US Core Implementation Guide
8.0.1 - STU 8

US Core Implementation Guide, published by HL7 International / Cross-Group Projects. This guide is not an authorized publication; it is the continuous build for version 8.0.1 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/US-Core/ and changes regularly. See the Directory of published versions

## Change Log

Page standards status: Informative

The US Core Implementation Guide Change Log captures updates, enhancements, clarifications, and corrections across multiple versions, reflecting community feedback, ballot processes, and alignment with evolving USCDI standards.

### How to Review Updates Between Versions

1. Identify Your Starting Point: Determine the version you’re currently using (e.g., 7.0.0) and the target version (e.g., 8.0.0). Each version builds on the previous version including intermediate ballot-related updates (e.g., January 2025 for v 8.0.0) so don't skip them when reviewing changes.
2. Review Version Summaries: Start with the “What’s New” section for each version including intermediate ballot versions to get a summary of important updates to the guide (e.g., new profiles in v8.0.0 supporting USCDI v5).
3. Examine Detailed Changes: Review the “Changes” section for each version for a complete list of a changes to the guide. Click the Jira Tracker (e.g., FHIR-123) links to see the underlying issue and resolution, and click on the “See Changes Here” links to view modified content directly in the guide.
4. Compare Across Versions: For a deeper analysis, refer to the Changes Between Versions page for detailed FHIR artifact comparisons.

### Version = 8.0.1 (Meets USCDI v5 Requirements)

- url: https://hl7.org/fhir/us/core/STU8.0.1/
- Based on FHIR version: 4.0.1

This technical update US Core have been reviewed and commented upon by the public through the HL7 errata process. The HL7 International Cross-Group Projects work group members have agreed to and voted on the resolution of the community comments.

#### What's new in Version 8.0.1 of US Core

- The US Core 8.0.0 to 8.0.1 update addresses a breaking changes to the US Core Version 8.0.0 Sex extension, which cause validation issues across versions. This update create a new US Core Individual Sex Extension and deprecates the US Core Sex Extension to ensure compatibility, align with the 2025 Executive Order, and resolve validation conflicts for existing resources.
- Various minor technical corrections.

#### Changes

- This technical update US Core has nine changes which are listed below.

Tracker Status: Change Impact (Change Category) Change Summary Jira Issue Link Updated Content Link

1. Applied: Non-substantive (Correction) Fix Link to Race & Ethnicity - CDC (CDCREC) code system FHIR-51137 See Changes:
   - US Core Race Extension
   - US Core Ethnicity Extension
2. Applied: Non-substantive (Correction) Typo in US Core Laboratory Result Observation Profile FHIR-51254 See Changes Here
3. Applied: Non-substantive (Correction) Typo in SMART well-known example FHIR-51363 See Changes Here
4. Applied: Non-substantive (Correction) Remove span tags FHIR-52125 See Changes Here
5. Applied: Non-substantive (Correction) Add missing target information to individual provenance table FHIR-52997 See Changes Here
6. Applied: Non-substantive (Correction) Correct the definition of the additional USCDI ServiceRequest element FHIR-53029 See Changes Here
7. Applied: Compatible, substantive (Correction) Rename The USCore sex extension FHIR-53047 See Changes Listed in introduction above.
8. Applied: Update CQL Library section Persuasive FHIR-53419 See Changes Here
9. Applied: Compatible, Non-substantive (Correction) Revert ICD9CM Code System URL back to `http://hl7.org/fhir/sid/icd-9-cm` FHIR-53476 See Changes Here

### Version = 8.0.0

- url: https://hl7.org/fhir/us/core/STU8/
- Based on FHIR version: 4.0.1

The changes in this annual update to US Core have been reviewed and commented upon by the public through the January 2025 HL7 balloting process. The HL7 International Cross-Group Projects work group members have agreed to and voted on the resolution of the community comments.

#### What's new in Version 8.0.0 of US Core:

Each update to a new version of US Core changes the US Core Profiles and conformance expectations. Implementers can find detailed comparisons between the FHIR artifacts in this 8.0.0 version of US Core and each previous major release on Changes Between Versions page. Below is an overview of significant changes between Version 8.0.0 and Version 8.0.0-ballot of US Core.

- To comply with Executive Order 14168, the following changes were made. Note that many of them are substantive and breaking changes for clients and servers:
  - Make `Patient.gender` optional for the US Core Patient Profile.
  - Remove "Name to Use" USCDI mapping guidance.
  - Remove USCDI mapping and guidance for the US Core Observation Sexual Orientation Profile.
  - Remove the US Core Birth Sex Extension from the US Core Patient Profile and guidance.
  - Deprecate the US Core Gender Identity Extension and remove it from the US Core Profile, USCDI mapping, and guidance.
  - Remove the Individual Pronouns Extension from the US Core Patient Profile, USCDI mapping, and guidance.
  - Remove the Patient Sex Parameter For Clinical Use Extension from the US Core Patient Profile, USCDI mapping, and guidance.
  - Redefine the US Core Sex Extension and update its binding to Federal Administrative Sex
  - Update US Core Patient Profile guidance
  - Replace "gender" with "sex" throughout the narrative sections of the guide.
- To promote the visibility of the future direction of US Core, we created a new Looking Ahead menu tab with the menu items:
  - US Core Roadmap: Existing content moved from the renamed Future of US Core page
  - Writing Vital Signs: Existing content moved from the renamed Future of US Core page
  - Patient Data Feed: New optional feature for servers implementing US Core. It allows clients to receive FHIR Subscription Notifications when events occur related to US Core content.
- We updated and corrected the individual provenance guidelines, adding new Additional USCDI elements representing the author to:
  - US Core AllergyIntolerance Profile
  - US Core Condition Encounter Diagnosis Profile
  - US Core Condition Problems and Health Concerns Profile
  - US Core CarePlan Profile
  - US Core Observation Occupation Profile
  - US Core Care Experience Preference Profile
  - US Core Treatment Intervention Preference Profile
- Based on community feedback, we have removed several Must Support elements from the US Core Condition Encounter Diagnosis Profile. These elements are typically not applicable or tracked with encounter diagnosis.
- We added best practice guidelines for granular scopes to the SMART on FHIR Obligations and Capabilities page.
- We added a new Relationship With Other IGs guidance page which compares US Core FHIR profiles with the International Patient Access (IPA) standard, highlighting alignment, compatibility, and additional requirements for compliance.
- We added guidance about Using CQL With US Core. When using Clinical Quality Language (CQL) with US Core profiles, CQL model definitions let authors reference slices and extensions as named elements within their CQL expressions. Therefore, we provided US Core model definitions using FHIR Library resources.
- We have updated our Must Support conformance page to add a section on slicing to document US Core's interpretation on slices and what properties they inherit.

- We continue our efforts to align terminology between US Core and HL7 C-CDA and link terminology directly to the FHIR® Terminology Service for VSAC Resources (Value Set Authority Center (VSAC)) or HL7 Terminology (THO) where applicable. The following ValueSets has been moved:

  Pre 8.0.0 US Core ValueSet | 8.0.0-Ballot ValueSet | THO/VSAC
  --- | --- | ---
  Language codes with language and optionally a region modifier | Languages | THO
  USPS Two Letter Alphabetic Codes | USPS State | THO
  OMB Ethnicity Categories | Ethnicity Categories | VSAC
  Detailed Ethnicity | Detailed Ethnicity | VSAC
  OMB Race Categories | Race Categories | VSAC
  Detailed Race | Detailed Race | VSAC

#### Changes:

The ballot-related comments resulted in over 100 changes to this specification, which are listed below:

Tracker Status: (Change Category) Change Summary Jira Issue Link Updated Content Link

1. Applied: (Clarification) Discourage use of ICD-10-CM header codes. FHIR-48742 See Changes Here:
   - US Core Condition Encounter Diagnosis Profile
   - US Core Condition Problems and Health Concerns Profile
2. Applied: (Correction) Remove additional USCDI tag from Element FHIR-48754 See Changes Here
3. Applied: (Clarification) Add guidance on reference to Observation target FHIR-48756 See Changes Here
4. Applied: (Clarification) Add conformance rule about using US Core profiles with Operations FHIR-48822 See Changes Here
5. Applied: (Enhancement) Change Screening Assessment Profile category:screening-assessment to Add'l USCDI FHIR-48849 See Changes Here
6. Applied: (Enhancement) Change Problems category to Add'l USCDI FHIR-48850 See Changes Here
7. Applied: (Clarification) Remove STU Note regarding the Argonauts 2023 SMART Imaging Access project FHIR-48851 See Changes Here
8. Applied: (Correction) Typo "PractitionerRole" instead of "PracitionRole" FHIR-48866 See Changes Here
9. Applied: (Clarification) Document how to find code systems for value sets in VSAC FHIR-48889 See Changes Here:
   - Terminology
   - VSAC to FHIR Code System Mapping Table
10. Applied (Correction) Update THO code system link FHIR-49009 See Changes Here
11. Applied: (Correction) Typo "content.attachment.url/data" instead of "content.url/data" FHIR-49023 See Changes Here:
    - US Core DocumentReference Profile
    - US Core ADI DocumentReference - Profile
12. Applied: (Correction) Add Provenance Author and Author Role to USCDI Table FHIR-49024 See Changes Here
13. Applied: (Clarification) Clarify the guidance using a MedicationRequest query to access "all medications" or "all active medications". FHIR-49038 See Changes Here
14. Applied: (Clarification) Clarify MedicationRequest Profile Specific Implementation Guidance on fetching active medications: FHIR-49039 See Changes Here
15. Applied: (Correction) Add author provenance documentation to all profiles listed Individual Level Provenance table.FHIR-49064 For example, see Changes Here
16. Applied: (Correction) Define the use of use the term "certifying Server system" and remove it from US Core Observation Screening Assessment Profile. FHIR-49065 See Changes Here:
    - US Core Observation Screening Assessment Profile
    - Additional USCDI Requirements
17. Applied: (Correction) Corrected MS target for MedicationRequest.requester and .reportedReference data elements in Individual Level Provenance Table FHIR-49066 See Changes Here
18. Applied: (Correction) Plural vs singular wording for provenance elements FHIR-49067 See Changes Here
19. Applied: (Correction) Typo "service should happen" instead of "serviceSHOULDhappen" FHIR-49068 See Changes Here
20. Applied: (Clarification) Clarify narrative section on ServiceRequest.code content FHIR-49069 See Changes Here
21. Applied: (Correction) typo "and" instead of "amd" FHIR-49087 See Changes Here
22. Applied: (Correction) Fix link FHIR-49089 See Changes Here
23. Applied: (Correction) typo "RESTful" instead of "RESTfUl" FHIR-49090 See Changes Here
24. Applied: (Correction) Correct figure label FHIR-49095 See Changes Here
25. Applied: (Correction) Add missing word "support" FHIR-49098 See Changes Here
26. Applied: (Correction) Add missing word "and" FHIR-49099 See Changes Here
27. Applied: (Correction) Update Specimen code to specimen type code in narrative FHIR-49100 See Changes Here
28. Applied: (Clarification) Clarify how an order is linked to the DiagnosticReport FHIR-49101 See Changes Here and Here
29. Applied: (Clarification) Clarify reporting specimen type best practice. FHIR-49102 See Changes Here
30. Applied: (Enhancement) Add guidance that other identifiers like NCSBN can be used. FHIR-49122 See Changes Here
31. Applied: (Enhancement) Clarify US Core's relationship with IPA FHIR-49123 See Changes Here
32. Applied: (Enhancement) Add asked-declined to Race and Ethnicity Value Sets FHIR-49134 (See Terminology Changes Listed in introduction above)
33. Applied: (Correction) Add ADI DocumentReference and Observation ADI Document to CapabilityStatements FHIR-49162 See Changes Here
34. Applied: (Correction) Observation should be US Core Observation Screening Assessment Profile FHIR-49163 See Changes Here
35. Applied: (Correction) Remove Duplicate Specific Implementation Guidance: FHIR-49164 See Changes Here
36. Applied: (Clarification) Language for linking to Assessment Profile is confusing FHIR-49197 See Changes Here
37. Applied: (Enhancement) Reference and link to the USCDI page from the Home Page. FHIR-49219 See Changes Here
38. Applied: (Enhancement) Added and corrected individual provenance elements FHIR-49221 See the summary of changes in the What's New section above.
39. Applied: (Clarfication) Align US Core and C-CDA Race and Ethnicity Value Set Concepts FHIR-49234 (See Terminology Changes Listed in introduction above)
40. Applied: (Clarification) Updated the QuickStarts for DocumentReference, Condition, and DocumentReference profile to use profile-specific examples and language. FHIR-49250 See Changes Here:
    - US Core ADI DocumentReference Profile
    - US Core DocumentReference Profile
    - US Core DiagnosticReport Profile for Laboratory Results Reporting
    - US Core DiagnosticReport Profile for Report and Note Exchange
    - US Core Condition Encounter Diagnosis Profile
    - US Core Condition Problems and Health Concerns Profile
41. Applied: (Correction) Update Observation.derivedFrom examples for Observation Screening Assessment Profile FHIR-49289 See Changes Here
42. Applied: (Correction) Update the VSAC CVX Vaccines Administered Vaccine Set value set FHIR-49292(StructureDefinition-us-core-immunization.html#profile)
43. Applied: (Correction) Correct CVX vaccine codes link FHIR-49293 See Changes Here
44. Applied: (Enhancement) Define the Acronym 'ADI' in all pages where it is used FHIR-49299 See Changes:
    - US Core ADI DocumentReference Profile
    - US Core Observation ADI Documentation Profile
45. Applied: (Clarification) Add version lineage to the US Core Observation Screening Assessment Profile's introduction. FHIR-49305 See Changes Here
46. Applied: (Correction) Corrections to typos FHIR-49306
47. Applied: (Correction) Fix typo 'Advance Directives' instead of 'Advanced Directives' FHIR-49307 See Changes Here
48. Applied: (Enhancement) Add Observation.code.text as an Additional USCDI element FHIR-49308 See Changes Here
49. Applied: (Enhancement) Change the slice for category 'assess-plan' from 1..1 Must Support to 0..1 Must Support. FHIR-49309 See Changes Here
50. Applied: (Clarification) Cardinality does not match element definition FHIR-49338 See Changes Here
51. Applied (Enhancement) Add "Plain Language" summary to the home page FHIR-49367 See Changes Here
52. Applied (Correction)Fix Typo in US Core Yearly Updates diagram FHIR-49376 See Changes Here
53. Applied: (Clarification) Update the preferred language recommendation FHIR-49391 See Changes Here:
    - US Core Patient Profile
    - US Core Encounter Profile
54. Applied (Clarification) Clarify reference to race and ethnicity category codes FHIR-49392 See Changes Here
55. Applied: (Clarification) Clarify reference to CDCREC FHIR-49393 See Changes Here
56. Applied: (Correction) Update SOP Payer Type value set.FHIR-49395
57. Applied: (Enhancement) Move Patient Communication Language valueset to HL7 Terminology (THO). FHIR-49397 See Changes Here
58. Applied: (Correction)Changed ONC to ASTP where appropriate FHIR-49399
59. Applied: (Correction) Add and apply guidance on FHIR Maturity Level. FHIR-49400 See Changes Here
60. Applied: (Clarification) Update US Core Location Type Value Set to meet industry use cases FHIR-49401 and FHIR-50937 See Changes
    - US Core Location Profile
    - Healthcare Service Location Type Combined
61. Applied: (Clarification) Spell out/define SOP in diagnostic report imaging study context FHIR-49402 See Changes Here
62. Applied: (Correction) Update Medication Route of Admin terminology binding FHIR-49403 See Changes Here
63. Applied: (Correction) Change number of common clinical notes to 10 FHIR-49413 See Changes Here
64. Applied: (Correction) Correction to Observation ADI Documentation Profile Introduction FHIR-49414 See Changes Here
65. Applied: (Clarification) Clarify guidance for the Observation ADI Documentation Profile Observation.value element FHIR-49415 See Changes Here
66. Applied: (Enhancement) Update to human readable VSAC link FHIR-49419 See Changes Here
67. Applied: (Clarification) Update guidance if endpoint is outside the FHIR base URL FHIR-49424 See Changes Here
68. Applied: (Correction) Remove duplicate listing and add US Core RelatedPerson Profile to listing to USCDI table FHIR-49432 See Changes Here
69. Applied: (Correction) Add same bindings to category "slicer" and "sliced" category elements in observation profiles. FHIR-49444 See Changes Here:
    - US Core Treatment Intervention Profile
    - US Core Care Experience Profile
    - US Core Observation ADI Documentation Profile
    - US Core Simple Observation
70. Applied: (Enhancement) Add guidance about using CQL and provide model definitions.FHIR-49477 See Changes Here
71. Applied: (Enhancement) Add ServiceRequest.code.text as an Additional USCDI element FHIR-49609 See Changes Here:
    - US Core ServiceRequest Profile
    - ServiceRequest Food Pantry Referral Example
72. Applied: (Clarification) Clarify how to categorize CDA documentsFHIR-49612 See Changes Here
73. Applied: (Clarification) Change binding for US Core ADI DocumentReference and .type FHIR-49615 See Changes Here
74. Applied: (Enhancement) Add CLIA/USCDI/HL7 elements mapping table and update metabolic panel example to include order. FHIR-49623 See Changes Here:
    - US Core DiagnosticReport Profile for Laboratory Results Reporting
    - Basic Metabolic Panel Example
    - ServiceRequest BMP Example
75. Applied: (Enhancement) Add CLIA/USCDI/HL7 elements mapping table and update CBC examples to include specimen. FHIR-49630 See Changes Here:
    - US Core Laboratory Result Observation Profile
    - Urine Specimen Example
    - Whole Blood Specimen Example
    - Erythrocytes Example
    - Hematocrit Example
    - Hemoglobin Example
    - Leukocytes Example
    - MCH Example
    - MCHC Example
    - MCV Example
    - Platelets Example
76. Applied: (Correction) Update Image and typo on Figure 2: US Core DocumentReference.category FHIR-49702 See Changes Here
77. Applied: (Enhancement) Remove US Core Laboratory Result Observation Profile as a Must Support target for the US Core DiagnosticReport Profile for Report and Note Exchange FHIR-49906 See Changes Here
78. Applied: (Correction) Correct the additional binding purpose code "current" rendering FHIR-49985 See Changes Here
79. Applied: (Clarification) Remove ICD-9 from additional bound value set in US Core Condition profiles FHIR-49986 See Changes Here
    - US Core Condition Encounter Diagnosis Profile
    - US Core Condition Problems and Health Concerns Profile
    - US Core Condition Codes Current
80. Applied: (Enhancement) Add Best Practices Guidance for Granular Scopes FHIR-50002 See Changes Here
81. Applied: (Clarification) Add introduction to Change log to clarify how to use. FHIR-50089 See Changes Here
82. Applied: (Clarification) Value sets referenced by US Core reviewed annually FHIR-50153
83. Applied: (Enhancement) Created a new "Looking Ahead" menu tab FHIR-50154 See Changes Here
84. Applied: (Enhancement) Added "Patient Data Feed" subscription guidance page to US Core FHIR-50155 See Changes Here
85. Applied (Enhancement) Add guidance on inactive codes to the Terminology page FHIR-50156 See Changes Here
86. Applied (Correction) Added missing profiles to "omitted" Profile list for individual level provenance FHIR-50163 See Changes Here
87. Applied: (Correction) Changes to comply with Executive Order 14168 FHIR-50177 See the summary of changes in the What's New section above.
88. Applied: (Clarification) Remove MS flag for Practitioner in MedicationDispense Profile FHIR-50239 See Changes Here
89. Applied: (Enhancement) Align Group Number/Name with USCDI Group Identifier FHIR-50283 See Changes Here
90. Applied: (Enhancement) Add section on slicing on the Must Support page FHIR-50286 See Changes Here
91. Applied: (Enhancement) Remove clinical Dates and statuses from the US Core Condition Encounter Diagnosis Profile FHIR-50288 See Changes Here
    - US Core Condition Encounter Diagnosis Profile
    - Encounter Diagnosis Example 1
    - Encounter Diagnosis Example 2
92. Applied: (Correction) Remove gender based search requirements FHIR-50380 See Changes Here
93. Applied: (Correction) Add copyright statements to Questionnaire examples FHIR-50399 See Changes Here:
    - Alcohol Use Disorder Identification Test - Consumption (AUDIT-C) Questionnaire Example
    - Exercise Vital Sign Questionnaire Example
    - Questionnaire Hunger Vital Sign (HVS) Example
    - Questionnaire PHQ-9 Example
    - Questionnaire PRAPARE Example
    - Tobacco, Alcohol, Prescription medications, and other Substance use screen (TAPS) Questionnaire Example
94. Applied: (Correction) Update the term "translation" to "additional coding" FHIR-50796 See Changes Here
95. Applied: (Clarification) Improve Language on Immunization.lotNumber for matching FHIR-50795 See Changes Here
96. Applied: (Correction) Improve Language on boolean flag FHIR-50794 See Changes Here
97. Applied: (Correction) Improve Language: Change Name to Code FHIR-50793 See Changes Here
98. Applied: (Clarification) Update SMART Launch dependency to version 2.2.0 FHIR-50787 See Changes Here
99. Applied (Enhancement) Move USPS value set to THO FHIR-50143 See Changes Here
100. Applied: (Correction) Expand US Core Laboratory Test Codes value set FHIR-49642 See Changes Here
101. Applied: (Enhancement) Add links in history page to approved patches FHIR-49642 See Changes Here

