Example Usage Scenarios:

The following are example usage scenarios for this profile:

• Query for a Patient's current or historical problems and health concerns
• Record or update a Patient's problems and health concerns

Mandatory and Must Support Data Elements

The following data elements must always be present (Mandatory definition) or must be supported if the data is present in the sending system (Must Support definition). They are presented below in a simple human-readable explanation. Profile specific guidance and examples are provided as well. The Formal Views below provides the formal summary, definitions, and terminology requirements.

Each Condition Must Have:

1. a category code of "problem-list-item" or "health-concern"
2. a code that identifies the condition*
3. a patient

Each Condition Must Support:

1. a timestamp when the resource last changed*
2. a clinical status of the condition (e.g., active or resolved)
3. a verification status
4. a date of diagnosis*
5. a date of onset*
6. an abatement date*
7. a date when recorded*

Additional USCDI Requirements:

These Additional USCDI Requirements elements are not Mandatory or Must Support but are required for ASTP Health IT certification testing and are included in the formal definition of the profile and the Condition examples.

1. additional health status/assessment categories*
2. a recorder*

*see guidance below

Profile Specific Implementation Guidance

This section provides detailed implementation guidance for the US Core Profile to support implementation and certification.

• For Encounter Diagnosis, use the US Core Condition Encounter Diagnosis Profile.
• *The Condition.code has an additional binding of "current" and a base "preferred" binding.
  • For the conformance rules on the current binding for coded data, review this section in the General Requirements page.
  • USCDI's applicable vocabulary standards for Problems/Health Concerns are SNOMED CT and ICD-10-CM.
    • The US Core Condition Codes supports ICD-9-CM for historical purposes only. When using ICD codes, only non-header ICD-10-CM codes SHOULD be used.
• See the Screening and Assessments guidance page for more information when exchanging Social Determinants of Health (SDOH) Problems/Health Concerns.
• *The category of "problem-list-item" or "health-concern" is required, and, at a minimum, Certifying Systems SHALL support, a category of "sdoh", SHOULD support the other US Core Simple Observation Category codes, and MAY support other categories.
  • If the category is "problem-list-item", Condition.clinicalStatus SHOULD be present.
• *The assertedDate Extension represents the date of diagnosis. The Condition.onsetDateTime represents the date of onset, or the date or estimated date when signs or symptoms of a condition began. The Condition.abatementdateTime is the date of resolution or remission. And the Condition.recordedDate is the date the record was created in the system. Since users don't always capture these four values, they will not always be available for Servers to share with Clients.
• * See the US Core General Guidance page for Searching Using lastUpdated. Updates to .meta.lastUpdated SHOULD reflect:
  • New problems and health concerns
  • Changes in the clinical status or verifications status of problems or health concerns

• *The profile elements Condition.asserter and Condition.recorder communicate the individual level provenance author data corresponding to the U.S. Core Data for Interoperability (USCDI) Provenance Author Data Elements.

Changes since version 8.0.0:

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

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Condition	C	0..*	Condition	Detailed information about conditions, problems or diagnoses Constraints: con-3, con-4, con-5
meta	SΣ	0..1	Meta	Metadata about the resource
lastUpdated	SΣ	0..1	instant	When the resource last changed
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
Slices for extension				Content/Rules for all slices
extension:assertedDate	S	0..1	dateTime	Date the condition was first asserted URL: http://hl7.org/fhir/StructureDefinition/condition-assertedDate
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
clinicalStatus	?!SΣC	0..1	CodeableConcept	active | recurrence | relapse | inactive | remission | resolved Binding: ConditionClinicalStatusCodes (required)
verificationStatus	?!SΣC	0..1	CodeableConcept	unconfirmed | provisional | differential | confirmed | refuted | entered-in-error Binding: ConditionVerificationStatus (required)
Slices for category	S	1..*	CodeableConcept	category codes Slice: Unordered, Open by value:$this Binding: ConditionCategoryCodes (extensible): A category assigned to the condition.
category:us-core	S	1..*	CodeableConcept	problem-list-item | health-concern Binding: US Core Problem or Health Concern (required): Note that other codes are permitted, see Required Bindings When Slicing by Value Sets
category:screening-assessment		0..*	CodeableConcept	𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: USCDI Health Status/Assessments Data Class Binding: US Core Simple Observation Category (required): Note that other codes are permitted, see Required Bindings When Slicing by Value Sets Additional Bindings Purpose Documentation US Core Screening Assessment Observation Category Min Binding USCDI Health Status/Assessments Data Elements
code	SΣ	1..1	CodeableConcept	Identification of the condition, problem or diagnosis Binding: US Core Condition Codes (preferred): Valueset to describe the actual problem experienced by the patient Additional Bindings Purpose Documentation US Core Condition Codes Current Current Required for new records
subject	SΣ	1..1	Reference(US Core Patient Profile S | Group)	Who has the condition?
onset[x]	SΣ	0..1		Estimated or actual date, date-time, or age
onsetDateTime			dateTime S
onsetAge			Age
onsetPeriod			Period
onsetRange			Range
onsetString			string
abatement[x]	SC	0..1		When in resolution/remission
abatementDateTime			dateTime S
abatementAge			Age
abatementPeriod			Period
abatementRange			Range
abatementString			string
recordedDate	SΣ	0..1	dateTime	Date record was first recorded
recorder	Σ	0..1	Reference(US Core Practitioner Profile | US Core Patient Profile | PractitionerRole | US Core RelatedPerson Profile)	𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: Who recorded the condition
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Condition.clinicalStatus	Base	required	Condition Clinical Status Codes	📦4.0.1	FHIR Std.
Condition.verificationStatus	Base	required	ConditionVerificationStatus	📦4.0.1	FHIR Std.
Condition.category	Base	extensible	Condition Category Codes	📍4.0.1	FHIR Std.
Condition.category:us-core	Base	required	US Core Problem or Health Concern	📦9.0.0-ballot	This IG
Condition.category:screening-assessment	Base	required	US Core Simple Observation Category	📦9.0.0-ballot	This IG
Condition.code	Base	preferred	US Core Condition Codes	📦9.0.0-ballot	This IG

