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: US Quality Core Simple Observation

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

Profile of Simple Observation for decision support/quality metrics. Defines the core set of elements and extensions for quality rule and measure authors.

Usage

Note: US-Core and US Quality Core define precise profiles for specific observations, as well as a general profile for LOINC-code laboratory result observations. US Quality Core inherits these US Core specific profiles directly and individually profiles others. When creating expressions for eCQMs or CDS artifacts with US Quality Core for the following clinical data, use the applicable profile directly rather than the generic USQualityCore Observation profile:

- US Core Pediatric Head Occipital-frontal Circumference Percentile Profile
- US Core Blood Pressure Profile
- US Core BMI Profile
- US Core Body Height Profile
- US Core Body Temperature Profile
- US Core Body Weight Profile
- US Core Head Circumference Profile
- US Core Heart Rate Profile
- US Core Pediatric BMI for Age Observation Profile
- US Core Pediatric Weight for Height Observation Profile
- US Core Pulse Oximetry Profile
- US Core Respiratory Rate Profile
- US Core Smoking Status Observation Profile
- US Core Observation Sexual Orientation Profile
- US Core Observation Pregnancy Intent Profile
- US Core Observation Pregnancy Status Profile
- USQualityCore Observation Clinical Result
- USQualityCore Laboratory Result Observation
- USQualityCore Observation Screening Assessment

As stated in the Home Page, US Quality Core derives from US Core and so the requirements on “MustSupport” defined in US Core must be respected. US Quality Core further describes and constrains the “MustSupport” functionality.

To create an expression specifically requesting information that an observation intentionally did not occur for a medical, patient or system reason, use the profile USQualityCore Observation Cancelled.

The following example illustrates the use of the observation profile.

    define "Pap Test with Results":
      [Observation: "Pap Test"] PapTest
        where PapTest.value is not null
          and PapTest.status in { 'final', 'amended', 'corrected', 'preliminary' }

See the patterns page for implementation and usage patterns.

### Examples

Frailty Observation Example
Gestational Age at Birth Example
Date and Time of Obstetric Delivery Example
Delivery Date Estimated Example
Number of Preterm Births Example
Number of Term Births Example
Number of Parity Example
Number of Pregnancies Example

USCDI+ Quality Elements:

- status: (USCDI+ Quality) (USCDI) registered | prliminary | final | amended | corrected | entered-in-error | unknown
- category: (USCDI+ Quality) (USCDI) Classification of type of observation
- category:us-core: (USCDI+ Quality) (USCDI) US Core classification of type of observation
- code: (USCDI+ Quality) (USCDI) Type of observation (code / type)
- effective[x]: (USCDI+ Quality) (USCDI) Clinically relevant time/time-period for observation
- value[x]: (USCDI+ Quality) (USCDI) Actual result

Usages:

- Refer to this Profile: US Quality Core AdverseEvent, US Quality Core Encounter, US Quality Core ImagingStudy, US Quality Core ImmunizationRecommendation... Show 5 more, US Quality Core Medication Not Requested, US Quality Core MedicationRequest, US Quality Core NonPatient Observation, US Quality Core Observation Cancelled and US Quality Core Simple Observation
- Examples for this Profile: Observation/example-births, Observation/example-delivery-date-estimate, Observation/example-frailty, Observation/example-gestation... Show 6 more, Observation/example-obstetric-delivery, Observation/example-odh, Observation/example-parity, Observation/example-pregnancies, Observation/example-preterm-births and Observation/example
- CapabilityStatements using this Profile: US Quality Core Client CapabilityStatement and US Quality Core Server CapabilityStatement

You can also check for usages in the FHIR IG Statistics

### Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

- Key Elements Table
- Differential Table
- Snapshot Table
- Statistics/References
- All

