USCDI

US Core Implementation Guide, published by HL7 International / Cross-Group Projects. This guide is not an authorized publication; it is the continuous build for version 8.0.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/US-Core/ and changes regularly. See the Directory of published versions

Page standards status: Informative

The US Core Profiles were initially designed to meet the 2015 Edition certification criterion for Patient Selection 170.315(g)(7) and Application Access – Data Category Request 170.315(g)(8). US Core Editors have updated the guide annually to meet subsequent U.S. Core Data for Interoperability (USCDI) requirements:

USCDI Version	US Core Version
v1	3.1.1
v1	4.0.0 (improved Must support guidance)
v2	5.0.1
v3	6.1.0
v4	7.0.0
v5	8.0.0

ONC's USCDI and FHIR US Core are complementary initiatives, with USCDI defining high-level data requirements and FHIR US Core providing detailed FHIR-based profiles for meeting those requirements. Mapping between them is necessary for achieving interoperability and consistency in healthcare data exchange within the United States. However, to make USCDI implementable in FHIR, an interpretation of USCDI is necessary. For information about what US Core Profile elements and US Core transactions are in scope for ONC Health IT Certification, see the US Core Conformance pages.

Note that:

USCDI Data Classes and Element names may differ from the FHIR US Core resource names and element names.
Not every USCDI Data Class and Element is mapped to a single profile.
Many US Core Profile elements do not map to a USCDI Data Classes and Element because US Core's usage is broader than certification and because additional US Core elements are required to make FHIR implementable.

Updates to US Core depend upon community input, and we encourage our audience to submit questions and feedback to US Core specifications by clicking on the Propose a change link in the footer of every page. In addition, we encourage our audience to request any necessary clarifications to USCDI through the USCDI ONDEC process that will help inform future updates to FHIR US Core.

The table below defines the relationship between the USCDI Data Classes and Elements and USCore profiles. It lists the US Core Profile used for the corresponding Data Classes and Elements. This information and FHIRPath expressions to USCDI Data Classes and Elements are available as a csv or excel file:

US Core Data for Interoperability USCDI

Allergies and Intolerances	US Core AllergyIntolerance Profile
•Substance (Medication)	US Core AllergyIntolerance Profile
•Substance (Drug Class)	US Core AllergyIntolerance Profile
•Substance (Non-Medication)	US Core AllergyIntolerance Profile
•Reaction	US Core AllergyIntolerance Profile

Care Team Members	US Core CareTeam Profile
•Name	US Core Practitioner Profile US Core Patient Profile US Core RelatedPerson Profile
•Identifier	US Core Practitioner Profile US Core Patient Profile
•Location	US Core PractitionerRole Profile US Core Practitioner Profile US Core Patient Profile US Core RelatedPerson Profile
•Telecom	US Core PractitionerRole Profile US Core Practitioner Profile US Core Patient Profile US Core RelatedPerson Profile
•Role	US Core CareTeam Profile

Clinical Notes	US Core DocumentReference Profile US Core DiagnosticReport Profile for Report and Note Exchange	See Clinical Notes Guidance
•Consultation Note	US Core DocumentReference Profile
•Discharge Summary Note	US Core DocumentReference Profile
•History & Physical	US Core DocumentReference Profile
•Imaging Narrative	US Core DocumentReference Profile US Core DiagnosticReport Profile for Report and Note Exchange
•Procedure Note	US Core DocumentReference Profile US Core DiagnosticReport Profile for Report and Note Exchange
•Progress Note	US Core DocumentReference Profile
•Operative Note	US Core DocumentReference Profile
•Emergency Department Note	US Core DocumentReference Profile

Clinical Tests	US Core Observation Clinical Result Profile US Core DiagnosticReport Profile for Report and Note Exchange
•Clinical Test	US Core Observation Clinical Result Profile US Core DiagnosticReport Profile for Report and Note Exchange
•Clinical Test Result/Report	US Core Observation Clinical Result Profile US Core DiagnosticReport Profile for Report and Note Exchange

Diagnostic Imaging	US Core Observation Clinical Result Profile US Core DiagnosticReport Profile for Report and Note Exchange
•Diagnostic Imaging Test	US Core Observation Clinical Result Profile US Core DiagnosticReport Profile for Report and Note Exchange
•Diagnostic Imaging Result/Report	US Core Observation Clinical Result Profile US Core DiagnosticReport Profile for Report and Note Exchange

Encounter	US Core Encounter Profile
•Identifier	US Core Encounter Profile
•Type	US Core Encounter Profile
•Diagnosis	US Core Condition Encounter Diagnosis Profile
•Time	US Core Encounter Profile
•Location	US Core Encounter Profile
•Disposition	US Core Encounter Profile