Constraints

Id	Grade	Path(s)	Description	Expression
con-3	best practice	Condition	Condition.clinicalStatus SHALL be present if verificationStatus is not entered-in-error and category is problem-list-item	clinicalStatus.exists() or verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code = 'entered-in-error').exists() or category.select($this='problem-list-item').empty()
con-4	error	Condition	If condition is abated, then clinicalStatus must be either inactive, resolved, or remission	abatement.empty() or clinicalStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-clinical' and (code='resolved' or code='remission' or code='inactive')).exists()
con-5	error	Condition	Condition.clinicalStatus SHALL NOT be present if verification Status is entered-in-error	verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code='entered-in-error').empty() or clinicalStatus.empty()
dom-2	error	Condition	If the resource is contained in another resource, it SHALL NOT contain nested Resources	contained.contained.empty()
dom-3	error	Condition	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	Condition	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	Condition	If a resource is contained in another resource, it SHALL NOT have a security label	contained.meta.security.empty()
dom-6	best practice	Condition	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 Condition

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Condition		0..*	Condition	Detailed information about conditions, problems or diagnoses
meta	S	0..1	Meta	Metadata about the resource
lastUpdated	S	0..1	instant	When the resource last changed
Slices for extension				Content/Rules for all slices
extension:assertedDate	S	0..1	dateTime	Date the condition was first asserted URL: http://hl7.org/fhir/StructureDefinition/condition-assertedDate
clinicalStatus	S	0..1	CodeableConcept	active | recurrence | relapse | inactive | remission | resolved Binding: ConditionClinicalStatusCodes (required)
verificationStatus	S	0..1	CodeableConcept	unconfirmed | provisional | differential | confirmed | refuted | entered-in-error Binding: ConditionVerificationStatus (required)
Slices for category	S	1..*	CodeableConcept	category codes Slice: Unordered, Open by value:$this
category:us-core	S	1..*	CodeableConcept	problem-list-item | health-concern Binding: US Core Problem or Health Concern (required): Note that other codes are permitted, see Required Bindings When Slicing by Value Sets
category:screening-assessment		0..*	CodeableConcept	𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: USCDI Health Status/Assessments Data Class Binding: US Core Simple Observation Category (required): Note that other codes are permitted, see Required Bindings When Slicing by Value Sets Additional Bindings Purpose Documentation US Core Screening Assessment Observation Category Min Binding USCDI Health Status/Assessments Data Elements
code	S	1..1	CodeableConcept	Identification of the condition, problem or diagnosis Binding: US Core Condition Codes (preferred): Valueset to describe the actual problem experienced by the patient Additional Bindings Purpose Documentation US Core Condition Codes Current Current Required for new records
subject	S	1..1	Reference(US Core Patient Profile S | Group)	Who has the condition?
onset[x]	S	0..1		Estimated or actual date, date-time, or age
onsetDateTime			dateTime S
onsetAge			Age
onsetPeriod			Period
onsetRange			Range
onsetString			string
abatement[x]	S	0..1		When in resolution/remission
abatementDateTime			dateTime S
abatementAge			Age
abatementPeriod			Period
abatementRange			Range
abatementString			string
recordedDate	S	0..1	dateTime	Date record was first recorded
recorder		0..1	Reference(US Core Practitioner Profile | US Core Patient Profile | PractitionerRole | US Core RelatedPerson Profile)	𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: Who recorded the condition
Documentation for this format

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
Condition.clinicalStatus	Base	required	Condition Clinical Status Codes	📦4.0.1	FHIR Std.
Condition.verificationStatus	Base	required	ConditionVerificationStatus	📦4.0.1	FHIR Std.
Condition.category:us-core	Base	required	US Core Problem or Health Concern	📦9.0.0-ballot	This IG
Condition.category:screening-assessment	Base	required	US Core Simple Observation Category	📦9.0.0-ballot	This IG
Condition.code	Base	preferred	US Core Condition Codes	📦9.0.0-ballot	This IG

