresse
d - risk
assessment
required.
Comment section
may be used for
charting.
Written
documenta
tion
Verbal
report
Lab report
Written
documenta
tion
Verbal
report
 Exemption
9
Topic
Information to be
Documented
(issues relating to
documentation)
35. Immunocompromised
- Related to
Disease
Consent
Directive
Risk Factors
Client Warnings
Deferrals
Immunization
Details
Grant or
Refusal
Factor
Warning
Deferral
Reason
Comments
NOTE:
Depending on the
client’s diseasespecific details
either a
Contraindication
and/or a
Precaution may
apply to specified
vaccines.

Immunocompromise
d - Related to Disease
Medical
Conditions
Special Considerations
Consideration Type
Contraindication
←See NOTE
 Precaution
←See NOTE
Reason
Severely
immunocomprise
d.
Comment section
could be used for
charting.
(Document for all
live vaccines MMR, Var, Rota,
FluMist, oral
typhoid, YF, OPV,
& BCG)
Immunosuppresse
d - risk
assessment
required.
Comment section
could be used for
charting.
Source
Written
documenta
tion
Verbal
report
Lab report
Written
documenta
tion
Verbal
report
 Exemption
36. Blank
forecasting
for the
following
immunocom
promised
clients:
Transplant
Candidate or
Recipient of
Solid
Organ/Tissue;
Islet Cell or
HSCT
 Contraindication
Enter applicable Risk
Factor (e.g.
Immunocompromise
d - Transplant
Candidate or
Recipient - Islet Cell,
etc.)
 Document this
warning:
"DO NOT GIVE ANY
VACCINE(S) Call
(PHONE NUMBER) to
review the specific
immunization
schedule for this
individual (BLANK
FORECASTING rule in
effect)."
 Precaution

Immunosuppresse
d-risk assessment
required
Written
documenta
tion
 Exemption
10
Topic
Information to be
Documented
(issues relating to
documentation)
Consent
Directive
Risk Factors
Client Warnings
Deferrals
Immunization
Details
Grant or
Refusal
Factor
Warning
Deferral
Reason
Comments
37. Client has
received a
blood
product that
cannot be
documented
in Panorama
(e.g., packed
cells)
Special Considerations
Consideration Type
 Contraindication
Reason
Source
 Recent
Administration of
a Blood Product
(document for all
applicable live
vaccines)
 Add “Effective
From” and
“Effective To”
dates
(refer to SIM
Chapter 5)
Written
documenta
tion
Verbal
report
 Recent
Administration of
a Blood Product
(document for all
applicable live
vaccines)
 Add “Effective
From” and
“Effective To”
dates
(refer to SIM
Chapter 5)
Written
documenta
tion
Verbal
report
 Precaution
 Exemption
Medical
Conditions
38. Client has
received an
immune
globulin
product
Note: At this time,
Panorama does
not identify
interaction rules
for immune
globulin products
and live vaccines.
Enter any applicable
Risk Factor (e.g. PostExposure - Rabies,
Post-Exposure Tetanus-prone
Wound – TIg
Needed, etc.)
 Contraindication
 Precaution
 Exemption
39. Client has
haemophilia
 Chronic Medical
Condition - Bleeding
Disorders
 Document this
warning:
“Severe Bleeding
Disorder”
11
Topic
Information to be
Documented
(issues relating to
documentation)
Consent
Directive
Risk Factors
Client Warnings
Deferrals
Immunization
Details
Grant or
Refusal
Factor
Warning
Deferral
Reason
Comments
Note: Choose 1 of
the vaccines given
on day of event to
document the SC,
“Event occurred
when vaccines
administered
{date}. (All
vaccines given on
this date do not
need to be
specified because
this will result in
several client
warnings instead
of the 1 warning
that is actually
required).
