# US Quality Core Service Not Requested - 2026 US Quality Core Implementation Guide v0.5.0

* [**Table of Contents**](toc.md)
* [**Artifacts Summary**](artifacts.md)
* **US Quality Core Service Not Requested**

## Resource Profile: US Quality Core Service Not Requested 

| | |
| :--- | :--- |
| *Official URL*:http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-servicenotrequested | *Version*:0.5.0 |
| Active as of 2026-05-15 | *Computable Name*:USQualityCoreServiceNotRequested |

 
Negation profile of ServiceRequest for decision support/quality metrics. Defines the core set of elements and extensions for quality rule and measure authors. 

### Guidance

  Reference Guidance for use of the Service Not Requested profile can be found [here.](http://hl7.org/fhir/us/core/STU6.1/StructureDefinition-us-core-servicerequest.html#mandatory-and-must-support-data-elements) 
* See the [Social Determinants of Health (SDOH)](https://hl7.org/fhir/us/core/sdoh.html) Guidance Page for more information when exchanging Social Determinants of Health (SDOH) Service Requests.
* The `ServiceRequest.category` binding must support at a minimum the [US Core ServiceRequest Category Codes](http://hl7.org/fhir/us/core/STU6.1/ValueSet-us-core-servicerequest-category.html). However, this valueset can be treated as [extensible](http://hl7.org/fhir/R4/terminologies.html#extensible) and other category codes can be used instead.
* The `ServiceRequest.code.extension:notDoneValueSet` valueset identifies a set of possible coded values representing activities that were not requested, ordered, or performed.
* The `ServiceRequest.subject` is Must Support with Must Support reference to US Quality Core Patient
  

**Usage**
The ServiceRequest and ServiceNotRequested profiles represent the positive and negative statements for a service request. 

  See the [patterns](patterns.md) page for implementation and usage patterns.  

### Examples

 

| | |
| :--- | :--- |
| [Negation Example with valueset](ServiceRequest-negation-example.md) | Service discontinued; indicates that none of the services in the given not done value set were requested. |
| [Negation Example with code](ServiceRequest-negation-example-code.md) | Service discontinued; indicates that the given service, by code, was not requested. |

 

Both of these example instances meet measure intent for exclusion as defined in the following illustrative CQL (informational; not part of conformance requirements): 

```
define "Intermittent Pneumatic Compression Devices Not Ordered":
  ["ServiceNotRequested": "Application of intermittent pneumatic compression devices (IPC)"] DeviceNotOrdered
    where (DeviceNotOrdered.reasonRefused() in "Medical Reason"
      or DeviceNotOrdered.reasonRefused() in "Patient Refusal")
      and DeviceNotOrdered.status in { 'active', 'completed', 'on-hold' }
```

For a more complete discussion of representation of negation within US Quality Core and quality improvement artifacts, see the [Negation in US Quality Core](general-requirements.md#negation-in-us-quality-core) topic.

**USCDI+ Quality Elements:**

* status: (USCDI+ Quality) (USCDI) draft | active | on-hold | revoked | completed | entered-in-error | unknown
* code: (USCDI+ Quality) (USCDI) What is being requested/ordered
* authoredOn: (USCDI+ Quality) (USCDI) Date request signed
* reasonCode: (USCDI+ Quality) (USCDI) Explanation/Justification for procedure or service
* reasonReference: (USCDI+ Quality) (USCDI) Explanation/Justification for service or service

**Usages:**

* Examples for this Profile: [ServiceRequest/negation-example-code](ServiceRequest-negation-example-code.md) and [ServiceRequest/negation-example](ServiceRequest-negation-example.md)
* CapabilityStatements using this Profile: [US Quality Core Client CapabilityStatement](CapabilityStatement-us-quality-core-client.md) and [US Quality Core Server CapabilityStatement](CapabilityStatement-us-quality-core-server.md)

You can also check for [usages in the FHIR IG Statistics](https://packages2.fhir.org/xig/resource/fhir.onc.us-quality-core|current/StructureDefinition/StructureDefinition-us-quality-core-servicenotrequested.json)

### Formal Views of Profile Content

 [Description of Profiles, Differentials, Snapshots and how the different presentations work](http://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#structure-definitions). 