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Condition	C	0..*	Condition	Detailed information about conditions, problems or diagnoses Constraints: con-3, con-4, con-5
id	Σ	0..1	id	Logical id of this artifact
meta	SΣ	0..1	Meta	Metadata about the resource
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
versionId	Σ	0..1	id	Version specific identifier
lastUpdated	SΣ	0..1	instant	When the resource last changed
source	Σ	0..1	uri	Identifies where the resource comes from
profile	Σ	0..*	canonical(StructureDefinition)	Profiles this resource claims to conform to
security	Σ	0..*	Coding	Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
tag	Σ	0..*	Coding	Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
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
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:assertedDate	S	0..1	dateTime	Date the condition was first asserted URL: http://hl7.org/fhir/StructureDefinition/condition-assertedDate
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	External Ids for this condition
clinicalStatus	?!SΣC	0..1	CodeableConcept	active | recurrence | relapse | inactive | remission | resolved Binding: ConditionClinicalStatusCodes (required)
verificationStatus	?!SΣC	0..1	CodeableConcept	unconfirmed | provisional | differential | confirmed | refuted | entered-in-error Binding: ConditionVerificationStatus (required)
Slices for category	S	1..*	CodeableConcept	category codes Slice: Unordered, Open by value:$this Binding: ConditionCategoryCodes (extensible): A category assigned to the condition.
category:us-core	S	1..*	CodeableConcept	problem-list-item | health-concern Binding: US Core Problem or Health Concern (required): Note that other codes are permitted, see Required Bindings When Slicing by Value Sets
category:screening-assessment		0..*	CodeableConcept	𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: USCDI Health Status/Assessments Data Class Binding: US Core Simple Observation Category (required): Note that other codes are permitted, see Required Bindings When Slicing by Value Sets Additional Bindings Purpose Documentation US Core Screening Assessment Observation Category Min Binding USCDI Health Status/Assessments Data Elements
severity		0..1	CodeableConcept	Subjective severity of condition Binding: Condition/DiagnosisSeverity (preferred): A subjective assessment of the severity of the condition as evaluated by the clinician.
code	SΣ	1..1	CodeableConcept	Identification of the condition, problem or diagnosis Binding: US Core Condition Codes (preferred): Valueset to describe the actual problem experienced by the patient Additional Bindings Purpose Documentation US Core Condition Codes Current Current Required for new records
bodySite	Σ	0..*	CodeableConcept	Anatomical location, if relevant Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.
subject	SΣ	1..1	Reference(US Core Patient Profile S | Group)	Who has the condition?
encounter	Σ	0..1	Reference(Encounter)	Encounter created as part of
onset[x]	SΣ	0..1		Estimated or actual date, date-time, or age
onsetDateTime			dateTime S
onsetAge			Age
onsetPeriod			Period
onsetRange			Range
onsetString			string
abatement[x]	SC	0..1		When in resolution/remission
abatementDateTime			dateTime S
abatementAge			Age
abatementPeriod			Period
abatementRange			Range
abatementString			string
recordedDate	SΣ	0..1	dateTime	Date record was first recorded
recorder	Σ	0..1	Reference(US Core Practitioner Profile | US Core Patient Profile | PractitionerRole | US Core RelatedPerson Profile)	𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: Who recorded the condition
asserter	Σ	0..1	Reference(Practitioner | PractitionerRole | Patient | RelatedPerson)	Person who asserts this condition
stage	C	0..*	BackboneElement	Stage/grade, usually assessed formally Constraints: con-1
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
summary	C	0..1	CodeableConcept	Simple summary (disease specific) Binding: ConditionStage (example): Codes describing condition stages (e.g. Cancer stages).
assessment	C	0..*	Reference(ClinicalImpression | DiagnosticReport | Observation)	Formal record of assessment
type		0..1	CodeableConcept	Kind of staging Binding: ConditionStageType (example): Codes describing the kind of condition staging (e.g. clinical or pathological).
evidence	C	0..*	BackboneElement	Supporting evidence Constraints: con-2
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	ΣC	0..*	CodeableConcept	Manifestation/symptom Binding: ManifestationAndSymptomCodes (example): Codes that describe the manifestation or symptoms of a condition.
detail	ΣC	0..*	Reference(Resource)	Supporting information found elsewhere
note		0..*	Annotation	Additional information about the Condition
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Condition.meta.security	Base	extensible	SecurityLabels	📍4.0.1	FHIR Std.
Condition.meta.tag	Base	example	Common Tags	📍4.0.1	FHIR Std.
Condition.language	Base	preferred	Common Languages	📍4.0.1	FHIR Std.
Condition.clinicalStatus	Base	required	Condition Clinical Status Codes	📦4.0.1	FHIR Std.
Condition.verificationStatus	Base	required	ConditionVerificationStatus	📦4.0.1	FHIR Std.
Condition.category	Base	extensible	Condition Category Codes	📍4.0.1	FHIR Std.
Condition.category:us-core	Base	required	US Core Problem or Health Concern	📦9.0.0-ballot	This IG
Condition.category:screening-assessment	Base	required	US Core Simple Observation Category	📦9.0.0-ballot	This IG
Condition.severity	Base	preferred	Condition/Diagnosis Severity	📍4.0.1	FHIR Std.
Condition.code	Base	preferred	US Core Condition Codes	📦9.0.0-ballot	This IG
Condition.bodySite	Base	example	SNOMED CT Body Structures	📍4.0.1	FHIR Std.
Condition.stage.summary	Base	example	Condition Stage	📍4.0.1	FHIR Std.
Condition.stage.type	Base	example	Condition Stage Type	📍4.0.1	FHIR Std.
Condition.evidence.code	Base	example	Manifestation and Symptom Codes	📍4.0.1	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
con-1	error	Condition.stage	Stage SHALL have summary or assessment	summary.exists() or assessment.exists()
con-2	error	Condition.evidence	evidence SHALL have code or details	code.exists() or detail.exists()
con-3	best practice	Condition	Condition.clinicalStatus SHALL be present if verificationStatus is not entered-in-error and category is problem-list-item	clinicalStatus.exists() or verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code = 'entered-in-error').exists() or category.select($this='problem-list-item').empty()
con-4	error	Condition	If condition is abated, then clinicalStatus must be either inactive, resolved, or remission	abatement.empty() or clinicalStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-clinical' and (code='resolved' or code='remission' or code='inactive')).exists()
con-5	error	Condition	Condition.clinicalStatus SHALL NOT be present if verification Status is entered-in-error	verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code='entered-in-error').empty() or clinicalStatus.empty()
dom-2	error	Condition	If the resource is contained in another resource, it SHALL NOT contain nested Resources	contained.contained.empty()
dom-3	error	Condition	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	Condition	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	Condition	If a resource is contained in another resource, it SHALL NOT have a security label	contained.meta.security.empty()
dom-6	best practice	Condition	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()