40. History of
fainting
Special
Circumsta
nces
41. Infant
receives
MMR prior to
first birthday
due to travel
to high risk
area or due
to potential
exposure
42. Confirmed
latex allergy
Special Considerations
Consideration Type
Reason
Source
 Contraindication
 Precaution
←See NOTE
 History of
Syncope
 Exemption
 Risk Factor as
applicable:

Travel – Publicly
Funded

Contact Measles
 Document this
warning:
“Latex allergy”
 Contraindication
Allergy
43. Allergy to a
vaccine
component
(i.e., eggs,
etc.)
 Precaution
 Allergy to a
Vaccine
Component –
Document specific
details in
“Comments” field
Verbal
report;
Written
documenta
tion
 Exemption
12
Topic
Information to be
Documented
(issues relating to
documentation)
Consent
Directive
Risk Factors
Client Warnings
Deferrals
Immunization
Details
Grant or
Refusal
Factor
Warning
Deferral
Reason
Comments
44. Mild to
moderate
vaccine side
effects that
do not meet
the
reportable
AEFI criteria
AEFIs
45. Mild to
moderate
vaccine side
effects that
do not meet
reportable
AEFI criteria
but PHN
assesses she
needs to alert
next PHN to
immunization
details
 Document this type
of warning (e.g.): "See
comments for DTaPIPV-Hib on December
12, 2014“
 Expire this warning
after next
immunization
received and update
comments as
required.
46. Severe,
unusual, or
unexpected
vaccine side
effect that
meets
reportable
AEFI criteria
 Document this
warning:
"Reportable AEFI for
immunizations
administered on this
date XX-XX-XXXX.
See Imms Details.
Submitted for MHO
review.”
 Refer to Bulletin
0028 for additional
information regarding
documentation.
Special Considerations
Consideration Type
Reason
Source
 Document in
Imms Details –
Update (e.g.):
“Redness and
swelling at
injection site
measuring 5 cm
diameter but not
extending past
next joint.
Resolved within
48 hours."
 Document in
Imms Details (for
all applicable
vaccines) - Update
(e.g.): “Redness
and swelling at
injection site
measuring 5 cm
diameter but not
extending past
next joint.
Resolved within
48 hours. Reaction
appears to be
more severe with
each subsequent
vaccine."
 Document in
Imms Details (for
all applicable
vaccines) - Update
(e.g.): "AEFI
meets reportable
criteria - paper
report dated XXXX-XXXX. Provide
details of AEFI.”
13
Topic
Information to be
Documented
(issues relating to
documentation)
47. Vaccine
leaked upon
administratio
n and a
second dose
was
administered
Unusual
Events
48. Vaccine
administered
by wrong
route
Consent
Directive
Risk Factors
Client Warnings
Deferrals
Immunization
Details
Grant or
Refusal
Factor
Warning
Deferral
Reason
Comments
Special Considerations
Consideration Type
Reason
Source
 Document in
Imms Details for
the first (invalid)
dose. "Mechanical
malfunction while
administering
dose. Dose to be
repeated. Report
form completed."
 Then document
the second dose.
Note that the first
dose will
automatically
invalidate once
the second dose is
documented.
 Document in
Imms Details –
Update: "Vaccine
given SC instead
of IM. Clinical
recommendation
to repeat dose the
same day or reschedule
according to
minimum interval
rules. Report form
completed"
14
Topic
Information to be
Documented
(issues relating to
documentation)
Consent
Directive
Risk Factors
Client Warnings
Deferrals
Immunization
Details
Grant or
Refusal
Factor
Warning
Deferral
Reason
Comments
Consideration Type
Reason
Source
 Action Invalidate this
dose in the Imms
Details screen - an
“X” will appear in
front of the date
for this vaccine on
the on the Client
Immunization
Profile and Profile
Report.
OR
"Vaccine given SC
instead of IM.
Medical
recommendation
that vaccine does
not need to be
repeated. Report
form completed."
 Action - No
need to invalidate
dose.
Unusual
Events
49. Vaccine dose
inadvertently
missed
50. MHO/MD
recommenda
tion for nonAEFI issues
Routine
school
vaccines
Special Considerations
51. Consent not
returned
Clinical nursing
decision
 Document this
warning (e.g.): "See
comments for (vaccine
name) on XX-XXXXXX."
