SHOULD Support the Following Implementation Guides: SMART App Launch version 2.0.0 and later FHIR RESTful Capabilities The US Core Server SHALL: Support the US Core Patient resource profile AND at least one additional resource profile from the list of US Core Profiles AND and all Must Support US Core Profiles and resources it references. A summary table listing all the Must Support references to other US Core Profiles and FHIR resources for each US Core Profile is located in the Must Support - Resource References section of the guide. Follow the requirements documented in the General Requirements and Must Support pages Return the following response classes: (Status 400): invalid parameter (Status 401/4xx): unauthorized request (Status 403): insufficient scopes (Status 404): unknown resource Support JSON source formats for all US Core interactions. The US Core Server SHOULD: Follow the guidance documented in the General Guidance page Support XML source formats for all US Core interactions. Identify the US Core profiles supported as part of the FHIR meta.profile attribute for each instance. NOTE: US Core SearchParameters referenced in this CapabilityStatement that are derived from standard FHIR SearchParameters are only defined to document Server and Client expectations. They specify additional expectations for the following SearchParameter elements: multipleAnd multipleOr comparator modifier chain They SHALL NOT be interpreted as search parameters for search. Servers and Clients SHOULD use the standard FHIR SearchParameters. Security: See the General Security Considerations section for requirements and recommendations. A server SHALL reject any unauthorized requests by returning an HTTP 401 "Unauthorized", HTTP 403 "Forbidden", or HTTP 404 "Not Found" Summary of System Wide Interactions MAY support the transaction interaction. MAY support the batch interaction. MAY support the search-system interaction. MAY support the history-system interaction. RESTful Capabilities by Resource/Profile: Summary Resource Type Supported Profiles Supported Searches Supported _includes Supported _revincludes Supported Operations AllergyIntolerance US Core AllergyIntolerance Profile clinical-status, patient patient+clinical-status - Provenance:target - CarePlan US Core CarePlan Profile category, date, patient, status patient+category, patient+category+status, patient+category+status+date, patient+category+date - Provenance:target - CareTeam US Core CareTeam Profile patient, role, status patient+role, patient+status CareTeam:participant:PractitionerRole, CareTeam:participant:Practitioner, CareTeam:participant:Patient, CareTeam:participant:RelatedPerson Provenance:target - Condition US Core Condition Encounter Diagnosis Profile, US Core Condition Problems and Health Concerns Profile abatement-date, asserted-date, category, clinical-status, code, encounter, onset-date, patient, recorded-date, _lastUpdated patient+category+encounter, patient+recorded-date, patient+_lastUpdated, patient+category+clinical-status, patient+category, patient+onset-date, patient+code, patient+clinical-status, patient+asserted-date, patient+abatement-date - Provenance:target - Coverage US Core Coverage Profile patient - Provenance:target - Device US Core Implantable Device Profile patient, status, type patient+status, patient+type - Provenance:target - DiagnosticReport US Core DiagnosticReport Profile for Report and Note exchange, US Core DiagnosticReport Profile for Laboratory Results Reporting category, code, date, _lastUpdated, patient, status patient+category+_lastUpdated, patient+status, patient+category, patient+category+date, patient+code, patient+code+date - Provenance:target - DocumentReference US Core DocumentReference Profile, US Core ADI DocumentReference Profile _id, category, date, patient, period, status, type patient+status, patient+category, patient+category+date, patient+type+period, patient+type - Provenance:target docref Encounter US Core Encounter Profile _id, class, date, _lastUpdated, discharge-disposition, identifier, location, patient, status, type date+patient, patient+_lastUpdated, patient+status, patient+type, patient+location, patient+discharge-disposition, class+patient - Provenance:target - Endpoint - - - - - Goal US Core Goal Profile description, lifecycle-status, patient, target-date patient+lifecycle-status, patient+description, patient+target-date - Provenance:target - HealthcareService - - - - - Immunization US Core Immunization Profile date, patient, status patient+status, patient+date - Provenance:target - Location US Core Location Profile address, address-city, address-postalcode, address-state, name - - - Media - - - - - Medication US Core Medication Profile - - - - MedicationDispense US Core MedicationDispense Profile patient, status, type patient+status+type, patient+status MedicationDispense:medication Provenance:target - MedicationRequest US Core MedicationRequest Profile authoredon, encounter, intent, patient, status patient+intent+encounter, patient+intent+status, patient+intent+authoredon, patient+intent MedicationRequest:medication Provenance:target - Observation US Core Observation ADI Documentation Profile, US Core Laboratory Result Observation Profile, US Core Observation Pregnancy Status Profile, US Core Observation Pregnancy Intent Profile, US Core Observation Occupation Profile, US Core Respiratory Rate Profile, US Core Simple Observation Profile, US Core Treatment Intervention Preference Profile, US Core Care Experience Preference Profile, US Core Heart Rate Profile, US Core Body Temperature Profile, US Core Pediatric Weight for Height Observation Profile, US Core Pulse Oximetry Profile, US Core Smoking Status Observation Profile, US Core Observation Sexual Orientation Profile, US Core Head Circumference Profile, US Core Body Height Profile, US Core BMI Profile, US Core Observation Screening Assessment Profile, US Core Average Blood Pressure Profile, US Core Blood Pressure Profile, US Core Observation Clinical Result Profile, US Core Pediatric BMI for Age Observation Profile, US Core Pediatric Head Occipital Frontal Circumference Percentile Profile, US Core Body Weight Profile, US Core Vital Signs Profile category, code, date, _lastUpdated, patient, status patient+category+_lastUpdated, patient+category, patient+category+status, patient+category+date, patient+code, patient+code+date - Provenance:target - Organization US Core Organization Profile address, name - - - Patient US Core Patient Profile _id, birthdate, death-date, family, given, identifier, name birthdate+name, death-date+family, birthdate+family - Provenance:target - Practitioner US Core Practitioner Profile _id, identifier, name - - - PractitionerRole US Core PractitionerRole Profile practitioner, specialty PractitionerRole:endpoint, PractitionerRole:practitioner - - Procedure US Core Procedure Profile code, date, patient, status patient+status, patient+date, patient+code+date - Provenance:target - Provenance US Core Provenance Profile - - - - Questionnaire SDC Base Questionnaire Profile - - - - QuestionnaireResponse US Core QuestionnaireResponse Profile _id, authored, patient, questionnaire, status patient+authored, patient+status, patient+questionnaire - Provenance:target - RelatedPerson US Core RelatedPerson Profile _id, name, patient patient+name - Provenance:target - ServiceRequest US Core ServiceRequest Profile _id, authored, category, code, patient, status patient+status, patient+category, patient+code+authored, patient+category+authored, patient+code - Provenance:target - Specimen US Core Specimen Profile _id, patient - - - ValueSet - - - - expand AllergyIntolerance Conformance Expectation: SHALL Supported Profiles: SHALL support: US Core AllergyIntolerance Profile Profile Interaction Summary: SHALL support search-type, read. SHOULD support vread, history-instance. MAY support create, update, patch, delete, history-type. Fetch and Search Criteria: A Server SHALL be capable of returning a AllergyIntolerance resource using: GET [base]/AllergyIntolerance/[id] A Server SHALL be capable of supporting the following _revincludes: Provenance:target - GET [base]/AllergyIntolerance?[parameter=value]&_revinclude=Provenance:target Search Parameter Summary: Conformance Parameter Type SHALL patient reference Search Parameter Combination Summary: Conformance Parameter Combination Types SHOULD patient+ clinical-status reference+token Search Parameter Requirements (When Used Alone or in Combination): clinical-status (token): The client SHALL provide at least a code value and MAY provide both the system and code values. The server SHALL support both. patient (reference): The client SHALL provide at least a id value and MAY provide both the Type and id values. The server SHALL support both. CarePlan Conformance Expectation: SHALL Resource Specific Documentation: Additional considerations for systems aligning with HL7 Consolidated (C-CDA) Care Plan requirements: US Core Goal SHOULD be present in CarePlan.goal US Core Condition SHOULD be present in CarePlan.addresses Assessment and Plan MAY be included as narrative text Supported Profiles: SHALL support: US Core CarePlan Profile Profile Interaction Summary: SHALL support search-type, read. SHOULD support vread, history-instance. MAY support create, update, patch, delete, history-type. Fetch and Search Criteria: A Server SHALL be capable of returning a CarePlan resource using: GET [base]/CarePlan/[id] A Server SHALL be capable of supporting the following _revincludes: Provenance:target - GET [base]/CarePlan?