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

## ValueSet: USQualityCore Negation Reason Codes

Official URL: http://fhir.org/guides/onc/us-quality-core/ValueSet/us-quality-core-negation-reason | Version: 0.5.0
Active as of 2026-05-15 | Computable Name: NegationReasonCodes

This value set defines the set of codes that can be used to indicate the reason an action was not taken

This value set was defined to support identifying any of the possible negation reason codes as part of USQualityCore profiles. The value set is composed of the codes from Medical Reason Not Done SCT, Patient Reason Not Done SCT, and System Reason as defined and available in the Value Set Authority Center.

References

- US Quality Core Communication Not Done
- US Quality Core Do Not Perform Reason
- US Quality Core Immunization Not Done
- US Quality Core MedicationAdministration Not Done
- US Quality Core MedicationDispense Declined
- US Quality Core Medication Not Requested
- US Quality Core Not Done Reason
- US Quality Core Procedure Not Done
- US Quality Core Task Rejected

### Logical Definition (CLD)

This value set includes codes based on the following rules:

- Import all the codes that are contained in Medical Reason Not Done SCT
- Import all the codes that are contained in Patient Reason Not Done SCT
- Import all the codes that are contained in System Reason

### Expansion

Expansion from tx.fhir.org based on:

- SNOMED CT United States edition 01-Sep 2025
- valueset Medical Reason Not Done SCT v20191212 (ValueSet)
- valueset Patient Reason Not Done SCT v20191212 (ValueSet)
- valueset System Reason v20170504 (ValueSet)
- valueset System Reason v20170504 (ValueSet)