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Observation | C | 0..* | USCoreSimpleObservationProfile(6.1.0) | assessment observation Constraints: obs-6, obs-7
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
status | ?!S Σ | 1..1 | code | (USCDI+ Quality) (USCDI) registered | prliminary | final | amended | corrected | entered-in-error | unknown Binding: Non-Negative Observation Status (required)
Slices for category | S | 1..* | CodeableConcept | (USCDI+ Quality) (USCDI) Classification of type of observation Slice: Unordered, Open by pattern:$this Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
category:us-core | S | 0..* | CodeableConcept | (USCDI+ Quality) (USCDI) US Core classification of type of observation Binding: US Core Simple Observation Category (required): Note that other codes are permitted, see Required Bindings When Slicing by Value Sets
code | S Σ | 1..1 | CodeableConcept | (USCDI+ Quality) (USCDI) Type of observation (code / type) Binding: LOINCCodes (preferred): This value set specifies the type of observation
subject | S Σ | 1..1 | Reference(US Quality Core Patient) | (USCDI) Who and/or what the observation is about
effective[x] | S Σ | 0..1 |  | (USCDI+ Quality) (USCDI) Clinically relevant time/time-period for observation
effectiveDateTime |  |  | dateTime S |
effectivePeriod |  |  | Period |
effectiveTiming |  |  | Timing |
effectiveInstant |  |  | instant |
performer | S Σ | 0..* | Reference(US Quality Core Practitioner | US Quality Core Organization | US Quality Core Patient | US Quality Core PractitionerRole | US Quality Core CareTeam | US Quality Core RelatedPerson) | (USCDI) Who is responsible for the observation
Slices for value[x] | S Σ C | 0..1 |  | (USCDI+ Quality) (USCDI) Actual result Slice: Unordered, Open by type:$this
valueQuantity |  |  | Quantity S |
valueCodeableConcept |  |  | CodeableConcept S |
valueString |  |  | string S |
valueBoolean |  |  | boolean S |
valueInteger |  |  | integer |
valueRange |  |  | Range |
valueRatio |  |  | Ratio |
valueSampledData |  |  | SampledData |
valueTime |  |  | time |
valueDateTime |  |  | dateTime |
valuePeriod |  |  | Period |
value[x]:valueCodeableConcept | S Σ C | 0..1 | CodeableConcept S | actual | potential Binding: US Core Observation Value Codes (SNOMED-CT) (preferred): SNOMED CT for coded results
interpretation |  | 0..* | CodeableConcept | High, low, normal, etc. Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
derivedFrom | Σ | 0..* | Reference(US Quality Core Simple Observation | US Quality Core QuestionnaireResponse | US Quality Core ImagingStudy | US Core DocumentReference Profile(6.1.0) | Media | MolecularSequence) | (USCDI) US Core Profiles or other resource the observation is made from
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Observation.status | Base | required | Non-Negative Observation Status | 📦0.5.0 | This IG
Observation.category | Base | preferred | Observation Category Codes | 📦4.0.1 | FHIR Std.
Observation.category:us-core | Base | required | US Core Simple Observation Category | 📦7.0.0 | US Core v7.0
Observation.code | Base | preferred | LOINC Codes | 📦4.0.1 | FHIR Std.
Observation.value[x]:valueCodeableConcept | Base | preferred | US Core Observation Value Codes (SNOMED-CT) | 📦6.1.0 | US Core v6.1
Observation.interpretation | Base | extensible | Observation Interpretation Codes | 📦4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | Observation | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Observation | 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 | error | Observation | 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 | error | Observation | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Observation | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`
obs-6 | error | Observation | dataAbsentReason SHALL only be present if Observation.value[x] is not present | `dataAbsentReason.empty() or value.empty()`
obs-7 | error | Observation | If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present | `value.empty() or component.code.where(coding.intersect(%resource.code.coding).exists()).empty()`