Key Elements View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Condition	C	0..*	Condition	Detailed information about conditions, problems or diagnoses Constraints: con-3, con-4, con-5
meta	SΣ	0..1	Meta	Metadata about the resource
lastUpdated	SΣ	0..1	instant	When the resource last changed
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
Slices for extension				Content/Rules for all slices
extension:assertedDate	S	0..1	dateTime	Date the condition was first asserted URL: http://hl7.org/fhir/StructureDefinition/condition-assertedDate
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
clinicalStatus	?!SΣC	0..1	CodeableConcept	active | recurrence | relapse | inactive | remission | resolved Binding: ConditionClinicalStatusCodes (required)
verificationStatus	?!SΣC	0..1	CodeableConcept	unconfirmed | provisional | differential | confirmed | refuted | entered-in-error Binding: ConditionVerificationStatus (required)
Slices for category	S	1..*	CodeableConcept	category codes Slice: Unordered, Open by value:$this Binding: ConditionCategoryCodes (extensible): A category assigned to the condition.
category:us-core	S	1..*	CodeableConcept	problem-list-item | health-concern Binding: US Core Problem or Health Concern (required): Note that other codes are permitted, see Required Bindings When Slicing by Value Sets
category:screening-assessment		0..*	CodeableConcept	𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: USCDI Health Status/Assessments Data Class Binding: US Core Simple Observation Category (required): Note that other codes are permitted, see Required Bindings When Slicing by Value Sets Additional Bindings Purpose Documentation US Core Screening Assessment Observation Category Min Binding USCDI Health Status/Assessments Data Elements
code	SΣ	1..1	CodeableConcept	Identification of the condition, problem or diagnosis Binding: US Core Condition Codes (preferred): Valueset to describe the actual problem experienced by the patient Additional Bindings Purpose Documentation US Core Condition Codes Current Current Required for new records
subject	SΣ	1..1	Reference(US Core Patient Profile S | Group)	Who has the condition?
onset[x]	SΣ	0..1		Estimated or actual date, date-time, or age
onsetDateTime			dateTime S
onsetAge			Age
onsetPeriod			Period
onsetRange			Range
onsetString			string
abatement[x]	SC	0..1		When in resolution/remission
abatementDateTime			dateTime S
abatementAge			Age
abatementPeriod			Period
abatementRange			Range
abatementString			string
recordedDate	SΣ	0..1	dateTime	Date record was first recorded
recorder	Σ	0..1	Reference(US Core Practitioner Profile | US Core Patient Profile | PractitionerRole | US Core RelatedPerson Profile)	𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: Who recorded the condition
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Condition.clinicalStatus	Base	required	Condition Clinical Status Codes	📦4.0.1	FHIR Std.
Condition.verificationStatus	Base	required	ConditionVerificationStatus	📦4.0.1	FHIR Std.
Condition.category	Base	extensible	Condition Category Codes	📍4.0.1	FHIR Std.
Condition.category:us-core	Base	required	US Core Problem or Health Concern	📦9.0.0-ballot	This IG
Condition.category:screening-assessment	Base	required	US Core Simple Observation Category	📦9.0.0-ballot	This IG
Condition.code	Base	preferred	US Core Condition Codes	📦9.0.0-ballot	This IG

