2026 US Quality Core Implementation Guide
0.5.0 - cibuild US

2026 US Quality Core Implementation Guide, published by Office of the National Coordinator for Health Information Technology (ONC). This guide is not an authorized publication; it is the continuous build for version 0.5.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/FHIR/us-quality-core/ and changes regularly. See the Directory of published versions

## Resource Profile: USQualityCoreConditionEncounterDiagnosis - Detailed Descriptions

Active as of 2026-05-15

Definitions for the us-quality-core-condition-encounter-diagnosis resource profile.

- Key Elements Table
- Differential Elements Table
- Snapshot Elements Table

Guidance on how to interpret the contents of this table can be foundhere

0. Condition
Definition | - A clinical condition, problem, diagnosis, or other event, situation, issue, or clinical concept that has risen to a level of concern.
Short | Detailed information about conditions, problems or diagnoses
Comments | -
Control | 0..*
Is Modifier | false
Must Support | false
Summary | false
Invariants | con-3: Condition.clinicalStatus SHALL be present if verificationStatus is not entered-in-error and category is problem-list-item (`clinicalStatus.exists() or verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code = 'entered-in-error').exists() or category.select($this='problem-list-item').empty()`) con-4: If condition is abated, then clinicalStatus must be either inactive, resolved, or remission (`abatement.empty() or clinicalStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-clinical' and (code='resolved' or code='remission' or code='inactive')).exists()`) con-5: Condition.clinicalStatus SHALL NOT be present if verification Status is entered-in-error (`verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code='entered-in-error').empty() or clinicalStatus.empty()`) dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty()) dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()) dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()) dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty()) dom-6: A resource should have narrative for robust management (text.`div`.exists()) con-3: Condition.clinicalStatus SHALL be present if verificationStatus is not entered-in-error and category is problem-list-item (clinicalStatus.exists() or verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code = 'entered-in-error').exists() or category.select($this='problem-list-item').empty()) con-4: If condition is abated, then clinicalStatus must be either inactive, resolved, or remission (abatement.empty() or clinicalStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-clinical' and (code='resolved' or code='remission' or code='inactive')).exists()) con-5: Condition.clinicalStatus SHALL NOT be present if verification Status is entered-in-error (verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code='entered-in-error').empty() or clinicalStatus.empty())
2. Condition.implicitRules
Definition | A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Short | A set of rules under which this content was created
Comments | Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
Control | 0..1
Type | uri
Is Modifier | true because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
4. Condition.extension:assertedDate
Slice Name | assertedDate
Definition | The date on which the existence of the Condition was first asserted or acknowledged.
Short | (USCDI) Date the condition was first asserted
Comments | The assertedDate is in the context of the recording practitioner and might not be the same as the recordedDate.
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Extension(Condition Asserted Date) (Extension Type: dateTime)
Is Modifier | false
Must Support | true
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
6. Condition.modifierExtension
Definition | May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Short | Extensions that cannot be ignored
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
Summary | false
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
8. Condition.clinicalStatus
Definition | The clinical status of the condition.
Short | (USCDI) active | recurrence | relapse | inactive | remission | resolvedactive | recurrence | relapse | inactive | remission | resolved
Comments | The data type is CodeableConcept because clinicalStatus has some clinical judgment involved, such that there might need to be more specificity than the required FHIR value set allows. For example, a SNOMED coding might allow for additional specificity.
Control | 0..1 This element is affected by the following invariants: con-3, con-4, con-5
Binding | The codes SHALL be taken from ConditionClinicalStatusCodes http://hl7.org/fhir/ValueSet/condition-clinical|4.0.1 (required to `http://hl7.org/fhir/ValueSet/condition-clinical` )
Type | CodeableConcept
Is Modifier | true because This element is labeled as a modifier because the status contains codes that mark the condition as no longer active.
Must Support | true
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
10. Condition.verificationStatus
Definition | The verification status to support the clinical status of the condition.
Short | (USCDI) unconfirmed | provisional | differential | confirmed | refuted | entered-in-errorunconfirmed | provisional | differential | confirmed | refuted | entered-in-error
Comments | verificationStatus is not required. For example, when a patient has abdominal pain in the ED, there is not likely going to be a verification status. The data type is CodeableConcept because verificationStatus has some clinical judgment involved, such that there might need to be more specificity than the required FHIR value set allows. For example, a SNOMED coding might allow for additional specificity.
Control | 0..1 This element is affected by the following invariants: con-3, con-5
Binding | The codes SHALL be taken from ConditionVerificationStatus http://hl7.org/fhir/ValueSet/condition-ver-status|4.0.1 (required to `http://hl7.org/fhir/ValueSet/condition-ver-status` )
