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

## US Quality Core Profiles

The following table lists the US Quality Core profiles that are part of the IG, which US Core profile they are derived from, if any, and the underlying FHIR resources:

US Quality Core (0.5.0) Profile | US Core (6.1.0) Profile | Base Resource
--- | --- | ---
2.1.1 AdverseEvent |  |
US Quality Core AdverseEvent | — | AdverseEvent
2.1.2 AllergyIntolerance |  |
US Quality Core AllergyIntolerance | US Core AllergyIntolerance | AllergyIntolerance
2.1.3 BodyStructure |  |
US Quality Core BodyStructure | — | BodyStructure
2.1.4 CarePlan |  |
US Quality Core CarePlan | US Core CarePlan | CarePlan
2.1.5 CareTeam |  |
US Quality Core CareTeam | US Core CareTeam | CareTeam
2.1.6 Claim |  |
US Quality Core Claim | — | Claim
2.1.7 ClaimResponse |  |
US Quality Core ClaimResponse | — | ClaimResponse
2.1.8 Communication |  |
US Quality Core Communication | — | Communication
US Quality Core Communication Not Done | — | Communication
2.1.9 CommunicationRequest |  |
US Quality Core CommunicationRequest | — | CommunicationRequest
2.1.10 Condition |  |
US Quality Core Condition Encounter Diagnosis | US Core Condition Encounter Diagnosis | Condition
US Quality Core Condition Problems Health Concerns | US Core Condition Problems Health Concerns | Condition
2.1.11 Coverage |  |
US Quality Core Coverage | US Core Coverage | Coverage
2.1.12 Device |  |
US Quality Core Device | — | Device
— | US Core Implantable Device | Device
2.1.13 DeviceRequest |  |
US Quality Core Device Not Requested | — | DeviceRequest
US Quality Core DeviceRequest | — | DeviceRequest
2.1.14 DeviceUseStatement |  |
US Quality Core DeviceUseStatement | — | DeviceUseStatement
2.1.15 DiagnosticReport |  |
US Quality Core DiagnosticReport Profile for Laboratory Results Reporting | US Core DiagnosticReport Profile for Laboratory Results Reporting | DiagnosticReport
US Quality Core DiagnosticReport Profile for Report and Note Exchange | US Core DiagnosticReport Profile for Report and Note Exchange | DiagnosticReport
2.1.16 Encounter |  |
US Quality Core Encounter | US Core Encounter | Encounter
2.1.17 FamilyMemberHistory |  |
US Quality Core FamilyMemberHistory | — | FamilyMemberHistory
2.1.18 Flag |  |
US Quality Core Flag | — | Flag
2.1.19 Goal |  |
US Quality Core Goal | US Core Goal | Goal
2.1.20 ImagingStudy |  |
US Quality Core ImagingStudy | — | ImagingStudy
2.1.21 Immunization |  |
US Quality Core Immunization | US Core Immunization | Immunization
US Quality Core Immunization Not Done | US Core Immunization | Immunization
2.1.22 ImmunizationEvaluation |  |
US Quality Core ImmunizationEvaluation | — | ImmunizationEvaluation
2.1.23 ImmunizationRecommendation |  |
US Quality Core ImmunizationRecommendation | — | ImmunizationRecommendation
2.1.24 Location |  |
US Quality Core Location | US Core Location | Location
2.1.25 Medication |  |
US Quality Core Medication | US Core Medication | Medication
2.1.26 MedicationAdministration |  |
US Quality Core MedicationAdministration | — | MedicationAdministration
US Quality Core MedicationAdministration Not Done | — | MedicationAdministration
2.1.27 MedicationDispense |  |
US Quality Core MedicationDispense | US Core MedicationDispense | MedicationDispense
US Quality Core MedicationDispense Declined | US Core MedicationDispense | MedicationDispense
2.1.28 MedicationRequest |  |
US Quality Core Medication Not Requested | US Core MedicationRequest | MedicationRequest
US Quality Core MedicationRequest | US Core MedicationRequest | MedicationRequest
2.1.29 MedicationStatement |  |
US Quality Core MedicationStatement | — | MedicationStatement
2.1.30 NutritionOrder |  |
US Quality Core NutritionOrder | — | NutritionOrder
2.1.31 Observation |  |
US Quality Core Simple Observation | US Core Simple Observation | Observation
US Quality Core Observation Cancelled | — | Observation
US Quality Core NonPatient Observation | — | Observation
US Quality Core Laboratory Result Observation | US Core Laboratory Result Observation | Observation
US Quality Core Observation Clinical Result | US Core Observation Clinical Result | Observation
US Quality Core Observation Screening Assessment | US Core Observation Screening Assessment | Observation
— | US Core Vital Signs | Observation
— | US Core Blood Pressure | Observation
— | US Core BMI | Observation
— | US Core Body Height | Observation
— | US Core Body Temperature | Observation
— | US Core Body Weight | Observation
— | US Core Head Circumference | Observation
— | US Core Heart Rate | Observation
— | US Core Pediatric BMI for Age Observation | Observation
— | US Core Pediatric Head Occipital-frontal Circumference Percentile | Observation
— | US Core Pediatric Weight for Height Observation | Observation
— | US Core Pulse Oximetry | Observation
— | US Core Respiratory Rate | Observation
— | US Core Smoking Status | Observation
— | US Core Observation Occupation | Observation
— | US Core Observation Sexual Orientation | Observation
— | US Core Observation Pregnancy Intent | Observation
— | US Core Observation Pregnancy Status | Observation
2.1.32 Organization |  |
US Quality Core Organization | US Core Organization | Organization
2.1.33 Patient |  |
US Quality Core Patient | US Core Patient | Patient
2.1.34 Practitioner |  |
US Quality Core Practitioner | US Core Practitioner | Practitioner
2.1.35 PractitionerRole |  |
US Quality Core PractitionerRole | US Core PractitionerRole | PractitionerRole
2.1.36 Procedure |  |
US Quality Core Procedure | US Core Procedure | Procedure
US Quality Core Procedure Not Done | US Core Procedure | Procedure
2.1.37 QuestionnaireResponse |  |
US Quality Core QuestionnaireResponse | US Core QuestionnaireResponse | QuestionnaireResponse
2.1.38 RelatedPerson |  |
US Quality Core RelatedPerson | US Core RelatedPerson | RelatedPerson
2.1.39 ServiceRequest |  |
US Quality Core Service Not Requested | US Core ServiceRequest | ServiceRequest
US Quality Core ServiceRequest | US Core ServiceRequest | ServiceRequest
2.1.40 Specimen |  |
— | US Core Specimen | Specimen
2.1.41 Substance |  |
US Quality Core Substance | — | Substance
2.1.42 Task |  |
US Quality Core Task | — | Task
US Quality Core Task Rejected | — | Task