This structure is derived from USCoreSimpleObservationProfile

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Observation |  | 0..* | USCoreSimpleObservationProfile(6.1.0) | assessment observation
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
status |  | 1..1 | code | (USCDI+ Quality) (USCDI) registered | prliminary | final | amended | corrected | entered-in-error | unknown Binding: Non-Negative Observation Status (required)
category |  | 1..* | CodeableConcept | (USCDI+ Quality) (USCDI) Classification of type of observation
Slices for category |  |  |  | Content/Rules for all slices
category:us-core |  | 0..* | CodeableConcept | (USCDI+ Quality) (USCDI) US Core classification of type of observation
code |  | 1..1 | CodeableConcept | (USCDI+ Quality) (USCDI) Type of observation (code / type) Binding: LOINCCodes (preferred): This value set specifies the type of observation
subject | Σ | 1..1 | Reference(US Quality Core Patient) | (USCDI) Who and/or what the observation is about
effective[x] | Σ | 0..1 |  | (USCDI+ Quality) (USCDI) Clinically relevant time/time-period for observation
effectiveDateTime |  |  | dateTime |
effectivePeriod |  |  | Period |
effectiveTiming |  |  | Timing |
effectiveInstant |  |  | instant |
performer |  | 0..* | Reference(US Quality Core Practitioner | US Quality Core Organization | US Quality Core Patient | US Quality Core PractitionerRole | US Quality Core CareTeam | US Quality Core RelatedPerson) | (USCDI) Who is responsible for the observation
Slices for value[x] | Σ | 0..1 |  | (USCDI+ Quality) (USCDI) Actual result Slice: Unordered, Open by type:$this
valueQuantity |  |  | Quantity |
valueCodeableConcept |  |  | CodeableConcept |
valueString |  |  | string |
valueBoolean |  |  | boolean |
valueInteger |  |  | integer |
valueRange |  |  | Range |
valueRatio |  |  | Ratio |
valueSampledData |  |  | SampledData |
valueTime |  |  | time |
valueDateTime |  |  | dateTime |
valuePeriod |  |  | Period |
value[x]:valueCodeableConcept |  | 0..1 | CodeableConcept | actual | potential Binding: US Core Observation Value Codes (SNOMED-CT) (preferred): SNOMED CT for coded results
interpretation |  | 0..* | CodeableConcept | High, low, normal, etc. Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
derivedFrom | Σ | 0..* | Reference(US Quality Core Simple Observation | US Quality Core QuestionnaireResponse | US Quality Core ImagingStudy | US Core DocumentReference Profile(6.1.0) | Media | MolecularSequence) | (USCDI) US Core Profiles or other resource the observation is made from
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
Observation.status | Base | required | Non-Negative Observation Status | 📦0.5.0 | This IG
Observation.code | Base | preferred | LOINC Codes | 📦4.0.1 | FHIR Std.
Observation.value[x]:valueCodeableConcept | Base | preferred | US Core Observation Value Codes (SNOMED-CT) | 📦6.1.0 | US Core v6.1
Observation.interpretation | Base | extensible | Observation Interpretation Codes | 📦4.0.1 | FHIR Std.