Facility Information	US Core Location Profile	See Facility Information Guidance
•Identifier	US Core Location Profile
•Type	US Core Location Profile
•Name	US Core Location Profile

Goals and Preferences	US Core Goal Profile
•Patient Goals	US Core Goal Profile
•SDOH Goals	US Core Goal Profile	See Screening and Assessments Guidance
•Treatment Intervention Preference	US Core Treatment Intervention Preference Profile
•Care Experience Preference	US Core Care Experience Preference Profile

Health Insurance Information	US Core Coverage Profile US Core Organization Profile
•Coverage Status	US Core Coverage Profile
•Coverage Type	US Core Coverage Profile
•Relationship to Subscriber	US Core Coverage Profile
•Member Identifier	US Core Coverage Profile
•Subscriber Identifier	US Core Coverage Profile
•Group Number	US Core Coverage Profile
•Payer Identifier	US Core Coverage Profile US Core Organization Profile

Health Status Assessments	US Core Simple Observation Profile US Core Condition Problems and Health Concerns Profile US Core Observation Screening Assessment Profile US Core QuestionnaireResponse Profile
•Health Concerns	US Core Condition Problems and Health Concerns Profile
•Functional Status	US Core Simple Observation Profile US Core Condition Problems and Health Concerns Profile US Core Observation Screening Assessment Profile US Core QuestionnaireResponse Profile	See Screening and Assessments Guidance
•Disability Status	US Core Simple Observation Profile US Core Condition Problems and Health Concerns Profile US Core Observation Screening Assessment Profile US Core QuestionnaireResponse Profile	See Screening and Assessments Guidance
•Mental/Cognitive Status	US Core Simple Observation Profile US Core Condition Problems and Health Concerns Profile US Core Observation Screening Assessment Profile US Core QuestionnaireResponse Profile	See Screening and Assessments Guidance
•Pregnancy Status	US Core Observation Pregnancy Status Profile US Core Observation Pregnancy Intent Profile
•Alcohol Use	US Core Simple Observation Profile US Core Condition Problems and Health Concerns Profile US Core Observation Screening Assessment Profile US Core QuestionnaireResponse Profile	See Screening and Assessments Guidance
•Substance Use	US Core Simple Observation Profile US Core Condition Problems and Health Concerns Profile US Core Observation Screening Assessment Profile US Core QuestionnaireResponse Profile	See Screening and Assessments Guidance
•Physical Activity	US Core Simple Observation Profile US Core Condition Problems and Health Concerns Profile US Core Observation Screening Assessment Profile US Core QuestionnaireResponse Profile	See Screening and Assessments Guidance
•SDOH Assessment	US Core Simple Observation Profile US Core Condition Problems and Health Concerns Profile US Core Observation Screening Assessment Profile US Core QuestionnaireResponse Profile	See Screening and Assessments Guidance
•Smoking Status	US Core Smoking Status Observation Profile

Immunizations	US Core Immunization Profile
•Immunizations	US Core Immunization Profile
•Lot Number	US Core Immunization Profile

Laboratory	US Core Laboratory Result Observation Profile US Core DiagnosticReport Profile for Laboratory Results Reporting US Core Specimen Profile
•Tests	US Core Laboratory Result Observation Profile US Core DiagnosticReport Profile for Laboratory Results Reporting
•Values/Results	US Core Laboratory Result Observation Profile US Core DiagnosticReport Profile for Laboratory Results Reporting
•Specimen Type	US Core Laboratory Result Observation Profile US Core Specimen Profile
•Result Status	US Core Laboratory Result Observation Profile US Core DiagnosticReport Profile for Laboratory Results Reporting
•Result Unit of Measure	US Core Laboratory Result Observation Profile
•Result Reference Range	US Core Laboratory Result Observation Profile
•Result Interpretation	US Core Laboratory Result Observation Profile
•Specimen Identifier	US Core Specimen Profile
•Specimen Source Site	US Core Specimen Profile
•Specimen Condition Acceptability	US Core Specimen Profile

Medical Devices	US Core Implantable Device Profile
•Unique Device Identifier(s) for a Patient's Implantable Device(s)	US Core Implantable Device Profile

Medications	US Core MedicationRequest Profile US Core MedicationDispense Profile US Core Medication Profile	See Medication List Guidance
•Medications	US Core Medication Profile US Core MedicationRequest Profile
•Dose	US Core MedicationRequest Profile
•Dose Unit of Measure	US Core MedicationRequest Profile
•Route of Administration	US Core MedicationRequest Profile US Core MedicationDispense Profile
•Indication	US Core MedicationRequest Profile
•Medication Instructions	US Core MedicationRequest Profile
•Medication Adherence	US Core MedicationRequest Profile US Core Medication Adherence Extension
•Fill Status	US Core MedicationDispense Profile