Type | CodeableConcept
Is Modifier | true because This element is labeled as a modifier because the status contains the code refuted and entered-in-error that mark the Condition as not currently valid.
Must Support | true
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
12. Condition.category
Definition | A category assigned to the condition.
Short | (USCDI) category codesproblem-list-item | encounter-diagnosis
Comments | The categorization is often highly contextual and may appear poorly differentiated or not very useful in other contexts.
Control | 10..*
Binding | Unless not suitable, these codes SHALL be taken from ConditionCategoryCodes http://hl7.org/fhir/ValueSet/condition-category|4.0.1 (extensible to `http://hl7.org/fhir/ValueSet/condition-category` ) A category assigned to the condition.
Type | CodeableConcept
Is Modifier | false
Must Support | true
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
Slicing | This element introduces a set of slices on `Condition.category`. The slices areUnordered and Open, and can be differentiated using the following discriminators: pattern @ $this
14. Condition.category:us-core
Slice Name | us-core
Definition | A category assigned to the condition.
Short | (USCDI) encounter-diagnosisproblem-list-item | encounter-diagnosis
Comments | The categorization is often highly contextual and may appear poorly differentiated or not very useful in other contexts.
Control | 10..1*
Binding | Unless not suitable, these codes SHALL be taken from ConditionCategoryCodes http://hl7.org/fhir/ValueSet/condition-category|4.0.1 (extensible to `http://hl7.org/fhir/ValueSet/condition-category` ) A category assigned to the condition.
Type | CodeableConcept
Is Modifier | false
Must Support | true
Summary | false
Pattern Value | `{ "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/condition-category", "code" : "encounter-diagnosis" }] }`
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
16. Condition.code
Definition | Identification of the condition, problem or diagnosis.
Short | (USCDI+ Quality) (USCDI) Identification of the condition, problem or diagnosisIdentification of the condition, problem or diagnosis
Control | 10..1
Binding | Unless not suitable, these codes SHALL be taken from For example codes, see US Core Condition Codes http://hl7.org/fhir/ValueSet/condition-code|4.0.1 (extensible to `http://hl7.org/fhir/us/core/ValueSet/us-core-condition-code` ) Valueset to describe the actual problem experienced by the patient Identification of the condition or diagnosis.
Type | CodeableConcept
Is Modifier | false
Must Support | true
Summary | true
Requirements | 0..1 to account for primarily narrative only resources.
Alternate Names | type
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
18. Condition.subject
Definition | Indicates the patient or group who the condition record is associated with.
Short | (USCDI) Who has the condition?Who has the condition?
Control | 1..1
Type | Reference(US Quality Core Patient, Patient, Group)
Is Modifier | false
Must Support | true
Summary | true
Requirements | Group is typically used for veterinary or public health use cases.
Alternate Names | patient
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
20. Condition.encounter
Definition | The Encounter during which this Condition was created or to which the creation of this record is tightly associated.
Short | (USCDI+ Quality) (USCDI) Encounter created as part ofEncounter created as part of
Comments | This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter. This record indicates the encounter this particular record is associated with. In the case of a "new" diagnosis reflecting ongoing/revised information about the condition, this might be distinct from the first encounter in which the underlying condition was first "known".
Control | 0..1
Type | Reference(US Quality Core Encounter, Encounter)
Is Modifier | false
Must Support | true
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
22. Condition.onset[x]
Definition | Estimated or actual date or date-time the condition began, in the opinion of the clinician.
Short | (USCDI) Estimated or actual date, date-time, or ageEstimated or actual date, date-time, or age
Comments | Age is generally used when the patient reports an age at which the Condition began to occur.
Control | 0..1
Type | Choice of: dateTime, Age, Period, Range, string
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Must Support Types | dateTime
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
24. Condition.abatement[x]
Definition | The date or estimated date that the condition resolved or went into remission. This is called "abatement" because of the many overloaded connotations associated with "remission" or "resolution" - Conditions are never really resolved, but they can abate.
Short | (USCDI) When in resolution/remissionWhen in resolution/remission
Comments | There is no explicit distinction between resolution and remission because in many cases the distinction is not clear. Age is generally used when the patient reports an age at which the Condition abated. If there is no abatement element, it is unknown whether the condition has resolved or entered remission; applications and users should generally assume that the condition is still valid. When abatementString exists, it implies the condition is abated.
Control | 0..1 This element is affected by the following invariants: con-4
Type | Choice of: dateTime, Age, Period, Range, string
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Must Support Types | dateTime
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
26. Condition.recordedDate
Definition | The recordedDate represents when this particular Condition record was created in the system, which is often a system-generated date.
Short | (USCDI+ Quality) (USCDI) Date record was first recordedDate record was first recorded
Control | 0..1
Type | dateTime
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