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Observation | C | 0..* | USCoreSimpleObservationProfile(6.1.0) | assessment observation Constraints: obs-6, obs-7
id | Σ | 0..1 | id | Logical id of this artifact
meta | Σ | 0..1 | Meta | Metadata about the resource
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
language |  | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained |  | 0..* | Resource | Contained, inline Resources
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier | Σ | 0..* | Identifier | Business Identifier for observation
basedOn | Σ | 0..* | Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest) | Fulfills plan, proposal or order
partOf | Σ | 0..* | Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy) | Part of referenced event
status | ?!S Σ | 1..1 | code | (USCDI+ Quality) (USCDI) registered | prliminary | final | amended | corrected | entered-in-error | unknown Binding: Non-Negative Observation Status (required)
Slices for category | S | 1..* | CodeableConcept | (USCDI+ Quality) (USCDI) Classification of type of observation Slice: Unordered, Open by pattern:$this Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
category:us-core | S | 0..* | CodeableConcept | (USCDI+ Quality) (USCDI) US Core classification of type of observation Binding: US Core Simple Observation Category (required): Note that other codes are permitted, see Required Bindings When Slicing by Value Sets
code | S Σ | 1..1 | CodeableConcept | (USCDI+ Quality) (USCDI) Type of observation (code / type) Binding: LOINCCodes (preferred): This value set specifies the type of observation
subject | S Σ | 1..1 | Reference(US Quality Core Patient) | (USCDI) Who and/or what the observation is about
focus | Σ | 0..* | Reference(Resource) | What the observation is about, when it is not about the subject of record
encounter | Σ | 0..1 | Reference(Encounter) | Healthcare event during which this observation is made
effective[x] | S Σ | 0..1 |  | (USCDI+ Quality) (USCDI) Clinically relevant time/time-period for observation
effectiveDateTime |  |  | dateTime S |
effectivePeriod |  |  | Period |
effectiveTiming |  |  | Timing |
effectiveInstant |  |  | instant |
issued | Σ | 0..1 | instant | Date/Time this version was made available
performer | S Σ | 0..* | Reference(US Quality Core Practitioner | US Quality Core Organization | US Quality Core Patient | US Quality Core PractitionerRole | US Quality Core CareTeam | US Quality Core RelatedPerson) | (USCDI) Who is responsible for the observation
Slices for value[x] | S Σ C | 0..1 |  | (USCDI+ Quality) (USCDI) Actual result Slice: Unordered, Open by type:$this
valueQuantity |  |  | Quantity S |
valueCodeableConcept |  |  | CodeableConcept S |
valueString |  |  | string S |
valueBoolean |  |  | boolean S |
valueInteger |  |  | integer |
valueRange |  |  | Range |
valueRatio |  |  | Ratio |
valueSampledData |  |  | SampledData |
valueTime |  |  | time |
valueDateTime |  |  | dateTime |
valuePeriod |  |  | Period |
value[x]:valueCodeableConcept | S Σ C | 0..1 | CodeableConcept S | actual | potential Binding: US Core Observation Value Codes (SNOMED-CT) (preferred): SNOMED CT for coded results
dataAbsentReason | C | 0..1 | CodeableConcept | Why the result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
interpretation |  | 0..* | CodeableConcept | High, low, normal, etc. Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
note |  | 0..* | Annotation | Comments about the observation
bodySite |  | 0..1 | CodeableConcept | Observed body part Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.
method |  | 0..1 | CodeableConcept | How it was done Binding: ObservationMethods (example): Methods for simple observations.
specimen |  | 0..1 | Reference(Specimen) | Specimen used for this observation
device |  | 0..1 | Reference(Device | DeviceMetric) | (Measurement) Device
referenceRange | C | 0..* | BackboneElement | Provides guide for interpretation Constraints: obs-3
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
low | C | 0..1 | SimpleQuantity | Low Range, if relevant
high | C | 0..1 | SimpleQuantity | High Range, if relevant
type |  | 0..1 | CodeableConcept | Reference range qualifier Binding: ObservationReferenceRangeMeaningCodes (preferred): Code for the meaning of a reference range.
appliesTo |  | 0..* | CodeableConcept | Reference range population Binding: ObservationReferenceRangeAppliesToCodes (example): Codes identifying the population the reference range applies to.
age |  | 0..1 | Range | Applicable age range, if relevant
text |  | 0..1 | string | Text based reference range in an observation
hasMember | Σ | 0..* | Reference(Observation | QuestionnaireResponse | MolecularSequence) | Related resource that belongs to the Observation group
derivedFrom | Σ | 0..* | Reference(US Quality Core Simple Observation | US Quality Core QuestionnaireResponse | US Quality Core ImagingStudy | US Core DocumentReference Profile(6.1.0) | Media | MolecularSequence) | (USCDI) US Core Profiles or other resource the observation is made from
component | Σ | 0..* | BackboneElement | Component results
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
code | Σ | 1..1 | CodeableConcept | Type of component observation (code / type) Binding: LOINCCodes (example): Codes identifying names of simple observations.
value[x] | Σ | 0..1 |  | Actual component result
valueQuantity |  |  | Quantity |
valueCodeableConcept |  |  | CodeableConcept |
valueString |  |  | string |
valueBoolean |  |  | boolean |
valueInteger |  |  | integer |
valueRange |  |  | Range |
valueRatio |  |  | Ratio |
valueSampledData |  |  | SampledData |
valueTime |  |  | time |
valueDateTime |  |  | dateTime |
valuePeriod |  |  | Period |
dataAbsentReason | C | 0..1 | CodeableConcept | Why the component result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
interpretation |  | 0..* | CodeableConcept | High, low, normal, etc. Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
referenceRange |  | 0..* | See referenceRange (Observation) | Provides guide for interpretation of component result
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Observation.language | Base | preferred | Common Languages | 📦4.0.1 | FHIR Std.
Observation.status | Base | required | Non-Negative Observation Status | 📦0.5.0 | This IG
Observation.category | Base | preferred | Observation Category Codes | 📦4.0.1 | FHIR Std.
Observation.category:us-core | Base | required | US Core Simple Observation Category | 📦7.0.0 | US Core v7.0
Observation.code | Base | preferred | LOINC Codes | 📦4.0.1 | FHIR Std.
Observation.value[x]:valueCodeableConcept | Base | preferred | US Core Observation Value Codes (SNOMED-CT) | 📦6.1.0 | US Core v6.1
Observation.dataAbsentReason | Base | extensible | DataAbsentReason | 📦4.0.1 | FHIR Std.
Observation.interpretation | Base | extensible | Observation Interpretation Codes | 📦4.0.1 | FHIR Std.
Observation.bodySite | Base | example | SNOMED CT Body Structures | 📦4.0.1 | FHIR Std.
Observation.method | Base | example | Observation Methods | 📦4.0.1 | FHIR Std.
Observation.referenceRange.​type | Base | preferred | Observation Reference Range Meaning Codes | 📦4.0.1 | FHIR Std.
Observation.referenceRange.​appliesTo | Base | example | Observation Reference Range Applies To Codes | 📦4.0.1 | FHIR Std.
Observation.component.​code | Base | example | LOINC Codes | 📦4.0.1 | FHIR Std.
Observation.component.​dataAbsentReason | Base | extensible | DataAbsentReason | 📦4.0.1 | FHIR Std.
Observation.component.​interpretation | Base | extensible | Observation Interpretation Codes | 📦4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | Observation | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Observation | 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 | error | Observation | 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 | error | Observation | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Observation | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`
obs-3 | error | Observation.referenceRange | Must have at least a low or a high or text | `low.exists() or high.exists() or text.exists()`
obs-6 | error | Observation | dataAbsentReason SHALL only be present if Observation.value[x] is not present | `dataAbsentReason.empty() or value.empty()`
obs-7 | error | Observation | If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present | `value.empty() or component.code.where(coding.intersect(%resource.code.coding).exists()).empty()`