The application of the following trackers are pending and will not be completed before publication

1. Resolved - change required: (Enhancement) Add codes from US Core Category to the Observation Category Codesystem FHIR-43541
2. Resolved - change required: (Correction) NAIC Code Number Identifier system not registered in THO FHIR-46185
3. Resolved - change required: (Correction) Change USEncounterDischargeDisposition from http://terminology.hl7.org/CodeSystem/nubc-UB92 to https://www.nubc.org/CodeSystem/PatDischargeStatus FHIR-49610
4. Publishing: (Enhancement) How to deal with searchparameters in the package that only convey expectations FHIR-48876

The following trackers have been identified as publishing issues and we are working with HL7 publishing to resolve them.

1. Publishing: (Clarification) Confusing for commercial vendor. Reads very confusing. FHIR-30783
2. Publishing: (Correction) Override built-in examples for address elements FHIR-43054
3. Publishing: (Enhancement) Deprecate every version before 3.1.1 FHIR-46065
4. Publishing: (Correction) Fix the US Core History Page FHIR-46749
5. Publishing: (Correction) Hyperlink discrepancy FHIR-49336, FHIR-49337

### Version = 8.0.0 - ballot

- url: https://hl7.org/fhir/us/core/2025Jan/
- Based on FHIR version : 4.0.1

#### The January 2025 Ballot

The January 2025 ballot addresses the following:

- We have updated US Core to include the new U.S. Core Data for Interoperability (USCDI) v5 Data Elements and Classes that the Office of the National Coordinator (ONC) published in July of 2024:

  - We have added the USCDI Clinical Notes Operative Note and Emergency Department Note data elements to US Core's "Common Clinical Notes" list and to the US Core Clinical Note Type value set.

  - For the USCDI Immunization Lot Number data element, we added `Immunization.lotNumber` to the US Core Immunization Profile as a Must Support element.

  - For the USCDI Route of Administration data element, we added `MedicationRequest.dosageInstruction.route` to the US Core MedicationRequest Profile and `MedicationDispense.dosageInstruction.route` to the US Core MedicationDispense Profile as Must Support elements and use an extensible value set of SNOMED CT and NCI Thesaurus SPL codes.

  - For the USCDI Orders data class:
    - The US Core MedicationRequest Profile supports the USCDI Medication Order data element.
    - To support the USCDI Laboratory Order, Diagnostic Imaging Order, Clinical Test Order, and Procedure Order data element, we provide detailed guidance on terminology for the US Core ServiceRequest Profile `ServiceRequest.category` and `ServiceRequest.code` elements.
  - For the USCDI Patient Demographics/Information data class:
    - The US Core Patient Profile `Patient.name.use` Additional USCDI element supports the USCDI Name to Use data element.
    - To support the USCDI Pronouns data element, we added the FHIR standard Individual Pronouns Extension to the US Core Patient Profile as an Additional USCDI element.
    - To support the USCDI Interpreter -Needed data element, we added the US Core Interpreter Needed Extension to the US Core Patient Profile and US Core Encounter Profile as Additional USCDI elements. (Note that the version 5.1.0 FHIR standard Patient Interpreter Required extension does not meet the USCDI terminology requirement or the multiple context needed. Change request FHIR-47587 was submitted to address these limitations.)
  - For the USCDI Observation data class:
    - To support the Sex Parameter for Clinical Use data element, we added the 5.1.0 FHIR standard Patient Sex Parameter for Clinical Use Extension to the US Core Patient Profile as an Additional USCDI element, and document its use on other US Core Profiles for specific clinical contexts.
    - To support the Advance Directive Observation data element, we added the US Core Observation ADI Documentation Profile, US Core ADI DocumentReference Profile, and US Core Authentication Time Extension.

  - For the USCDI Provenance Author and Author Role data elements, because systems typically do not use the Provenance Resource to represent this information at an individual level (in other words, activities by the patient or provider), We updated the Basic Provenance page to document the various FHIR resource elements that track the "small p provenance" information at the individual level. Based on current usage, we added these Must Support elements to the following profiles:

    - `Observation.performer` to US Core Vitals Signs
    - `Observation.performer` to US Core Average Blood Pressure Profile
    - `Observation.performer` to US Core Observation Clinical Result Profile and US Core Laboratory Result Observation Profile
    - `Observation.performer` to US Core Smoking Status Observation Profile
    - `DiagnosticReport.resultsInterpreter` to US Core DiagnosticReport Profile for Laboratory Results Reporting
    - `DiagnosticReport.resultsInterpreter` to US Core DiagnosticReport Profile for Report and Note Exchange
    - `Goal.expressedBy` to US Core Goal Profile
    - `Immunization.performer.actor` to US Core Immunization Profile

    and these Additional USCDI elements to the following profiles:

    - `Observation.performer` to US Core Observation Pregnancy Intent Profile and US Core Observation Pregnancy Status Profile
    - `Observation.performer` to US Core Observation Sexual Orientation Profile
    - `Procedure.performer.actor` to US Core Procedure
  - Other USCDI changes:
    - We updated the US Core Location Profile `Location.type` binding to US Core Location Type to support:
      - the National Healthcare Safety Network (NHSN) Healthcare Facility Patient Care Location (HSLOC) codes as an applicable standard to the USCDI Encounter Location data element,
      - the Centers for Medicare & Medicaid Services (CMS) maintained Place of Service Code Set(POS) codes (see FHIR-46258)
- We updated and clarified the conformance rules for *Additional USCDI Requirements, Must Support for Resource References, and included lists of Must Support target profiles for each US Core Profile on the Must Support page.
- We clarified the conformance expectation for Screening and Assessment category codes when using US Core Profiles used to represent those activities. For details see the changes associated with FHIR-45319.

- We continue our efforts to align terminology between US Core and HL7 C-CDA and link terminology directly to the FHIR® Terminology Service for VSAC Resources (Value Set Authority Center (VSAC)) or HL7 Terminology (THO) where applicable. The following ValueSets has been moved:

  Pre 8.0.0-Ballot US Core ValueSet | 8.0.0-Ballot ValueSet | THO/VSAC
  --- | --- | ---
  US Core Discharge Disposition Value Set | V3 Discharge Disposition | THO
  US Core Pregnancy Status Codes | Pregnancy Status Observation | VSAC
  US Core Pregnancy Intent Codes | Pregnancy Intention | VSAC
  US Core Survey Codes | Screening and Assessment Survey Codes | VSAC
  US Core Encounter Type | Encounter Type | VSAC

#### Changes:

- Implementers submitted over 60 trackers since the publication of US Core ver 8.0.0. We have addressed them and applied over 50 changes listed below:

Tracker Status: (Change Category) Summary Jira Issue Link to Updated Content

1. Resolved - change required: (Enhancement) Fix the US Core History Page FHIR-42950 and FHIR-46749 See Changes Here
2. Applied: (Enhancement) Make Must Support Reference Table more visible FHIR-44977 See Changes Here:
   - Must Support - Resource References
   - Must Support Elements
   - FHIR RESTful Capabilities
3. Applied: (Correction) Update Condition.code ICD9 value set link and add STU Note FHIR-45136 See Changes Here
4. Applied: (Clarification) Clarify definition of Clinical Information Reconciliation and Incorporation (CIRI) FHIR-45267 See Changes Here
5. Applied: (Enhancement) Remove dated footnote from Provenance page. FHIR-45283
6. Applied (Enhancement) Add SNOMED NUCC Mapping link to US Core PractitionerRole Profile guidanceFHIR-45286 See Changes Here
7. Applied: (Clarification) Clarify Observation Screening Assessment category Must Support requirements FHIR-45319 and FHIR-46052 See Changes Here:
   - Screening and Assessments
   - US Core Observation Screening Assessment Profile
   - US Core Screening Assessment Observation Maximum Category
   - US Core Simple Observation Profile
   - US Core Condition Problems and Health Concerns Profile
   - US Core Screening Assessment Condition Category
8. Applied: (Clarification) Clarify Must Support requirements for requestors FHIR-45448 See Changes Here
9. Applied: (Correction) Move "time-period" from Must Support to Must Have section in introduction. FHIR-45726 See Changes Here
10. Applied: (Clarification) Align the Sig description in the medication profile introductions. FHIR-45951 See Changes Here:
    - US Core MedicationDispense Profile
    - US Core MedicationRequest Profile
11. Applied: (Clarification) Clarify Role and use of US Core SearchParameters vs FHIR standard SearchParameters FHIR-46036 See Changes Here:
    - US Core Search Parameters
    - SearchParameter: USCoreAllergyintoleranceClinicalStatus
    - US Core Server CapabilityStatement - FHIR RESTful Capabilities
12. Applied: (Correction) Procedure.code should be Procedure.performed FHIR-46037 See Changes Here
13. Applied: (Correction) Correct Examples FHIR-46099 See Changes Here:
    - 10 Minute Apgar Score Panel Example
    - Hvs Item Example 88122-7
    - Hvs Item Example 88123-5
    - HVSPanel Example 88121-9
14. Applied: (Clarification) Remove the Must Support on DiagnosticReport (Report and Notes) `media.link` FHIR-46240 See Changes Here
15. Applied: (Clarification) Clarify the level of granular scopes server shall support FHIR-46277 See Changes Here
16. Applied: (Enhancement) Reference specific version of USCDI for each version of USCore FHIR-46466 See Changes Here:
    - USCDI
    - Publication (Version) History
    - Change Log
    - Future of US Core
17. Applied: (Correction) Change page status from "Informative" to "Trial-use" where appropriate FHIR-46514 (See the tracker comments for a list of changes)
18. Applied: (Clarification) Clarify conformance requirements for structured assessments FHIR-47139 See Changes Here
19. Applied: (Enhancement) Replace US Core Discharge Disposition Value Set with equivalent HL7 Terminology (THO) Value Set FHIR-47416 and FHIR-46194
    - US Core Encounter Profile
    - Encounter 1036 Example
20. Applied: (Enhancement) Tighten constraint on name.use to support better patient matching FHIR-48416 See Changes Here
21. Applied: (Correction)Change "status" to "active flag" in US Core RelatedPerson introductionFHIR-48439 See Changes Here
22. Applied: (Clarification) Remove resolves declaration from US Core CapabilityStatements FHIR-48446 See Changes Here:
    - US Core Server CapabilityStatement - FHIR RESTful Capabilities
    - US Core Client CapabilityStatement - FHIR RESTful Capabilities html#additional-uscdi-requirements)
23. Applied: (Enhancement) Add section on client best practices for search FHIR-45179 See Changes Here
24. Applied: (Clarification) Clarify the '_revinclude` expectations for Provenance FHIR-46077 See Changes Here:
    - US Core Provenance Profile
    - AllergyIntolerance Provenance Example 1
    - AllergyIntolerance Provenance Example 2
25. Applied: (Enhancement) Continue to harmonize/share value sets used in US Core and C-CDA in the US Core 8.0 ballot and C-CDA 4.0 ballot FHIR-46181 (See Changes Listed in introduction above)
26. Applied: (Enhancement) Updates and Corrections to Medication Clinical Drug VSAC Valueset used by US Core Medication, MedicationDispense Profile, and MedicationRequest Profiles FHIR-46255 See Changes Here
27. Applied: (Enhancement) Replace US Core Pregnancy Status Codes Value Set with equivalent Value Set Authority Center (VSAC) Value Set FHIR-46257 See Changes Here
28. Applied: (Enhancement) Allow CMS Place of Service codes for 'location.type' in US Core Location Profile FHIR-46258 See Changes Here:
    - US Core Location Profile
    - US Core Location Type ValueSet
29. Applied: (Enhancement) Replace US Core Pregnancy Intent Codes Value Set with equivalent Value Set Authority Center (VSAC) Value Set FHIR-46263 See Changes Here
30. Applied: (Enhancement) Add SDOH Goals value set as "Additional Binding" in Goal Profile FHIR-46266 See Changes Here
31. Applied: (Correction) Specify SMART App Launch Version FHIR-46279 Here:
    - Security
    - US Core Server CapabilityStatement
32. Applied: (Enhancement) Replace US Core Survey Codes Value Set with Value Set Authority Center (VSAC) Value Set and remove Laboratory LOINCs FHIR-46347 See Changes Here
33. Applied: (Clarification) Clarify when granular scopes overlap FHIR-46748 See Changes Here
34. Applied: (Enhancement) Add USCDI v5 Data Elements to US Core FHIR-48443 See Changes Listed in the 8.0.0-Ballot Introduction above.
35. Applied: (Correction) Update US Core Clinical Note Type Valueset to align with Clinical Note Guidance FHIR-48607 Here:
    - US Core Clinical Note Type
    - Clinical Notes
36. Applied: (Correction) Change Average Blood Pressure Profile `Observation.subject` minimum from 0 to 1 FHIR-45724 See Changes Here
37. Applied: (Enhancement) Align Encounter Type between C-CDA and FHIR US Core and Replace US Core Encounter Type Value Set with equivalent Value Set Authority Center (VSAC) Value Set FHIR-46259 See Changes Here
38. Applied: (Clarification) Update Must Support page when no reference targets labeled Must Support and update must support labels for Observation.performer targets FHIR-48442 See Changes Here:
    - Must Support - Resource References
    - US Core Simple Observation Profile
    - US Core Observation Screening Assessment Profile
39. Applied: (Enhancement) Update Guidance on Sex and Gender in USCore FHIR-44115 See Changes Here
40. Applied: (Correction) Spelling errors in US Core Server Capability Statement FHIR-45451See Changes Here
41. Applied: (Correction) Fix broken PHINVADS links FHIR-45494 See Changes Here
42. Applied: (Correction) Typo in Condition's granular scope FHIR-45961 See Changes Here
43. Applied: (Clarification) Clarify expectations for US@ for health systems FHIR-46020 See Changes Here
44. Pre-Applied: (Clarification) Clarify how "Additional USCDI" is applied for complex elements FHIR-46028 See Changes Here
45. Applied: (Enhancement) Create SCT Specimen Condition value set to include SNOMED CT FHIR-47061 See Changes Here:
    - US Core Specimen Profile
    - US Core Specimen Condition ValueSet
    - Lipemic Serum Specimen Example
46. Applied: (Clarification) Remove `.meta.lastUpdated` STU comments FHIR-48542
47. Applied: (Correction) Update link to UDI Specification FHIR-48688 See Changes Here
48. Applied: (Correction) add MS=False flag to QuestionnaireResponse.authored target FHIR-48847 See Changes Here
49. Applied: (Correction) add MS=False flags to Procedure.basedOn targets FHIR-48848 See Changes Here
50. **Applied ** (Correction) US Core Survey Codes expansion error FHIR-46272 See Changes Here

The application of the following trackers are pending and will not be completed by the ballot date.