Guidance on how to interpret the contents of this table can be foundhere

0. Condition
2. Condition.code
Short | (USCDI+ Quality) (USCDI) Identification of the condition, problem or diagnosis
4. Condition.subject
Short | (USCDI) Who has the condition?
Type | Reference(US Quality Core Patient)
6. Condition.encounter
Short | (USCDI+ Quality) (USCDI) Encounter created as part of
Type | Reference(US Quality Core Encounter)
8. Condition.onset[x]
Short | (USCDI) Estimated or actual date, date-time, or age
Type | Choice of: dateTime, Age, Period, Range, string
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
10. Condition.abatement[x]
Short | (USCDI) When in resolution/remission
Type | Choice of: dateTime, Age, Period, Range, string
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
12. Condition.recordedDate
Short | (USCDI+ Quality) (USCDI) Date record was first recorded

Guidance on how to interpret the contents of this table can be foundhere

0. Condition
Definition | -
Short | Detailed information about conditions, problems or diagnoses
Comments | -
Control | 0..*
Is Modifier | false
Must Support | false
Summary | false
Invariants | con-3: Condition.clinicalStatus SHALL be present if verificationStatus is not entered-in-error and category is problem-list-item (`clinicalStatus.exists() or verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code = 'entered-in-error').exists() or category.select($this='problem-list-item').empty()`) con-4: If condition is abated, then clinicalStatus must be either inactive, resolved, or remission (`abatement.empty() or clinicalStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-clinical' and (code='resolved' or code='remission' or code='inactive')).exists()`) con-5: Condition.clinicalStatus SHALL NOT be present if verification Status is entered-in-error (`verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code='entered-in-error').empty() or clinicalStatus.empty()`) dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (`contained.contained.empty()`) dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (`contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`) dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (`contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`) dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (`contained.meta.security.empty()`) dom-6: A resource should have narrative for robust management (`text.`div`.exists()`)
2. Condition.id
Definition | The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Short | Logical id of this artifact
Comments | The only time that a resource does not have an id is when it is being submitted to the server using a create operation.
Control | 0..1
Type | id
Is Modifier | false
Summary | true
4. Condition.meta
Definition | The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
Short | Metadata about the resource
Control | 0..1
Type | Meta
Is Modifier | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
6. Condition.implicitRules
Definition | A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Short | A set of rules under which this content was created
Comments | Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
Control | 0..1
Type | uri
Is Modifier | true because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
8. Condition.language
Definition | The base language in which the resource is written.
Short | Language of the resource content
Comments | Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).
Control | 0..1
Binding | The codes SHOULD be taken from CommonLanguages (preferred to `http://hl7.org/fhir/ValueSet/languages` ) A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
Type | code
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
10. Condition.text
Definition | A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
Short | Text summary of the resource, for human interpretation
Comments | Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.
Control | 0..1
Type | Narrative
Is Modifier | false
Summary | false
Alternate Names | narrative, html, xhtml, display
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
12. Condition.contained
Definition | These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
Short | Contained, inline Resources
Comments | This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
Control | 0..*
Type | Resource
Is Modifier | false
Summary | false
Alternate Names | inline resources, anonymous resources, contained resources
14. Condition.extension
Definition | An Extension
Short | Extension
Control | 0..*
Type | Extension
Is Modifier | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
Slicing | This element introduces a set of slices on `Condition.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
16. Condition.extension:assertedDate
Slice Name | assertedDate
Definition | The date on which the existence of the Condition was first asserted or acknowledged.
Short | (USCDI) Date the condition was first asserted
Comments | The assertedDate is in the context of the recording practitioner and might not be the same as the recordedDate.
