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 CommunicationRequest

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

Profile of CommunicationRequest 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.

### Examples

CommunicationRequest Example

Usages:

- Examples for this Profile: CommunicationRequest/example

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
--- | --- | --- | --- | ---
CommunicationRequest |  | 0..* | CommunicationRequest | A request for information to be sent to a receiver
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
status | ?!Σ | 1..1 | code | draft | active | on-hold | revoked | completed | entered-in-error | unknown Binding: RequestStatus (required): The status of the communication request.
category |  | 0..* | CodeableConcept | Message category Binding: CommunicationCategory (preferred)
doNotPerform | ?!Σ | 0..1 | boolean | True if request is prohibiting action
subject |  | 0..1 | Reference(US Quality Core Patient) | Focus of message
encounter | Σ | 0..1 | Reference(US Quality Core Encounter) | Encounter created as part of
recipient |  | 0..* | Reference(US Quality Core Device | US Core Implantable Device Profile(6.1.0) | US Quality Core Organization | US Quality Core Patient | US Quality Core Practitioner | US Quality Core RelatedPerson | Group | CareTeam) | Message recipient
sender | Σ | 0..1 | Reference(US Quality Core Device | US Core Implantable Device Profile(6.1.0) | US Quality Core Organization | US Quality Core Patient | US Quality Core Practitioner | US Quality Core RelatedPerson) | Message sender
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
CommunicationRequest.​status | Base | required | RequestStatus | 📍4.0.1 | FHIR Std.
CommunicationRequest.​category | Base | preferred | CommunicationCategory | 📦4.0.1 | FHIR Std.

#### Constraints

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

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
CommunicationRequest |  | 0..* | CommunicationRequest | A request for information to be sent to a receiver
status |  | 1..1 | code | draft | active | on-hold | revoked | completed | entered-in-error | unknown
category |  | 0..* | CodeableConcept | Message category Binding: CommunicationCategory (preferred)
doNotPerform |  | 0..1 | boolean | True if request is prohibiting action
subject |  | 0..1 | Reference(US Quality Core Patient) | Focus of message
encounter |  | 0..1 | Reference(US Quality Core Encounter) | Encounter created as part of
recipient |  | 0..* | Reference(US Quality Core Device | US Core Implantable Device Profile(6.1.0) | US Quality Core Organization | US Quality Core Patient | US Quality Core Practitioner | US Quality Core RelatedPerson | Group | CareTeam) | Message recipient
sender |  | 0..1 | Reference(US Quality Core Device | US Core Implantable Device Profile(6.1.0) | US Quality Core Organization | US Quality Core Patient | US Quality Core Practitioner | US Quality Core RelatedPerson) | Message sender
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
CommunicationRequest.​category | Base | preferred | CommunicationCategory | 📦4.0.1 | FHIR Std.