[parameter=value]&_revinclude=Provenance:target Search Parameter Combination Summary: Conformance Parameter Combination Types SHALL patient+ category reference+token SHOULD patient+ category+ status reference+token+token SHOULD patient+ category+ status+ date reference+token+token+date SHOULD patient+ category+ date reference+token+date Search Parameter Requirements (When Used Alone or in Combination): category (token): The client SHALL provide at least a code value and MAY provide both the system and code values. The server SHALL support both. date (date): A client SHALL provide a value precise to the second + time offset. A server SHALL support a value precise to the second + time offset. patient (reference): The client SHALL provide at least a id value and MAY provide both the Type and id values. The server SHALL support both. status (token): The client SHALL provide at least a code value and MAY provide both the system and code values. The server SHALL support both. CareTeam Conformance Expectation: SHALL Resource Specific Documentation: In order to access care team member's names, identifiers, locations, and contact information, the CareTeam profile supports several types of care team participants. They are represented as references to other profiles and include the following four profiles which are marked as must support: US Core Practitioner Profile US Core PractitionerRole Profile US Core Patient Profile US Core RelatedPerson Profile Although both US Core Practitioner Profile and US Core PractitionerRole are must support, the server system is not required to support both types of references, but SHALL support at least one of them. The client application SHALL support all four profile references. Bacause the US Core PractitionerRole Profile supplies the provider's location and contact information and a reference to the Practitioner, server systems SHOULD reference it instead of the US Core Practitioner Profile. Servers that support only US Core Practitioner Profile and do not support the US Core PractitionerRole Profile SHALL provide implementation specific guidance how to access a provider’s location and contact information using only the Practitioner resource. Supported Profiles: SHALL support: US Core CareTeam Profile Profile Interaction Summary: SHALL support search-type, read. SHOULD support vread, history-instance. MAY support create, update, patch, delete, history-type. Fetch and Search Criteria: A Server SHALL be capable of returning a CareTeam resource using: GET [base]/CareTeam/[id] A Server SHOULD be capable of supporting the following _includes: CareTeam:participant:PractitionerRole: GET [base]/CareTeam?[parameter=value]&_include=CareTeam:participant:PractitionerRole CareTeam:participant:Practitioner: GET [base]/CareTeam?[parameter=value]&_include=CareTeam:participant:Practitioner CareTeam:participant:Patient: GET [base]/CareTeam?[parameter=value]&_include=CareTeam:participant:Patient CareTeam:participant:RelatedPerson: GET [base]/CareTeam?[parameter=value]&_include=CareTeam:participant:RelatedPerson A Server SHALL be capable of supporting the following _revincludes: Provenance:target - GET [base]/CareTeam?[parameter=value]&_revinclude=Provenance:target Search Parameter Summary: Conformance Parameter Type SHOULD role token Search Parameter Combination Summary: Conformance Parameter Combination Types SHOULD patient+ role reference+token SHALL patient+ status reference+token Search Parameter Requirements (When Used Alone or in Combination): patient (reference): The client SHALL provide at least a id value and MAY provide both the Type and id values. The server SHALL support both. role (token): The client SHALL provide at least a code value and MAY provide both the system and code values. The server SHALL support both. status (token): The client SHALL provide at least a code value and MAY provide both the system and code values. The server SHALL support both. Condition Conformance Expectation: SHALL Resource Specific Documentation: For Encounter Diagnosis use the US Core Condition Encounter Diagnosis Profile. When Condition.category is "encounter-diagnosis" the encounter, SHOULD be referenced in Condition.encounter. For Problems and Health Concerns use the US Core Condition Problems and Health Concerns Profile. When Condition.category is a "problems-list-item", the `Condition.clinicalStatus SHOULD be present. There is no single element in Condition that represents the date of diagnosis. It may be the assertedDate Extension, Condition.onsetDateTime, or Condition.recordedDate. Although all three are marked as must support, the server is not required to support all. A server SHALL support Condition.recordedDate. A server SHALL support at least one of the assertedDate Extension and Condition.onsetDateTime. A server may support both, which means they support all three elements. The client application SHALL support all three elements. See the US Core General Guidance page for Searching Using lastUpdated. Updates to Condition.meta.lastUpdated SHOULD reflect: New problems and health concerns Changes in the clinical status or verifications status of problems or health concern Supported Profiles: SHALL support: US Core Condition Encounter Diagnosis Profile SHALL support: US Core Condition Problems and Health Concerns Profile Profile Interaction Summary: SHALL support search-type, read. SHOULD support vread, history-instance. MAY support create, update, patch, delete, history-type. Fetch and Search Criteria: A Server SHALL be capable of returning a Condition resource using: GET [base]/Condition/[id] A Server SHALL be capable of supporting the following _revincludes: Provenance:target - GET [base]/Condition?[parameter=value]&_revinclude=Provenance:target Search Parameter Summary: Conformance Parameter Type SHALL patient reference Search Parameter Combination Summary: Conformance Parameter Combination Types SHOULD patient+ category+ encounter reference+token+reference SHOULD patient+ recorded-date reference+date SHOULD patient+ _lastUpdated reference+date SHOULD patient+ category+ clinical-status reference+token+token SHALL patient+ category reference+token SHOULD patient+ onset-date reference+date SHOULD patient+ code reference+token SHOULD patient+ clinical-status reference+token SHOULD patient+ asserted-date reference+date SHOULD patient+ abatement-date reference+date Search Parameter Requirements (When Used Alone or in Combination): abatement-date (date): A client SHALL provide a value precise to the second + time offset. A server SHALL support a value precise to the second + time offset. asserted-date (date): A client SHALL provide a value precise to the second + time offset. A server SHALL support a value precise to the second + time offset. category (token): The client SHALL provide at least a code value and MAY provide both the system and code values. The server SHALL support both. clinical-status (token): The client SHALL provide at least a code value and MAY provide both the system and code values. The server SHALL support both. code (token): The client SHALL provide at least a code value and MAY provide both the system and code values. The server SHALL support both. encounter (reference): The client SHALL provide at least a id value and MAY provide both the Type and id values. The server SHALL support both. onset-date (date): A client SHALL provide a value precise to the second + time offset. A server SHALL support a value precise to the second + time offset. patient (reference): The client SHALL provide at least a id value and MAY provide both the Type and id values. The server SHALL support both. recorded-date (date): A client SHALL provide a value precise to the second + time offset. A server SHALL support a value precise to the second + time offset. _lastUpdated (date): A server SHALL document the types of changes that can be detected using this parameter. A client SHALL provide a value precise to the second + time offset. A server SHALL support a value precise to the second + time offset. Coverage Conformance Expectation: SHALL Supported Profiles: SHALL support: US Core Coverage Profile Profile Interaction Summary: SHALL support search-type, read. SHOULD support vread, history-instance. MAY support create, update, patch, delete, history-type. Fetch and Search Criteria: A Server SHALL be capable of returning a Coverage resource using: GET [base]/Coverage/[id] A Server SHALL be capable of supporting the following _revincludes: Provenance:target - GET [base]/Coverage?[parameter=value]&_revinclude=Provenance:target Search Parameter Summary: Conformance Parameter Type SHALL patient reference Search Parameter Requirements (When Used Alone or in Combination): patient (reference): The client SHALL provide at least a id value and MAY provide both the Type and id values. The server SHALL support both. Device Conformance Expectation: SHALL Resource Specific Documentation: Implantable medical devices that have UDI information SHALL represent the UDI code in Device.udiCarrier.carrierHRF. All of the five UDI-PI elements that are present in the UDI code SHALL be represented in the corresponding US Core Implantable Device Profile element. UDI may not be present in all scenarios such as historical implantable devices, patient reported implant information, payer reported devices, or improperly documented implants. If UDI is not present and the manufacturer and/or model number information is available, they SHOULD be included to support historical reports of implantable medical devices as follows: manufacturer -> Device.manufacturer model -> Device.model Servers SHOULD support query by Device.type to allow clients to request the patient's devices by a specific type. Note: The Device.type is too granular to differentiate implantable vs. non-implantable devices. Supported Profiles: SHALL support: US Core Implantable Device Profile Profile Interaction Summary: SHALL support search-type, read. SHOULD support vread, history-instance. MAY support create, update, patch, delete, history-type. Fetch and Search Criteria: A Server SHALL be capable of returning a Device resource using: GET [base]/Device/[id] A Server SHALL be capable of supporting the following _revincludes: Provenance:target - GET [base]/Device?