1. Resolved - change required: (Enhancement) Create a tracker to THO to add codes from US Core Category to the Observation Category Codesystem FHIR-43541
2. Triaged: (Correction) US Core Coverage Profile FHIR-44122
3. Triaged: (Correction) US Core Coverage.Type Code Link Update FHIR-44124
4. Triaged: (Correction) US Core Terminology Reference List # 62 FHIR-44138
5. Resolved - change required: (Correction) NAIC Code Number Identifier system not registered in THO FHIR-46185

The following trackers have been identified as publishing issues and we are working with HL7 publishing to resolve them.

1. Publishing: (Clarification) Confusing for commercial vendor. Reads very confusing. FHIR-30783
2. Publishing: (Correction) AllergyIntolerance does not show constraint FHIR-34636
3. Publishing: (Correction) Override built-in examples for address elements FHIR-43054
4. Publishing: (Correction) US Core detailed ethnicity expansion error FHIR-46638 See STU Notes:
   - Detailed ethnicity
   - Detailed race
5. Publishing: (Enhancement) Deprecate every version before 3.1.1 FHIR-46065 See Changes Here:
   - Change Log
   - History Page

### Version = 7.0.0 (Meets USCDI v4 Requirements)

- url: https://hl7.org/fhir/us/core/STU7/
- Based on FHIR version: 4.0.1

The changes in this annual update to US Core have been reviewed and commented upon by the public through the January 2024 HL7 balloting process. The HL7 International Cross-Group Projects work group members have agreed to and voted on the resolution of the community comments.

#### What's new in Version 7.0.0 of US Core:

Each update to a new version of US Core changes the US Core Profiles and conformance expectations. Implementers can find detailed comparisons between the FHIR artifacts in this 7.0.0 version of US Core and each previous major release on Changes Between Versions page. Below is an overview of significant changes between Version 7.0.0 and Version 7.0.0-ballot of US Core.

- SMART on FHIR Obligations and Capabilities: We rewrote the SMART scopes guidance page to clarify the granular scope requirement in HTI-1 final rule, and expanded the guidance to include SMART on FHIR capabilities, token introspection, and `/.well-known/smart-configuration`.
- `meta.lastUpdated` and `_lastUpdated`: We added the `meta.lastUpdated` element as Must Support and recommend using the `_lastUpdated` search parameter for the US Core Profiles listed below. The General Guidance page documents how to use them to represent and search for resources whose content has changed. We also updated the guidance on the deletion of records.
  - US Core Laboratory Result Observation Profile
  - US Core DiagnosticReport Profile for Laboratory Results Reporting
  - US Core Condition Problems and Health Concerns Profile
  - US Core Encounter Profile
  - Searching Using lastUpdated
  - Representing Deleted Information
- US Core Medication Adherence Extension: In the previous ballot version, we added support for Medication Adherence as an Additional USCDI Requirement using the new US Core Medication Adherence Extension. In this version, we simplified the adherence codes and changed the information source from a FHIR Reference to actor codes.
- US Core Average Blood Pressure Profile: In the previous ballot version, we added the US Core Average Blood Pressure Profile to support the USCDI Average Blood Pressure data element. It was rewritten, and the guidance was updated in this version. Notably, it is based upon the FHIR Observation and not the US Core Vital Signs Profile.
- US Core Smoking Status Observation Profile. This Profile and its terminology were updated to accommodate more smoking-related observations.

- We continue our efforts to link terminology directly to the FHIR® Terminology Service for VSAC Resources (Value Set Authority Center (VSAC)) where applicable and, as a result, align terminology between US Core and HL7 C-CDA. In this version, the following value sets have been added or moved to VSAC:

  Pre 7.0.0 US Core ValueSet | 7.0.0 VSAC ValueSet
  --- | ---
  US Core Smoking Status Observation Codes | Smoking status type
  Smoking Status | Smoking status comprehensive
  UsCoreVitalSigns | VitalSignResultType
  BirthSex | Birth Sex

#### Changes:

The ballot-related comments resulted in over 80 changes to this specification, which are listed below:

Tracker Status: (Change Category) Summary Jira Issue Link to Updated Content

1. Applied: (Enhancement) Updated Gender Identity binding to align with C-CDA FHIR-43052 See Changes Here
2. Applied: (Clarification) Rename fhir-write to vitals-write FHIR-43400 See Changes Here
3. Applied: (Clarification) Clarify that the Average Blood Pressure profile is protocol agnostic. FHIR-43402 See Changes Here
4. Applied: (Clarification) Add example to Must Support - Complex Elements section FHIR-43430 See Changes Here
5. Applied: (Clarification) Clarify that only `Patient.deceasedDateTime` is "Additional USCDI Requirement" FHIR-43431 See Changes Here
6. Applied: (Correction) Fix table rendering to remove duplicates FHIR-43432 See Changes Here
7. Applied: (Enhancement) Change Medication Adherence Information Source from Reference to Code FHIR-43466 and See Changes Here and Here
8. Applied: (Enhancement) References specific extension for measurement protocol FHIR-43536 See Changes Here and Here
9. Applied: (Clarification) Clarify reference to average BP panel FHIR-43537 See Changes Here
10. Applied: (Clarification) Derive Average Blood Pressure directly from Observation FHIR-43538 See Changes Here and Here
11. Applied: (Clarification) Constrain Average Blood Pressure Profile Observation.value to max = 0 FHIR-43539 See Changes Here
12. Applied: (Clarification) Broaden Profile Purpose Statement FHIR-43540 See Changes Here
13. Applied: (Enhancement) Add reference in the profile description to the base resource for scope and usage definitions. FHIR-43543 For example See Change Here
14. Applied: (Clarification) Remove note to balloters regarding the terminology FHIR-43547 See Changes Here and Here
15. Applied: (Enhancement) Add guidance how to express conditional Goals FHIR-43552 See Changes Here and Here
16. Applied: (Clarification) Clarify Specimen Condition definition FHIR-43567 See Changes Here
17. Applied: (Clarification) Updates to Care Experience Preference Profile and Treatment Intervention Preference Profiles introduction FHIR-43568 See Changes Here and Here
18. Applied: (Enhancement) Add choice of must support for Specimen.accessionIdentifier vs Specimen.identifier FHIR-43585 See Changes Here
19. Applied (Clarification) Clarify location extension to use when not in Encounter FHIR-43587 See Changes Here
20. Applied: (Clarification) Reason for Referral Clarification/Correction FHIR-43588 See Changes Here and Here
21. Applied: (Enhancement) Update the terminology bindings and allow effectivePeriod for Smoking Status FHIR-43589 and FHIR-43355 See Changes Here:
    - US Core Smoking Status Observation Profile
    - Smoking Status Type ValueSet
    - Smoking Status Comprehensive
    - Some Day Smoker Example
    - Cigarette Pack-Years Example
22. Applied: (Clarification) Clarify that not all US Core extensions are used in US Core Profiles FHIR-43590 See Changes Here
23. Applied: (Correction) Fixed scopes formats FHIR-43616 See Changes Here
24. Applied: (Clarification) Document that multiple races and ethnicities are supported in the extension FHIR-43624 See Changes Here
25. Applied: (Enhancement) Move US Core Vital Signs ValueSet to VSAC FHIR-43633 See Changes Here and Here
26. Applied: (Clarification) Added guidance for using NDC codesFHIR-43641 See Changes Here
27. Resolved - change required: (Enhancement) Add _lastUpdated search parameter guidance FHIR-43659 The changes are listed above
28. Applied: (Enhancement) Edit Medication Adherence codes and provide examples FHIR-43757 See Changes Here
29. Applied (Enhancement) Update and clarify US Core Scopes requirements FHIR-43761 See Changes Here and Here
30. Applied: (Correction) Fix Rendering in granular scope tables FHIR-43770 See Changes Here
31. Applied: (Correction) Fix format error FHIR-43773 See Changes Here
32. Applied: (Clarification) Restore the FHIR Core resource definitions and comments FHIR-43800 For example See Changes Here
33. Applied (Enhancement) Clarify the use of USCDI Health Assessment Value Sets FHIR-43922 See Changes Here
34. Applied: (Clarification) Add Note to Vital Signs Profile regarding known validation errorsFHIR-43928 See Changes Here
35. Applied (Clarification)Clarify reason for referral options FHIR-43929 See Changes Here
36. Applied: (Correction) Change Quantity to SimpleQuantity MedicationRequest and MedicationDispense profiles FHIR-43932 See Changes Here and Here
37. Applied: (Correction) Move elements from "must have" to "must support" in Immunization profile introduction FHIR-43934 See Changes Here
38. Applied: (Clarification) Race extension cardinality / documentation does not match value set FHIR-43937 See Changes Here
39. Applied: (Correction) Update diagram in Section 3.6.4.3 FHIR-43938 See Changes Here
40. Applied: (Correction) Undo copy/paste error to US Simple Observation Profile description FHIR-43954 See Changes Here
41. Applied: (Correction) change "treatment-intervention" to "treatment-intervention-profile" FHIR-44008 See Changes Here
42. Applied: (Correction) Add hyperlink FHIR-44009 See Changes Here
43. Applied: (Correction) Restore the missing graphics FHIR-44010 and FHIR-44011 See Changes Here and Here
44. Applied: (Correction) Restore the missing example FHIR-44012 See Changes Here
45. Applied: (Correction) Fix table formatting on Screening & assessments page - FHIR-44014 See Changes Here
46. Applied: (Clarification) Add guidance for goals in Screening & Assessments page FHIR-44015 See Changes Here
47. Applied: (Correction) Change "US Core Laboratory Result Observation Profile." to "US Core Observation Clinical Result Profile." FHIR-44016 See Changes Here
48. Applied: (Correction) Where superfluous, Remove references to versions of USCDI FHIR-44017 For example See Changes Here
49. Applied: (Correction) Remove erroneous text FHIR-44018 and FHIR-44022 See Changes Here and Here
50. Applied: (Enhancement) Add guidance/constraints for use of UCUM for reference range in Laboratory Result Observation Profile FHIR-44023 See Changes Here and Here
51. Applied: (Correction) Correct "e.g." and "i.e." to "e.g.," "i.e.," throughout guide FHIR-44053
52. Applied: (Clarification) Updated to specific link text instead generic "Here" for bulleted list of changes FHIR-44055 See Changes Here
53. Applied: (Clarification) Clarify encounter in DiagnosticReport FHIR-44056 See Changes Here)
54. Applied: (Clarification) Change "may" to "can" to avoid conformance verbs FHIR-44060 See Changes Here and Here
55. Applied: (Correction) Clarify Medication Adherence Extension definitions FHIR-44076 See Changes Here
56. Applied: (Correction) Remove redundant sentence from Server CapabilityStatement description FHIR-44112 See Changes Here
57. Applied: (Clarification) Clarify the use of UCUM for Quantity datatypes in Lab Observations FHIR-44117 See Changes Here and Here
58. Applied: (Correction) Remove US Core from CapabilityStatement.instantiates FHIR-44121 See Changes Here
59. Applied: (Clarification) Include FHIR R6 Sex and Gender content in Patient Profile Introduction FHIR-44123 See Changes Here
60. Applied: (Enhancement) Remove ASKU from value sets and use DAR concept instead FHIR-44127 and FHIR-41571 See Changes:
    - US Core Gender Identity Extension
    - US Core Birth Sex Extension
    - US Core Observation Sexual Orientation Profile
61. Applied: (Enhancement) Add non-binary to gender identity value set FHIR-44132 See Changes Here
62. Applied: (Correction) Correct reference to USCDI Average Blood Pressure element from "data class" to "data element" in change log FHIR-44405 See Changes Here
63. Applied: (Correction) bold text "SHALL NOT" FHIR-44507 See Changes Here
64. Applied: (Enhancement) Continue US Core and C-CDA value set alignment initiatives FHIR-44522 The Value sets are listed above
65. Applied: (Clarification) Update Treatment Intervention Observation.code to LOINC FHIR-44019 and FHIR-44539 See Changes Here
66. Applied: (Correction) Add Social Determinants of Health Screening Assessments And Questions to Screening and Assessments Page FHIR-44545 See Changes Here
67. Applied: (Correction) fix codes in US Core Average Blood Pressure Profile search examples FHIR-44623 For example, See Changes Here
68. Applied: (Clarification) Update guidance for servers not supporting PractitionerRole FHIR-44624 See Changes Here
69. Applied: (Correction) change "resources" to "resources types" FHIR-44650 See Changes Here
70. Applied: (Correction) Update average blood pressure example to be more realistic FHIR-44668 See Changes Here
71. Applied: (Clarification) Clarify Must Support requirements for Practitioner.address FHIR-44693 See Changes Here and Here
72. Applied: (Clarification) Update Goal introduction to match profile FHIR-44694 See Changes Here
73. Applied: (Enhancement) Sex Extension's value set is too restrictive FHIR-44710 See Changes Here
74. Applied: (Enhancement) Update Condition.code and Procedure.code from extensible to current FHIR-44715 See Changes Here:
    - US Core Condition Encounter Diagnosis Profile
    - US Core Condition Problems and Health Concerns Profile
    - US Core Procedure Profile
    - General Requirements
75. Applied: (Clarification) Update guidance on Referencing US Core Profiles FHIR-44759 See Changes Here
76. Applied: (Enhancement) Relax Sex binding to "extensible" FHIR-44764 See Changes Here
77. Applied: (Enhancement) Combine the tables of Must Support references andAdditional USCDI references FHIR-44946 See Changes Here
78. Applied: (Correction) QA Error: specify version of http://terminology.hl7.org/CodeSystem/provenance-participant-type FHIR-44967 See Changes Here
79. Applied: (Clarification) Align category term with community understanding FHIR-45002 See Changes Here
80. Applied: (Enhancement) Add Guidance on meeting the definition of 'X' FHIR-45177 See Changes Here
81. Applied: (Clarification) Clarify 𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜 requirements for Reference datatype FHIR-45204 See Changes Here:
    - US Core Procedure Profile
    - US Core ServiceRequest Profile
    - US Core MedicationRequest Profile
82. Applied: (Correction) Update DocumentReference.content.format binding FHIR-45302 See Changes Here
83. Applied: (Correction) Update code system URL in US Core Discharge Disposition FHIR-45303 See Changes Here

The application of the following tracker is pending and will not be completed by the publication date.

1. Resolved - change required: (Enhancement) Create a tracker to THO to add codes from US Core Category to the Observation Category Codesystem FHIR-43541

The following trackers have been identified as publishing issues and we are working with HL7 publishing to resolve them.