This value set contains 82 concepts

System | Code | Display (en) | Inactive | status | JSON | XML
`http://snomed.info/sct` | 183932001 | Procedure contraindicated |  |  |  |
`http://snomed.info/sct` | 183964008 | Treatment not indicated |  |  |  |
`http://snomed.info/sct` | 183966005 | Drug treatment not indicated |  |  |  |
`http://snomed.info/sct` | 216952002 | Failure in dosage |  |  |  |
`http://snomed.info/sct` | 266721009 | Absent response to treatment |  |  |  |
`http://snomed.info/sct` | 269191009 | Late effect of medical and surgical care complication |  |  |  |
`http://snomed.info/sct` | 274512008 | Drug therapy discontinued |  |  |  |
`http://snomed.info/sct` | 31438003 | Drug resistance |  |  |  |
`http://snomed.info/sct` | 35688006 | Complication of medical care |  |  |  |
`http://snomed.info/sct` | 371133007 | Treatment modification | inactive | inactive |  |
`http://snomed.info/sct` | 397745006 | Medical contraindication | inactive | inactive |  |
`http://snomed.info/sct` | 407563006 | Treatment not tolerated |  |  |  |
`http://snomed.info/sct` | 410529002 | Not needed |  |  |  |
`http://snomed.info/sct` | 410534003 | Not indicated |  |  |  |
`http://snomed.info/sct` | 410536001 | Contraindicated |  |  |  |
`http://snomed.info/sct` | 416098002 | Drug allergy |  |  |  |
`http://snomed.info/sct` | 416406003 | Procedure discontinued |  |  |  |
`http://snomed.info/sct` | 419511003 | Propensity to adverse reactions to drug |  |  |  |
`http://snomed.info/sct` | 428024001 | Clinical trial participant |  |  |  |
`http://snomed.info/sct` | 428119001 | Procedure not indicated |  |  |  |
`http://snomed.info/sct` | 445528004 | Treatment changed |  |  |  |
`http://snomed.info/sct` | 59037007 | Drug intolerance |  |  |  |
`http://snomed.info/sct` | 62014003 | Drug reaction |  |  |  |
`http://snomed.info/sct` | 79899007 | Drug interaction |  |  |  |
`http://snomed.info/sct` | 105480006 | Refusal of treatment by patient | inactive | inactive |  |
`http://snomed.info/sct` | 134397009 | Angiotensin converting enzyme inhibitor declined |  |  |  |
`http://snomed.info/sct` | 160932005 | Financial problem |  |  |  |
`http://snomed.info/sct` | 160934006 | Financial circumstances change |  |  |  |
`http://snomed.info/sct` | 182890002 | Patient requests alternative treatment | inactive | inactive |  |
`http://snomed.info/sct` | 182895007 | Drug declined by patient |  |  |  |
`http://snomed.info/sct` | 182896008 | Drug declined by patient - dislikes taste |  |  |  |
`http://snomed.info/sct` | 182897004 | Drug declined by patient - side effects |  |  |  |
`http://snomed.info/sct` | 182898009 | Drug declined by patient - inconvenient |  |  |  |
`http://snomed.info/sct` | 182900006 | Drug declined by patient - patient beliefs |  |  |  |
`http://snomed.info/sct` | 182901005 | Drug declined by patient - alternative therapy |  |  |  |
`http://snomed.info/sct` | 182902003 | Drug declined by patient - cannot pay script |  |  |  |
`http://snomed.info/sct` | 182903008 | Drug declined by patient - reason unknown |  |  |  |
`http://snomed.info/sct` | 183944003 | Procedure refused | inactive | inactive |  |
`http://snomed.info/sct` | 183945002 | Procedure refused for religious reason |  |  |  |
`http://snomed.info/sct` | 183946001 | Procedure refused - uncooperative |  |  |  |
`http://snomed.info/sct` | 183947005 | Refused procedure - after thought | inactive | inactive |  |
`http://snomed.info/sct` | 183948000 | Refused procedure - parent's wish |  |  |  |
`http://snomed.info/sct` | 184081006 | Patient has moved away | inactive | inactive |  |
`http://snomed.info/sct` | 185479006 | Patient dissatisfied with result |  |  |  |
`http://snomed.info/sct` | 185481008 | Dissatisfied with doctor |  |  |  |
`http://snomed.info/sct` | 224187001 | Variable income |  |  |  |
`http://snomed.info/sct` | 225928004 | Patient self-discharge against medical advice |  |  |  |
`http://snomed.info/sct` | 266710000 | Drugs not taken/completed |  |  |  |
`http://snomed.info/sct` | 266966009 | Family illness |  |  |  |
`http://snomed.info/sct` | 275694009 | Patient defaulted from follow-up | inactive | inactive |  |
`http://snomed.info/sct` | 275936005 | Patient noncompliance - general |  |  |  |
`http://snomed.info/sct` | 281399006 | Did not attend | inactive | inactive |  |
`http://snomed.info/sct` | 310343007 | Further opinion sought |  |  |  |
`http://snomed.info/sct` | 315640000 | Influenza vaccination declined |  |  |  |
`http://snomed.info/sct` | 371138003 | Refusal of treatment by parents | inactive | inactive |  |
`http://snomed.info/sct` | 373787003 | Delay - patient choice |  |  |  |
`http://snomed.info/sct` | 401084003 | Angiotensin II receptor antagonist declined |  |  |  |
`http://snomed.info/sct` | 406149000 | Medication refused |  |  |  |
`http://snomed.info/sct` | 408367005 | Patient forgets to take medication | inactive | inactive |  |
`http://snomed.info/sct` | 413310006 | Patient non-compliant - refused access to services | inactive | inactive |  |
`http://snomed.info/sct` | 413311005 | Patient non-compliant - refused intervention / support |  |  |  |
`http://snomed.info/sct` | 413312003 | Patient non-compliant - refused service | inactive | inactive |  |
`http://snomed.info/sct` | 416432009 | Procedure not wanted |  |  |  |
`http://snomed.info/sct` | 423656007 | Income insufficient to buy necessities |  |  |  |
`http://snomed.info/sct` | 424739004 | Income sufficient to buy only necessities |  |  |  |
`http://snomed.info/sct` | 443390004 | Refused |  |  |  |
`http://snomed.info/sct` | 609589008 | Refused by parents of subject | inactive | inactive |  |
`http://snomed.info/sct` | 713247000 | Procedure discontinued by patient |  |  |  |
`http://snomed.info/sct` | 107724000 | Patient transfer |  |  |  |
`http://snomed.info/sct` | 182856006 | Drug not available - out of stock |  |  |  |
`http://snomed.info/sct` | 182857002 | Drug not available - off market |  |  |  |
`http://snomed.info/sct` | 185335007 | Appointment canceled by hospital |  |  |  |
`http://snomed.info/sct` | 224194003 | Not entitled to benefits |  |  |  |
`http://snomed.info/sct` | 224198000 | Delay in receiving benefits |  |  |  |
`http://snomed.info/sct` | 224199008 | Loss of benefits |  |  |  |
`http://snomed.info/sct` | 242990004 | Drug not available for administration |  |  |  |
`http://snomed.info/sct` | 266756008 | Medical care unavailable |  |  |  |
`http://snomed.info/sct` | 270459005 | Patient on waiting list | inactive | inactive |  |
`http://snomed.info/sct` | 309017000 | Referred to doctor |  |  |  |
`http://snomed.info/sct` | 309846006 | Treatment not available | inactive | inactive |  |
`http://snomed.info/sct` | 419808006 | Finding related to health insurance issues |  |  |  |
`http://snomed.info/sct` | 424553001 | Uninsured medical expenses |  |  |  |

Explanation of the columns that may appear on this page:

Level | A few code lists that FHIR defines are hierarchical - each code is assigned a level. In this scheme, some codes are under other codes, and imply that the code they are under also applies
System | The source of the definition of the code (when the value set draws in codes defined elsewhere)
Code | The code (used as the code in the resource instance)
Display | The display (used in the display element of a Coding). If there is no display, implementers should not simply display the code, but map the concept into their application
Definition | An explanation of the meaning of the concept
Comments | Additional notes about how to use the code