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 Medication

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

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

Usage

See the patterns page for implementation and usage patterns.

    define function "GetMedicationCode"(request MedicationRequest):
      if request.medication is CodeableConcept then
        request.medication as CodeableConcept
      else
        (singleton from ([Medication] M where M.id = GetId((request.medication as Reference).reference))).code

### Examples

Example of an IV medication - Alemtuzumab

USCDI+ Quality Elements:

- code: (USCDI+ Quality) (USCDI) Codes that identify this medication

Usages:

- Refer to this Profile: US Quality Core AdverseEvent, US Quality Core Medication, US Quality Core MedicationAdministration, US Quality Core MedicationDispense and US Quality Core MedicationStatement
- Examples for this Profile: Medication/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
--- | --- | --- | --- | ---
Medication |  | 0..* | USCoreMedicationProfile(6.1.0) | Definition of a Medication
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
code | S Σ | 1..1 | CodeableConcept | (USCDI+ Quality) (USCDI) Codes that identify this medication Binding: Medication Clinical Drug (extensible)
status | ?!Σ | 0..1 | code | active | inactive | entered-in-error Binding: Medication Status Codes (required): A coded concept defining if the medication is in active use.
manufacturer | Σ | 0..1 | Reference(US Quality Core Organization) | Manufacturer of the item
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Medication.code | Base | extensible | Medication Clinical Drug | 📦20170601 | VSAC v0.18
Medication.status | Base | required | Medication status codes | 📍4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | Medication | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Medication | 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 | Medication | 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 | Medication | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Medication | 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()`

This structure is derived from USCoreMedicationProfile

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Medication |  | 0..* | USCoreMedicationProfile(6.1.0) | Definition of a Medication
code |  | 1..1 | CodeableConcept | (USCDI+ Quality) (USCDI) Codes that identify this medication
manufacturer |  | 0..1 | Reference(US Quality Core Organization) | Manufacturer of the item
ingredient |  |  |  |
item[x] |  | 1..1 |  | The actual ingredient or content
itemCodeableConcept |  |  | CodeableConcept |
itemReference |  |  | Reference(US Quality Core Substance | US Quality Core Medication) |
isActive |  | 0..1 | boolean | Active ingredient indicator
Documentation for this format

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Medication |  | 0..* | USCoreMedicationProfile(6.1.0) | Definition of a Medication
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 this medication
code | S Σ | 1..1 | CodeableConcept | (USCDI+ Quality) (USCDI) Codes that identify this medication Binding: Medication Clinical Drug (extensible)
status | ?!Σ | 0..1 | code | active | inactive | entered-in-error Binding: Medication Status Codes (required): A coded concept defining if the medication is in active use.
manufacturer | Σ | 0..1 | Reference(US Quality Core Organization) | Manufacturer of the item
form |  | 0..1 | CodeableConcept | powder | tablets | capsule + Binding: SNOMEDCTFormCodes (example): A coded concept defining the form of a medication.
amount | Σ | 0..1 | Ratio | Amount of drug in package
ingredient |  | 0..* | BackboneElement | Active or inactive ingredient
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
item[x] |  | 1..1 |  | The actual ingredient or content
itemCodeableConcept |  |  | CodeableConcept |
itemReference |  |  | Reference(US Quality Core Substance | US Quality Core Medication) |
isActive |  | 0..1 | boolean | Active ingredient indicator
strength |  | 0..1 | Ratio | Quantity of ingredient present
batch |  | 0..1 | BackboneElement | Details about packaged medications
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
lotNumber |  | 0..1 | string | Identifier assigned to batch
expirationDate |  | 0..1 | dateTime | When batch will expire
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Medication.language | Base | preferred | Common Languages | 📦4.0.1 | FHIR Std.
Medication.code | Base | extensible | Medication Clinical Drug | 📦20170601 | VSAC v0.18
Medication.status | Base | required | Medication status codes | 📍4.0.1 | FHIR Std.
Medication.form | Base | example | SNOMED CT Form Codes | 📦4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | Medication | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Medication | 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 | Medication | 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 | Medication | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Medication | 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()`