1. Publishing:: (Clarification) Confusing for commercial vendor. Reads very confusing. FHIR-30783
2. Publishing:: (Correction) AllergyIntolerance does not show constraint FHIR-34636
3. Publishing: (Correction) Override built-in examples for address elements FHIR-43054

### Version = 7.0.0 - ballot

- url: https://hl7.org/fhir/us/core/2024Jan/
- Based on FHIR version : 4.0.1

#### The January 2024 Ballot

This ballot addresses the following:

- We have updated US Core to include the new U.S. Core Data for Interoperability (USCDI) v4 Data Elements and Classes that the Office of the National Coordinator (ONC) published in July of 2023:

  - For the USCDI Allergies and Intolerances Substance (Non-Medication) data element, no change was needed for the US Core AllergyIntolerance Profile because the existing `code` element binding to Common substances for allergy and intolerance documentation including refutations already includes "Non-pharmacologic agent"

  - For the USCDI Encounter Identifier data element, no changes were needed because the US Core Encounter Profile already supports `Encounter.identifier` as a Must Support element.

  - For the USCDI Facility Information data class and elements, the US Core Location Profile already supports Facility Name and has been updated to support Facility Identifier and Type. The US Core Immunization Profile has been updated to reference the US Core Location resource directly as a Must Support element, and the following US Core Profiles have been updated to indirectly reference the location/facility via US Core Encounter Profile as a Must Support element:
    - US Core DiagnosticReport Profile for Laboratory Results Reporting
    - US Core Immunization Profile
    - US Core MedicationDispense Profile
    - US Core Observation Clinical Result Profile
    - US Core Procedure Profile
    - US Core ServiceRequest Profile
  - For the USCDI Time of Procedure data element, no changes were needed because:
    - the US Core Procedure Profile already supports `Procedure.performed[x]` as a Must Support element.
    - the US Core DiagnosticReport Profile for Report and Note Exchange already supports `DiagnosticReport.performed[x]` as a Must Support element.
    - the US Core Immunization Profile already supports `Immunization.occurrence[x]` as a Must Support element.

  - For the USCDI Average Blood Pressure data element, the new US Core Average Blood Pressure Profile has been added to US Core. It is based on the US Core Blood Pressure Profile and uses the Vital Signs with Qualifying Elements: Average Blood Pressure Profile as a blueprint.

  - For the USCDI Medications data class and elements, the US Core MedicationRequest Profile already supports Medication Instructions and has been updated to support Medication Adherence as an Additional USCDI Requirement using the new US Core Medication Adherence Extension.

  - For the USCDI Laboratory data class and elements, the US Core Laboratory Result Observation Profile already supports Result Unit of Measure data element for using UCUM for coded quantity units and has been updated to support Result Reference Range and Result Interpretation as Must Support elements. The US Core Specimen Profile has been updated to support Specimen Identifier as a Must Support element, and Specimen Source Site and Specimen Condition Acceptability as Additional USCDI Requirements.

  - For the USCDI Goals and Preferences data class Treatment Intervention Preference and Care Experience Preference data elements, US Core Treatment Intervention Preference Profile and US Core Care Experience Preference Profile have been added to US Core and use the PACIO Advance Directive Interoperability Implementation Guide's Care Experience Preference Profile and Personal Intervention Preference Profile as blueprints.

  - For the USCDI Health Status Assessments data class, including the data elements Physical Activity, Substance Use, and Alcohol Use, US Core's Screening and Assessments Guidance is used. To enhance interoperability, an extensible "starter set" of concepts constrains each Screening and Assessments domain. These value sets are summarized here.
- Clarify USCDI Requirements: We updated our documentation and approach on the relationship between USCDI and US Core how we identify Must Support vs Additional USCDI Requirements. See examples of this and association documentation:
  - US Core Patient Profile
  - US Core Conformance Artifacts
  - Additional USCDI Requirements
  - USCDI
  - Summary of Additional USCDI Requirement References

- We continue our efforts to link terminology directly to the FHIR® Terminology Service for VSAC Resources (Value Set Authority Center (VSAC) where applicable and, as a result, align terminology between US Core and HL7 C-CDA. The following value sets have been moved:

  Pre 7.0.0-Ballot US Core ValueSet | 7.0.0-Ballot VSAC ValueSet
  --- | ---
  US Core Sexual Orientation | Sexual Orientation

- Added Procedure.reasonCode and Procedure.reasonReference as Additional USCDI Requirements to meet the USCDI Data Element,Reason for Referral when a ServiceRequest is not used to request a procedure. See these changes:
  - US Core Procedure
  - US Core ServiceRequest
  - Procedure Example
  - USCDI

- Scopes: To meet the ONC’s granular scope requirement in HTI-1 proposed rule, we added required support for granular scopes as defined in Version 2.0.0 of SMART App Launch and moved the SMART scopes guidance from Future of US Core to a Conformance Page and updated requirements for each profile.

- FHIR Write: Add Argonaut Write Guidance for Vital Sign Observations to Record or Update Data section on the Future of US Core Page. See Changes Here and Here

- Based on the feedback from the US Core variance request process, we updated several profiles to permit implementers can references to other `subject` entities as defined in the base standard. This is in addition to the Must Support reference to US Core Patient. We are interested in comments on what the impact on client applications will be. For an example of this change Here)

- Implementers submitted over 60 trackers since the publication of US Core ver 6.0.0 and 6.1.0 We have addressed them and applied over 50 changes listed below:

Tracker Status: Summary Jira Issue Link to Updated Content

1. APPLIED: Update CarePlan text status element's short description to reflect the status values FHIR-43015 See Changes Here
2. APPLIED: Update Smoking Status status element's short description to reflect the status values FHIR-43118 See Changes Here
3. APPLIED: Correct invalid invariants us-core-3 and us-core-4 FHIR-41523 See Changes Here and Here and Here
4. APPLIED: Correct invalid invariants pd-1 and us-core-13 FHIR-41586 See Changes Here
5. APPLIED: Correct invalid invariant us-core-1 FHIR-41670 See Changes Here and Here
6. APPLIED: Correct invalid SearchParameter expression for USCoreConditionAssertedDate FHIR-41673 See Changes Here
7. APPLIED: Fix Typo in Tribal Extension FHIR-41739 See Changes Here
8. APPLIED: Fix Missing Data Example FHIR-42805 See Changes Here
9. APPLIED: Update introduction to USCDI tableFHIR-42801 See Changes Here
10. APPLIED: Fix us-core-5 invariant FHIR-42814 See Changes Here
11. APPLIED: Update guidance on referencing PractitionerRole FHIR-42906 See Changes Here and Here
12. APPLIED: Add Project US@ Requirements FHIR-43025 See Changes:
    - US Core Patient
    - Patient Example
    - US Core RelatedPerson
    - US Core Organization
    - US Core Practitioner
    - US Core Location
13. APPLIED: Fix Typo: Change ServiceRequest.reasonReference to Observation.derivedFrom FHIR-43045 See Changes Here
14. APPLIED: Add link in history page to approved patches FHIR-42950 See Changes Here
15. APPLIED: Medication Adherence Scope Clarification FHIR-42845 See Changes Here and Here
16. APPLIED: Update profile + interaction requirements FHIR-42789 and FHIR-42847 See Changes Here
17. APPLIED: Provide guidance on NAHDO SOP codes for Medicare Part A,B,C,and D FHIR-42793 See Changes Here
18. APPLIED: Correct description of Occupation Profile FHIR-42867 See Changes Here
19. APPLIED: Move the SMART scopes guidance from Future of US Core to a Conformance Page FHIR-42864 See Changes Here and Here
20. APPLIED: Add Argonaut Write Guidance for Vital Sign Observations to Record or Update Data section on the Future of US Core Page FHIR-42863 See Changes Here and Here
21. APPLIED: Migrate US Core Terminology to VSAC FHIR-42846 See this version's introduction
22. APPLIED: Clarify note in Search Parameters and Operations page FHIR-42783 See Changes Here
23. APPLIED: Fix errors in USCDI mapping table FHIR-42862 See Changes Here
24. APPLIED: Clarify Coverage status FHIR-42777 See Changes Here
25. APPLIED: Permit Subject element to references to other entities besides Patient FHIR-42759 See Changes Here
26. APPLIED: Correct Regex for us-core-1 XPath invariant FHIR-42738 See Changes Here)
27. APPLIED: Add USCDI Version 4 Data Elements to US Core FHIR-42161 See the Introduction to this version above and Changes Here
28. APPLIED: Remove guidance to identify version of SNOMED in an instance FHIR-42160 See Changes Here
29. APPLIED: Add Procedure.reasonCode and Procedure.reasonReference as Reason for Referral FHIR-42136 and FHIR-41761 See Changes:
    - US Core Procedure
    - US Core ServiceRequest
    - Procedre Example
    - USCDI
30. APPLIED: USCDI - FHIR US Core Relationship Clarification FHIR-42130 See Changes Here
31. APPLIED: Typo FHIR-42069 See Changes Here
32. APPLIED: Clarify when to include multiple attachments as part of a clinical note FHIR-41902 See Changes Here
33. APPLIED: Limit context for jurisdiction extension FHIR-41867 See Changes Here
34. APPLIED: Add VSAC Value Sets to Terminology Page FHIR-41681 See Changes Here
35. APPLIED: APGAR should be Apgar FHIR-41666 See Changes Here
36. APPLIED: Correct invalid invariants pd-1 and us-core-13 FHIR-41586 See Changes Here
37. APPLIED: Clarify Additional USCDI Requirements FHIR-41572 See Changes:
    - US Core Patient Profile
    - US Core Conformance Artifacts
    - Additional USCDI Requirements
    - USCDI
    - Summary of Additional USCDI Requirement References
38. APPLIED: Change ASKU in value set to asked-declined FHIR-41571 See Changes Here and Here
39. APPLIED: update canonical urls in examples and capability statements to include the version FHIR-41256 See Changes Here and Here
40. APPLIED: Add Preferred Language guidance FHIR-40773 See Changes Here
41. APPLIED: Update UCUM guidance FHIR-40604 See Changes Here
42. APPLIED: Added interpretation to laboratory result examples FHIR-40297 See Changes Here

The following trackers have been identified as publishing issues and we will work with HL7 publishing to resolve them.

1. APPLIED Excel downloads missing header row FHIR-41709
2. PUBLISHING Condition profile descriptions are not appearing in IG Detailed Description Snapshot View (other places) FHIR-40813
3. PUBLISHING RelatedPerson relationshiptype should have binding to FHIR value set RelatedPerson-relationshiptype FHIR-34755
4. PUBLISHING: AllergyIntolerance does not show constraint FHIR-34636
5. PUBLISHING Confusing for commercial vendor. Reads very confusing. FHIR-30783
6. PUBLISHING In most of the data elements – “Binding is from base FHIR and US Core Vital Signs” Need this to be one single combined listing FHIR-30780
7. PUBLISHING valueset-simple-language.xml QA Error FHIR-30107
8. APPLIED Patient Examples QA Errors: CDCREC code system in VSAC FHIR-30105

### Version = 6.1.0 (Meets USCDI v3 Requirements)

- url: https://hl7.org/fhir/us/core/STU6.1/
- Based on FHIR version : 4.0.1

The changes in this STU Update to US Core 6.0.0 have been reviewed by the public through the HL7 STU update process. The resolution of the community comments has been agreed to and voted on by the members of the HL7 International Cross-Group Projects work group.

#### What's new in Version 6.1.0 of US Core:

To meet the U.S. Core Data for Interoperability (USCDI) v3 "sex" data element, US Core added the US Core Sex Extension as a USCDI Requirement(). The US Core Birth Sex Extension is no longer a USCDI Requirement.

#### Updates and Corrected Errata in Version 6.1.0 of US Core:

Tracker Status: Summary Jira Issue Link to Updated Content

1. Applied: Add Sex extension necessary to satisfy USCDI v3 FHIR-41301 and FHIR-41352 See Changes Here, Here, and Here
2. Applied: Update link to CDC Race and Ethnicity Code Set FHIR-41277 See Changes Here
3. Applied: Typo change `Condition.onsetDate` to `Condition.onsetDateTime` FHIR-41239 See Changes Here
4. Applied: Clarify US Core USCDI Requirement Extension not intended for implementers FHIR-41238 See Changes Here
5. Applied: Correct Provenance Example FHIR-41316 See Changes Here
6. Applied: Update Changes between versions table FHIR-41434 See Changes Here
7. Applied: update us-core-3 and us-core-4 FHIR-41454 See Changes Here

### Version = 6.0.0

- url: https://hl7.org/fhir/us/core/STU6/
- Based on FHIR version : 4.0.1

The changes in this annual update to US Core have been reviewed and commented upon by the public through the January 2023 HL7 balloting process. The resolution of the community comments has been agreed to and voted on by the members of the HL7 International Cross-Group Projects work group.

#### What's new in Version 6.0.0 of US Core:

Each update to a new version of US Core changes the US Core Profiles and conformance expectations. Implementers can find detailed comparisons between the FHIR artifacts in this 6.0.0 version of US Core and each previous major release on Changes Between Versions page. This section provides an overview of the significant changes in Version 6.0.0 of US Core.

- New and updated resources to meet the U.S. Core Data for Interoperability (USCDI) v3 new Data Elements and Classes that the Office of the National Coordinator (ONC) published in July of 2022. This table summarizes the USCDI Data Classes and Data Elements and the corresponding US Core Profile(s).
  - The new US Core Coverage Profile represent and access data related to an individual's health insurance coverage for health care.
  - The profiles from version 5.0.1 have been renamed and re-scoped in this version to accommodate the USCDI Health Status/Assessments Data Classes.
    - The US Core Observation Screening Assessment Profile replaces the US Core Observation Survey Profile and US Core Observation SDOH Assessment Profile, and the US Core Simple Observation Profile replaces the US Core Observation Social History Profile. See the Cross Version Comparisons Table on the Changes Between Versions page for a summary of profile revisions between versions.
    - The SDOH Assessments documentation has been rewritten and renamed to Screening and Assessments, reflecting its expanded coverage of Health Status/Assessments Data Elements including: Functional Status, Disability Status, and Mental/Cognitive Status in addition to SDOH Assessments.
  - The new US Core Observation Pregnancy Status Profile and US Core Observation Pregnancy Intent Profile have been added to communicate pregnancy status.
  - The US Core Laboratory Result Observation Profile supports the result status and terminology requirements for coded and numeric results.
  - The new US Core Specimen Profile has been added to support Specimen Type.
  - The US Core MedicationRequest Profile was updated to support Dose, Dose Unit of Measure, Indication,.
  - The new US Core MedicationDispense Profile has been added to support Fill Status.
  - Updated Patient Demographics/Information:
    - To support Date of Death US Core Patient Profile was updated
    - The new US Core Tribal Affiliation Extension has been added to support Tribal Affiliation
    - The US Core Birth Sex Extension meets the patient sex requirement (NOTE: US Core 6.1.0 added the US Core Sex Extension as a USCDI Requirement. The US Core Birth Sex Extension is no longer a USCDI Requirement.)
    - To support Related Person's Name and Related Person's Relationship US Core RelatedPerson Profile was updated
    - The new US Core Observation Occupation Profile supports a patient's Occupation and Occupation Industry
  - Reason for Referral is supported by an updated US Core ServiceRequest Profile and US Core Procedure Profile

- The US Core Observation Clinical Result Profile supersedes version 5.0.1 US Core Observation Clinical Test Result Profile and US Core Observation Imaging Result Profile. In addition, it is the base for the US Core Laboratory Result Observation Profile. The Cross Version Comparisons Table on the Changes Between Versions page summarized these significant revisions.

- Document the USCDI Requirement conformance category: Besides Mandatory and Must Support elements, the US Core Profile elements consist of USCDI Requirements elements for ONC Health IT Certification. This version clarifies the meaning and documents how it is communicated in the StructureDefinitions and on the profile pages

- Expanded CapabilityStatement Narrative: Each US Core Profile contains references to other resources that it depends on or is related to. The CapabilityStatements narrative provides a table summarizing the Must Support references for US Core Profiles to help implementers understand their required capabilities.

- Expanded documentation on the Terminology page: In addition to detailing the Code Systems unique to this guide, links all the Code Systems used in US Core are listed.

- Introduce US Core SMART Scopes as a candidate requirements under consideration, and provide example for each Profile.

- We continue our efforts to link terminology directly to the FHIR® Terminology Service for VSAC Resources (Value Set Authority Center (VSAC) where applicable and, as a result, align terminology between US Core and HL7 C-CDA.