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Extension(Condition Asserted Date) (Extension Type: dateTime)
Is Modifier | false
Must Support | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
18. Condition.modifierExtension
Definition | May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Short | Extensions that cannot be ignored
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
Summary | false
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
20. Condition.identifier
Definition | Business identifiers assigned to this condition by the performer or other systems which remain constant as the resource is updated and propagates from server to server.
Short | External Ids for this condition
Comments | This is a business identifier, not a resource identifier (see discussion). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and a Person resource instance might share the same social insurance number.
Note | This is a business identifier, not a resource identifier (see discussion)
Control | 0..*
Type | Identifier
Is Modifier | false
Summary | true
Requirements | Allows identification of the condition as it is known by various participating systems and in a way that remains consistent across servers.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
22. Condition.clinicalStatus
Definition | The clinical status of the condition.
Short | (USCDI) active | recurrence | relapse | inactive | remission | resolved
Comments | The data type is CodeableConcept because clinicalStatus has some clinical judgment involved, such that there might need to be more specificity than the required FHIR value set allows. For example, a SNOMED coding might allow for additional specificity.
Control | 0..1 This element is affected by the following invariants: con-3, con-4, con-5
Binding | The codes SHALL be taken from ConditionClinicalStatusCodes (required to `http://hl7.org/fhir/ValueSet/condition-clinical` )
Type | CodeableConcept
Is Modifier | true because This element is labeled as a modifier because the status contains codes that mark the condition as no longer active.
Must Support | true
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
24. Condition.verificationStatus
Definition | The verification status to support the clinical status of the condition.
Short | (USCDI) unconfirmed | provisional | differential | confirmed | refuted | entered-in-error
Comments | verificationStatus is not required. For example, when a patient has abdominal pain in the ED, there is not likely going to be a verification status. The data type is CodeableConcept because verificationStatus has some clinical judgment involved, such that there might need to be more specificity than the required FHIR value set allows. For example, a SNOMED coding might allow for additional specificity.
Control | 0..1 This element is affected by the following invariants: con-3, con-5
Binding | The codes SHALL be taken from ConditionVerificationStatus (required to `http://hl7.org/fhir/ValueSet/condition-ver-status` )
Type | CodeableConcept
Is Modifier | true because This element is labeled as a modifier because the status contains the code refuted and entered-in-error that mark the Condition as not currently valid.
Must Support | true
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
26. Condition.category
Definition | A category assigned to the condition.
Short | (USCDI) category codes
Comments | The categorization is often highly contextual and may appear poorly differentiated or not very useful in other contexts.
Control | 1..*
Binding | Unless not suitable, these codes SHALL be taken from ConditionCategoryCodes (extensible to `http://hl7.org/fhir/ValueSet/condition-category` ) A category assigned to the condition.
Type | CodeableConcept
Is Modifier | false
Must Support | true
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
Slicing | This element introduces a set of slices on `Condition.category`. The slices areUnordered and Open, and can be differentiated using the following discriminators: pattern @ $this
28. Condition.category:us-core
Slice Name | us-core
Definition | A category assigned to the condition.
Short | (USCDI) encounter-diagnosis
Comments | The categorization is often highly contextual and may appear poorly differentiated or not very useful in other contexts.
Control | 1..1
Binding | Unless not suitable, these codes SHALL be taken from ConditionCategoryCodes (extensible to `http://hl7.org/fhir/ValueSet/condition-category` ) A category assigned to the condition.
Type | CodeableConcept
Is Modifier | false
Must Support | true
Summary | false
Pattern Value | `{ "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/condition-category", "code" : "encounter-diagnosis" }] }`
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
30. Condition.severity
Definition | A subjective assessment of the severity of the condition as evaluated by the clinician.
Short | Subjective severity of condition
Comments | Coding of the severity with a terminology is preferred, where possible.
Control | 0..1