[parameter=value]&_revinclude=Provenance:target Search Parameter Summary: Conformance Parameter Type SHALL patient reference Search Parameter Combination Summary: Conformance Parameter Combination Types SHOULD patient+ status reference+token SHOULD patient+ type reference+token Search Parameter Requirements (When Used Alone or in Combination): patient (reference): The client SHALL provide at least a id value and MAY provide both the Type and id values. The server SHALL support both. status (token): The client SHALL provide at least a code value and MAY provide both the system and code values. The server SHALL support both. type (token): The client SHALL provide at least a code value and MAY provide both the system and code values. The server SHALL support both. DiagnosticReport Conformance Expectation: SHALL Resource Specific Documentation: For laboratory result reports use the US Core DiagnosticReport Profile for Laboratory Results Reporting Profile. Updates to .meta.lastUpdated SHOULD reflect: New laboratory reports Changes in the status of laboratory reports including events that trigger the same status (e.g., amended → amended). For imaging and non-laboratory clinical test result reports use the US Core DiagnosticReport Profile for Report and Note Exchange Profile. Diagnostic imaging results in visual images requiring interpretation and clinical test results/reports may also reference images as part of the report. There is no single approach for accessing imaging studies alongside clinical data using a single authorization flow to give patients and providers access to the images. The DiagnosticReport.media.link element SHOULD be used to support links to various patient-friendly content, such as jpg images of x-rays (see the DiagnosticReport Chest X-ray Report Example). The DiagnosticReport.imagingStudy element SHOULD be used to support exchange with systems that can view DICOM (Digital Imaging and Communications in Medicine) studies, series, and SOP (Service-Object Pair) instances referenced in the [ImagingStudy] resource. Alternatively, systems can use business identifiers such as accession numbers in the identifier element to access the source images from external sources. The DiagnosticRequest.basedOn element connects the DiagnosticReport to the originating order in the EHR. Systems that initiate the lab order SHOULD use this element when reporting the results. Supported Profiles: SHALL support: US Core DiagnosticReport Profile for Report and Note exchange SHALL support: US Core DiagnosticReport Profile for Laboratory Results Reporting Profile Interaction Summary: SHALL support create†, search-type, read. SHOULD support vread, history-instance. MAY support update, patch, delete, history-type. create† This conformance expectation applies only to the US Core DiagnosticReport Profile for Report and Note exchange profile. The conformance expectation for the US Core DiagnosticReport Profile for Laboratory Results Reporting is MAY. Fetch and Search Criteria: A Server SHALL be capable of returning a DiagnosticReport resource using: GET [base]/DiagnosticReport/[id] A Server SHALL be capable of supporting the following _revincludes: Provenance:target - GET [base]/DiagnosticReport?[parameter=value]&_revinclude=Provenance:target Search Parameter Summary: Conformance Parameter Type SHALL patient reference Search Parameter Combination Summary: Conformance Parameter Combination Types SHOULD patient+ category+ _lastUpdated reference+token+date SHOULD patient+ status reference+token SHALL patient+ category reference+token SHALL patient+ category+ date reference+token+date SHALL patient+ code reference+token SHOULD patient+ code+ date reference+token+date Search Parameter Requirements (When Used Alone or in Combination): category (token): The client SHALL provide at least a code value and MAY provide both the system and code values. The server SHALL support both. code (token): The client SHALL provide at least a code value and MAY provide both the system and code values. The server SHALL support both. date (date): A client SHALL provide a value precise to the second + time offset. A server SHALL support a value precise to the second + time offset. _lastUpdated (date): A server SHALL document the types of changes that can be detected using this parameter. A client SHALL provide a value precise to the second + time offset. A server SHALL support a value precise to the second + time offset. patient (reference): The client SHALL provide at least a id value and MAY provide both the Type and id values. The server SHALL support both. status (token): The client SHALL provide at least a code value and MAY provide both the system and code values. The server SHALL support both. DocumentReference Conformance Expectation: SHALL Resource Specific Documentation: For Advance Directive Information (ADI) documents use the US Core ADI DocumentReference Profile. For other clinical documents use the US Core DiagnosticReport Profile for Report and Note Exchange. See the Clinical Notes page for important definitions, requirements, and guidance on creating, using, and sharing Clinical Notes. The DocumentReference.type binding Must Support at a minimum the 10 Common Clinical Notes and may extend to the full US Core DocumentReference Type Value Set The DocumentReference resources can represent the referenced content using either an address where the document can be retrieved using DocumentReference.attachment.url or the content as inline base64 encoded data using DocumentReference.attachment.data. Although both are marked as must support, the server system is not required to support an address, and inline base64 encoded data, but SHALL support at least one of these elements. The client application SHALL support both elements. The content.attachment.url may refer to a FHIR Binary Resource (i.e. [base]/Binary/[id]), FHIR Document Bundle (i.e [base]/Bundle/[id] or another endpoint. If there are multiple DocumentReference.content element repetitions, these SHALL all represent the same document in different format or attachment metadata. The content element SHALL NOT contain different versions of the same content. For version handling use multiple DocumentReferences with DocumentReference.relatesTo Every DocumentReference must have a responsible Organization. The organization responsible for the DocumentReference SHALL be present either in DocumentReference.custodian or accessible in the Provenance resource targeting the DocumentReference using Provenance.agent.who or Provenance.agent.onBehalfOf. Supported Profiles: SHALL support: US Core DocumentReference Profile SHALL support: US Core ADI DocumentReference Profile Profile Interaction Summary: SHALL support create, search-type, read. SHOULD support vread, history-instance. MAY support update, patch, delete, history-type. Operation Summary: SHALL support the $docref operation A server SHALL be capable of responding to a $docref operation and capable of returning at least a reference to a generated CCD document, if available. MAY provide references to other 'on-demand' and 'stable' documents (or 'delayed/deferred assembly') that meet the query parameters as well. If a context date range is supplied the server ** SHOULD** provide references to any document that falls within the date range. If no date range is supplied, then the server SHALL provide references to last or current document(s). SHOULD document what resources, if any, are returned as included resources GET [base]/DocumentReference/$docref?patient=[id] Fetch and Search Criteria: A Server SHALL be capable of returning a DocumentReference resource using: GET [base]/DocumentReference/[id] A Server SHALL be capable of supporting the following _revincludes: Provenance:target - GET [base]/DocumentReference?[parameter=value]&_revinclude=Provenance:target Search Parameter Summary: Conformance Parameter Type SHALL _id token SHALL patient reference Search Parameter Combination Summary: Conformance Parameter Combination Types SHOULD patient+ status reference+token SHALL patient+ category reference+token SHALL patient+ category+ date reference+token+date SHOULD patient+ type+ period reference+token+date SHALL patient+ type reference+token Search Parameter Requirements (When Used Alone or in Combination): category (token): The client SHALL provide at least a code value and MAY provide both the system and code values. The server SHALL support both. date (date): A client SHALL provide a value precise to the second + time offset. A server SHALL support a value precise to the second + time offset. patient (reference): The client SHALL provide at least a id value and MAY provide both the Type and id values. The server SHALL support both. period (date): A client SHALL provide a value precise to the second + time offset. A server SHALL support a value precise to the second + time offset. status (token): The client SHALL provide at least a code value and MAY provide both the system and code values. The server SHALL support both. type (token): The client SHALL provide at least a code value and MAY provide both the system and code values. The server SHALL support both. Encounter Conformance Expectation: SHALL Resource Specific Documentation: The Encounter resource can represent a reason using either a code with Encounter.reasonCode, or a reference with Encounter.reasonReference to Condition or other resource. Although both are marked as must support, the server systems are not required to support both a code and a reference, but they SHALL support at least one of these elements. The client application SHALL support both elements. if Encounter.reasonReference references an Observation, it SHOULD conform to a US Core Observation if applicable. (for example, a laboratory result should conform to the US Core Laboratory Result Observation Profile) The location address can be represented by either by the Location referenced by Encounter.location.location or indirectly through the Organization referenced by Encounter.serviceProvider. Although both are marked as must support, the server systems are not required to support both Encounter.location.location and Encounter.serviceProvider, but they SHALL support at least one of these elements. The client application SHALL support both elements. If the event facility/location differs from the Encounter.location, systems SHOULD reference it directly: Servers can use the US Core Interpreter Needed Extension on this profile or the [US Core Patient Profile] to communicate whether a patient needs an interpreter. Although the extension is marked as an Additional USCDI Requirements on both US Core Patient and US Core Encounter Profiles, the certifying Server system is not required to support the extension on both profiles, but SHALL support the extension on at least one. The certifying Client application SHALL support the extension on both profiles. Systems SHOULD designate the patient's preferred language in the Patient.communication.preferred element. Updates to .meta.lastUpdated SHOULD reflect: New encounters/visits Changes in the status of encounters, including events that trigger the same status (e.g., in-progress → in-progress). These status changes correspond to events that can initiate [HL7 V2] ADT messages. Supported Profiles: SHALL support: US Core Encounter Profile Profile Interaction Summary: SHALL support search-type, read. SHOULD support vread, history-instance. MAY support create, update, patch, delete, history-type. Fetch and Search Criteria: A Server SHALL be capable of returning a Encounter resource using: GET [base]/Encounter/[id] A Server SHALL be capable of supporting the following _revincludes: Provenance:target - GET [base]/Encounter?