This structure is derived from USCoreSimpleObservationProfile

Summary

Mandatory: 2 elements

Structures

This structure refers to these other structures:

- US Quality Core Patient (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-patient)
- US Quality Core Practitioner (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-practitioner)
- US Quality Core Organization (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-organization)
- US Quality Core PractitionerRole (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-practitionerrole)
- US Quality Core CareTeam (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-careteam)
- US Quality Core RelatedPerson (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-relatedperson)
- US Quality Core Simple Observation (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-simple-observation)
- US Quality Core QuestionnaireResponse (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-questionnaireresponse)
- US Quality Core ImagingStudy (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-imagingstudy)
- US Core DocumentReference Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference|6.1.0)

Slices

This structure defines the following Slices:

- The element 1 is sliced based on the value of Observation.value[x]

Key Elements View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Observation | C | 0..* | USCoreSimpleObservationProfile(6.1.0) | assessment observation Constraints: obs-6, obs-7
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
status | ?!S Σ | 1..1 | code | (USCDI+ Quality) (USCDI) registered | prliminary | final | amended | corrected | entered-in-error | unknown Binding: Non-Negative Observation Status (required)
Slices for category | S | 1..* | CodeableConcept | (USCDI+ Quality) (USCDI) Classification of type of observation Slice: Unordered, Open by pattern:$this Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
category:us-core | S | 0..* | CodeableConcept | (USCDI+ Quality) (USCDI) US Core classification of type of observation Binding: US Core Simple Observation Category (required): Note that other codes are permitted, see Required Bindings When Slicing by Value Sets
code | S Σ | 1..1 | CodeableConcept | (USCDI+ Quality) (USCDI) Type of observation (code / type) Binding: LOINCCodes (preferred): This value set specifies the type of observation
subject | S Σ | 1..1 | Reference(US Quality Core Patient) | (USCDI) Who and/or what the observation is about
effective[x] | S Σ | 0..1 |  | (USCDI+ Quality) (USCDI) Clinically relevant time/time-period for observation
effectiveDateTime |  |  | dateTime S |
effectivePeriod |  |  | Period |
effectiveTiming |  |  | Timing |
effectiveInstant |  |  | instant |
performer | S Σ | 0..* | Reference(US Quality Core Practitioner | US Quality Core Organization | US Quality Core Patient | US Quality Core PractitionerRole | US Quality Core CareTeam | US Quality Core RelatedPerson) | (USCDI) Who is responsible for the observation
Slices for value[x] | S Σ C | 0..1 |  | (USCDI+ Quality) (USCDI) Actual result Slice: Unordered, Open by type:$this
valueQuantity |  |  | Quantity S |
valueCodeableConcept |  |  | CodeableConcept S |
valueString |  |  | string S |
valueBoolean |  |  | boolean S |
valueInteger |  |  | integer |
valueRange |  |  | Range |
valueRatio |  |  | Ratio |
valueSampledData |  |  | SampledData |
valueTime |  |  | time |
valueDateTime |  |  | dateTime |
valuePeriod |  |  | Period |
value[x]:valueCodeableConcept | S Σ C | 0..1 | CodeableConcept S | actual | potential Binding: US Core Observation Value Codes (SNOMED-CT) (preferred): SNOMED CT for coded results
interpretation |  | 0..* | CodeableConcept | High, low, normal, etc. Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
derivedFrom | Σ | 0..* | Reference(US Quality Core Simple Observation | US Quality Core QuestionnaireResponse | US Quality Core ImagingStudy | US Core DocumentReference Profile(6.1.0) | Media | MolecularSequence) | (USCDI) US Core Profiles or other resource the observation is made from
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Observation.status | Base | required | Non-Negative Observation Status | 📦0.5.0 | This IG
Observation.category | Base | preferred | Observation Category Codes | 📦4.0.1 | FHIR Std.
Observation.category:us-core | Base | required | US Core Simple Observation Category | 📦7.0.0 | US Core v7.0
Observation.code | Base | preferred | LOINC Codes | 📦4.0.1 | FHIR Std.
Observation.value[x]:valueCodeableConcept | Base | preferred | US Core Observation Value Codes (SNOMED-CT) | 📦6.1.0 | US Core v6.1
Observation.interpretation | Base | extensible | Observation Interpretation Codes | 📦4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | Observation | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Observation | 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 | error | Observation | 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 | error | Observation | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Observation | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`
obs-6 | error | Observation | dataAbsentReason SHALL only be present if Observation.value[x] is not present | `dataAbsentReason.empty() or value.empty()`
obs-7 | error | Observation | If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present | `value.empty() or component.code.where(coding.intersect(%resource.code.coding).exists()).empty()`