Binding | The codes SHOULD be taken from Condition/DiagnosisSeverity (preferred to `http://hl7.org/fhir/ValueSet/condition-severity` ) A subjective assessment of the severity of the condition as evaluated by the clinician.
Type | CodeableConcept
Is Modifier | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
32. Condition.code
Definition | Identification of the condition, problem or diagnosis.
Short | (USCDI+ Quality) (USCDI) Identification of the condition, problem or diagnosis
Control | 1..1
Binding | Unless not suitable, these codes SHALL be taken from US Core Condition Codes (extensible to `http://hl7.org/fhir/us/core/ValueSet/us-core-condition-code` ) Valueset to describe the actual problem experienced by the patient
Type | CodeableConcept
Is Modifier | false
Must Support | true
Summary | true
Requirements | 0..1 to account for primarily narrative only resources.
Alternate Names | type
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
34. Condition.bodySite
Definition | The anatomical location where this condition manifests itself.
Short | Anatomical location, if relevant
Comments | Only used if not implicit in code found in Condition.code. If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension bodySite. May be a summary code, or a reference to a very precise definition of the location, or both.
Control | 0..*
Binding | For example codes, see SNOMEDCTBodyStructures (example to `http://hl7.org/fhir/ValueSet/body-site` ) Codes describing anatomical locations. May include laterality.
Type | CodeableConcept
Is Modifier | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
36. Condition.subject
Definition | Indicates the patient or group who the condition record is associated with.
Short | (USCDI) Who has the condition?
Control | 1..1
Type | Reference(US Quality Core Patient)
Is Modifier | false
Must Support | true
Summary | true
Requirements | Group is typically used for veterinary or public health use cases.
Alternate Names | patient
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
38. Condition.encounter
Definition | The Encounter during which this Condition was created or to which the creation of this record is tightly associated.
Short | (USCDI+ Quality) (USCDI) Encounter created as part of
Comments | This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter. This record indicates the encounter this particular record is associated with. In the case of a "new" diagnosis reflecting ongoing/revised information about the condition, this might be distinct from the first encounter in which the underlying condition was first "known".
Control | 0..1
Type | Reference(US Quality Core Encounter)
Is Modifier | false
Must Support | true
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
40. Condition.onset[x]
Definition | Estimated or actual date or date-time the condition began, in the opinion of the clinician.
Short | (USCDI) Estimated or actual date, date-time, or age
Comments | Age is generally used when the patient reports an age at which the Condition began to occur.
Control | 0..1
Type | Choice of: dateTime, Age, Period, Range
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Must Support Types | dateTime
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
42. Condition.abatement[x]
Definition | The date or estimated date that the condition resolved or went into remission. This is called "abatement" because of the many overloaded connotations associated with "remission" or "resolution" - Conditions are never really resolved, but they can abate.
Short | (USCDI) When in resolution/remission
Comments | There is no explicit distinction between resolution and remission because in many cases the distinction is not clear. Age is generally used when the patient reports an age at which the Condition abated. If there is no abatement element, it is unknown whether the condition has resolved or entered remission; applications and users should generally assume that the condition is still valid. When abatementString exists, it implies the condition is abated.
Control | 0..1 This element is affected by the following invariants: con-4
Type | Choice of: dateTime, Age, Period, Range
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Must Support Types | dateTime
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
44. Condition.recordedDate
Definition | The recordedDate represents when this particular Condition record was created in the system, which is often a system-generated date.
Short | (USCDI+ Quality) (USCDI) Date record was first recorded
Control | 0..1
Type | dateTime
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
46. Condition.recorder
Definition | Individual who recorded the record and takes responsibility for its content.
Short | Who recorded the condition
Control | 0..1
Type | Reference(Practitioner, PractitionerRole, Patient, RelatedPerson)
Is Modifier | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
48. Condition.asserter
Definition | Individual who is making the condition statement.
Short | Person who asserts this condition
Control | 0..1