[parameter=value]&_revinclude=Provenance:target Search Parameter Summary: Conformance Parameter Type SHALL _id token SHOULD identifier token SHALL patient reference Search Parameter Combination Summary: Conformance Parameter Combination Types SHALL date+ patient date+reference SHOULD patient+ _lastUpdated reference+date SHOULD patient+ status reference+token SHOULD patient+ type reference+token SHOULD patient+ location reference+reference SHOULD patient+ discharge-disposition reference+token SHOULD class+ patient token+reference Search Parameter Requirements (When Used Alone or in Combination): class (token): The client SHALL provide at least a code value and MAY provide both the system and code values. The server SHALL support both. date (date): A client SHALL provide a value precise to the second + time offset. A server SHALL support a value precise to the second + time offset. _lastUpdated (date): A server SHALL document the types of changes that can be detected using this parameter. A client SHALL provide a value precise to the second + time offset. A server SHALL support a value precise to the second + time offset. discharge-disposition (token): The client SHALL provide at least a code value and MAY provide both the system and code values. The server SHALL support both. identifier (token): The client SHALL provide at least a code value and MAY provide both the system and code values. The server SHALL support both. location (reference): The client SHALL provide at least a id value and MAY provide both the Type and id values. The server SHALL support both. patient (reference): The client SHALL provide at least a id value and MAY provide both the Type and id values. The server SHALL support both. status (token): The client SHALL provide at least a code value and MAY provide both the system and code values. The server SHALL support both. type (token): The client SHALL provide at least a code value and MAY provide both the system and code values. The server SHALL support both. Endpoint Conformance Expectation: SHALL Resource Specific Documentation: The Media Resource is a Must Support referenced resource when using the US Core PractitionerRole Profile. Profile Interaction Summary: SHOULD support read, vread. MAY support create, search-type, update, patch, delete, history-instance, history-type. Fetch and Search Criteria: A Server SHOULD be capable of returning a Endpoint resource using: GET [base]/Endpoint/[id] Goal Conformance Expectation: SHALL Resource Specific Documentation: Although both Goal.startDate and Goal.target.dueDate are marked as must support, the server system is not required to support both, but SHALL support at least one of these elements. The client application SHALL support both elements. Supported Profiles: SHALL support: US Core Goal Profile Profile Interaction Summary: SHALL support search-type, read. SHOULD support vread, history-instance. MAY support create, update, patch, delete, history-type. Fetch and Search Criteria: A Server SHALL be capable of returning a Goal resource using: GET [base]/Goal/[id] A Server SHALL be capable of supporting the following _revincludes: Provenance:target - GET [base]/Goal?[parameter=value]&_revinclude=Provenance:target Search Parameter Summary: Conformance Parameter Type SHALL patient reference Search Parameter Combination Summary: Conformance Parameter Combination Types SHOULD patient+ lifecycle-status reference+token SHOULD patient+ description reference+token SHOULD patient+ target-date reference+date Search Parameter Requirements (When Used Alone or in Combination): lifecycle-status (token): The client SHALL provide at least a code value and MAY provide both the system and code values. The server SHALL support both. patient (reference): The client SHALL provide at least a id value and MAY provide both the Type and id values. The server SHALL support both. target-date (date): A client SHALL provide a value precise to the day. A server SHALL support a value a value precise to the day. HealthcareService Conformance Expectation: MAY Resource Specific Documentation: The HealthcareService Resource is a referenced resource when using the US Core PractitionerRole Profile and subject to constraint us-core-13: "SHALL have a practitioner, an organization, a healthcare service, or a location." Profile Interaction Summary: SHOULD support read, vread. MAY support create, search-type, update, patch, delete, history-instance, history-type. Fetch and Search Criteria: A Server SHOULD be capable of returning a HealthcareService resource using: GET [base]/HealthcareService/[id] Immunization Conformance Expectation: SHALL Resource Specific Documentation: Based upon the ASTP U.S. Core Data for Interoperability (USCDI) requirements, CVX vaccine codes are required and the NDC vaccine codes SHOULD be supported as an additional code. Supported Profiles: SHALL support: US Core Immunization Profile Profile Interaction Summary: SHALL support search-type, read. SHOULD support vread, history-instance. MAY support create, update, patch, delete, history-type. Fetch and Search Criteria: A Server SHALL be capable of returning a Immunization resource using: GET [base]/Immunization/[id] A Server SHALL be capable of supporting the following _revincludes: Provenance:target - GET [base]/Immunization?[parameter=value]&_revinclude=Provenance:target Search Parameter Summary: Conformance Parameter Type SHALL patient reference Search Parameter Combination Summary: Conformance Parameter Combination Types SHOULD patient+ status reference+token SHOULD patient+ date reference+date Search Parameter Requirements (When Used Alone or in Combination): date (date): A client SHALL provide a value precise to the second + time offset. A server SHALL support a value precise to the second + time offset. patient (reference): The client SHALL provide at least a id value and MAY provide both the Type and id values. The server SHALL support both. status (token): The client SHALL provide at least a code value and MAY provide both the system and code values. The server SHALL support both. Location Conformance Expectation: SHALL Resource Specific Documentation: Systems SHOULD follow the Project US@ Technical Specification for Patient Addresses Final Version 1.0 as the standard style guide for Location.address.line and Location.address.city. Supported Profiles: SHALL support: US Core Location Profile Profile Interaction Summary: SHALL support search-type, read. SHOULD support vread, history-instance. MAY support create, update, patch, delete, history-type. Fetch and Search Criteria: A Server SHALL be capable of returning a Location resource using: GET [base]/Location/[id] Search Parameter Summary: Conformance Parameter Type SHALL address string SHOULD address-city string SHOULD address-postalcode string SHOULD address-state string SHALL name string Media Conformance Expectation: SHALL Resource Specific Documentation: The Media Resource is a Must Support referenced resource when using the US Core DiagnosticReport Profile for Report and Note Exchange. Profile Interaction Summary: SHOULD support read, vread. MAY support create, search-type, update, patch, delete, history-instance, history-type. Fetch and Search Criteria: A Server SHOULD be capable of returning a Media resource using: GET [base]/Media/[id] Medication Conformance Expectation: SHALL Resource Specific Documentation: The MedicationRequest resource can represent a medication, using an external reference to a Medication resource. If an external Medication Resource is used in a MedicationRequest, then the READ SHALL be supported. Supported Profiles: SHALL support: US Core Medication Profile Profile Interaction Summary: SHALL support read. SHOULD support vread, history-instance. MAY support create, search-type, update, patch, delete, history-type. Fetch and Search Criteria: A Server SHALL be capable of returning a Medication resource using: GET [base]/Medication/[id] MedicationDispense Conformance Expectation: SHALL Resource Specific Documentation: This Profile can represent a medication using a code or reference a Medication resource. The Server systems are not required to support both a code and a reference, but SHALL support at least one of these methods. The Client application SHALL support all methods. Systems that primarily rely on NDC codes instead of RxNorm to represent medications can use the National Library of Medicine's (NLM) NDC to RxNorm mappings to aid in additional codings. When referencing a Medication resource in .medicationReference, the resource may be contained or an external resource. If an external reference to a Medication resource is used, the Server SHALL support the _include parameter for searching this element. Supported Profiles: SHALL support: US Core MedicationDispense Profile Profile Interaction Summary: SHALL support search-type, read. SHOULD support vread, history-instance. MAY support create, update, patch, delete, history-type. Fetch and Search Criteria: A Server SHALL be capable of returning a MedicationDispense resource using: GET [base]/MedicationDispense/[id] A Server SHOULD be capable of supporting the following _includes: MedicationDispense:medication: GET [base]/MedicationDispense?