### Referencing US Quality Core Profiles

There are a number of US Quality Core profiles inherited directly from US Core profiles, if any, or other FHIR resources (i.e. US Core Implantable Device Profile, FHIR Vital Signs, US Core Smoking Status etc.) and the underlying Reference elements can address the US Core or FHIR profiles for the items referenced. For any other references to base FHIR resources or not formally defined in a US Quality Core Profile, the referenced resource SHALL be a US Quality Core Profile if a US Quality Core Profile exists for the resource type. For example, US Core Smoking Status references US Core Patient profile, the reference to Patient SHALL be a valid US Quality Core Patient.

Note to Implementers: US Quality Core profiles have been developed with the principle that if the profiles only need to provide references to US Quality Core Profiles, that is insufficient to require individual US Quality Core profiles for all US Core profiles. There are edge cases using this approach where the FHIR validator would not validate an assumption made by the measure author, such as that an encounter traced through an observation is a US Quality Core Encounter. We think that general validation of all the resources provided to the context of a measure evaluation can address that risk without the need for deriving specific profiles that only constraint reference types. We seek feedback on this point.

This change will strengthen the requirement to use a US Quality Core profile when using a base FHIR or US Core profile not formally defined in US Quality Core and to use US Quality Core profiles as referenced resources if a US Quality Core Profile exists for that resource.