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
CommunicationRequest |  | 0..* | CommunicationRequest | A request for information to be sent to a receiver
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 | Unique identifier
basedOn | Σ | 0..* | Reference(Resource) | Fulfills plan or proposal
replaces | Σ | 0..* | Reference(CommunicationRequest) | Request(s) replaced by this request
groupIdentifier | Σ | 0..1 | Identifier | Composite request this is part of
status | ?!Σ | 1..1 | code | draft | active | on-hold | revoked | completed | entered-in-error | unknown Binding: RequestStatus (required): The status of the communication request.
statusReason |  | 0..1 | CodeableConcept | Reason for current status Binding Description: (example): Codes identifying the reason for the current state of a request.
category |  | 0..* | CodeableConcept | Message category Binding: CommunicationCategory (preferred)
priority | Σ | 0..1 | code | routine | urgent | asap | stat Binding: RequestPriority (required): Codes indicating the relative importance of a communication request.
doNotPerform | ?!Σ | 0..1 | boolean | True if request is prohibiting action
medium |  | 0..* | CodeableConcept | A channel of communication Binding: v3 Code System ParticipationMode (example): Codes for communication mediums such as phone, fax, email, in person, etc.
subject |  | 0..1 | Reference(US Quality Core Patient) | Focus of message
about |  | 0..* | Reference(Resource) | Resources that pertain to this communication request
encounter | Σ | 0..1 | Reference(US Quality Core Encounter) | Encounter created as part of
payload |  | 0..* | BackboneElement | Message payload
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
content[x] |  | 1..1 |  | Message part content
contentString |  |  | string |
contentAttachment |  |  | Attachment |
contentReference |  |  | Reference(Resource) |
occurrence[x] | Σ | 0..1 |  | When scheduled
occurrenceDateTime |  |  | dateTime |
occurrencePeriod |  |  | Period |
authoredOn | Σ | 0..1 | dateTime | When request transitioned to being actionable
requester | Σ | 0..1 | Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson | Device) | Who/what is requesting service
recipient |  | 0..* | Reference(US Quality Core Device | US Core Implantable Device Profile(6.1.0) | US Quality Core Organization | US Quality Core Patient | US Quality Core Practitioner | US Quality Core RelatedPerson | Group | CareTeam) | Message recipient
sender | Σ | 0..1 | Reference(US Quality Core Device | US Core Implantable Device Profile(6.1.0) | US Quality Core Organization | US Quality Core Patient | US Quality Core Practitioner | US Quality Core RelatedPerson) | Message sender
reasonCode | Σ | 0..* | CodeableConcept | Why is communication needed? Binding: v3 Code System ActReason (example): Codes for describing reasons for the occurrence of a communication.
reasonReference | Σ | 0..* | Reference(Condition | Observation | DiagnosticReport | DocumentReference) | Why is communication needed?
note |  | 0..* | Annotation | Comments made about communication request
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
CommunicationRequest.​language | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std.
CommunicationRequest.​status | Base | required | RequestStatus | 📍4.0.1 | FHIR Std.
CommunicationRequest.​statusReason | Base | example |  | Not State | Unknown
CommunicationRequest.​category | Base | preferred | CommunicationCategory | 📦4.0.1 | FHIR Std.
CommunicationRequest.​priority | Base | required | Request priority | 📍4.0.1 | FHIR Std.
CommunicationRequest.​medium | Base | example | v3 Code System ParticipationMode | 📦2018-08-12 | FHIR Std.
CommunicationRequest.​reasonCode | Base | example | v3 Code System ActReason | 📦2018-08-12 | FHIR Std.

#### Constraints

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

Summary

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 Encounter (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-encounter)
- US Quality Core Device (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-device)
- US Core Implantable Device Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-implantable-device|6.1.0)
- US Quality Core Organization (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-organization)
- US Quality Core Practitioner (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-practitioner)
- US Quality Core RelatedPerson (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-relatedperson)

Key Elements View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
CommunicationRequest |  | 0..* | CommunicationRequest | A request for information to be sent to a receiver
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
status | ?!Σ | 1..1 | code | draft | active | on-hold | revoked | completed | entered-in-error | unknown Binding: RequestStatus (required): The status of the communication request.
category |  | 0..* | CodeableConcept | Message category Binding: CommunicationCategory (preferred)
doNotPerform | ?!Σ | 0..1 | boolean | True if request is prohibiting action
subject |  | 0..1 | Reference(US Quality Core Patient) | Focus of message
encounter | Σ | 0..1 | Reference(US Quality Core Encounter) | Encounter created as part of
recipient |  | 0..* | Reference(US Quality Core Device | US Core Implantable Device Profile(6.1.0) | US Quality Core Organization | US Quality Core Patient | US Quality Core Practitioner | US Quality Core RelatedPerson | Group | CareTeam) | Message recipient
sender | Σ | 0..1 | Reference(US Quality Core Device | US Core Implantable Device Profile(6.1.0) | US Quality Core Organization | US Quality Core Patient | US Quality Core Practitioner | US Quality Core RelatedPerson) | Message sender
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
CommunicationRequest.​status | Base | required | RequestStatus | 📍4.0.1 | FHIR Std.
CommunicationRequest.​category | Base | preferred | CommunicationCategory | 📦4.0.1 | FHIR Std.

#### Constraints

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

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
CommunicationRequest |  | 0..* | CommunicationRequest | A request for information to be sent to a receiver
status |  | 1..1 | code | draft | active | on-hold | revoked | completed | entered-in-error | unknown
category |  | 0..* | CodeableConcept | Message category Binding: CommunicationCategory (preferred)
doNotPerform |  | 0..1 | boolean | True if request is prohibiting action
subject |  | 0..1 | Reference(US Quality Core Patient) | Focus of message
encounter |  | 0..1 | Reference(US Quality Core Encounter) | Encounter created as part of
recipient |  | 0..* | Reference(US Quality Core Device | US Core Implantable Device Profile(6.1.0) | US Quality Core Organization | US Quality Core Patient | US Quality Core Practitioner | US Quality Core RelatedPerson | Group | CareTeam) | Message recipient
sender |  | 0..1 | Reference(US Quality Core Device | US Core Implantable Device Profile(6.1.0) | US Quality Core Organization | US Quality Core Patient | US Quality Core Practitioner | US Quality Core RelatedPerson) | Message sender
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
CommunicationRequest.​category | Base | preferred | CommunicationCategory | 📦4.0.1 | FHIR Std.