Observation	US Core Observation ADI Documentation Profile US Core ADI DocumentReference Profile US Core Patient Profile
•Advance Directive Observation	US Core Observation ADI Documentation Profile US Core ADI DocumentReference Profile
•Sex Parameter for Clinical Use	US Core Patient Profile Patient Sex Parameter for Clinical Use Extension

Orders	US Core MedicationRequest Profile US Core ServiceRequest Profile
•Medication Order	US Core MedicationRequest Profile
•Laboratory Order	US Core ServiceRequest Profile
•Diagnostic Imaging Order	US Core ServiceRequest Profile
•Clinical Test Order	US Core ServiceRequest Profile
•Procedure Order	US Core ServiceRequest Profile

Patient Demographics	US Core Patient Profile US Core Observation Sexual Orientation Profile US Core Observation Sexual Orientation Profile US Core Observation Sexual Orientation Profile US Core Observation Occupation Profile
•First Name	US Core Patient Profile
•Last Name	US Core Patient Profile
•Previous Name	US Core Patient Profile
•Middle Name (including middle initial)	US Core Patient Profile
•Suffix	US Core Patient Profile
•Name to Use	US Core Patient Profile
•Pronouns	US Core Patient Profile Individual Pronouns Extension
•Sex	US Core Patient Profile US Core Sex Extension
•Date of Birth	US Core Patient Profile
•Date of Death	US Core Patient Profile
•Race	US Core Patient Profile US Core Race Extension
•Ethnicity	US Core Patient Profile US Core Ethnicity Extension
•Tribal Affiliation	US Core Patient Profile US Core Tribal Affiliation Extension
•Gender Identity	US Core Patient Profile US Core Gender Identity Extension
•Sexual Orientation	US Core Observation Sexual Orientation Profile
•Preferred Language	US Core Patient Profile
•Interpreter Needed	US Core Patient Profile US Core Encounter Profile US Core Interpreter Needed Extension
•Address	US Core Patient Profile
•Previous Address	US Core Patient Profile
•Email	US Core Patient Profile
•Phone Number	US Core Patient Profile
•Related Person's Name	US Core RelatedPerson Profile
•Related Person's Relationship	US Core RelatedPerson Profile
•Occupation	US Core Observation Occupation Profile
•Occupation Industry	US Core Observation Occupation Profile

Patient Summary and Plan	US Core CarePlan Profile
•Assessment and Plan of Treatment	US Core CarePlan Profile

Problems	US Core Condition Problems and Health Concerns Profile
•Date of Resolution	US Core Condition Problems and Health Concerns Profile assertedDate Extension
•Date of Diagnosis	US Core Condition Problems and Health Concerns Profile assertedDate Extension
•SDOH Problems/Health Concerns	US Core Condition Problems and Health Concerns Profile	See Screening and Assessments Guidance

Procedures	US Core Procedure Profile US Core ServiceRequest Profile
•Procedure	US Core Procedure Profile
•Performance Time	US Core Procedure Profile US Core DiagnosticReport Profile for Report and Note Exchange US Core Immunization Profile
•Reason for Referral	US Core ServiceRequest Profile US Core Procedure Profile
•SDOH Interventions	US Core ServiceRequest Profile US Core Procedure Profile	See Screening and Assessments Guidance

Provenance	US Core Provenance Profile	See Basic Provenance Guidance
•Author Time Stamp	US Core Provenance Profile
•Author Organization	US Core Provenance Profile

Vital Signs	US Core Vital Signs Profile
•Average Blood Pressure	US Core Average Blood Pressure Profile
•Diastolic blood pressure	US Core Blood Pressure Profile
•Systolic blood pressure	US Core Blood Pressure Profile
•Body height	US Core Body Height Profile
•Body weight	US Core Body Weight Profile
•Heart rate	US Core Heart Rate Profile
•Respiratory rate	US Core Respiratory Rate Profile
•Body temperature	US Core Body Temperature Profile
•Pulse oximetry	US Core Pulse Oximetry Profile
•Inhaled oxygen concentration	US Core Pulse Oximetry Profile
•BMI Percentile (2-20 years old)	US Core Pediatric BMI for Age Observation Profile
•Weight-for-length Percentile (Birth - 36 months)	US Core Pediatric Weight for Height Observation Profile
•Occipital Frontal Head Circumference Percentile (Birth - 36 months)	US Core Pediatric Head Occipital Frontal Circumference Percentile Profile