#### Changes:

These changes are a result of over 150 January 2023 Ballot related trackers which are listed below:

Tracker Status: Summary Jira Issue Link to Updated Content

1. Applied: Remove html entities from examples FHIR-37474
2. Applied: Change Condition patient + category search to SHALL support FHIR-37918 See Changes Here
3. Applied: Diagnostic Report Laboratory Codes LOINC CLASSTYPE value should be "1" FHIR-37933 See Changes Here
4. Applied: Additional guidance for accessing imaging studies FHIR-38808 See Changes Here
5. Applied: Allow multiple NPIs for Organizations and Practitioners FHIR-39382 See Changes Here
6. Applied: Keep QuestionnaireResponse and Update Screening and Assessments page FHIR-39495 See Changes:
   - Here
   - Here
   - Here
   - Here
   - Here
   - Here
   - Here
7. Applied: Fix slicing in Observation.component:industryFHIR-39608 See Changes Here
8. Applied: Add support for Condition search that include patient + category + status FHIR-39610 See Changes Here
9. Applied: Reference only reason for using MedicationDispense FHIR-39611 See Changes Here
10. Applied: Revert to simplegenderIdentify extension FHIR-39615 See Changes Here
11. Applied: Duplicated words FHIR-39637 See Changes Here
12. Applied: Missing comma FHIR-39638 See Changes Here
13. Applied: Clarify that Observation.specimen is a MustSupport FHIR-39639 See Changes Here
14. Applied: Clarify and updates examples to use SNOMED CT US Edition FHIR-39640 See Changes Here and Here
15. Applied: Add NDC codes to the Medication Guidance FHIR-39641 See Changes Here
16. Applied: Extra trailing parenthesis FHIR-39643 See Changes Here
17. Applied: Clinical Judgement Profile does not exist FHIR-39650 See Changes Here
18. Applied: Clarify the difference between Simple Observation and Screening Assessment FHIR-39652 See Changes Here and Here
19. Applied: uscore or us-core FHIR-39653
20. Applied: Fix $docref examples FHIR-39658 See Changes Here
21. Applied: Resolve conflicting guidance in Observation Blood Pressure FHIR-39659 See Changes Here
22. Applied: Clarify how profiles are defined FHIR-39703 See Changes Here and Here and Here
23. Applied: Clarify where the US Core Profile FHIR Restful transactions are defined? FHIR-39704 See Changes Here
24. Applied: Use ValueSet and not value set when a FHIR ValueSet is intended FHIR-39705 See Changes Here
25. Applied: Use uppercase "Must Support" and not lowercase "must support" FHIR-39706
26. Applied: Document Must Support and Modifier Elements FHIR-39707 See Changes Here
27. Applied: Common format for Resources and Resource fields FHIR-39708
28. Applied: Use of mandatory text FHIR-39709
29. Applied: Add reference to FHIR section on language support FHIR-39710 See Changes Here
30. Applied: Refer to FHIR specification as base definition for RESTful operations FHIR-39711 See Changes Here
31. Applied: POST based searches FHIR-39712 See Changes Here
32. Applied: Clarify compartment based search FHIR-39713 See Changes Here
33. Applied: Updated CapabilityStatement to list un-profiled required resources FHIR-39714 See Changes Here
34. Applied: Change "Systems" to "Servers" FHIR-39716 See Changes Here
35. Applied: Update "Clinical Note Server" to "FHIR Server" FHIR-39717 See Changes Here and Here
36. Applied: DocumentReference, DiagnosticReport and embedded documents FHIR-39718 See Changes Here
37. Applied: Correction and clarify use of $expand FHIR-39719 See Changes Here and Here
38. Applied: Clarify MedicationAdministration and MedicationStatement support. FHIR-39720 See Changes Here
39. Applied: The use of Observations where QuestionnaireReponse is more applicable FHIR-39722 See Changes Here
40. Applied: Updated CapabilityStatement to list required referenced profiles and resources FHIR-39723 See Changes Here
41. Applied: External link is missing FHIR-39725 See Changes Here
42. Applied: Change whenHandedOver from min =1 to min =0 FHIR-39732 See Changes Here
43. Applied: Wrong resource referenced FHIR-39733 See Changes Here
44. Applied: plural/singular mismatch FHIR-39734 See Changes Here
45. Applied: Screening and Assessment typo FHIR-39735 See Changes Here
46. Applied: Missing Hyperlinks FHIR-39736 See Changes Here
47. Applied: Clarify period of pregnancy intent FHIR-39737 See Changes Here
48. Applied: Missing Hyperlinks FHIR-39738 See Changes Here and See Changes Here
49. Applied: Add a "memberId" slice to Coverage.identifier and add guidanceFHIR-39743 See Changes Here
50. Applied: Change RelatedPerson search to combination of Patient + Name FHIR-39791 See Changes Here
51. Applied: RelatedPerson uses text from Observation Laboratory profile FHIR-39792 See Changes Here
52. Applied: Reference only reason for using MedicationDispense FHIR-39856 See Changes Here
53. Applied: Adjust USCDI Mapping references to MedicationRequest Profile FHIR-39857 See Changes Here
54. Applied: Adjust USCDI Mapping references to DiagnosticReport Profile FHIR-39858 See Changes Here
55. Applied: Add USCDI Mapping references for Disability Status and Mental/Cognitive Status FHIR-39859 See Changes Here
56. Applied: Adjust USCDI Mapping references to Patient Profile FHIR-39860 See Changes Here
57. Applied: Fix Value set expansion FHIR-39861 See Changes Here
58. Applied: Extensions - context of use FHIR-39863 See Changes Here
59. Applied: Add more Lab Result examples FHIR-39868 See Changes Here
60. Applied: MedicationRequest - Change prescriber to 0..1 this information is not known for patient reported medications. FHIR-39869 See Changes Here
61. Applied: Update Profile Formal Views labels FHIR-39873
62. Applied: Provide guidance for Prescriptions Sent by Mail FHIR-39878 See Changes Here
63. Applied: Change CarePlan.text from Mandatory min = 1 to Must Support min = 0 FHIR-39902 See Changes Here
64. Applied: Using SNOMED CT United States Edition Typo FHIR-39903 See Changes Here
65. Applied: Update the Change log FHIR-39923 See Changes Here
66. Applied: Define the term Screening and Assessment FHIR-39938 See Changes Here
67. Applied: Clarify that Simple Observation Profile captures any sort of “simple” observations FHIR-39940 See Changes Here
68. Applied: Correct the description of the Simple Observation Profile FHIR-39942 See Changes Here
69. Applied: Provide further guidance on use of US Core vs other domain specific IGs FHIR-39943 See Changes Here
70. Applied: Reframe Screening and Assessments Page FHIR-39944 See Changes Here
71. Applied: Update the Screening and Assessment Activities diagram FHIR-39945 See Changes Here
72. Applied: Update the “Screening and Assessment Activities” diagram with proper profile name FHIR-39946 See Changes Here
73. Applied: Update Screening and Assessments” title and content FHIR-39947 See Changes Here
74. Applied: Correct titleFHIR-39948 See Changes Here
75. Aoplied: Update description of Screening Assessments Profile FHIR-39949 See Changes Here
76. Applied: Change Header FHIR-39950 See Changes Here
77. Applied: Correct title of section 3.6.2.2 US Core Observation Simple Observation Profile FHIR-39951 See Changes Here
78. Applied: Require US Core Server to support the Simple Observation profile for simple assessments FHIR-39953 See Changes Here
79. Applied: Correct the link and sentence for assessment category codes FHIR-39954 See Changes Here
80. Applied: Describe the purpose and intent of “Grouping” and update the diagram FHIR-39955 See Changes Here
81. Applied: Remove US Core Common SDOH Assessments ValueSet FHIR-39956
82. Applied: Fix link text FHIR-39958 See Changes Here
83. Applied: Remove MS from Observation Screening Assessment Observation.performer Practitioner Reference FHIR-39964 See Changes Here
84. Applied: Revert references the US Core QuestionnaireResponse Profile FHIR-39965 See Changes Here
85. Applied: Correct link issue in “Profile specific implementation guidance section” of the ServiceRequest Profile FHIR-39966 See Changes Here
86. Applied: Coverage.type binding clarification FHIR-39982 See Changes Here
87. Applied: Rename US Core Observation Category Value Set FHIR-40034 See Changes Here
88. Applied: Extra ) in Screening and Assessments FHIR-40041 See Changes Here
89. Applied: Fix the link. FHIR-40043 See Changes Here
90. Applied: Fix Pregnancy status codes FHIR-40045 See Changes Here
91. Applied: RelatedPerson profile text contains Observation content FHIR-40048 See Changes Here
92. Applied: 2 typos in history page FHIR-40069 See Changes Here
93. Applied: Reword a Quick Start example FHIR-40072 See Changes Here
94. Applied: Consider alternative answer choices for pregnancy intent codes FHIR-40084 See Changes Here
95. Applied: Improve Screening Assessment Observation.hasMember short description FHIR-40085 See Changes Here
96. Applied Update the “bindings when slicing by value sets” figure FHIR-40086 See Changes Here
97. Applied: Update Condition category slices to align with Observation/ServiceRequestFHIR-40087 See Changes Here
98. Applied: Add guidance to the Procedure profile to express sdoh category FHIR-40088 See Changes Here and
99. Applied: Improve language as to the expectations of clinicalStatus when category is problem list FHIR-40089 See Changes Here
100. Applied: Align with FHIR DS4P IG FHIR-40090 See Changes Here
101. Applied: Remove AHC HRSN screening tool examples FHIR-40091
102. Applied: Add guidance show collection method and performer can be captured using Provenance FHIR-40092 See Changes Here and Here
103. Applied: Remove MustSupport from DocumentReference.category requiring clinical-note FHIR-40102 See Changes Here
104. Applied: Add Goal.startDate as 0..1 MS with choice of supporting this or Goal.target.dueDate FHIR-40103 See Changes Here
105. Applied: Clarify that other category codes are permitted and Remove MS from Observation.performer Practitioner Reference FHIR-40104 See Changes Here
106. Applied: Add to the code systems chart FHIR-40124 See Changes Here
107. Applied: Make Specimen.subject must support FHIR-40136 See Changes Here
108. Applied: Clarify use of unknown for occupation. FHIR-40137 See Changes Here, Here and Here
109. Applied: Clarify applicability of DiagnosticReport in USCDI Mapping FHIR-40138 See Changes Here
110. Applied: Remove the word "status" from introductory text FHIR-40149 See Changes Here
111. Applied: Incorrect link for "record or update" and additional examples FHIR-40151 See Changes Here
112. Applied: Incorrect Resource noted in the introductory paragraph FHIR-40155 See Changes Here
113. Applied: Define JobFHIR-40158 See Changes Here
114. Applied: Member or subscriber id is must have but the element cardinality is 0..* FHIR-40160 See Changes Here
115. Applied: Modify comment regarding Screening and Assessments FHIR-40161 See Changes Here
116. Applied: Modify Examples/ValueSet for Language Codes FHIR-40165 See Changes Here
117. Applied: Add Guidance for more advanced Occupation detail.FHIR-40166 See Changes Here
118. Applied: Add implementer guidance FHIR-40170 See Changes Here
119. Applied: Add guidance for current job FHIR-40172 See Changes Here
120. Applied: Add guidance to clarify multiple codings can be used FHIR-40178 See Changes Here
121. Applied: Add _include guidance for Specimen FHIR-40180 See Changes Here
122. Applied: Update Industry NAICS Detail (ODH) to extensible. FHIR-40181 See Changes Here
123. Applied: Remove duplicate of Notes: Quick Start intro bullets FHIR-40182 See Changes Here
124. Applied: Add search guidance FHIR-40183 See Changes Here
125. Applied: Update profile description to state the profile represents a patient's 'Past or Present Job' FHIR-40187 See Changes Here
126. Applied: Give guidance on SMART v2 scopes FHIR-40192 See Changes Here and Here
127. Applied: Remove the SFCU extension, and retain the birth-sex extension to meet USCDI Patient Sex. FHIR-40197 See Changes Here
128. Applied: Clarify guidance FHIR-40199 See Changes Here
129. Applied: Document expectations for Additional USCDI Requirements FHIR-40200 See Changes Here and Here
130. Applied: ServiceRequest Profile Implementation Specific Guidance - incorrect reference to ServiceRequest.reasonCode FHIR-40202 See Changes Here
131. Applied: Tribal Affiliation Extension - add guidance to that extension:isEnrolled is an optional extension FHIR-40203 See Changes Here
132. Applied: Change Observation Occupation binding strength extensible FHIR-40204 See Changes Here
133. Applied: Change whenHandedOver cardinality 0..1 FHIR-40205 See Changes Here
134. Applied: MedicationRequest.reasonCodeableConcept does not exist FHIR-40235 See Changes Here
135. Applied: Clarify patient previous name and previous address FHIR-40299 See Changes Here
136. Applied: Update PractitionerRole.role binding FHIR-40372 See Changes Here
137. Applied: Remove MS from Patient on CareTeam.participant.member FHIR-40415 See Changes Here
138. Applied: Update laboratory results example FHIR-40427 See Changes Here
139. Applied: Update laboratory results example FHIR-40428 See Changes Here
140. Applied: Add Specimen to BUN example FHIR-40429 See Changes Here
141. Applied: Additional guidance for accessing imaging studies FHIR-40514 See Changes Here
142. Applied: Update example to follow 58410-2 CBC panel FHIR-40521 See Changes Here
143. Applied: Flag additional USCDI requirements in a computable way FHIR-40553 See Changes Here
144. Applied: Corrected expression in Condition asserted-date search parameter FHIR-40573 See Changes Here
145. Applied: List only base profiles for reasonReference. FHIR-40656 See Changes Here and Here
146. Applied: Remove US Core QuestionnaireResponse Tag Element FHIR-40742 See Changes Here and Here
147. Applied: Clarify Direct address options FHIR-40583 See Changes Here

### Version = 6.0.0 - ballot

- url: https://hl7.org/fhir/us/core/2023Jan/
- Based on FHIR version : 4.0.1

#### The January 2023 Ballot

This ballot addresses the following:

- We have updated US Core to include the U.S. Core Data for Interoperability (USCDI) v3 Data Elements and Classes that the Office of the National Coordinator (ONC) published in July of 2022:

  - Applied: Health Insurance Information Using US Core to represent and access data related to an individual's insurance coverage for health care.
  - Applied: The SDOH Assessments documentation has been rewritten and renamed to Screening and Assessments, reflecting its expanded coverage of Health Status/Assessments Data Elements. It documents how to use US Core Observation Screening Assessment Profile and the US Core Simple Observation Profile to represent and access health status and assessments, including: Functional Status, Disability Status, and Mental/Cognitive Status in addition to SDOH Assessments.
  - Applied: US Core Observation Pregnancy Status Profile and US Core Observation Pregnancy Intent Profile have been added to specifically address pregnancy status.
  - Applied: Laboratory: The US Core Laboratory Observation Profile already supports the result status and terminology requirements for coded and numeric results. The US Core Specimen Profile has been added to support Specimen Type.
  - Applied: Medications: Updates to the US Core MedicationRequest Profile to support Dose, Dose Unit of Measure, Indication and the US Core MedicationDispense Profile has been added to support Fill Status.
  - Applied: Patient Demographics/Information
    - Date of Death See Change Here
    - Tribal Affiliation See Change Here
    - Sex (for clinical use)See Change Here
      - Note that the US Core BirthSex Extension will not be deprecated.
    - Related Person's Name and Related Person's Relationship See
    - Occupation and Occupation Industry See Change Here
  - Applied: Procedures: Reason for Referral See Change Here and See Change Here
- Several profiles from version 5.0.1 have been retired or renamed and rescoped in this version to accommodate the USCDI Health Status/Assessments Data Classes and as a result of implementer feedback. The Cross Version Comparisions Table summarized these significant revisions.
- We continue our efforts to link terminology directly to the FHIR® Terminology Service for VSAC Resources (Value Set Authority Center (VSAC) - NIH) where applicable and, as a result, align terminology between US Core and HL7 C-CDA.
- Implementers submitted over 70 trackers since the publication of US Core ver 5.0.0 and 5.0.1. We have addressed them and applied over 50 changes listed below:

Tracker Status: Summary Jira Issue Link to Updated Content

1. Applied: US Core: Require Provenance Resource for Create/Update/Delete Events, AuditEvent for Read FHIR-14388 See Changes Here and See Changes Here
2. Applied: Add recommended search combination of patient + status FHIR-19803 See Changes Here
3. Applied: Consider adding years since quite smoking FHIR-20131 See Changes Here
4. Applied: Create a US Core extension to communicate the state jurisdiction for an element FHIR-26943 See Changes Here
5. Applied: Update missing data for coded data examples FHIR-31381 See Changes Here
6. Applied: Clarify the purpose of Clinical Test Observation Profile FHIR-35114 See Changes Here
7. Applied: Clarify how to read Profile Page FHIR-36083 See Changes Here
8. Applied: Clarify organization responsible for the DocumentReference FHIR-36654 See Changes Here
9. Applied: Clarify Device UDI-PI requirements FHIR-36657 See Changes Here
10. Applied: Add 'problem-list-item' condition example FHIR-36759 See Changes Here
11. Applied: Fix LOINC LP code links FHIR-36763 See Changes Here
12. Applied: Fix Link to "Direct Secure Messaging" FHIR-36764 See Changes Here
13. Applied: Update US Core Practitioner to clarify work related contact information FHIR-36765 See Changes Here
14. Applied: CLD for US Core Non Laboratory Codes value set is not computable FHIR-36789 See Changes Here
15. Applied: US Core Organization slice for CLIA does not list an HTA/THO approved external identifier system FHIR-36926 See Changes Here
16. Applied: Remove effectiveDateTime invariant from Sexual Orientation and Simple Observation (aka Social History) Profiles FHIR-36932 See Changes Here and See Changes Here
17. Applied: Correct code system URI for HCPCS FHIR-37336 See Changes Here
18. Applied change 'resources' to 'profiles' FHIR-37343 See Changes Here
19. Applied: Clarify Expectations for Observation.value[x] in blood pressure and pulse oximetry profiles FHIR-37358 See Changes Here and See Changes Here
20. Applied: Clarify vaccineCode code system URI FHIR-37400 See Changes Here
21. Applied: Typos on SDOH Guidance Page FHIR-37469 See Changes Here
22. Applied Add Constraint to validate NPI FHIR-37498 See Changes Here and See Changes Here
23. Applied: Remove extra instance or the word "resource" in Lab observation narrative profile FHIR-37507 See Changes Here
24. Applied: Allow multiple Gender Identities and associated dates. FHIR-37509 See Changes Here
25. Applied: Typos on Patient and Practitioner "Name" SearchParameter pages FHIR-37541 See Changes Here and See Changes Here
26. Applied: Add Guidance on DocumentReference.category FHIR-37592 See Changes Here
27. Applied: Correct us-core-6 invariant expression FHIR-37704 See Changes Here
28. Applied: Change Immunization.primarySource to must support and update definition FHIR-37723 See Changes Here
29. Applied: Added supportedProfiles to US Core CapabilityStatementsFHIR-37766 See Changes Here
30. Applied: Clarify how to use categories vis a vis codes in US Core Diagnostic Report Category element FHIR-37770 See Changes Here
31. Applied: Clarify that US Core requires any version of SMART? FHIR-37813 See Changes Here
32. Applied: Typo of "DiagnostisReport" in Clinical Notes Guidance FHIR-37819 See Changes Here
33. Applied: Update $docref type input to multiple Codings FHIR-37894 See Changes Here and See Changes Here
34. Applied: Add Conformance expectation of SHOULD to resolve for server Capability FHIR-37901 See Changes Here
35. Applied: Change Condition patient + category search to SHALL support FHIR-37918 See Changes Here
36. Applied: Typo in Observation SDOH profile FHIR-37928 See Changes Here
37. Applied: Typo in Condition Problems and Health Concerns search example FHIR-37929 See Changes Here
38. Applied: Update Laboratory Loinc Valueset description FHIR-37933 See Changes Here
39. Applied: Clarify that guide uses US Edition of SNOMED and update links to it FHIR-38190 See Changes Here
40. Applied: Update QuickStart to include all the search requirements by type. FHIR-38629 See Changes Here
41. Applied: Specify $docref's operates on DocumentReference endpoint FHIR-38658 See Changes Here
42. Applied: Remove comment in $docref FHIR-38686 See Changes Here
43. Applied: Add USCDI V3 Requirements FHIR-38702 See Changes Listed in introduction above.
44. Applied: Correct documentation on Procedure.performed attribute FHIR-38737 See Changes Here
45. Applied: Improve docref documentation FHIR-38746 See Changes Here
46. Applied: Fix title for US Core Pediatric Head Occipital Frontal Circumference Observation Profile FHIR-38794 See Changes Here
47. Applied: Add Refill and Quantity to MedRequest FHIR-39343 See Changes Here
48. Applied: Fix Quick Start Rendering FHIR-39367 See Changes Here
49. Applied: Remove Bulk Dependency FHIR-39377 See Changes Here
50. Applied: Fix Cross Version Comparisons section FHIR-39417 See Changes Here
51. Applied: Add Ballot Comment to CarePlan for community feedback FHIR-32949 See Changes Here
52. Applied: Change ServiceRequest.category to min=0 FHIR-39493 See Changes Here
53. Applied: Fix provenance-1 FHIR-39518 See Changes Here

### Version = 5.0.1 (Meets USCDI v2 Requirements)

- url: https://hl7.org/fhir/us/core/STU5.0.1/
- Based on FHIR version : 4.0.1

The changes in this errata to version 5.0.0 of US Core have been reviewed by the public through the HL7 errata process. The resolution of the community comments has been agreed to and voted on by the members of the HL7 International Cross-Group Projects work group.

#### Corrected Errata in Version 5.0.1 of US Core:

Tracker Status: Summary Jira Issue Link to Updated Content

1. Applied: Typos in Condition Profile URls FHIR-37585 See Changes:
   - Here
   - Here
2. Applied: Update VSAC dependency package version and remove STU Notes where expansion now supported by publisher FHIR-37586
3. Applied: Correct misapplied tracker - for `agent.who` remove MS from reference Practitioner and add to Organization FHIR-28517 See Change Here

### Version = 5.0.0

- url: https://hl7.org/fhir/us/core/STU5/
- Based on FHIR version : 4.0.1

The changes in this annual update to US Core have been reviewed and commented upon by the public through the January 2022 HL7 balloting process. The resolution of the community comments has been agreed to and voted on by the members of the HL7 International Cross-Group Projects work group.

#### What's new in Version 5.0.0 of US Core:

- New and updated resources to meet the U.S. Core Data for Interoperability (USCDI) v2 new Data Elements and Classes that the Office of the National Coordinator (ONC) published in July of 2021:
  - A Social Determinants Of Health (SDOH) guidance page on using US Core to represent and access SDOH Assessments, Goals, Interventions, and Problems/Health Concerns.
  - US Core Observation Survey Profile, US Core Observation SDOH Assessment Profile, and US Core QuestionnaireResponse Profile to represent SDOH Assessments
  - US Core ServiceRequest Profile to represent SDOH Interventions
  - US Core Observation Clinical Result Profile to represent Clinical Test Results
  - US Core Observation Clinical Result Profile to represent Imaging Results
  - US Core Gender Identity Extension for patient demographics
  - US Core Observation Sexual Orientation Profile for patient demographics
  - US Core RelatedPerson Profile to represent care member such as a caretaker.
  - Updates to US Core CareTeam Profile
  - Updates to US Core Encounter Profile
  - US Core Condition has been split into:
    - US Core Condition Encounter Diagnosis Profile to represent encounter diagnosis
    - US Core Condition Problems and Health Concerns Profile to represent problems and health concerns included SDOH health concerns.
- New pages and headers:
  - Change Log new header and page. content migrated from the Directory of published versions page to create this page
  - Conformance new Header that contains these pages:
    - General Requirements content migrated from version 4.0.0 General Requirements and Conformance Expectation pages
    - Must Support renamed and edited from version 4.0.0 Conformance Expectation pages
  - USCDI content migrated from version 4.0.0 General Requirements Page
  - Changes Between Versions rewritten and renamed from version 4.0.0 DSTU2 to R4 Conversion page
- Link more terminology directly to the FHIR Terminology Service for VSAC Resources and align terminology between US Core and HL7 C-CDA.

#### Changes:

These changes are a result of over 100 January 2022 Ballot related trackers which are listed below:

Tracker Status: Summary Jira Issue Link to Updated Content

1. Applied: Remove requirement for component SDOH Assessment's Observations FHIR-34384 See Change Here
2. Applied: Clarify clinicalStatus invariant FHIR-34468 See Change Here
3. Applied: Fix Ethnicity ValueSet description FHIR-34488 See Change Here
4. Applied: Remove MS from ServiceRequest.occurrenceDateTime add MS to ServiceRequest.occurrencePeriod FHIR-34493 See Change Here
5. Applied: Change Goal.description search requirement from SHALL to SHOULD FHIR-34546 See Change Here
6. Applied: Warn client that categorization is fuzzy for SDOH FHIR-34550 See Change Here
7. Applied: Split US Core Condition into two profile: Encounter Diagnosis and Problems/Health Concerns FHIR-34553 See Change:
   - Here
   - Here
8. Applied: Update narrative on abatement date FHIR-34554 See Change Here
9. Applied: Change Clinical Tests Observations category to "clinical-test" and add guidance FHIR-34555 See Changes:
   - Here
   - Here
   - Here
   - Here
10. Applied: Update all occurrences of U.S. Core Data for Interoperability (USCDI) v1 to v2 or removed specific references to version. FHIR-34613 For Example, See Change Here
11. Applied: Referencing US Core Profiles FHIR-34623 See Change Here
12. Applied: Correct code system in example snippetFHIR-34624 See Change Here
13. Applied: Add further clarification between slicing a binding (4.1.0) vs using extensible binding (4.0.0) FHIR-34626 See Change Here
14. Applied: Fix typo FHIR-34627
15. Applied: Clarify reported guidance on how secondary sourced MedicationRequest information can be represented. FHIR-34628 See Change Here
16. Applied: Fix contextDirection in Example 1FHIR-34629 See Change Here
17. Applied: Fix Medication List Examples FHIR-34630 See Change Here
18. Applied: Correct Careteam Narrative errors (remove reference to Organization) FHIR-34637 See Change Here
19. Applied: Fix typo FHIR-34638
20. Applied: Added missing search query parameter values FHIR-34642 See Change Here
21. Applied: Inconsistent on conditional required element FHIR-34643 See Change:
    - Here
    - Here
22. Applied: ServiceRequest.category:us-core should be required? FHIR-34645 See Change Here
23. Applied: Remove Condition.category "us-core-1" (due to FHIR-34553) and change Immunization.vaccineCode "us-core-1" to "us-core-5", Patient.name.family "us-core-8" to "us-core-6 " to remove duplicate invariant id, is now 'us-core-1', 'us-core-2', 'us-core-3', 'us-core-4', 'us-core-5', 'us-core-6', 'us-core-7', 'us-core-8', 'us-core-9','us-core-10','us-core-13', 'us-core-14' FHIR-34646 See Change:
    - Here
    - Here
24. Applied: Clarify that SDOH data elements does not include work information (see ODH) FHIR-34701 See Change:
    - Here
    - Here
25. Applied: Add 386053000 "Evaluation procedure" ,410606002 "Social service procedure" to the ServiceRequest Category Code FHIR-34747 See Change Here
26. Applied: Broaden Common SDOH assessment concepts and clarify is a starter set FHIR-34752 See Change:
    - Here
    - Here
    - Here
27. Applied: Clinical Test Result Observation Profile Must Have needs to address the 3 slices for procedure, exam, and activity in the explanatory text FHIR-34753 See Change Here
28. Applied: Clarify guidance for use of Patient.genderIdentity, Patient.birthsex, and pre-existing Patient.gender FHIR-34754 See Change Here
29. Resolved - change required: List profiles by type and create table comparing Observation Profiles FHIR-34890 See Changes:
    - Here
    - Here
    - Here
30. Applied: Lab Result and Specimen Information for RBC Observation is Missing FHIR-34910 See Change
    - Here
    - Here
    - Here
31. Applied: Added guidance on Observation.category limitations FHIR-34949 See Change Here
32. Applied: Add guidance on Imaging DiagnosticReport ontology FHIR-34958 See Change Here
33. Applied: Clarify that the profile guidance is not limited to profiled elements FHIR-34971 See Change Here
34. Applied: Fix asterisk notation in profiles FHIR-34972 See Change Here
35. Applied: Clarify "time" elements used in the DiagnosticReport profiles FHIR-34973 See Change:
    - Here
    - Here
36. Applied: Change the query parameter value to be consistent with previous statement FHIR-35047 See Change Here
37. Applied: Re-ordered sections in Downloads page and provide a zip file of schematrons FHIR-35064 See Change Here
38. Applied: Split General Guidance page into 1) USCDI 3)General Guidance. Split Conformance Expectations into General Requirements and Must Support. Move General Guidance to General Requirements FHIR-35065 See Changes:
    - Here
    - Here
    - Here
    - Here
39. Applied: Clarify expectations for supporting multiple versions of US Core.FHIR-35067 See Change Here
40. Applied: Clarify that Changes Between Versions (né DSTU2 to R4 Conversion) page documents a set of best practices FHIR-35068 See Change Here
41. Applied: Typo in Category Codes section FHIR-35072 See Change Here
42. Applied: Typo FHIR-35115
43. Applied: Provide guidance when specific code systems are to be used in ServiceRequest FHIR-35122 See Change Here
44. Applied: Clarify description for effective time. FHIR-35125 See Change Here
45. Applied: Fix CareTeam example's participant.role value FHIR-35152 See Change Here
46. Applied: US Core Condition profile "status" is ambiguous; clarify to be clinicalStatus FHIR-35280 See Change Here
47. Applied: Align Observation category for SDOH assessments FHIR-35282 See Change Here
48. Applied: Add effective[x] 0..1 MS to US Core Observation Social History Profile FHIR-35283 See Change Here
49. Applied: Clarify Condition.clinicalStatus requirements and searching using clinical-status FHIR-35318 See Change Here
50. Applied: Fix link FHIR-35362
51. Applied: Modify example usage text in all profile pages FHIR-35363 See Change Here
52. Applied: Clarify modeling of SDOH screening using Observations, Add QuestionnaireResponse profile as alternative screening instrument FHIR-35364 See Changes:
    - Here
    - Here
    - Here
    - Here
53. Applied: Clarify $docref operation expectations FHIR-35380 See Change Here
54. Applied: Typo FHIR-35388
55. Applied: Duplicate sections in US Core RelatedPerson Profile profile FHIR-35452
56. Applied: Updated guidance on changes between versions FHIR-35576 See Change Here
57. Applied: Split section on "deleted" from "entered in error" FHIR-35622 See Change Here
58. Applied: Use "sdoh" instead of "LG41762-2" for SDOH Categories and Tags FHIR-35644 See Changes:
    - Here
    - Here
    - Here
59. Applied: Update Gender Identity Value setFHIR-35677 See Change Here
60. Applied: Remove "OTH" from OMB Race Category valueSet FHIR-35694 See Change Here
61. Applied:Add basic introduction to the FHIR RESTful Search interaction in the home page FHIR-35755 See Change Here
62. Applied: Remove MS from DiagnosticReport.imagingStudy FHIR-35759 See Change Here
63. Applied: Media example data value fails regex FHIR-35790 See Change Here
64. Applied: Typo FHIR-35844
65. Applied: Typo FHIR-35851
66. Applied: Change fixed category slice to max=1 FHIR-35854 See Change Here
67. Applied: Clarify narrative of status "active" element. FHIR-35870 See Change Here
68. Applied: allow ethnicity extension in FamilyMemberHistory FHIR-35997 See Change Here
69. Applied: allow race extension in FamilyMemberHistory FHIR-35998 See Change Here
70. Applied: Update Condition Implementation Guidance to reflect current USCDI terminology standards FHIR-36056 See Change Here
71. Applied: Clarify expectations for reader FHIR-36057 See Changes:
    - Here
    - Here
72. Applied: Update US Core Yearly Updates FHIR-36058 See Change Here
73. Applied: Remove "Cause of death" from Condition.category and remove US Core Condition Category Codes ValueSet FHIR-36104
74. Applied: Add OTH to sexual orientation ValueSet FHIR-36166 See Change Here
75. Applied: Updated coding `system` in Missing Data documentation FHIR-36177 See Change Here
76. Applied: Add "Other Race" to OMB Race Categories FHIR-36247 See Change Here
77. Applied: Add MS to Device.distinctIdentifier to correct editorial error FHIR-36303 See Change Here
78. Applied: Fix provenance-1 invariant FHIR-36328 See Change Here
79. Applied: Correct _targetProfile element in Provenance StructureDefinition FHIR-36344 See Change Here
80. Applied: Correct guidance on accessing VSAC Valuesets FHIR-36639 See Change Here
81. Applied: Move change log from version history to new change log page in IG FHIR-36703 See Change Here
82. Applied: Remove redundant example sections FHIR-36728
83. Applied: Realign ids names and titles for all new profiles for consistency FHIR-36766 See Change Here
84. Applied: Move profile page introduction into StructureDefinition description FHIR-36824 See Change Here
85. Applied: Fixed profile, Added STU Note, Updated FHIR Core Vitals Profile binding in FHIR R4B. FHIR-27845 See Change Here
86. Applied: Change Encounter.reasonReference from 0..1 to 0..* FHIR-36862 See Change Here
87. Applied: Change URL for CDT from http://ada.org/cdt to http://www.ada.org/cdt. FHIR-36861 See Change Here

#### The Following Trackers Will be Applied in Future Version

Due external dependencies and publication tooling limitations, the application of these resolutions have been deferred.