Differential View

This structure is derived from USCoreSimpleObservationProfile

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Observation |  | 0..* | USCoreSimpleObservationProfile(6.1.0) | assessment observation
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
status |  | 1..1 | code | (USCDI+ Quality) (USCDI) registered | prliminary | final | amended | corrected | entered-in-error | unknown Binding: Non-Negative Observation Status (required)
category |  | 1..* | CodeableConcept | (USCDI+ Quality) (USCDI) Classification of type of observation
Slices for category |  |  |  | Content/Rules for all slices
category:us-core |  | 0..* | CodeableConcept | (USCDI+ Quality) (USCDI) US Core classification of type of observation
code |  | 1..1 | CodeableConcept | (USCDI+ Quality) (USCDI) Type of observation (code / type) Binding: LOINCCodes (preferred): This value set specifies the type of observation
subject | Σ | 1..1 | Reference(US Quality Core Patient) | (USCDI) Who and/or what the observation is about
effective[x] | Σ | 0..1 |  | (USCDI+ Quality) (USCDI) Clinically relevant time/time-period for observation
effectiveDateTime |  |  | dateTime |
effectivePeriod |  |  | Period |
effectiveTiming |  |  | Timing |
effectiveInstant |  |  | instant |
performer |  | 0..* | Reference(US Quality Core Practitioner | US Quality Core Organization | US Quality Core Patient | US Quality Core PractitionerRole | US Quality Core CareTeam | US Quality Core RelatedPerson) | (USCDI) Who is responsible for the observation
Slices for value[x] | Σ | 0..1 |  | (USCDI+ Quality) (USCDI) Actual result Slice: Unordered, Open by type:$this
valueQuantity |  |  | Quantity |
valueCodeableConcept |  |  | CodeableConcept |
valueString |  |  | string |
valueBoolean |  |  | boolean |
valueInteger |  |  | integer |
valueRange |  |  | Range |
valueRatio |  |  | Ratio |
valueSampledData |  |  | SampledData |
valueTime |  |  | time |
valueDateTime |  |  | dateTime |
valuePeriod |  |  | Period |
value[x]:valueCodeableConcept |  | 0..1 | CodeableConcept | actual | potential Binding: US Core Observation Value Codes (SNOMED-CT) (preferred): SNOMED CT for coded results
interpretation |  | 0..* | CodeableConcept | High, low, normal, etc. Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
derivedFrom | Σ | 0..* | Reference(US Quality Core Simple Observation | US Quality Core QuestionnaireResponse | US Quality Core ImagingStudy | US Core DocumentReference Profile(6.1.0) | Media | MolecularSequence) | (USCDI) US Core Profiles or other resource the observation is made from
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
Observation.status | Base | required | Non-Negative Observation Status | 📦0.5.0 | This IG
Observation.code | Base | preferred | LOINC Codes | 📦4.0.1 | FHIR Std.
Observation.value[x]:valueCodeableConcept | Base | preferred | US Core Observation Value Codes (SNOMED-CT) | 📦6.1.0 | US Core v6.1
Observation.interpretation | Base | extensible | Observation Interpretation Codes | 📦4.0.1 | FHIR Std.