 

Other representations of profile: [CSV](StructureDefinition-us-quality-core-servicenotrequested.csv), [Excel](StructureDefinition-us-quality-core-servicenotrequested.xlsx), [Schematron](StructureDefinition-us-quality-core-servicenotrequested.sch) 



## Resource Content

```json
{
  "resourceType" : "StructureDefinition",
  "id" : "us-quality-core-servicenotrequested",
  "url" : "http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-servicenotrequested",
  "version" : "0.5.0",
  "name" : "USQualityCoreServiceNotRequested",
  "title" : "US Quality Core Service Not Requested",
  "status" : "active",
  "experimental" : false,
  "date" : "2026-05-15",
  "publisher" : "Office of the National Coordinator for Health Information Technology (ONC)",
  "contact" : [{
    "name" : "Office of the National Coordinator for Health Information Technology (ONC)",
    "telecom" : [{
      "system" : "url",
      "value" : "https://www.healthit.gov/feedback"
    }]
  }],
  "description" : "Negation profile of ServiceRequest for decision support/quality metrics. Defines the core set of elements and extensions for quality rule and measure authors.",
  "jurisdiction" : [{
    "coding" : [{
      "system" : "urn:iso:std:iso:3166",
      "code" : "US",
      "display" : "United States of America"
    }],
    "text" : "USA"
  }],
  "fhirVersion" : "4.0.1",
  "mapping" : [{
    "identity" : "workflow",
    "uri" : "http://hl7.org/fhir/workflow",
    "name" : "Workflow Pattern"
  },
  {
    "identity" : "v2",
    "uri" : "http://hl7.org/v2",
    "name" : "HL7 v2 Mapping"
  },
  {
    "identity" : "rim",
    "uri" : "http://hl7.org/v3",
    "name" : "RIM Mapping"
  },
  {
    "identity" : "w5",
    "uri" : "http://hl7.org/fhir/fivews",
    "name" : "FiveWs Pattern Mapping"
  },
  {
    "identity" : "quick",
    "uri" : "http://siframework.org/cqf",
    "name" : "Quality Improvement and Clinical Knowledge (QUICK)"
  }],
  "kind" : "resource",
  "abstract" : false,
  "type" : "ServiceRequest",
  "baseDefinition" : "http://hl7.org/fhir/us/core/StructureDefinition/us-core-servicerequest|6.1.0",
  "derivation" : "constraint",
  "differential" : {
    "element" : [{
      "id" : "ServiceRequest",
      "path" : "ServiceRequest",
      "constraint" : [{
        "key" : "snr-1",
        "severity" : "error",
        "human" : "to indicate what service was not performed, either at least one coding in the code or a notDoneValueSet extension shall be provided",
        "expression" : "code.extension('http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-notDoneValueSet').exists() xor code.coding.exists()"
      }],
      "mustSupport" : false
    },
    {
      "id" : "ServiceRequest.extension:reasonRefused",
      "path" : "ServiceRequest.extension",
      "sliceName" : "reasonRefused",
      "short" : "Extension",
      "min" : 1,
      "max" : "1",
      "type" : [{
        "code" : "Extension",
        "profile" : ["http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-doNotPerformReason"]
      }]
    },
    {
      "id" : "ServiceRequest.status",
      "extension" : [{
        "url" : "http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement",
        "valueBoolean" : true
      },
      {
        "url" : "http://fhir.org/guides/onc/us-quality-core/StructureDefinition/uscdiplusquality",
        "valueBoolean" : true
      }],
      "path" : "ServiceRequest.status",
      "short" : "(USCDI+ Quality) (USCDI) draft | active | on-hold | revoked | completed | entered-in-error | unknown"
    },
    {
      "id" : "ServiceRequest.doNotPerform",
      "path" : "ServiceRequest.doNotPerform",
      "short" : "True if service/procedure should not be performed",
      "min" : 1,
      "max" : "1",
      "type" : [{
        "code" : "boolean"
      }],
      "fixedBoolean" : true
    },
    {
      "id" : "ServiceRequest.code",
      "extension" : [{
        "url" : "http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement",
        "valueBoolean" : true
      },
      {
        "url" : "http://fhir.org/guides/onc/us-quality-core/StructureDefinition/uscdiplusquality",
        "valueBoolean" : true
      }],
      "path" : "ServiceRequest.code",
      "short" : "(USCDI+ Quality) (USCDI) What is being requested/ordered"
    },
    {
      "id" : "ServiceRequest.code.extension:notDoneValueSet",
      "path" : "ServiceRequest.code.extension",
      "sliceName" : "notDoneValueSet",
      "short" : "What was not requested",
      "min" : 0,
      "max" : "1",
      "type" : [{
        "code" : "Extension",
        "profile" : ["http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-notDoneValueSet"]
      }],
      "condition" : ["snr-1"]
    },
    {
      "id" : "ServiceRequest.subject",
      "extension" : [{
        "url" : "http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement",