This warning could
be end-dated after
next immunization
received. Update
comment field as
required.
 Document in
Imms Details
(e.g.):
"6 cm swelling at
injection site but
does not extend
past joint. MHO
recommends
Benadryl prior to
next
immunization"
ON HOLD UNTIL
MASS IMMS IN
PLACE
15
Topic
Information to be
Documented
(issues relating to
documentation)
Consent
Directive
Risk Factors
Client Warnings
Deferrals
Immunization
Details
Grant or
Refusal
Factor
Warning
Deferral
Reason
Comments
52. Consent
obtained but
child never
present at
school for
immunization
Routine
school
vaccines
53. Consent
received for
school-age
vaccines but
child moves
from school
prior to
immunizing
Incomplet
e vaccine
history
(written
document
ation
unavailabl
e)
Vaccine
series
offered.
Parent
consents to
booster
doses only.
Consideration Type
Reason
Source
ON HOLD UNTIL
MASS IMMS IN
PLACE
Note: RHAs may
choose to add
under Client
Details – Health
Services the SDL
as the school
where written
consent was
obtained and
stored.
Documentati
on in
Consent
Directives
not required
- Refer to
15-16 PSIS
document
54. School aged
child that
parent wants
immunized at
health centre
55. Parent
indicates
child (birth to
grade 12) is
up-to-date
with
immunization
s but has no
documentati
on.
Special Considerations
 Document this
warning: “Will attend
health centre for
school-age vaccines”
If consents:
 Grant
Enter
vaccine(s)
provided
 Document this
warning:
"No documentation of
historical vaccines
available. Parent
reports vaccines up-todate for age."
 Action - End dated
warning when vaccine
series completed.
(Note: Vaccines will
continue to forecast
as due until a
complete series for
age has been
administered. Do not
override the dose
number for a child
with an
undocumented
immunization history.)
16
Topic
Information to be
Documented
(issues relating to
documentation)
56. Parent
indicates
child is up-todate with
immunization
s but has no
written
documentati
on.
Vaccines
offered but
parent
refuses.
Incomplet
e vaccine
history
(written
document
ation
unavailabl
e)
57. Foreign-born
adult with no
documented
immunization
history.
Vaccines
offered.
Consent
Directive
Risk Factors
Client Warnings
Deferrals
Immunization
Details
Grant or
Refusal
Factor
Warning
Deferral
Reason
Comments
 Refusal
Indicate
Parent/
Guardian/
Client
Refusal
(vaccine will
still forecast)
If consents:
 Grant
Enter
vaccine(s)
provided
If refuses:
 Refusal
Indicate
Client
Refusal
(vaccine will
still forecast)
Special Considerations
Consideration Type
Reason
Source
 Document this
warning:
“No written
documentation of
historical vaccines
available. Parent
reports vaccines up-todate for age.” (Note:
Vaccines will continue
to be forecasted as
due until a complete
series for age has
been administered. Do
not override the dose
number for a child
with an
undocumented
immunization history.)
 Document this
warning if vaccine(s)
refused:
“No written
documentation of
historical vaccines
available. Client
reports vaccines up-todate for age.”
17
Topic
Information to be
Documented
(issues relating to
documentation)
58. Td- Revised
Dose:
Canadianborn adult
with no
written
documentati
on of
immunization
history but
recalls having
had
childhood/sc
hool
immunization
s
59. Canadianborn adult
with no
written
documentati
on of
immunization
history but
recalls having
had all
childhood/sc
hool
immunization
s
Consent
Directive
Risk Factors
Client Warnings
Deferrals
Immunization
Details
Grant or
Refusal
Factor
Warning
Deferral
Reason
Comments
 Document this
warning: “Client
reports received all
childhood/school
vaccines but no
written
documentation
available”.
Special Considerations
Consideration Type
Reason
Source
 Action – Revise
dose number to 4.
 Add Revised
Dose Comment
(e.g.) - "Accepted
verbal
immunization
history"
 Document this
warning:
“Client reports
received all
childhood/school
vaccines but no
written
documentation
available”.
18