Constraints

Id	Grade	Path(s)	Description	Expression
con-3	best practice	Condition	Condition.clinicalStatus SHALL be present if verificationStatus is not entered-in-error and category is problem-list-item	clinicalStatus.exists() or verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code = 'entered-in-error').exists() or category.select($this='problem-list-item').empty()
con-4	error	Condition	If condition is abated, then clinicalStatus must be either inactive, resolved, or remission	abatement.empty() or clinicalStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-clinical' and (code='resolved' or code='remission' or code='inactive')).exists()
con-5	error	Condition	Condition.clinicalStatus SHALL NOT be present if verification Status is entered-in-error	verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code='entered-in-error').empty() or clinicalStatus.empty()
dom-2	error	Condition	If the resource is contained in another resource, it SHALL NOT contain nested Resources	contained.contained.empty()
dom-3	error	Condition	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	Condition	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	Condition	If a resource is contained in another resource, it SHALL NOT have a security label	contained.meta.security.empty()
dom-6	best practice	Condition	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 Condition

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Condition		0..*	Condition	Detailed information about conditions, problems or diagnoses
meta	S	0..1	Meta	Metadata about the resource
lastUpdated	S	0..1	instant	When the resource last changed
Slices for extension				Content/Rules for all slices
extension:assertedDate	S	0..1	dateTime	Date the condition was first asserted URL: http://hl7.org/fhir/StructureDefinition/condition-assertedDate
clinicalStatus	S	0..1	CodeableConcept	active | recurrence | relapse | inactive | remission | resolved Binding: ConditionClinicalStatusCodes (required)
verificationStatus	S	0..1	CodeableConcept	unconfirmed | provisional | differential | confirmed | refuted | entered-in-error Binding: ConditionVerificationStatus (required)
Slices for category	S	1..*	CodeableConcept	category codes Slice: Unordered, Open by value:$this
category:us-core	S	1..*	CodeableConcept	problem-list-item | health-concern Binding: US Core Problem or Health Concern (required): Note that other codes are permitted, see Required Bindings When Slicing by Value Sets
category:screening-assessment		0..*	CodeableConcept	𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: USCDI Health Status/Assessments Data Class Binding: US Core Simple Observation Category (required): Note that other codes are permitted, see Required Bindings When Slicing by Value Sets Additional Bindings Purpose Documentation US Core Screening Assessment Observation Category Min Binding USCDI Health Status/Assessments Data Elements
code	S	1..1	CodeableConcept	Identification of the condition, problem or diagnosis Binding: US Core Condition Codes (preferred): Valueset to describe the actual problem experienced by the patient Additional Bindings Purpose Documentation US Core Condition Codes Current Current Required for new records
subject	S	1..1	Reference(US Core Patient Profile S | Group)	Who has the condition?
onset[x]	S	0..1		Estimated or actual date, date-time, or age
onsetDateTime			dateTime S
onsetAge			Age
onsetPeriod			Period
onsetRange			Range
onsetString			string
abatement[x]	S	0..1		When in resolution/remission
abatementDateTime			dateTime S
abatementAge			Age
abatementPeriod			Period
abatementRange			Range
abatementString			string
recordedDate	S	0..1	dateTime	Date record was first recorded
recorder		0..1	Reference(US Core Practitioner Profile | US Core Patient Profile | PractitionerRole | US Core RelatedPerson Profile)	𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: Who recorded the condition
Documentation for this format

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
Condition.clinicalStatus	Base	required	Condition Clinical Status Codes	📦4.0.1	FHIR Std.
Condition.verificationStatus	Base	required	ConditionVerificationStatus	📦4.0.1	FHIR Std.
Condition.category:us-core	Base	required	US Core Problem or Health Concern	📦9.0.0-ballot	This IG
Condition.category:screening-assessment	Base	required	US Core Simple Observation Category	📦9.0.0-ballot	This IG
Condition.code	Base	preferred	US Core Condition Codes	📦9.0.0-ballot	This IG