[parameter=value]&_include=MedicationDispense:medication A Server SHALL be capable of supporting the following _revincludes: Provenance:target - GET [base]/MedicationDispense?[parameter=value]&_revinclude=Provenance:target Search Parameter Summary: Conformance Parameter Type SHALL patient reference Search Parameter Combination Summary: Conformance Parameter Combination Types SHOULD patient+ status+ type reference+token+token SHOULD patient+ status reference+token Search Parameter Requirements (When Used Alone or in Combination): patient (reference): The client SHALL provide at least a id value and MAY provide both the Type and id values. The server SHALL support both. status (token): The client SHALL provide at least a code value and MAY provide both the system and code values. The server SHALL support both. type (token): The client SHALL provide at least a code value and MAY provide both the system and code values. The server SHALL support both. MedicationRequest Conformance Expectation: SHALL Resource Specific Documentation: This Profile can represent a medication using a code or reference a Medication resource. The Server systems are not required to support both a code and a reference, but SHALL support at least one of these methods. The Client application SHALL support all methods. Systems that primarily rely on NDC codes instead of RxNorm to represent medications can use the National Library of Medicine's (NLM) NDC to RxNorm mappings to aid in additional codings. When referencing a Medication resource in .medicationReference, the resource may be contained or an external resource. If an external reference to a Medication resource is used, the Server SHALL support the _include parameter for searching this element. The MedicationRequest resource can represent that information is from a secondary source using either a boolean flag or reference in MedicationRequest.reportedBoolean, or a reference using MedicationRequest.reportedReference to Practitioner or other resource. Although both are marked as must support, the server systems are not required to support both a boolean and a reference, but SHALL choose to support at least one of these elements. The client application SHALL support both elements. When recording “self-prescribed” medication, requester SHOULD be used to indicate the Patient or RelatedPerson as the prescriber. (See the Medication List section for guidance on accessing a patient medications including over the counter (OTC) medication and other substances taken for medical and recreational use.) The MedicationRequest resource can communicate the reason or indication for treatment using either a code in MedicationRequest.reasonCode or a reference using MedicationRequest.reasonReference. Although both MedicationRequest.reasonCode and MedicationRequest.reasonReference are marked as Additional USCDI Requirements. The certifying server system is not required to support both but SHALL support at least one of these elements. The certifying client application SHALL support both elements. when using MedicationRequest.reasonReference: Servers SHALL support at least one target resource in MedicationRequest.reasonReference. Clients SHALL support all target resources. The referenced resources SHOULD be a US Core Profile as documented in Referencing US Core Profiles. Supported Profiles: SHALL support: US Core MedicationRequest Profile Profile Interaction Summary: SHALL support search-type, read. SHOULD support vread, history-instance. MAY support create, update, patch, delete, history-type. Fetch and Search Criteria: A Server SHALL be capable of returning a MedicationRequest resource using: GET [base]/MedicationRequest/[id] A Server SHOULD be capable of supporting the following _includes: MedicationRequest:medication: GET [base]/MedicationRequest?[parameter=value]&_include=MedicationRequest:medication A Server SHALL be capable of supporting the following _revincludes: Provenance:target - GET [base]/MedicationRequest?[parameter=value]&_revinclude=Provenance:target Search Parameter Combination Summary: Conformance Parameter Combination Types SHOULD patient+ intent+ encounter reference+token+reference SHALL patient+ intent+ status reference+token+token SHOULD patient+ intent+ authoredon reference+token+date SHALL patient+ intent reference+token Search Parameter Requirements (When Used Alone or in Combination): authoredon (date): A client SHALL provide a value precise to the second + time offset. A server SHALL support a value precise to the second + time offset. encounter (reference): The client SHALL provide at least a id value and MAY provide both the Type and id values. The server SHALL support both. intent (token): The client SHALL provide at least a code value and MAY provide both the system and code values. The server SHALL support both. patient (reference): The client SHALL provide at least a id value and MAY provide both the Type and id values. The server SHALL support both. status (token): The client SHALL provide at least a code value and MAY provide both the system and code values. The server SHALL support both. Observation Conformance Expectation: SHALL Resource Specific Documentation: Systems SHOULD support Observation.effectivePeriod to accurately represent tests that are collected over a period of time (for example, a 24-Hour Urine Collection test). An Observation without a value, SHALL include a reason why the data is absent unless there are component observations, or references to other Observations that are grouped within it Systems that never provide an observation without a value are not required to support Observation.dataAbsentReason An Observation.component without a value, SHALL include a reason why the data is absent. Systems that never provide an component observation without a component value are not required to support Observation.component.dataAbsentReason. There are multiple Observation profiles. Refer to the specific profile page for profile specific conformance rules and guidance Supported Profiles: SHALL support: US Core Observation ADI Documentation Profile SHALL support: US Core Laboratory Result Observation Profile SHALL support: US Core Observation Pregnancy Status Profile SHALL support: US Core Observation Pregnancy Intent Profile SHALL support: US Core Observation Occupation Profile SHALL support: US Core Respiratory Rate Profile SHALL support: US Core Simple Observation Profile SHALL support: US Core Treatment Intervention Preference Profile SHALL support: US Core Care Experience Preference Profile SHALL support: US Core Heart Rate Profile SHALL support: US Core Body Temperature Profile SHALL support: US Core Pediatric Weight for Height Observation Profile SHALL support: US Core Pulse Oximetry Profile SHALL support: US Core Smoking Status Observation Profile MAY support: US Core Observation Sexual Orientation Profile SHALL support: US Core Head Circumference Profile SHALL support: US Core Body Height Profile SHALL support: US Core BMI Profile SHALL support: US Core Observation Screening Assessment Profile SHALL support: US Core Average Blood Pressure Profile SHALL support: US Core Blood Pressure Profile SHALL support: US Core Observation Clinical Result Profile SHALL support: US Core Pediatric BMI for Age Observation Profile SHALL support: US Core Pediatric Head Occipital Frontal Circumference Percentile Profile SHALL support: US Core Body Weight Profile SHALL support: US Core Vital Signs Profile Profile Interaction Summary: SHALL support search-type, read. SHOULD support vread, history-instance. MAY support create, update, patch, delete, history-type. Fetch and Search Criteria: A Server SHALL be capable of returning a Observation resource using: GET [base]/Observation/[id] A Server SHALL be capable of supporting the following _revincludes: Provenance:target - GET [base]/Observation?[parameter=value]&_revinclude=Provenance:target Search Parameter Combination Summary: Conformance Parameter Combination Types SHOULD patient+ category+ _lastUpdated reference+token+date SHALL patient+ category reference+token SHOULD patient+ category+ status reference+token+token SHALL patient+ category+ date reference+token+date SHALL patient+ code reference+token SHOULD patient+ code+ date reference+token+date Search Parameter Requirements (When Used Alone or in Combination): category (token): The client SHALL provide at least a code value and MAY provide both the system and code values. The server SHALL support both. code (token): The client SHALL provide at least a code value and MAY provide both the system and code values. The server SHALL support both. date (date): A client SHALL provide a value precise to the second + time offset. A server SHALL support a value precise to the second + time offset. _lastUpdated (date): A server SHALL document the types of changes that can be detected using this parameter. A client SHALL provide a value precise to the second + time offset. A server SHALL support a value precise to the second + time offset. patient (reference): The client SHALL provide at least a id value and MAY provide both the Type and id values. The server SHALL support both. status (token): The client SHALL provide at least a code value and MAY provide both the system and code values. The server SHALL support both. Organization Conformance Expectation: SHALL Resource Specific Documentation: Systems SHALL support National Provider Identifier (NPI) for organizations and SHOULD support Clinical Laboratory Improvement Amendments (CLIA) and the National Association of Insurance Commissioners NAIC Company code (sometimes called "NAIC Number" or "cocode") for Organization.Identifier. Systems SHOULD follow the Project US@ Technical Specification for Patient Addresses Final Version 1.0 as the standard style guide for Organization.address.line and Organization.address.city. Supported Profiles: SHALL support: US Core Organization Profile Profile Interaction Summary: SHALL support search-type, read. SHOULD support vread, history-instance. MAY support create, update, patch, delete, history-type. Fetch and Search Criteria: A Server SHALL be capable of returning a Organization resource using: GET [base]/Organization/[id] Search Parameter Summary: Conformance Parameter Type SHALL address string SHALL name string Patient Conformance Expectation: SHALL Resource Specific Documentation: The Patient's Social Security Numbers SHOULD NOT be used as a patient identifier in Patient.identifier.value. The Complex Extensions for Race and Ethnicity allow for one or more codes of which: Must Support at least one category code from the OMB Race and Ethnicity Category Value Sets that draw from the Race & Ethnicity - CDC (CDCREC] code system. MAY include additional codes from the detailed ethnicity and detailed race value sets drawn from the Race & Ethnicity - CDC (CDCREC) code system SHALL include a text description Although Patient.deceased[x] is marked as 헔?