Type | Reference(Practitioner, PractitionerRole, Patient, RelatedPerson)
Is Modifier | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
50. Condition.stage
Definition | Clinical stage or grade of a condition. May include formal severity assessments.
Short | Stage/grade, usually assessed formally
Control | 0..*
Type | BackboneElement
Is Modifier | false
Summary | false
Invariants | con-1: Stage SHALL have summary or assessment (`summary.exists() or assessment.exists()`) ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
52. Condition.stage.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | Unique id for inter-element referencing
Control | 0..1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
54. Condition.stage.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Short | Additional content defined by implementations
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
56. Condition.stage.modifierExtension
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Short | Extensions that cannot be ignored even if unrecognized
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summary | true
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Alternate Names | extensions, user content, modifiers
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
58. Condition.stage.summary
Definition | A simple summary of the stage such as "Stage 3". The determination of the stage is disease-specific.
Short | Simple summary (disease specific)
Control | 0..1 This element is affected by the following invariants: con-1
Binding | For example codes, see ConditionStage (example to `http://hl7.org/fhir/ValueSet/condition-stage` ) Codes describing condition stages (e.g. Cancer stages).
Type | CodeableConcept
Is Modifier | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
60. Condition.stage.assessment
Definition | Reference to a formal record of the evidence on which the staging assessment is based.
Short | Formal record of assessment
Control | 0..* This element is affected by the following invariants: con-1
Type | Reference(ClinicalImpression, DiagnosticReport, Observation)
Is Modifier | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
62. Condition.stage.type
Definition | The kind of staging, such as pathological or clinical staging.
Short | Kind of staging
Control | 0..1
Binding | For example codes, see ConditionStageType (example to `http://hl7.org/fhir/ValueSet/condition-stage-type` ) Codes describing the kind of condition staging (e.g. clinical or pathological).
Type | CodeableConcept
Is Modifier | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
64. Condition.evidence
Definition | Supporting evidence / manifestations that are the basis of the Condition's verification status, such as evidence that confirmed or refuted the condition.
Short | Supporting evidence
Comments | The evidence may be a simple list of coded symptoms/manifestations, or references to observations or formal assessments, or both.
Control | 0..*
Type | BackboneElement
Is Modifier | false
Summary | false
Invariants | con-2: evidence SHALL have code or details (`code.exists() or detail.exists()`) ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
66. Condition.evidence.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | Unique id for inter-element referencing
Control | 0..1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
68. Condition.evidence.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Short | Additional content defined by implementations
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
70. Condition.evidence.modifierExtension
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Short | Extensions that cannot be ignored even if unrecognized
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summary | true
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Alternate Names | extensions, user content, modifiers
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
72. Condition.evidence.code
Definition | A manifestation or symptom that led to the recording of this condition.
Short | Manifestation/symptom
Control | 0..* This element is affected by the following invariants: con-2
Binding | For example codes, see ManifestationAndSymptomCodes (example to `http://hl7.org/fhir/ValueSet/manifestation-or-symptom` ) Codes that describe the manifestation or symptoms of a condition.
Type | CodeableConcept
Is Modifier | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
74. Condition.evidence.detail
Definition | Links to other relevant information, including pathology reports.
Short | Supporting information found elsewhere
Control | 0..* This element is affected by the following invariants: con-2
Type | Reference(Resource)
Is Modifier | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
76. Condition.note
Definition | Additional information about the Condition. This is a general notes/comments entry for description of the Condition, its diagnosis and prognosis.
Short | Additional information about the Condition
Control | 0..*
Type | Annotation
Is Modifier | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)