Snapshot View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Condition	C	0..*	Condition	Detailed information about conditions, problems or diagnoses Constraints: con-3, con-4, con-5
id	Σ	0..1	id	Logical id of this artifact
meta	SΣ	0..1	Meta	Metadata about the resource
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
versionId	Σ	0..1	id	Version specific identifier
lastUpdated	SΣ	0..1	instant	When the resource last changed
source	Σ	0..1	uri	Identifies where the resource comes from
profile	Σ	0..*	canonical(StructureDefinition)	Profiles this resource claims to conform to
security	Σ	0..*	Coding	Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
tag	Σ	0..*	Coding	Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
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
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:assertedDate	S	0..1	dateTime	Date the condition was first asserted URL: http://hl7.org/fhir/StructureDefinition/condition-assertedDate
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	External Ids for this condition
clinicalStatus	?!SΣC	0..1	CodeableConcept	active | recurrence | relapse | inactive | remission | resolved Binding: ConditionClinicalStatusCodes (required)
verificationStatus	?!SΣC	0..1	CodeableConcept	unconfirmed | provisional | differential | confirmed | refuted | entered-in-error Binding: ConditionVerificationStatus (required)
Slices for category	S	1..*	CodeableConcept	category codes Slice: Unordered, Open by value:$this Binding: ConditionCategoryCodes (extensible): A category assigned to the condition.
category:us-core	S	1..*	CodeableConcept	problem-list-item | health-concern Binding: US Core Problem or Health Concern (required): Note that other codes are permitted, see Required Bindings When Slicing by Value Sets
category:screening-assessment		0..*	CodeableConcept	𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: USCDI Health Status/Assessments Data Class Binding: US Core Simple Observation Category (required): Note that other codes are permitted, see Required Bindings When Slicing by Value Sets Additional Bindings Purpose Documentation US Core Screening Assessment Observation Category Min Binding USCDI Health Status/Assessments Data Elements
severity		0..1	CodeableConcept	Subjective severity of condition Binding: Condition/DiagnosisSeverity (preferred): A subjective assessment of the severity of the condition as evaluated by the clinician.
code	SΣ	1..1	CodeableConcept	Identification of the condition, problem or diagnosis Binding: US Core Condition Codes (preferred): Valueset to describe the actual problem experienced by the patient Additional Bindings Purpose Documentation US Core Condition Codes Current Current Required for new records
bodySite	Σ	0..*	CodeableConcept	Anatomical location, if relevant Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.
subject	SΣ	1..1	Reference(US Core Patient Profile S | Group)	Who has the condition?
encounter	Σ	0..1	Reference(Encounter)	Encounter created as part of
onset[x]	SΣ	0..1		Estimated or actual date, date-time, or age
onsetDateTime			dateTime S
onsetAge			Age
onsetPeriod			Period
onsetRange			Range
onsetString			string
abatement[x]	SC	0..1		When in resolution/remission
abatementDateTime			dateTime S
abatementAge			Age
abatementPeriod			Period
abatementRange			Range
abatementString			string
recordedDate	SΣ	0..1	dateTime	Date record was first recorded
recorder	Σ	0..1	Reference(US Core Practitioner Profile | US Core Patient Profile | PractitionerRole | US Core RelatedPerson Profile)	𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: Who recorded the condition
asserter	Σ	0..1	Reference(Practitioner | PractitionerRole | Patient | RelatedPerson)	Person who asserts this condition
stage	C	0..*	BackboneElement	Stage/grade, usually assessed formally Constraints: con-1
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
summary	C	0..1	CodeableConcept	Simple summary (disease specific) Binding: ConditionStage (example): Codes describing condition stages (e.g. Cancer stages).
assessment	C	0..*	Reference(ClinicalImpression | DiagnosticReport | Observation)	Formal record of assessment
type		0..1	CodeableConcept	Kind of staging Binding: ConditionStageType (example): Codes describing the kind of condition staging (e.g. clinical or pathological).
evidence	C	0..*	BackboneElement	Supporting evidence Constraints: con-2
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	ΣC	0..*	CodeableConcept	Manifestation/symptom Binding: ManifestationAndSymptomCodes (example): Codes that describe the manifestation or symptoms of a condition.
detail	ΣC	0..*	Reference(Resource)	Supporting information found elsewhere
note		0..*	Annotation	Additional information about the Condition
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Condition.meta.security	Base	extensible	SecurityLabels	📍4.0.1	FHIR Std.
Condition.meta.tag	Base	example	Common Tags	📍4.0.1	FHIR Std.
Condition.language	Base	preferred	Common Languages	📍4.0.1	FHIR Std.
Condition.clinicalStatus	Base	required	Condition Clinical Status Codes	📦4.0.1	FHIR Std.
Condition.verificationStatus	Base	required	ConditionVerificationStatus	📦4.0.1	FHIR Std.
Condition.category	Base	extensible	Condition Category Codes	📍4.0.1	FHIR Std.
Condition.category:us-core	Base	required	US Core Problem or Health Concern	📦9.0.0-ballot	This IG
Condition.category:screening-assessment	Base	required	US Core Simple Observation Category	📦9.0.0-ballot	This IG
Condition.severity	Base	preferred	Condition/Diagnosis Severity	📍4.0.1	FHIR Std.
Condition.code	Base	preferred	US Core Condition Codes	📦9.0.0-ballot	This IG
Condition.bodySite	Base	example	SNOMED CT Body Structures	📍4.0.1	FHIR Std.
Condition.stage.summary	Base	example	Condition Stage	📍4.0.1	FHIR Std.
Condition.stage.type	Base	example	Condition Stage Type	📍4.0.1	FHIR Std.
Condition.evidence.code	Base	example	Manifestation and Symptom Codes	📍4.0.1	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
con-1	error	Condition.stage	Stage SHALL have summary or assessment	summary.exists() or assessment.exists()
con-2	error	Condition.evidence	evidence SHALL have code or details	code.exists() or detail.exists()
con-3	best practice	Condition	Condition.clinicalStatus SHALL be present if verificationStatus is not entered-in-error and category is problem-list-item	clinicalStatus.exists() or verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code = 'entered-in-error').exists() or category.select($this='problem-list-item').empty()
con-4	error	Condition	If condition is abated, then clinicalStatus must be either inactive, resolved, or remission	abatement.empty() or clinicalStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-clinical' and (code='resolved' or code='remission' or code='inactive')).exists()
con-5	error	Condition	Condition.clinicalStatus SHALL NOT be present if verification Status is entered-in-error	verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code='entered-in-error').empty() or clinicalStatus.empty()
dom-2	error	Condition	If the resource is contained in another resource, it SHALL NOT contain nested Resources	contained.contained.empty()
dom-3	error	Condition	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	Condition	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	Condition	If a resource is contained in another resource, it SHALL NOT have a security label	contained.meta.security.empty()
dom-6	best practice	Condition	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 Condition