헗?헗?헜?헧?헜?헢?헡?헔?헟? 헨?헦?헖?헗?헜?, certifying systems are not required to support both choices, but SHALL support at least Patient.deceasedDateTime. Servers can use the US Core Interpreter Needed Extension on this profile or the US Core Encounter Profile to communicate whether a patient needs an interpreter. Although the extension is marked as an Additional USCDI Requirement on both US Core Patient and US Core Encounter Profiles, the certifying Server system is not required to support the extension on both profiles but SHALL support the extension on at least one. The certifying Client application SHALL support the extension on both profiles. Systems SHOULD designate the patient's preferred language in the Patient.communication.preferred element. Certifying systems SHALL and non-certifying systems SHOULD follow the Project US@ Technical Specification for Patient Addresses Final Version 1.0 as the standard style guide for Patient.address.line and Patient.address.city for new and updated records. Supported Profiles: SHALL support: US Core Patient Profile Profile Interaction Summary: SHALL support search-type, read. SHOULD support vread, history-instance. MAY support create, update, patch, delete, history-type. Fetch and Search Criteria: A Server SHALL be capable of returning a Patient resource using: GET [base]/Patient/[id] A Server SHALL be capable of supporting the following _revincludes: Provenance:target - GET [base]/Patient?[parameter=value]&_revinclude=Provenance:target Search Parameter Summary: Conformance Parameter Type SHALL _id token SHALL identifier token SHALL name string Search Parameter Combination Summary: Conformance Parameter Combination Types SHALL birthdate+ name date+string SHOULD death-date+ family date+string SHOULD birthdate+ family date+string Search Parameter Requirements (When Used Alone or in Combination): birthdate (date): A client SHALL provide a value precise to the day. A server SHALL support a value a value precise to the day. death-date (date): A client SHALL provide a value precise to the day. A server SHALL support a value a value precise to the day. family (string): A server SHALL support a value precise to the day. identifier (token): The client SHALL provide at least a code value and MAY provide both the system and code values. The server SHALL support both. Practitioner Conformance Expectation: SHALL Resource Specific Documentation: Servers that support only US Core Practitioner Profile and do not support the US Core PractitionerRole Profile SHALL provide implementation specific guidance how to access a provider’s location and contact information using only the Practitioner resource. Although Practitioner.address is marked as Must Support, the server system is not required to support it if they support the US Core PractitionerRole Profile, but SHALL support it if they do not support the US Core PractitionerRole Profile. The client application SHALL support both. To balance the privacy of healthcare workers with the patient's right to access information. Only professional/work contact information about the practitioner SHOULD be available to the patient (such as a work address or office telephone number). Systems SHOULD follow the Project US@ Technical Specification for Patient Addresses Final Version 1.0 as the standard style guide for Practitioner.address.line and Practitioner.address.city. Supported Profiles: SHALL support: US Core Practitioner Profile Profile Interaction Summary: SHALL support search-type, read. SHOULD support vread, history-instance. MAY support create, update, patch, delete, history-type. Fetch and Search Criteria: A Server SHALL be capable of returning a Practitioner resource using: GET [base]/Practitioner/[id] Search Parameter Summary: Conformance Parameter Type SHOULD _id token SHALL identifier token SHALL name string Search Parameter Requirements (When Used Alone or in Combination): identifier (token): The client SHALL provide at least a code value and MAY provide both the system and code values. The server SHALL support both. PractitionerRole Conformance Expectation: SHALL Resource Specific Documentation: Due to implementer feedback, some US Core Profiles reference the PractitionerRole resource instead of the US Core PractitionerRole Profile. However the US Core PractitionerRole Profile SHOULD be used as the default profile if referenced by another US Core profile. Supported Profiles: SHALL support: US Core PractitionerRole Profile Profile Interaction Summary: SHALL support search-type, read. SHOULD support vread, history-instance. MAY support create, update, patch, delete, history-type. Fetch and Search Criteria: A Server SHALL be capable of returning a PractitionerRole resource using: GET [base]/PractitionerRole/[id] A Server SHOULD be capable of supporting the following _includes: PractitionerRole:endpoint: GET [base]/PractitionerRole?[parameter=value]&_include=PractitionerRole:endpoint PractitionerRole:practitioner: GET [base]/PractitionerRole?[parameter=value]&_include=PractitionerRole:practitioner Search Parameter Summary: Conformance Parameter Type SHALL practitioner reference SHALL specialty token Search Parameter Requirements (When Used Alone or in Combination): practitioner (reference): The client SHALL provide at least a id value and MAY provide both the Type and id values. The server SHALL support both. specialty (token): The client SHALL provide at least a code value and MAY provide both the system and code values. The server SHALL support both. Procedure Conformance Expectation: SHALL Resource Specific Documentation: Procedure codes can be taken from SNOMED-CT, CPT, HCPCS II, ICD-10-PCS, CDT. LOINC. Only LOINC concepts that reflect actual procedures SHOULD be used A procedure including an implantable device SHOULD use Procedure.focalDevice with a reference to the US Core Implantable Device Profile. Servers and Clients SHALL support both US Core ServiceRequest and US Core Procedure Profiles for communicating the reason or justification for a referral as Additional USCDI Requirements. Typically, the reason or justification for a referral or consultation is communicated through Procedure.basedOn linking the Procedure to the US Core ServiceRequest Profile that includes either ServiceRequest.reasonCode or ServiceRequest.reasonReference. When the Procedure does not have an associated ServiceRequest, it is communicated through the US Core Procedure Profile's Procedure.reasonCode or Procedure.reasonReference. Depending on the procedure being documented, a server will select the appropriate Profile to use. Although both Procedure.reasonCode and Procedure.reasonReference are marked as Additional USCDI Requirements. The certifying server system is not required to support both but SHALL support at least one of these elements. The certifying client application SHALL support both elements. when using Procedure.reasonReference: Servers SHALL support at least one target resource in Procedure.reasonReference. Clients SHALL support all target resources . The referenced resources SHOULD be a US Core Profile. Supported Profiles: SHALL support: US Core Procedure Profile Profile Interaction Summary: SHALL support search-type, read. SHOULD support vread, history-instance. MAY support create, update, patch, delete, history-type. Fetch and Search Criteria: A Server SHALL be capable of returning a Procedure resource using: GET [base]/Procedure/[id] A Server SHALL be capable of supporting the following _revincludes: Provenance:target - GET [base]/Procedure?