##### Working with HL7 publishing to resolve these publishing issues:

Tracker Status: Summary Jira Issue Application Status

1. Resolved - change required: Patient Examples QA Errors: CDCREC code system in VSAC FHIR-30105 Manual code expansion and STU Note Present. Working with HL7 publishing to fix integration with VSAC.
2. Resolved - change required: valueset-simple-language.xml QA Error FHIR-30107 Working with HL7 publishing to fix.
3. Resolved - change required: Extensions used that are not defined in the scope FHIR-35775

##### Working with HL7 IG Authoring project to address these issues on IG readability:

Tracker Status: Summary Jira Issue Application Status

1. Resolved - change required: In most of the data elements – “Binding is from base FHIR and US Core Vital Signs” Need this to be one single combined listing FHIR-30780
2. Resolved - change required: AllergyIntolerance does not show constraint FHIR-34636
3. Resolved - change required: RelatedPerson relationshiptype should have binding to FHIR value set RelatedPerson-relationshiptype FHIR-34755

### Version = 4.1.0

- Publication Date: 2021-11-30
- url: https://hl7.org/fhir/us/core/2022Jan
- Based on FHIR version : 4.0.1

#### Changes:

The January 2022 Ballot

This Ballot addresses the following issues:

- Adds United States Core Data for Interoperability (USCDI) V2 updates that the Office of the National Coordinator (ONC) published in July of 2021 with these new Data Elements and Classes:
  - Applied: A Social Determinants Of Health (SDOH) Guidance page to document and provide guidance on using US Core to represent and access SDOH Assessments and Here, Goals, Interventions represented by ServiceRequest + Procedure, and Problems/Health Concerns
  - Applied: Clinical Tests and Diagnostic Imaging also see Changes Here
  - Applied: Patient Gender Identity and Sexual Identity
  - Applied: Care Team Member: Name, Identifier, Location, Telecom and Role See Change Here and Here and Here
  - Applied: Encounter: Diagnosis, Disposition, Location, Time, Type See Change Here
  - Applied: Problems: Date of Diagnosis and Date of Resolution See Change Here
- Continued efforts to link terminology directly to the FHIR® Terminology Service for VSAC Resources (Value Set Authority Center (VSAC) - NIH) where applicable and as a result align terminology between US Core and HL7 C-CDA.
- Updated uscdii table for easier browsing.
- Addition of consolidated CSV and Excel File representations of Profiles to enable testers and analysts to review elements properties across profiles in a single table
- Addressed and applied over 30 trackers submitted by implementers since the previous STU2 ballot for US Core ver 4.0.0:

Tracker Status: Summary Jira Issue Link to Updated Content

1. Applied: Make values in direct and birth sex extensions min=1 FHIR-26459 See Change:
   - Here
   - Here
2. Applied: FIX imm-1.json NDC/CVX codes QA Error FHIR-30104 See Change:
   - Here
   - Here
3. Applied: Fix patient search parameter definitions to only target Patient FHIR-32305 See Change Here
4. Applied: Provide a caution to the user that a query of MedicationRequest does not provide complete information. FHIR-32720 See Change Here
5. Applied: Make Condition.encounter 0..1 MS FHIR-32844 See Change Here
6. Applied: Correction on USCoreCarePlanProfile Binding FHIR-32846 See Change Here
7. Applied: Fix title for BMI Profile FHIR-32847 See Change Here
8. Applied: Remove unchanged elements from Differentials FHIR-32848 For example change see
9. Applied: Create US Core slices for category elements FHIR-32857 See Change:
   - Here
   - Here
   - Here
   - Here
10. Applied: Change drug class value set for allergens to align with C-CDA FHIR-32953 See Change Here
11. Applied: Referencing incorrect figure FHIR-32961 See Change Here
12. Applied: Clarify Guidance for missing data for Coding data type element FHIR-33048 See Change Here
13. Applied: Fix us-core-1 Invariant for Observation FHIR-33052 See Change Here
14. Applied: Remove requirement to use only 401 from capabiltystatement FHIR-33069 See Change Here
15. Applied: US Core to USCDI guidance page – add patient email FHIR-33079 See Change Here
16. Applied: Utilize "use" field for patient previous name and previous address FHIR-33080 See Change Here
17. Applied: Fix search parameter list FHIR-33123 See Change Here
18. Applied: Clarify requirement on date searches without prefix FHIR-33156 See Change Here
19. Applied: Clarify distinction between repeated search params and "composite" params FHIR-33159 See Change Here
20. Applied: Add content as mandatory element in narrative for documentreference FHIR-33160 See Change Here
21. Applied: Fix invalid elements in extensions FHIR-33233 See Change: - Here - Here - Here
22. Applied: Make Procedure.performed conditionally mandatory FHIR-33243 See Change Here
23. Applied: add same Null options to Race and Ethnicity FHIR-34036 See Change - Here - Here - Here - Here
24. Applied: Clarify MustSupport for Observation.component.value[x] vs dataAbsentReason FHIR-34061 See Change: - Here - Here
25. Applied: Add Null options to US Core Birth Sex Extension FHIR-34133 See Change Here
26. Applied: USCDI v2 update FHIR-34231 SEE SECTION ABOVE
27. Applied: Fix Observation Examples using `appliesTo` FHIR-34286 See Change Here
28. Applied: Correct CapabilityStatement SMART IG reference FHIR-34281 See Change Here
29. Applied: Make DiagnosticReport.effective and DiagnosticReport.issued conditionally mandatory FHIR-34330 See Change:
    - Here
    - Here
30. Applied: fix URLSee Change Here
31. Applied: US Core search page is not working FHIR-34028 - Coordination with HL7 IG publishing team to Correct

The Following Trackers Will be Applied Following this Ballot

Due external dependencies and publication tooling limitations, the application of these resolutions have been deferred.

Tracker Status: Summary Jira Issue Link to Updated Content

1. Resolved - change required: US Core Pulse Oximetry Profile nonconformant UCUM Unit for Oxygen Concentration FHIR-27845 - Awaiting FHIR-4b updates to update base FHIR Vitals Profile, STU Note Present
2. Resolved - change required: Patient Examples QA Errors: CDCREC code system in VSAC FHIR-30105 - Coordination with VSAC and IG publishing team to Correct and align Code System OIDS between FHIR, CCDA, and VSAC, Note To Balloters Present
3. Resolved - change required: valueset-simple-language.xml QA Error FHIR-30107 - Coordination with IG publishing team to Correct - Note To Balloters present
4. Resolved - change required: Display only differential invariants and terminology tables in Differential View FHIR-30780 - Coordination with HL7 IG publishing team to Correct
5. Resolved - change required: Confusing to reads invariants and terminology tables in Differential View FHIR-30783 - Coordination with HL7 IG publishing team to Correct
6. Resolved - change required: Wrong link to IG homepage from package manifest FHIR-33132 - Coordination with HL7 IG publishing team to Correct

### Version = 4.0.0 (Meets USCDI v1 Requirements)

- Publication Date: 2021-06-28
- url: https://hl7.org/fhir/us/core/STU4
- Based on FHIR version : 4.0.1

#### Changes:

The changes in this annual update to US Core have been reviewed and commented upon by the public through the January 2021 HL7 balloting process. The resolution of the community comments has been agreed to and voted on by the members of the sponsoring work group HL7 International Cross-Group Projects.

The key changes are summarized below:

1. New Conformance Expectations page
   - Defining different ways to implement and conform to US Core.
   - Clarification of the Must Support definitions as it relates to various FHIR elements such a choice datatype and references.
2. Publishing a set US Core Vital Signs independent of the FHIR core profile upon which it is based
   - US Core Vital Signs Profile
   - US Core Blood Pressure Profile
   - US Core BMI Profile
   - US Core Head Circumference Profile
   - US Core Body Height Profile
   - US Core Body Weight Profile
   - US Core Body Temperature Profile
   - US Core Heart Rate Profile
   - US Core Respiratory Rate Profile
3. Linking terminology directly to the FHIR® Terminology Service for VSAC Resources (Value Set Authority Center (VSAC) - NIH) where applicable: US Core Value Set, VSAC Value Set, VSAC OID, extensional? 1. Detailed ethnicity, Detailed Ethnicity, 2.16.840.1.114222.4.11.877, No 1. OMB Ethnicity Categories, Ethnicity, 2.16.840.1.114222.4.11.837, Yes 1. US Core CareTeam Provider Roles, Care Team Member Function, 2.16.840.1.113762.1.4.1099.30, Yes 1. US Core Medication Codes (RxNorm), Medication Clinical Drug, 2.16.840.1.113762.1.4.1010.4, Yes 1. US Core Provider Specialty (NUCC), Healthcare Provider Taxonomy, 2.16.840.1.114222.4.11.1066, No 1. US Core Smoking Status, Smoking Status, 2.16.840.1.113883.11.20.9.38, Yes 1. US Core Vaccine Administered Value Set (CVX), CVX Vaccines Administered Vaccine Set, 2.16.840.1.113762.1.4.1010.6, Yes 1. US Core Common substances for allergy and intolerance documentation including refutations, Common substances for allergy and intolerance documentation including refutations, 2.16.840.1.113762.1.4.1186.8, No
4. Migrating to the standard set of HL7 FHIR IG templates for publishing. Although we strove to minimize the differences between this version and the previous versions of US Core, these changes are notable:
   - Additional Features include:
     - Addition of vocabulary and constraint tables to the profile pages
     - Addition of a summary table and to the profile page introduction
     - Addition of "Snapshot Table (Must Support)" Tab to profile views
   - Due to restrictions on customizable content, the full narrative text summaries of profiles is no longer available.
5. Addressing over 90 January 2021 Ballot related trackers resulting in the followed detailed changes.

Listed below are the resolved trackers for this version:

Status: Summary:(Jira Issue) Link to Change

1. Applied:Update PractitionerRole.practitioner to )..1 MS (FHIR-29681) See Change Here
2. Applied:Change CareTeam `status` search parameter compositeOR expectation to SHOULD (FHIR-29768) See Change Here
3. Applied:Provide guidance on the population of narrative (FHIR-29777) See Change Here
4. Applied: Change $docref start and end input parameter types from `date` to `dateTime` (FHIR-29825) See Change Here
5. Applied: The history file markdown rendering of the table (FHIR-30100) See Change Here
6. Applied:footnote rendering - pre-applied (FHIR-30101) See Change Here
7. Applied:Random Section Numbering (Reminder for tooling issue) (FHIR-30102) See Change Here
8. Applied:Move section 1.5 US Core Conformance Requirements (FHIR-30103) See Change Here
9. Applied:Make custodian optional on document reference (FHIR-30108) See Change Here
10. Applied:Remove required binding on procedure and condition (FHIR-30109) See Changes:
    - Here
    - Here
    - Here
11. Applied:Update DocumentReference CCD operation (FHIR-30110) See Change Here
12. Applied:Update DocumentReference MustSupport to choice of data or url (FHIR-30111) See Change Here
13. Applied:Reference to 3 new document types - addressing corresponding metadat (FHIR-30112) See Change Here AND See Change Here
14. Applied:Typo (FHIR-30113)
15. Applied:Clarify Must Support of Complex elements (FHIR-30321) See Change Here
16. Applied:Clarify that VSAC FHIR API only retrieves a definition (FHIR-30344) See Change Here
17. Applied:Allergy Intolerance example for UNKNOWN allergy status does not use unknown (FHIR-30345) See Change Here
18. Applied:Corrected allergy intolerance example SNOMED CT code (FHIR-30346) See Change Here
19. Applied:Allergy codes updated to snomed product hierarchy in VSAC(FHIR-30347) See Change Here
20. Applied:Clarify plans to align with Gender Harmony(FHIR-30350) See Change Here
21. Applied:Typos on Conformance Expectations Page (FHIR-30353) See Change Here
22. Applied:clarify use of additional codings (FHIR-30354) See Change Here
23. Applied:Clarify server requirements for Choice of Profile Elements scenario (FHIR-30355) See Change Here
24. Applied:Add all options to Procedure.performed[x] (FHIR-30391) See Change Here
25. Applied:Updated MedicationRequest.authoredOn from mandatory to must support(FHIR-30430) See Change Here
26. Applied:Typo (FHIR-30460) See Change Here
27. Applied: Update Encounter Type CPT Description (FHIR-30470) See Change Here
28. Applied: Clarify Missing Data language for coded data elements with required binding strength (FHIR-30630) See Change Here
29. Applied:Note re language codes(FHIR-30654) See Change Here
30. Applied:Change URL for Healthcare Common Procedure Coding System (HCPCS) level II alphanumeric codes(FHIR-30655) See Changes Here and Here
31. Applied:Typo (FHIR-30656)
32. Applied: Explain the relationship between US CORE and an evolving USCDI. (FHIR-30657) See Change Here
33. Applied:Correct 2 bullet points in section 1.2. (FHIR-30658) See Change Here
34. Applied:Clarify actors (FHIR-30659) See Change Here
35. Applied:Edit basic provenance (FHIR-30660) See Change Here
36. Applied:Clarify the duplication requirement for scanned documents in DocumentReference and DiagnosticReport. (FHIR-30662) See Change Here
37. Applied:Clarify that clients should retain data visualization between DSTU2 to R4 upgrades. (FHIR-30665) See Change Here
38. Applied:Add provenance to writing/updating guidance? (FHIR-30666) See Change Here
39. Applied:Clarify Code System section and update codesystem table (FHIR-30667) See Change Here
40. Applied: Clarify guidance on implantable medical devices. (FHIR-30669) See Change Here
41. Applied: Make udi_HRF a Must Support element. (FHIR-30670) See Change Here
42. Applied: Clarify UDI information. (FHIR-30672) See Changes:
    - Here
    - Here
43. Applied:Clarify text (FHIR-30673) See Change Here
44. Applied:Typos (FHIR-30674)
45. Applied:Clarify prohibition on using contained resources. (FHIR-30677) See Change Here
46. Applied:Add guidance on suppressed data. (FHIR-30678) See Change Here
47. Applied:Clarify what is meant by "support the other elements." (FHIR-30680) See Change Here
48. Applied:Typo(FHIR-30681)
49. Applied:Fix typos (FHIR-30683) Various Changes
50. Applied:Update on Guidance on DataAbsentReason for Observations (FHIR-30685) See Change Here
51. Applied:Clarify use of qualifier LOINCs (FHIR-30690) See Change Here
52. Applied: Fix Typo (FHIR-30695) See Change Here
53. Applied: Update on Guidance on DataAbsentReason for Observations (FHIR-30699) See Change Here
54. Applied: Clarify what is intended with "additional observations"(FHIR-30772) See Change Here
55. Applied: Add statement about clinical safety to the security page (FHIR-30776) See Change Here
56. Applied: Added clarification to vitals profile regarding use of additional codings and component observations. (FHIR-30778) See Change Here
57. Applied: Typo (FHIR-30782) See Change Here
58. Applied: Clarify resource search requirements CapabilityStatements and provide guidance on search for multiple patients using Bulk data (FHIR-30787) See Changes:
    - Here
    - Here
59. Applied: Add MedicationAdministration to the Future Page. (FHIR-30788) See Change Here
60. Applied: Fix text in $docref description (FHIR-30810) See Change Here
61. Applied: Mandate that CapabilityStatement.instantiates refer to US Core (FHIR-30889) See Change Here
62. Applied: Add binding so Vitals will render it in differential view (FHIR-31391) See Change Here
63. Applied: Update to URI from OID for CDT in Procedure Code ValueSet (FHIR-31556) See Change Here
64. Applied: Add DocumentReference.content is under "must have" list (FHIR-31364) See Change Here
65. Applied: Update Must Support Bullet regarding missing data (FHIR-31507) See Change Here
66. Applied: Update use context for Race and Ethnicity extensions (FHIR-31008) See Change Here
67. Applied: Add guidance on "POST based search" (FHIR-31585) See Changes:
    - Here
    - Here
68. Applied: Add reference to Mapping from LOINC scale type to FHIR data type (FHIR-31084) See Change Here
69. Applied: Update Observation.value[x] definition (FHIR-31083) See Change Here
70. Applied: Add LOINC to procedure codes (FHIR-31514) See Change Here
71. Applied: Make PractitionerRole.organization must support and add invariant (FHIR-29680) See Change Here
72. Applied: Fix FHIRPath constraint for provenance-1(FHIR-31020) See Change Here
73. Applied: Add guidance to BMI Profile(FHIR-32658) See Change Here
74. Applied: Write usage note for non-vaccination CVX codes(FHIR-31899) See Change Here
75. Applied: Clarify that Extensible binding can always provide a mapped code(FHIR-32010) See Change Here
76. Applied: Clarify RESTFul requirements(FHIR-31490) See Changes:
    - Here
    - Here
    - Here
    - Here
77. Applied: fix Procedure Example error (FHIR-30106) See Change Here

Known issues:

We are working to fix these issues that may come up when using US CORE. We will correct them in a future version of the guide

Publishing

- Resolved - change required:Confusing for commercial vendor. Reads very confusing. (FHIR-30783) proposal is to make the differential tab the default view, see publishing plans here timeline unknown.
- Resolved - change required:In most of the data elements – “Binding is from base FHIR and US Core Vital Signs” Need this to be one single combined listing (FHIR-30780) proposal is to limit the terminology and invariants to view shown. see Zulip chat timeline unknown.
- Resolved - change required:Why are there separate codes for USCoreVitalSigns and the Systolic.value and the diastolic value? (FHIR-30779) proposal is to work with publishing to "clean up" terminology and invariants to view shown. see: see Zulip chat timeline unknown.