Snapshot View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
CommunicationRequest |  | 0..* | CommunicationRequest | A request for information to be sent to a receiver
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 | Unique identifier
basedOn | Σ | 0..* | Reference(Resource) | Fulfills plan or proposal
replaces | Σ | 0..* | Reference(CommunicationRequest) | Request(s) replaced by this request
groupIdentifier | Σ | 0..1 | Identifier | Composite request this is part of
status | ?!Σ | 1..1 | code | draft | active | on-hold | revoked | completed | entered-in-error | unknown Binding: RequestStatus (required): The status of the communication request.
statusReason |  | 0..1 | CodeableConcept | Reason for current status Binding Description: (example): Codes identifying the reason for the current state of a request.
category |  | 0..* | CodeableConcept | Message category Binding: CommunicationCategory (preferred)
priority | Σ | 0..1 | code | routine | urgent | asap | stat Binding: RequestPriority (required): Codes indicating the relative importance of a communication request.
doNotPerform | ?!Σ | 0..1 | boolean | True if request is prohibiting action
medium |  | 0..* | CodeableConcept | A channel of communication Binding: v3 Code System ParticipationMode (example): Codes for communication mediums such as phone, fax, email, in person, etc.
subject |  | 0..1 | Reference(US Quality Core Patient) | Focus of message
about |  | 0..* | Reference(Resource) | Resources that pertain to this communication request
encounter | Σ | 0..1 | Reference(US Quality Core Encounter) | Encounter created as part of
payload |  | 0..* | BackboneElement | Message payload
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
content[x] |  | 1..1 |  | Message part content
contentString |  |  | string |
contentAttachment |  |  | Attachment |
contentReference |  |  | Reference(Resource) |
occurrence[x] | Σ | 0..1 |  | When scheduled
occurrenceDateTime |  |  | dateTime |
occurrencePeriod |  |  | Period |
authoredOn | Σ | 0..1 | dateTime | When request transitioned to being actionable
requester | Σ | 0..1 | Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson | Device) | Who/what is requesting service
recipient |  | 0..* | Reference(US Quality Core Device | US Core Implantable Device Profile(6.1.0) | US Quality Core Organization | US Quality Core Patient | US Quality Core Practitioner | US Quality Core RelatedPerson | Group | CareTeam) | Message recipient
sender | Σ | 0..1 | Reference(US Quality Core Device | US Core Implantable Device Profile(6.1.0) | US Quality Core Organization | US Quality Core Patient | US Quality Core Practitioner | US Quality Core RelatedPerson) | Message sender
reasonCode | Σ | 0..* | CodeableConcept | Why is communication needed? Binding: v3 Code System ActReason (example): Codes for describing reasons for the occurrence of a communication.
reasonReference | Σ | 0..* | Reference(Condition | Observation | DiagnosticReport | DocumentReference) | Why is communication needed?
note |  | 0..* | Annotation | Comments made about communication request
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
CommunicationRequest.​language | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std.
CommunicationRequest.​status | Base | required | RequestStatus | 📍4.0.1 | FHIR Std.
CommunicationRequest.​statusReason | Base | example |  | Not State | Unknown
CommunicationRequest.​category | Base | preferred | CommunicationCategory | 📦4.0.1 | FHIR Std.
CommunicationRequest.​priority | Base | required | Request priority | 📍4.0.1 | FHIR Std.
CommunicationRequest.​medium | Base | example | v3 Code System ParticipationMode | 📦2018-08-12 | FHIR Std.
CommunicationRequest.​reasonCode | Base | example | v3 Code System ActReason | 📦2018-08-12 | FHIR Std.

#### Constraints

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

Summary

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 Encounter (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-encounter)
- US Quality Core Device (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-device)
- US Core Implantable Device Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-implantable-device|6.1.0)
- US Quality Core Organization (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-organization)
- US Quality Core Practitioner (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-practitioner)
- US Quality Core RelatedPerson (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-relatedperson)

Other representations of profile: CSV, Excel, Schematron