[parameter=value]&_revinclude=Provenance:target Search Parameter Summary: Conformance Parameter Type SHALL patient reference Search Parameter Combination Summary: Conformance Parameter Combination Types SHOULD patient+ status reference+token SHALL patient+ date reference+date SHOULD patient+ code+ date reference+token+date Search Parameter Requirements (When Used Alone or in Combination): code (token): The client SHALL provide at least a code value and MAY provide both the system and code values. The server SHALL support both. date (date): A client SHALL provide a value precise to the second + time offset. A server SHALL support a value precise to the second + time offset. patient (reference): The client SHALL provide at least a id value and MAY provide both the Type and id values. The server SHALL support both. status (token): The client SHALL provide at least a code value and MAY provide both the system and code values. The server SHALL support both. Provenance Conformance Expectation: SHALL Resource Specific Documentation: The US Core Provenance resource SHALL be supported for these US Core resources: AllergyIntolerance CarePlan CareTeam Condition Coverage Device DiagnosticReport DocumentReference Encounter Goal Immunization MedicationDispense MedicationRequest Observation Patient Procedure QuestionnaireResponse RelatedPerson ServiceRequest If a system receives a provider in Provenance.agent.who as free text they must capture who sent them the information as the organization. On request they SHALL provide this organization as the source and MAY include the free text provider. Systems that need to know the activity has occurred SHOULD populate the activity. Supported Profiles: SHALL support: US Core Provenance Profile Profile Interaction Summary: SHALL support read. SHOULD support vread, history-instance. MAY support create, search-type, update, patch, delete, history-type. Fetch and Search Criteria: A Server SHALL be capable of returning a Provenance resource using: GET [base]/Provenance/[id] Questionnaire Conformance Expectation: SHOULD Resource Specific Documentation: US Core defines two ways to represent the questions and responses to screening and assessment instruments: Observation: US Core Observation Screening Assessment Profile Questionnaire/QuestionnaireResponse: SDC Base Questionnaire/US Core QuestionnaireResponse Profile US Core Servers SHALL support US Core Observation Screening Assessment Profile and SHOULD support the SDC Base Questionnaire Profile/US Core QuestionnaireResponse Profile Supported Profiles: SHALL support: SDC Base Questionnaire Profile Profile Interaction Summary: SHOULD support read, vread. MAY support create, search-type, update, patch, delete, history-instance, history-type. Fetch and Search Criteria: A Server SHOULD be capable of returning a Questionnaire resource using: GET [base]/Questionnaire/[id] QuestionnaireResponse Conformance Expectation: SHOULD Resource Specific Documentation: US Core defines two ways to represent the questions and responses to screening and assessment instruments: Observation: US Core Observation Screening Assessment Profile Questionnaire/QuestionnaireResponse: SDC Base Questionnaire/US Core QuestionnaireResponse Profile US Core Servers SHALL support US Core Observation Screening Assessment Profile and SHOULD support the SDC Base Questionnaire Profile/US Core QuestionnaireResponse Profile Supported Profiles: SHALL support: US Core QuestionnaireResponse Profile Profile Interaction Summary: SHOULD support search-type, read, vread, history-instance. MAY support create, update, patch, delete, history-type. Fetch and Search Criteria: A Server SHOULD be capable of returning a QuestionnaireResponse resource using: GET [base]/QuestionnaireResponse/[id] A Server SHALL be capable of supporting the following _revincludes: Provenance:target - GET [base]/QuestionnaireResponse?[parameter=value]&_revinclude=Provenance:target Search Parameter Summary: Conformance Parameter Type SHALL _id token SHALL patient reference Search Parameter Combination Summary: Conformance Parameter Combination Types SHOULD patient+ authored reference+date SHOULD patient+ status reference+token SHOULD patient+ questionnaire reference+reference Search Parameter Requirements (When Used Alone or in Combination): authored (date): A client SHALL provide a value precise to the second + time offset. A server SHALL support a value precise to the second + time offset. patient (reference): The client SHALL provide at least a id value and MAY provide both the Type and id values. The server SHALL support both. questionnaire (reference): The client SHALL provide at least a id value and MAY provide both the Type and id values. The server SHALL support both. status (token): The client SHALL provide at least a code value and MAY provide both the system and code values. The server SHALL support both. RelatedPerson Conformance Expectation: SHALL Resource Specific Documentation: Systems SHOULD follow the Project US@ Technical Specification for Patient Addresses Final Version 1.0 as the standard style guide for RelatedPerson.address.line and RelatedPerson.address.city. Supported Profiles: SHALL support: US Core RelatedPerson Profile Profile Interaction Summary: SHALL support search-type, read. SHOULD support vread, history-instance. MAY support create, update, patch, delete, history-type. Fetch and Search Criteria: A Server SHALL be capable of returning a RelatedPerson resource using: GET [base]/RelatedPerson/[id] A Server SHALL be capable of supporting the following _revincludes: Provenance:target - GET [base]/RelatedPerson?[parameter=value]&_revinclude=Provenance:target Search Parameter Summary: Conformance Parameter Type SHALL _id token SHOULD name string SHOULD patient reference Search Parameter Combination Summary: Conformance Parameter Combination Types SHOULD patient+ name reference+string Search Parameter Requirements (When Used Alone or in Combination): patient (reference): The client SHALL provide at least a id value and MAY provide both the Type and id values. The server SHALL support both. ServiceRequest Conformance Expectation: SHALL Resource Specific Documentation: The Must Support ServiceRequest.category is bound, at a minimum, to the US Core ServiceRequest Category Codes, and other category codes can be used. API consumers can query by category when accessing patient information. For the USCDI Laboratory Order, Imaging Order, Clinical Test Order, and Procedure Order Data Elements, implementers SHOULD use the corresponding category codes listed in the table on the US Core ServiceRequest Profile page. For example, laboratory orders would have the category code "108252007" (Laboratory procedure). The ServiceRequest.code value set is broad to accommodate a wide variety of use cases and SHOULD be constrained to a subset for a particular use case or domain. These value sets contain concepts that span many use cases and are not bound to any USCDI Data Element. However, the table on the US Core ServiceRequest Profile page identifies additional value set bindings for the USCDI Laboratory Order, Imaging Order and Clinical Test Order Data Elements. Implementers SHOULD conform to the binding strengths for each USCDI Order context listed in the table. For example, laboratory orders are extensibly bound to the LOINC Common Laboratory Orders Value Set. Note that the USCDI Class Procedure Order Data Element has no additional binding. Servers and Clients SHALL support both US Core ServiceRequest and US Core Procedure Profiles for communicating the reason or justification for a referral as Additional USCDI Requirements. Typically, the reason or justification for a referral or consultation is communicated through Procedure.basedOn linking the Procedure to the US Core ServiceRequest Profile that includes either ServiceRequest.reasonCode or ServiceRequest.reasonReference. When the Procedure does not have an associated ServiceRequest, it is communicated through the US Core Procedure Profile's Procedure.reasonCode or Procedure.reasonReference. Depending on the procedure being documented, a server will select the appropriate Profile to use. Although both ServiceRequest.reasonCode and ServiceRequest.reasonReference are marked as Additional USCDI Requirements, the certifying server system is not required to support both, but SHALL support at least one of these elements. The certifying client application SHALL support both elements. when using ServiceRequest.reasonReference: Servers SHALL support at least one target resource in ServiceRequest.reasonReference. Clients SHALL support all target resources. The referenced resources SHOULD be a US Core Profile as documented in Referencing US Core Profiles. Supported Profiles: SHALL support: US Core ServiceRequest Profile Profile Interaction Summary: SHALL support read. SHOULD support vread, history-instance. MAY support create, search-type, update, patch, delete, history-type. Fetch and Search Criteria: A Server SHALL be capable of returning a ServiceRequest resource using: GET [base]/ServiceRequest/[id] A Server SHALL be capable of supporting the following _revincludes: Provenance:target - GET [base]/ServiceRequest?[parameter=value]&_revinclude=Provenance:target Search Parameter Summary: Conformance Parameter Type SHALL _id token SHALL patient reference Search Parameter Combination Summary: Conformance Parameter Combination Types SHOULD patient+ status reference+token SHALL patient+ category reference+token SHOULD patient+ code+ authored reference+token+date SHALL patient+ category+ authored reference+token+date SHALL patient+ code reference+token Search Parameter Requirements (When Used Alone or in Combination): authored (date): A client SHALL provide a value precise to the second + time offset. A server SHALL support a value precise to the second + time offset. category (token): The client SHALL provide at least a code value and MAY provide both the system and code values. The server SHALL support both. code (token): The client SHALL provide at least a code value and MAY provide both the system and code values. The server SHALL support both. patient (reference): The client SHALL provide at least a id value and MAY provide both the Type and id values. The server SHALL support both. status (token): The client SHALL provide at least a code value and MAY provide both the system and code values. The server SHALL support both. Specimen Conformance Expectation: SHALL Resource Specific Documentation: Although both Specimen.identifier and Specimen.accessionIdentifier are marked as Must Support, the server system is not required to support both, but SHALL support at least one of these elements. The client application SHALL support both. Supported Profiles: SHALL support: US Core Specimen Profile Profile Interaction Summary: SHALL support read. SHOULD support vread, history-instance. MAY support create, search-type, update, patch, delete, history-type. Fetch and Search Criteria: A Server SHALL be capable of returning a Specimen resource using: GET [base]/Specimen/[id] Search Parameter Summary: Conformance Parameter Type SHALL _id token SHOULD patient reference ValueSet Conformance Expectation: SHOULD Operation Summary: SHOULD support the $expand operation If a server supports DocumentReference for creating, using, and sharing clinical notes, it SHOULD also support the context and contextdirection parameters of the $expand operation to enable clients to determine the supported note and report types, as well as the supported read/write formats for notes on the server.