        "valueBoolean" : true
      }],
      "path" : "ServiceRequest.subject",
      "short" : "(USCDI) Individual or Entity the service is ordered for",
      "type" : [{
        "code" : "Reference",
        "targetProfile" : ["http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-patient"]
      }]
    },
    {
      "id" : "ServiceRequest.occurrence[x]",
      "extension" : [{
        "url" : "http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement",
        "valueBoolean" : true
      }],
      "path" : "ServiceRequest.occurrence[x]",
      "short" : "(USCDI) When service should occur",
      "type" : [{
        "code" : "dateTime"
      },
      {
        "code" : "Period"
      },
      {
        "code" : "Timing"
      }]
    },
    {
      "id" : "ServiceRequest.authoredOn",
      "extension" : [{
        "url" : "http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement",
        "valueBoolean" : true
      },
      {
        "url" : "http://fhir.org/guides/onc/us-quality-core/StructureDefinition/uscdiplusquality",
        "valueBoolean" : true
      }],
      "path" : "ServiceRequest.authoredOn",
      "short" : "(USCDI+ Quality) (USCDI) Date request signed",
      "min" : 1,
      "max" : "1"
    },
    {
      "id" : "ServiceRequest.requester",
      "extension" : [{
        "url" : "http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement",
        "valueBoolean" : true
      }],
      "path" : "ServiceRequest.requester",
      "short" : "(USCDI)",
      "type" : [{
        "code" : "Reference",
        "targetProfile" : ["http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-practitioner",
        "http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-practitionerrole",
        "http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-organization",
        "http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-patient",
        "http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-relatedperson",
        "http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-device",
        "http://hl7.org/fhir/us/core/StructureDefinition/us-core-implantable-device|6.1.0"]
      }]
    },
    {
      "id" : "ServiceRequest.reasonCode",
      "extension" : [{
        "url" : "http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement",
        "valueBoolean" : true
      },
      {
        "url" : "http://fhir.org/guides/onc/us-quality-core/StructureDefinition/uscdiplusquality",
        "valueBoolean" : true
      }],
      "path" : "ServiceRequest.reasonCode",
      "short" : "(USCDI+ Quality) (USCDI) Explanation/Justification for procedure or service",
      "type" : [{
        "code" : "CodeableConcept"
      }],
      "binding" : {
        "strength" : "extensible",
        "valueSet" : "http://hl7.org/fhir/us/core/ValueSet/us-core-condition-code"
      }
    },
    {
      "id" : "ServiceRequest.reasonReference",
      "extension" : [{
        "url" : "http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement",
        "valueBoolean" : true
      },
      {
        "url" : "http://fhir.org/guides/onc/us-quality-core/StructureDefinition/uscdiplusquality",
        "valueBoolean" : true
      }],
      "path" : "ServiceRequest.reasonReference",
      "short" : "(USCDI+ Quality) (USCDI) Explanation/Justification for service or service",
      "definition" : "Indicates another resource that provides a justification for why this service is being requested.   May relate to the resources referred to in `supportingInfo`.",
      "comment" : "This element represents why the referral is being made and may be used to decide how the service will be performed, or even if it will be performed at all.    To be as specific as possible,  a reference to  *Observation* or *Condition* should be used if available.  Otherwise when referencing  *DiagnosticReport*  it should contain a finding  in `DiagnosticReport.conclusion` and/or `DiagnosticReport.conclusionCode`.   When using a reference to *DocumentReference*, the target document should contain clear findings language providing the relevant reason for this service request.  Use  the CodeableConcept text element in `ServiceRequest.reasonCode` if the data is free (uncoded) text as shown in the [CT Scan example](servicerequest-example-di.html).",
      "min" : 0,
      "max" : "*",
      "base" : {
        "path" : "ServiceRequest.reasonReference",
        "min" : 0,
        "max" : "*"
      },
      "type" : [{
        "code" : "Reference",
        "targetProfile" : ["http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-condition-encounter-diagnosis",
        "http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-condition-problems-health-concerns"]
      }],
      "isModifier" : false,
      "isSummary" : true
    }]
  }
}

```