This structure is derived from USCoreMedicationProfile

Summary

Structures

This structure refers to these other structures:

- US Quality Core Organization (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-organization)
- US Quality Core Substance (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-substance)
- US Quality Core Medication (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-medication)

Key Elements View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Medication |  | 0..* | USCoreMedicationProfile(6.1.0) | Definition of a Medication
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
code | S Σ | 1..1 | CodeableConcept | (USCDI+ Quality) (USCDI) Codes that identify this medication Binding: Medication Clinical Drug (extensible)
status | ?!Σ | 0..1 | code | active | inactive | entered-in-error Binding: Medication Status Codes (required): A coded concept defining if the medication is in active use.
manufacturer | Σ | 0..1 | Reference(US Quality Core Organization) | Manufacturer of the item
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Medication.code | Base | extensible | Medication Clinical Drug | 📦20170601 | VSAC v0.18
Medication.status | Base | required | Medication status codes | 📍4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | Medication | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Medication | 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 | Medication | 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 | Medication | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Medication | 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()`

Differential View

This structure is derived from USCoreMedicationProfile

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Medication |  | 0..* | USCoreMedicationProfile(6.1.0) | Definition of a Medication
code |  | 1..1 | CodeableConcept | (USCDI+ Quality) (USCDI) Codes that identify this medication
manufacturer |  | 0..1 | Reference(US Quality Core Organization) | Manufacturer of the item
ingredient |  |  |  |
item[x] |  | 1..1 |  | The actual ingredient or content
itemCodeableConcept |  |  | CodeableConcept |
itemReference |  |  | Reference(US Quality Core Substance | US Quality Core Medication) |
isActive |  | 0..1 | boolean | Active ingredient indicator
Documentation for this format

Snapshot View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Medication |  | 0..* | USCoreMedicationProfile(6.1.0) | Definition of a Medication
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 this medication
code | S Σ | 1..1 | CodeableConcept | (USCDI+ Quality) (USCDI) Codes that identify this medication Binding: Medication Clinical Drug (extensible)
status | ?!Σ | 0..1 | code | active | inactive | entered-in-error Binding: Medication Status Codes (required): A coded concept defining if the medication is in active use.
manufacturer | Σ | 0..1 | Reference(US Quality Core Organization) | Manufacturer of the item
form |  | 0..1 | CodeableConcept | powder | tablets | capsule + Binding: SNOMEDCTFormCodes (example): A coded concept defining the form of a medication.
amount | Σ | 0..1 | Ratio | Amount of drug in package
ingredient |  | 0..* | BackboneElement | Active or inactive ingredient
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
item[x] |  | 1..1 |  | The actual ingredient or content
itemCodeableConcept |  |  | CodeableConcept |
itemReference |  |  | Reference(US Quality Core Substance | US Quality Core Medication) |
isActive |  | 0..1 | boolean | Active ingredient indicator
strength |  | 0..1 | Ratio | Quantity of ingredient present
batch |  | 0..1 | BackboneElement | Details about packaged medications
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
lotNumber |  | 0..1 | string | Identifier assigned to batch
expirationDate |  | 0..1 | dateTime | When batch will expire
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Medication.language | Base | preferred | Common Languages | 📦4.0.1 | FHIR Std.
Medication.code | Base | extensible | Medication Clinical Drug | 📦20170601 | VSAC v0.18
Medication.status | Base | required | Medication status codes | 📍4.0.1 | FHIR Std.
Medication.form | Base | example | SNOMED CT Form Codes | 📦4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | Medication | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Medication | 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 | Medication | 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 | Medication | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Medication | 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()`

This structure is derived from USCoreMedicationProfile

Summary

Structures

This structure refers to these other structures:

- US Quality Core Organization (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-organization)
- US Quality Core Substance (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-substance)
- US Quality Core Medication (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-medication)

Other representations of profile: CSV, Excel, Schematron