Terminology

- Resolved - change required: valueset-simple-language.xml QA error "Error from server: Language valuesets cannot be expanded as they are based on a grammar" (FHIR-30107) this error is still extant from prior version of US Core and has yet to be resolved. Work with publishing to fix and created STU note. see Zulip chat
- Resolved - change required: Patient Examples QA Errors: CDCREC code system in VSAC Patient (FHIR-30105) CDCREC codes and code system value not aligned with VSAC. Workaround is to publish the CDCREC code system and valuesets in USCore until this content is moved to HL7 Terminology Add an STU Note. Zulip chat1 and Zulip chat2 and Zulip chat3
- Resolved - change required:imm-1.json NDC/CVX codes QA Error (FHIR-30104) Work with terminology server team to correct. see Zulip chat
- Resolved - change required:Pulse Ox Example: observation-satO2-fiO2 (FHIR-27845) Proposed Jira ticket to resolve in base made an STU note that is technically not conformant with the base FHIR vital profile. See Zulip chat

### Version = 3.2.0

- Publication Date: 2021-1-30
- url: https://hl7.org/fhir/us/core/2021Jan
- Based on FHIR version : 4.0.1

#### Changes:

The changes in this version have been voted on by the members of the sponsoring work group HL7 International Cross-Group Projects. This version addresses the following key issues:

1. Clarification of the Must Support definitions as it relates to:
   - Polymorphic datatypes, which of the possible types must be supported
   - Reference datatype (Reference, canonical) which of the target types must be supported
   - The vital signs profile in the Core Specification which profiles must be supported
   - New Conformance Expectations page (see individual trackers below for details)
2. Publishing a set US Core Vital Signs independent of the FHIR core profile upon which it is based (see individual trackers below for details)
   - US Core Vital Signs Profile
   - US Core Blood Pressure Profile
   - US Core BMI Profile
   - US Core Head Circumference Profile
   - US Core Body Height Profile
   - US Core Body Weight Profile
   - US Core Body Temperature Profile
   - US Core Heart Rate Profile
   - US Core Respiratory Rate Profile
3. Linking terminology directly to the FHIR® Terminology Service for VSAC Resources (Value Set Authority Center (VSAC) - NIH) where applicable

- We are seeking to resolve several technical and policy glitches when using VSAC directly prior to publishing which include the requirement to log in using your own UMLS API Key requiring a current UMLS account to view the value sets. VSAC UMLS Licensing information.
- To view the VSAC value set, use the link `https://vsac.nlm.nih.gov/valueset/{OID}/expansion` in your browser replacing the {OID} with the OID from the table below.
- Enumerated (extensional) value sets can also be downloaded as a FHIR ValueSet resource. To do this, use the link `https://cts.nlm.nih.gov/fhir/ValueSet/{OID}` in your browser replacing the {OID} with the OID from the table below.

- NOTE that the Code System value used in FHIR® Terminology Service for VSAC Resources for Race and Ethnicity (CDCREC) concepts does not align with historical and current usage of OIDs in C-CDA and US Core. This issue has not been resolved in time for publication of the ballot version of this guide. As a result validation errors may occur when validating against this version of the US Core Patient Profile. Feedback on which code system value to use is welcome.

  1. US Core Value Set, VSAC Value Set, VSAC OID, extensional?
  2. Detailed ethnicity, Detailed Ethnicity, 2.16.840.1.114222.4.11.877, No
  3. Detailed Race, Race, 2.16.840.1.113883.1.11.14914, No
  4. OMB Ethnicity Categories, Ethnicity, 2.16.840.1.114222.4.11.837, Yes
  5. US Core CareTeam Provider Roles, Care Team Member Function, 2.16.840.1.113762.1.4.1099.30, Yes
  6. US Core Medication Codes (RxNorm), Medication Clinical Drug, 2.16.840.1.113762.1.4.1010.4, Yes
  7. US Core Provider Specialty (NUCC), Healthcare Provider Taxonomy, 2.16.840.1.114222.4.11.1066, No
  8. US Core Smoking Status, Smoking Status, 2.16.840.1.113883.11.20.9.38, Yes
  9. US Core Vaccine Administered Value Set (CVX), CVX Vaccines Administered Vaccine Set, 2.16.840.1.113762.1.4.1010.6, Yes
  10. US Core Common substances for allergy and intolerance documentation including refutations, Common substances for allergy and intolerance documentation including refutations, 2.16.840.1.113762.1.4.1186.8, No

1. Migrating to the standard set of HL7 FHIR IG templates for publishing. Although we strove to minimize the differences between this version and the previous versions of US Core, these changes are notable:
   - Additional Features include:
     - Addition of vocabulary and constraint tables to the profile pages
     - Addition of a summary table and to the profile page introduction
     - Addition of "Snapshot Table (Must Support)" Tab to profile views
   - Due to restrictions on customizable content, the following features of prior versions are no longer available:
     - Full narrative text summaries of profiles NOTE: We are seeking feedback on whether to retain these full narrative text summaries for this guide (an example can be seen here by clicking on the "Text Summary" tab)*
2. Addressing over 95 outstanding trackers.

Trackers items and links to the updated content listed below are the resolved trackers for this version:

1. Must Support Over Interpreted (FHIR-28375) Changes throughout the profiles – added conformance page See Change Here

2. Replace the US Core Update Allergy substances value set with VSAC reference (FHIR-29322) See Change Here

3. Update Organization Quick Start Example Search. (FHIR-29269) See Change Here

4. birthsex binding applied to the wrong element in US Core Patient StructuredDefinition/differential (FHIR-29262) See Change Here

5. us-core-12 invariant interpretation (FHIR-28942) See Changes Here

6. Incorrect Description Observation.component (Pulse Ox) (FHIR-28934) See Change Here

7. References should be constrained to use `reference` not `identifier` (FHIR-28573) See Change Here

8. Update USCorePatientName search description for consistency (FHIR-28540) See Change Here

9. Make Provenance.author optional (FHIR-28517) See Change Here

10. Add must support type choices for US Core Goal.target.due[x]. (FHIR-28477) See Change Here

11. Immunization Profile Mandatory and Must Support Intro is missing attributes (FHIR-28452) See Change Here

12. DiagnosticReport-cardiology-report JSON and XML samples contain invalid hashes (FHIR-28408) See Change Here

13. MedicationRequest.medication[x] (FHIR-28395) See Change Here

14. Fix MedicationRequest.encounter reference (FHIR-28258) See Change Here

15. Fix typo: "an another" -> "another" (FHIR-28227) See Change Here

16. Declare mustSupport on Organization telecom children (FHIR-28216) See Change Here

17. Resolve remaining discrepancies with FHIR R4 Search Parameters (FHIR-28181) See Changes Here:
    - 1 SearchParameter-us-core-condition-onset-date
    - 2 SearchParameter-us-core-organization-name
    - 3 SearchParameter-us-core-location-name

18. Provenance without activity is not very useful (FHIR-28179) See Change Here

19. Make Provenance.target.reference mandatory (FHIR-28165) See Change Here

20. Missing narrative Element (FHIR-28159) See Change Here

21. "Updated guidance regarding gender and sex." (FHIR-28138) See Change Here

22. Replace the US Core Smoking Status with VSAC reference (FHIR-28123,FHIR-26059) See Change Here

23. Timing association for smoking status changed from `issued` to `effectiveDateTime` (FHIR-28090) See Change Here

24. Remove Must Support from Patient.telecom (FHIR-27731) See Change Here

25. Remove Must Support from Patient.communication.language (FHIR-27730) See Change Here

26. Remove Must Support from us-core-birthsex extension (FHIR-27729) See Change Here

27. Remove Must Support from us-core-ethnicity extension (FHIR-27728) See Change Here

28. Remove Must Support from us-core-race extension (FHIR-27727) See Change Here

29. Expand US Core state value set to include US Military codes (FHIR-26833) See Change Here

30. Fixed Value Set Expansion Operation examples (FHIR-26625) See Change Here

31. Add must support reference type choices for US Core laboratory DiagnosticReport.performer (FHIR-25120) See Change Here

32. Fix US-Core-1 constraint on Observation.effectivePeriod (FHIR-29658) See Change Here

33. Change bindings from extensible to required for Condition.code value set: US Core Condition Category Codes Procedure.code value set: US Core Procedure Codes (FHIR-29563) See Changes Here:
    - 1 StructureDefinition-us-core-condition-definitions
    - 2 StructureDefinition-us-core-procedure-definitions

34. Remove text "an author responsible for the update". Keep author organization (FHIR-28516) See Change Here

35. "Clarify expectations when accessing "other endpoint" for DocumentReference.content.attachment.url" (FHIR-28472) See Change Here

36. Add a required category to smoking status (FHIR-28436) See Change Here

37. Use of US Core Profile when not explicitly referenced when using Contained resources (FHIR-28396) See Change Here

38. DocumentReference.custodian to be Optional (FHIR-28393) See Proposed Change Here

39. Encounter.serviceProvider Must Support and Encounter.location.location Optional (FHIR-28392) See Change Here

40. Observation.hasMember Vital Signs Panel Profile Reference Choice (FHIR-28391) See Change Here

41. Add must support type choices for Observation.value[x] for Lab Observation Profile (FHIR-28390) See Change Here

42. Add must support type choices for Observation.effective[x] for Lab Observation Profile (FHIR-28389) See Change Here

43. Add must support type choices for Immunization.occurrence[x] (FHIR-28388) See Change Here

44. Add must support type choices for DiagnosticReport.effective[x] for Note Data (FHIR-28387) See Change Here

45. Add must support type choices for DiagnosticReport.effective[x] for Lab Data Type (FHIR-28385) See Change Here

46. Add must support reference type choices for Provenance.agent.who Reference (FHIR-28383) See Change Here

47. Add must support reference type choices for MedicationRequest.requester Reference (FHIR-28382) See Change Here

48. Add must support reference type choices for MedicationRequest.reported Choice (FHIR-28381) See Change Here

49. Add must support reference type choices for DocumentReference.author Reference (FHIR-28380) See Change Here

50. Add must support reference type choices for DiagnosticReport.performer for Note (FHIR-28379) See Change Here

51. Add must support reference type choices for DiagnosticReport.performer for Lab (FHIR-28378) See Change Here

52. Add must support reference type choices for CareTeam.participant.member Reference (FHIR-28376) See Change Here

53. Add choice for and type choices for Encounter.reasonReference (FHIR-27951) See Change Here

54. Add choice for Procedure.performed[x] (FHIR-29695) See Change Here

55. Clarify deleted resources requirements and guidance (FHIR-28091) See Change Here

56. Clarify search by date precision conformance expectations (FHIR-27906) See Change Here
    - General Guidance
    - Example in QuickStart
    - Example in CapabilityStatement
57. Clarify search by reference conformance expectations (FHIR-27905) See Changes Here:
    - General Guidance
    - Example in QuickStart
    - Example in CapabilityStatement

58. Add "Cause of Death" to category codes to meet the Public Health Use Case for VRDR (FHIR-27904) See Change Here

59. Address non-implantable device and how to document usage (FHIR-27896, FHIR-23715, FHIR-23715) See Change Here

60. Resource constraints based on Jurisdiction which are not well documented (FHIR-27810) See Change Here

61. Updated CPT copyright to current year (FHIR-27770) See Change Here

62. Change binding for CareTeam.participant.role from NUCC to Care Team Member Function, replace the US Core Careteam Provider Roles Value Set with VSAC reference (FHIR-27769) See Change Here

63. Remove US Core Server Capability Statement requires support for HTTP status 410-deleted (FHIR-26597) See Change Here

64. Change US Core Condition Codes Value Set Logical Definition (FHIR-26060) See Change Here

65. Recommend against using SSN for Patient.identifier (FHIR-24903) See Change Here

66. Remove identifier (OID) from ValueSet: US Core Encounter Type (FHIR-29691) See Change Here

67. Review vocabulary to align with CCDA and use VSAC valueset where possible (FHIR-22488) See Changes Here:
    - Detailed ethnicity –> Detailed Ethnicity
    - Detailed Race –> Race
    - OMB Ethnicity –> Categories|Ethnicity
    - US Core Medication Codes (RxNorm) –> Medication Clinical Drug and here
    - US Core Provider Specialty (NUCC) –> Healthcare Provider Taxonomy
    - US Core Vaccine Administered Value Set (CVX) –> CVX Vaccines Administered Vaccine Set

68. Remove CVX-NDC mapping table (FHIR-29745) See Change Here

69. Since CarePlan.text.div is min== 1 add must support == true element to be consistent with US Core design (FHIR-29765) See Change Here

70. Remove unused US Core ICD-10-PCS Procedure Codes valueset (FHIR-29822)

71. Remove Clinical Notes Guidance References to ONC 2019 NPRM and move requirements to main body (FHIR-29824) See Change Here

### Version = 3.1.1 (Meets USCDI V1 requirements)

- Publication Date: 2020-6-30
- url: https://hl7.org/fhir/us/core/STU3.1.1
- Based on FHIR version : 4.0.1

#### Changes:

This update addresses several technical corrections and errata and clarifications. They have been reviewed and voted on by the members of the HL7 International Cross-Group Projects WorkGroup who is sponsoring this errata release and reconciliation of the comments.:

1. Add guidance for representing patient name suffix and previous patient name to the US Core Patient Profile (FHIR-28129)
2. Correct copy/paste error in Goal Profile (FHIR-28109)
3. Correct US Core Provider Specialty (NUCC) ValueSet to hide abstract grouping codes (FHIR-27975)
4. Added example of US Core Direct Extension to Practitioner-2 Example (FHIR-27947)
5. Corrected technical errors in pediatric profiles StructureDefinitions (FHIR-27946)
6. Corrected errors in DiagnosticReport Cardiology Example (FHIR-27913)
7. Update Federal Register link for OMB race and ethnicity category classifications. (FHIR-27907)
8. Clarified token search syntax (FHIR-27897).
9. Corrected US Core DocumentReference Profile to support multiple attachments (FHIR-25778).
10. Fix FHIRPath Expression in USCoreGoalTargetDate (FHIR-27892).
11. Fix FHIRPath Expression in USCoreProcedureDate(FHIR-27887).
12. Add omitted "ge" comparators to SearchParameters (FHIR-27893).
13. Remove Must Support References to non US Core Profiles (FHIR-27876)
14. Add missing reaction to the US Core AllergyIntolerance Profile (FHIR-27867).
15. Clarify reference to US Core Patient in Vitals Signs Profiles (FHIR-27857).
16. Corrected US Core Pulse Oximetry Profile component.valueQuantity.code and component.valueQuantity.unit min from 0 to 1 to be consistent with the valueQuantity constraints within US Core (FHIR-27846)
17. Correct UCUM Unit in US Core Pulse Oximetry Profile Text Summary (FHIR-27845)
18. Update Procedure Codes Value Set to include ICD-10 PCS codes (FHIR-27836)
19. Update Procedure Codes Value Set to include CDT codes (FHIR-27737)
20. Clarify that pediatric vital sign percentile Observations should reference growth chart (FHIR-27549),
21. Added Missing US core Head Occipital-frontal Circumference Percentile Profile (FHIR-27542).
22. Correct requirements for supporting CLIA identifiers (FHIR-27158)
23. Change Description of ICD-10-PCS Value Set (FHIR-27116)
24. Correct AllergyIntolerance guidance for verificationStatus (FHIR-27096)
25. Fix example US Core heart-rate example (FHIR-27086)
26. review period comments Update smoking status codes to align with USCDI (FHIR-27082).
27. Fix invariant provenance-1 (FHIR-27065)
28. Fix invalid json snippet (FHIR-27001)
29. review period comments Remove Provenance requirement from Medication, Location, Practitioner, PractitionerRole, and Organization and correct copy and paste error to Medication and Provenance searchType support in CapabilityStatement (FHIR-26840, FHIR-28161).
30. Correction on USCDI Table change "MedicationStatement" to "MedicationRequest" and remove references to MedicationStatement in the Medication Profile and CapabilityStatements (FHIR-26840).
31. Clarify that US Core Location/PractitionerRole are not being referenced by other resources (FHIR-26840).
32. Correct editing error restoring Write and Operation capability guidance into DocumentReference QuickStart (FHIR-26840).
33. Clarify guidance that servers SHALL support search with status if status required (FHIR-26840).
34. Correct canonical url for ImplementationGuide (FHIR-26686).
35. Correct system URI for ICD-10 procedure codes (FHIR-26679).
36. Fix invariant us-core-1 (FHIR-26605).
37. Change valueCode min from 0 to 1 for US Core Birth Sex Extension and valueBoolean min from 0 to 1 forUS Core Direct email Extension (FHIR-26459).
38. Change valueQuantity min from 1 to 0 for US Core Pediatric BMI for Age Observation Profile and US Core Pediatric Weight for Height Observation Profile (FHIR-26363).
39. Add page contents to Clinical Notes Guidance and Basic Provenance pages (FHIR-25785).
40. Fix duplicate URL causing validation failure. (FHIR-25536).
41. Fix Invariant us-core-8 (FHIR-25459).
42. Corrected the wording "should support" to "shall support" in Clinical Notes Guidance (FHIR-25455).
43. Fix Invariant us-core-8 to allow for Data Absent Reason Extension on Patient name.(FHIR-25249).
44. Fix Link to LOINC LP29708-2 (FHIR-25213).
45. Corrected guidance for conveying "Patient-Reported medications" (FHIR-25035)

To review changes to US Core versions earlier than 3.1.1, refer to the USCore 7.0.0 Change Log.