Summary

Mandatory: 3 elements
Must-Support: 12 elements

Structures

This structure refers to these other structures:

• US Core Patient Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient)
• US Core Practitioner Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner)
• US Core RelatedPerson Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-relatedperson)

Extensions

This structure refers to these extensions:

• http://hl7.org/fhir/StructureDefinition/condition-assertedDate

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of Condition.category

Maturity: 3

Quick Start

Below is an overview of the required Server RESTful FHIR interactions for this profile - for example, search and read operations - when supporting the US Core interactions to access this profile's information (Profile Support + Interaction Support). Note that systems that support only US Core Profiles (Profile Only Support) are not required to support these interactions. See the US Core Server CapabilityStatement for a complete list of supported RESTful interactions for this IG.

• See the Scopes Format section for a description of the SMART scopes syntax.
• See the Search Syntax section for a description of the US Core search syntax.
• See the General Requirements section for additional rules and expectations when a Server requires status parameters.
• See the General Guidance section for additional guidance on searching for multiple patients.

US Core Scopes

Servers providing access to problems and health concern data SHALL support these US Core SMART Scopes:

• resource level scopes: <patient|user|system>/Condition.rs

• granular scopes: <patient|user|system>/Condition.rs?category=http://terminology.hl7.org/CodeSystem/condition-category|problem-list-item

• granular scopes: <patient|user|system>/Condition.rs?category=http://hl7.org/fhir/us/core/CodeSystem/condition-category|health-concern

Mandatory Search Parameters:

The following search parameters and search parameter combinations SHALL be supported:

1. SHALL support searching for all conditions including problems, health concerns, and encounter diagnosis for a patient using the patient search parameter:

   GET [base]/Condition?patient={Type/}[id]

   Example:

   1. GET [base]/Condition?patient=1137192

   Implementation Notes: Fetches a bundle of all Condition resources for the specified patient (how to search by reference)

2. SHALL support searching using the combination of the patient and category search parameters:

   GET [base]/Condition?patient={Type/}[id]&category={system|}[code]

   Example:

   1. GET [base]/Condition?patient=1032702&category=problem-list-item

   Implementation Notes: Fetches a bundle of all Condition resources for the specified patient and category = "problem-list-item". (how to search by reference and how to search by token)

Optional Search Parameters:

The following search parameter combinations SHOULD be supported:

1. SHOULD support searching using the combination of the patient and clinical-status search parameters:

   GET [base]/Condition?patient={Type/}[id]&clinical-status=http://terminology.hl7.org/CodeSystem/condition-clinical|active,http://terminology.hl7.org/CodeSystem/condition-clinical|recurrance,http://terminology.hl7.org/CodeSystem/condition-clinical|remission

   Example:

   1. GET [base/Condition?patient=1032702&clinical-status=http://terminology.hl7.org/CodeSystem/condition-clinical|active,http://terminology.hl7.org/CodeSystem/condition-clinical|recurrance,http://terminology.hl7.org/CodeSystem/condition-clinical|remission

   Implementation Notes: Fetches a bundle of all Condition resources for the specified patient and all "active" statuses (active,relapse,remission). This will exclude Conditions with no clinicalStatus specified. (how to search by reference and how to search by token)