Snapshot View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Observation | C | 0..* | USCoreSimpleObservationProfile(6.1.0) | assessment observation Constraints: obs-6, obs-7
id | Σ | 0..1 | id | Logical id of this artifact
meta | Σ | 0..1 | Meta | Metadata about the resource
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
language |  | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained |  | 0..* | Resource | Contained, inline Resources
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier | Σ | 0..* | Identifier | Business Identifier for observation
basedOn | Σ | 0..* | Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest) | Fulfills plan, proposal or order
partOf | Σ | 0..* | Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy) | Part of referenced event
status | ?!S Σ | 1..1 | code | (USCDI+ Quality) (USCDI) registered | prliminary | final | amended | corrected | entered-in-error | unknown Binding: Non-Negative Observation Status (required)
Slices for category | S | 1..* | CodeableConcept | (USCDI+ Quality) (USCDI) Classification of type of observation Slice: Unordered, Open by pattern:$this Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
category:us-core | S | 0..* | CodeableConcept | (USCDI+ Quality) (USCDI) US Core classification of type of observation Binding: US Core Simple Observation Category (required): Note that other codes are permitted, see Required Bindings When Slicing by Value Sets
code | S Σ | 1..1 | CodeableConcept | (USCDI+ Quality) (USCDI) Type of observation (code / type) Binding: LOINCCodes (preferred): This value set specifies the type of observation
subject | S Σ | 1..1 | Reference(US Quality Core Patient) | (USCDI) Who and/or what the observation is about
focus | Σ | 0..* | Reference(Resource) | What the observation is about, when it is not about the subject of record
encounter | Σ | 0..1 | Reference(Encounter) | Healthcare event during which this observation is made
effective[x] | S Σ | 0..1 |  | (USCDI+ Quality) (USCDI) Clinically relevant time/time-period for observation
effectiveDateTime |  |  | dateTime S |
effectivePeriod |  |  | Period |
effectiveTiming |  |  | Timing |
effectiveInstant |  |  | instant |
issued | Σ | 0..1 | instant | Date/Time this version was made available
performer | S Σ | 0..* | Reference(US Quality Core Practitioner | US Quality Core Organization | US Quality Core Patient | US Quality Core PractitionerRole | US Quality Core CareTeam | US Quality Core RelatedPerson) | (USCDI) Who is responsible for the observation
Slices for value[x] | S Σ C | 0..1 |  | (USCDI+ Quality) (USCDI) Actual result Slice: Unordered, Open by type:$this
valueQuantity |  |  | Quantity S |
valueCodeableConcept |  |  | CodeableConcept S |
valueString |  |  | string S |
valueBoolean |  |  | boolean S |
valueInteger |  |  | integer |
valueRange |  |  | Range |
valueRatio |  |  | Ratio |
valueSampledData |  |  | SampledData |
valueTime |  |  | time |
valueDateTime |  |  | dateTime |
valuePeriod |  |  | Period |
value[x]:valueCodeableConcept | S Σ C | 0..1 | CodeableConcept S | actual | potential Binding: US Core Observation Value Codes (SNOMED-CT) (preferred): SNOMED CT for coded results
dataAbsentReason | C | 0..1 | CodeableConcept | Why the result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
interpretation |  | 0..* | CodeableConcept | High, low, normal, etc. Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
note |  | 0..* | Annotation | Comments about the observation
bodySite |  | 0..1 | CodeableConcept | Observed body part Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.
method |  | 0..1 | CodeableConcept | How it was done Binding: ObservationMethods (example): Methods for simple observations.
specimen |  | 0..1 | Reference(Specimen) | Specimen used for this observation
device |  | 0..1 | Reference(Device | DeviceMetric) | (Measurement) Device
referenceRange | C | 0..* | BackboneElement | Provides guide for interpretation Constraints: obs-3
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
low | C | 0..1 | SimpleQuantity | Low Range, if relevant
high | C | 0..1 | SimpleQuantity | High Range, if relevant
type |  | 0..1 | CodeableConcept | Reference range qualifier Binding: ObservationReferenceRangeMeaningCodes (preferred): Code for the meaning of a reference range.
appliesTo |  | 0..* | CodeableConcept | Reference range population Binding: ObservationReferenceRangeAppliesToCodes (example): Codes identifying the population the reference range applies to.
age |  | 0..1 | Range | Applicable age range, if relevant
text |  | 0..1 | string | Text based reference range in an observation
hasMember | Σ | 0..* | Reference(Observation | QuestionnaireResponse | MolecularSequence) | Related resource that belongs to the Observation group