2. SHOULD support searching using the combination of the patient and category and clinical-status search parameters:

   GET [base]/Condition?patient={Type/}[id]&category={system|}[code]&clinical-status=http://terminology.hl7.org/CodeSystem/condition-clinical|active,http://terminology.hl7.org/CodeSystem/condition-clinical|recurrance,http://terminology.hl7.org/CodeSystem/condition-clinical|remission

   Example:

   1. GET [base]/Condition?patient=1032702&category=problem-list-item&clinical-status=http://terminology.hl7.org/CodeSystem/condition-clinical|active,http://terminology.hl7.org/CodeSystem/condition-clinical|recurrance,http://terminology.hl7.org/CodeSystem/condition-clinical|remission

   Implementation Notes: Fetches a bundle of all Condition resources for the specified patient and category = "problem-list-item" for all "active" statuses (active,relapse,remission). This will exclude Conditions with no clinicalStatus specified. (how to search by reference and how to search by token)

3. SHOULD support searching using the combination of the patient and category and encounter search parameters:

   GET [base]/Condition?patient={Type/}[id]&category={system|}[code]&encounter={Type/}[id]

   Example:

   1. GET [base]/Condition?patient=1032702&category=problem-list-item&encounter=Encounter/1036

   Implementation Notes: Fetches a bundle of all Condition resources for the specified patient, encounter, and category = "problem-list-item". (how to search by reference and how to search by token)

4. SHOULD support searching using the combination of the patient and code search parameters:

   GET [base]/Condition?patient={Type/}[id]&code={system|}[code]

   Example:

   1. GET [base]/Condition?patient=1032702&code=http://snomed.info/sct|51868009

   Implementation Notes: Fetches a bundle of all Condition resources for the specified patient and code. (how to search by reference and how to search by token)

5. SHOULD support searching using the combination of the patient and onset-date search parameters:
   • including support for these onset-date comparators: gt,lt,ge,le
   • including optional support for AND search on onset-date (e.g.onset-date=[date]&onset-date=[date]]&...)

   GET [base]/Condition?patient={Type/}[id]&onset-date={gt|lt|ge|le}[date]{&onset-date={gt|lt|ge|le}[date]&...}

   Example:

   1. GET [base]Condition?patient=555580&onset-date=ge2018-01-14

   Implementation Notes: Fetches a bundle of all Condition resources for the specified patient and date. (how to search by reference and how to search by date)

6. SHOULD support searching using the combination of the patient and asserted-date search parameters:
   • including support for these asserted-date comparators: gt,lt,ge,le
   • including optional support for AND search on asserted-date (e.g.asserted-date=[date]&asserted-date=[date]]&...)

   GET [base]/Condition?patient={Type/}[id]&asserted-date={gt|lt|ge|le}[date]{&asserted-date={gt|lt|ge|le}[date]&...}

   Example:

   1. GET [base]Condition?patient=555580&asserted-date=ge2018-01-14

   Implementation Notes: Fetches a bundle of all Condition resources for the specified patient and date. (how to search by reference and how to search by date)

7. SHOULD support searching using the combination of the patient and recorded-date search parameters:
   • including support for these recorded-date comparators: gt,lt,ge,le
   • including optional support for AND search on recorded-date (e.g.recorded-date=[date]&recorded-date=[date]]&...)

   GET [base]/Condition?patient={Type/}[id]&recorded-date={gt|lt|ge|le}[date]{&recorded-date={gt|lt|ge|le}[date]&...}

   Example:

   1. GET [base]Condition?patient=555580&recorded-date=ge2018-01-14

   Implementation Notes: Fetches a bundle of all Condition resources for the specified patient and date. (how to search by reference and how to search by date)

8. SHOULD support searching using the combination of the patient and abatement-date search parameters:
   • including support for these abatement-date comparators: gt,lt,ge,le
   • including optional support for AND search on abatement-date (e.g.abatement-date=[date]&abatement-date=[date]]&...)

   GET [base]/Condition?patient={Type/}[id]&abatement-date={gt|lt|ge|le}[date]{&abatement-date={gt|lt|ge|le}[date]&...}

   Example:

   1. GET [base]Condition?patient=555580&abatement-date=ge2018-01-14

   Implementation Notes: Fetches a bundle of all Condition resources for the specified patient and date. (how to search by reference and how to search by date)

9. SHOULD support searching using the combination of the patient and _lastUpdated search parameters:
   • including support for these _lastUpdated comparators: gt,lt,ge,le
   • including optional support for AND search on _lastUpdated (e.g._lastUpdated=[date]&_lastUpdated=[date]]&...)

   GET [base]/Condition?patient={Type/}[id]&_lastUpdated={gt|lt|ge|le}[date]{&_lastUpdated={gt|lt|ge|le}[date]&...}

   Example:

   1. GET [base]/Condition?patient=1032702&_lastUpdated=ge2024-01-01T00:00:00Z

   Implementation Notes: Fetches a bundle of all Condition resources for the specified patient and _lastUpdated. See the US Core General Guidance page for Searching Using lastUpdated. (how to search by reference and how to search by date)