derivedFrom | Σ | 0..* | Reference(US Quality Core Simple Observation | US Quality Core QuestionnaireResponse | US Quality Core ImagingStudy | US Core DocumentReference Profile(6.1.0) | Media | MolecularSequence) | (USCDI) US Core Profiles or other resource the observation is made from
component | Σ | 0..* | BackboneElement | Component results
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
code | Σ | 1..1 | CodeableConcept | Type of component observation (code / type) Binding: LOINCCodes (example): Codes identifying names of simple observations.
value[x] | Σ | 0..1 |  | Actual component result
valueQuantity |  |  | Quantity |
valueCodeableConcept |  |  | CodeableConcept |
valueString |  |  | string |
valueBoolean |  |  | boolean |
valueInteger |  |  | integer |
valueRange |  |  | Range |
valueRatio |  |  | Ratio |
valueSampledData |  |  | SampledData |
valueTime |  |  | time |
valueDateTime |  |  | dateTime |
valuePeriod |  |  | Period |
dataAbsentReason | C | 0..1 | CodeableConcept | Why the component result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
interpretation |  | 0..* | CodeableConcept | High, low, normal, etc. Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
referenceRange |  | 0..* | See referenceRange (Observation) | Provides guide for interpretation of component result
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Observation.language | Base | preferred | Common Languages | 📦4.0.1 | FHIR Std.
Observation.status | Base | required | Non-Negative Observation Status | 📦0.5.0 | This IG
Observation.category | Base | preferred | Observation Category Codes | 📦4.0.1 | FHIR Std.
Observation.category:us-core | Base | required | US Core Simple Observation Category | 📦7.0.0 | US Core v7.0
Observation.code | Base | preferred | LOINC Codes | 📦4.0.1 | FHIR Std.
Observation.value[x]:valueCodeableConcept | Base | preferred | US Core Observation Value Codes (SNOMED-CT) | 📦6.1.0 | US Core v6.1
Observation.dataAbsentReason | Base | extensible | DataAbsentReason | 📦4.0.1 | FHIR Std.
Observation.interpretation | Base | extensible | Observation Interpretation Codes | 📦4.0.1 | FHIR Std.
Observation.bodySite | Base | example | SNOMED CT Body Structures | 📦4.0.1 | FHIR Std.
Observation.method | Base | example | Observation Methods | 📦4.0.1 | FHIR Std.
Observation.referenceRange.​type | Base | preferred | Observation Reference Range Meaning Codes | 📦4.0.1 | FHIR Std.
Observation.referenceRange.​appliesTo | Base | example | Observation Reference Range Applies To Codes | 📦4.0.1 | FHIR Std.
Observation.component.​code | Base | example | LOINC Codes | 📦4.0.1 | FHIR Std.
Observation.component.​dataAbsentReason | Base | extensible | DataAbsentReason | 📦4.0.1 | FHIR Std.
Observation.component.​interpretation | Base | extensible | Observation Interpretation Codes | 📦4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | Observation | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Observation | 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 | error | Observation | 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 | error | Observation | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Observation | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`
obs-3 | error | Observation.referenceRange | Must have at least a low or a high or text | `low.exists() or high.exists() or text.exists()`
obs-6 | error | Observation | dataAbsentReason SHALL only be present if Observation.value[x] is not present | `dataAbsentReason.empty() or value.empty()`
obs-7 | error | Observation | If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present | `value.empty() or component.code.where(coding.intersect(%resource.code.coding).exists()).empty()`

This structure is derived from USCoreSimpleObservationProfile

Summary

Mandatory: 2 elements

Structures

This structure refers to these other structures:

- US Quality Core Patient (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-patient)
- US Quality Core Practitioner (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-practitioner)
- US Quality Core Organization (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-organization)
- US Quality Core PractitionerRole (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-practitionerrole)
- US Quality Core CareTeam (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-careteam)
- US Quality Core RelatedPerson (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-relatedperson)
- US Quality Core Simple Observation (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-simple-observation)
- US Quality Core QuestionnaireResponse (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-questionnaireresponse)
- US Quality Core ImagingStudy (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-imagingstudy)
- US Core DocumentReference Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference|6.1.0)

Slices

This structure defines the following Slices:

- The element 1 is sliced based on the value of Observation.value[x]

Other representations of profile: CSV, Excel, Schematron