HL7 International / Cross-Group Projects
This Section describes the expected capabilities of the US Core Server actor which is responsible for providing responses to the queries submitted by the US Core Requestors. The complete list of FHIR profiles, RESTful operations, and search parameters supported by US Core Servers are defined. Systems implementing this capability statement should meet the ASTP 2015 Common Clinical Data Set (CCDS) access requirement for Patient Selection 170.315(g)(7) and Application Access - Data Category Request 170.315(g)(8) and the ASTP [U.S. Core Data for Interoperability (USCDI) Version 5 July 2024](https://www.healthit.gov/isp/sites/isp/files/2024-07/USCDI-Version-5-July-2024-Final.pdf).
Used by permission of HL7 International, all rights reserved Creative Commons License
The US Core Server **SHALL**: 1. Support the US Core Patient resource profile AND at least one additional resource profile from the list of US Core Profiles AND and all *Must Support* US Core Profiles and resources it references. - A summary table listing all the *Must Support* references to other US Core Profiles and FHIR resources for each US Core Profile is located in the [Must Support - Resource References](must-support.html#must-support---resource-references) section of the guide. 1. Follow the requirements documented in the [General Requirements](general-requirements.html) and [Must Support](must-support.html) pages 1. Return the following response classes: - (Status 400): invalid parameter - (Status 401/4xx): unauthorized request - (Status 403): insufficient scopes - (Status 404): unknown resource 1. Support JSON source formats for all US Core interactions. The US Core Server **SHOULD**: 1. Follow the guidance documented in the [General Guidance](general-guidance.html) page 1. Support XML source formats for all US Core interactions. 1. Identify the US Core profiles supported as part of the FHIR `meta.profile` attribute for each instance. **NOTE**: US Core SearchParameters referenced in this CapabilityStatement that are derived from standard FHIR SearchParameters are only defined to document Server and Client expectations. They specify additional expectations for the following SearchParameter elements: - `multipleAnd` - `multipleOr` - `comparator` - `modifier` - `chain` They **SHALL NOT** be interpreted as search parameters for search. Servers and Clients **SHOULD** use the standard FHIR SearchParameters.
1. See the [General Security Considerations](security.html) section for requirements and recommendations. 1. A server **SHALL** reject any unauthorized requests by returning an `HTTP 401` "Unauthorized", `HTTP 403` "Forbidden", or `HTTP 404` "Not Found"
The client **SHALL** provide at least a code value and **MAY** provide both the system and code values. The server **SHALL** support both.
The client **SHALL** provide at least a id value and **MAY** provide both the Type and id values. The server **SHALL** support both.
* Additional considerations for systems aligning with [HL7 Consolidated (C-CDA)](http://www.hl7.org/implement/standards/product_brief.cfm?product_id=492) Care Plan requirements: - US Core Goal **SHOULD** be present in CarePlan.goal - US Core Condition **SHOULD** be present in CarePlan.addresses - Assessment and Plan **MAY** be included as narrative text
A client **SHALL** provide a value precise to the *second + time offset*. A server **SHALL** support a value precise to the *second + time offset*.
* In order to access care team member's names, identifiers, locations, and contact information, the CareTeam profile supports several types of care team participants. They are represented as references to other profiles and include the following four profiles which are marked as must support: 1. US Core Practitioner Profile 1. US Core PractitionerRole Profile 1. US Core Patient Profile 1. US Core RelatedPerson Profile * Although *both* US Core Practitioner Profile and US Core PractitionerRole are must support, the server system is not required to support both types of references, but **SHALL** support *at least* one of them. * The client application **SHALL** support all four profile references. * Bacause the *US Core PractitionerRole Profile* supplies the provider's location and contact information and a reference to the Practitioner, server systems **SHOULD** reference it instead of the *US Core Practitioner Profile*. * Servers that support only US Core Practitioner Profile and do not support the US Core PractitionerRole Profile **SHALL** provide implementation specific guidance how to access a provider’s location and contact information using only the Practitioner resource.
* For Encounter Diagnosis use the *US Core Condition Encounter Diagnosis Profile*. * When `Condition.category` is "encounter-diagnosis" the encounter, **SHOULD** be referenced in `Condition.encounter`. * For Problems and Health Concerns use the *US Core Condition Problems and Health Concerns Profile*. * When `Condition.category` is a "problems-list-item", the `Condition.clinicalStatus **SHOULD** be present. * There is no single element in Condition that represents the date of diagnosis. It may be the assertedDate Extension, `Condition.onsetDateTime`, or `Condition.recordedDate`. * Although all three are marked as must support, the server is not required to support all. * A server **SHALL** support `Condition.recordedDate`. * A server **SHALL** support at least one of the assertedDate Extension and `Condition.onsetDateTime`. A server may support both, which means they support all three elements. * The client application **SHALL** support all three elements. * See the US Core General Guidance page for [Searching Using lastUpdated](general-guidance.html#searching-using-lastupdated). Updates to `Condition.meta.lastUpdated` **SHOULD** reflect: * New problems and health concerns * Changes in the clinical status or verifications status of problems or health concern
A server **SHALL** document the types of changes that can be detected using this parameter. A client **SHALL** provide a value precise to the *second + time offset*. A server **SHALL** support a value precise to the *second + time offset*.
* Implantable medical devices that have UDI information **SHALL** represent the UDI code in `Device.udiCarrier.carrierHRF`. - All of the five UDI-PI elements that are present in the UDI code **SHALL** be represented in the corresponding US Core Implantable Device Profile element. UDI may not be present in all scenarios such as historical implantable devices, patient reported implant information, payer reported devices, or improperly documented implants. If UDI is not present and the manufacturer and/or model number information is available, they **SHOULD** be included to support historical reports of implantable medical devices as follows: manufacturer -> `Device.manufacturer` model -> `Device.model` * Servers **SHOULD** support query by Device.type to allow clients to request the patient's devices by a specific type. Note: The Device.type is too granular to differentiate implantable vs. non-implantable devices.
* For laboratory result reports use the *US Core DiagnosticReport Profile for Laboratory Results Reporting Profile*. * Updates to `.meta.lastUpdated` **SHOULD** reflect: * New laboratory reports * Changes in the status of laboratory reports including events that trigger the same status (e.g., amended → amended). * For imaging and non-laboratory clinical test result reports use the *US Core DiagnosticReport Profile for Report and Note Exchange Profile*. * Diagnostic imaging results in visual images requiring interpretation and clinical test results/reports may also reference images as part of the report. There is no single approach for accessing imaging studies alongside clinical data using a single authorization flow to give patients and providers access to the images. * The `DiagnosticReport.media.link` element **SHOULD** be used to support links to various patient-friendly content, such as jpg images of x-rays (see the DiagnosticReport Chest X-ray Report Example). * The `DiagnosticReport.imagingStudy` element **SHOULD** be used to support exchange with systems that can view DICOM (Digital Imaging and Communications in Medicine) studies, series, and SOP (Service-Object Pair) instances referenced in the [ImagingStudy] resource. * Alternatively, systems can use business identifiers such as accession numbers in the `identifier` element to access the source images from external sources. * The `DiagnosticRequest.basedOn` element connects the DiagnosticReport to the originating order in the EHR. Systems that initiate the lab order **SHOULD** use this element when reporting the results.
This conformance expectation applies **only** to the *US Core DiagnosticReport Profile for Report and Note exchange* profile. The conformance expectation for the *US Core DiagnosticReport Profile for Laboratory Results Reporting* is **MAY**.
* For Advance Directive Information (ADI) documents use the *US Core ADI DocumentReference Profile*. * For other clinical documents use the *US Core DiagnosticReport Profile for Report and Note Exchange*. * See the [Clinical Notes](clinical-notes.html) page for important definitions, requirements, and guidance on creating, using, and sharing Clinical Notes. * The `DocumentReference.type` binding Must Support at a minimum the [10 Common Clinical Notes](ValueSet-us-core-clinical-note-type.html) and may extend to the full US Core DocumentReference Type Value Set * The DocumentReference resources can represent the referenced content using either an address where the document can be retrieved using `DocumentReference.attachment.url` or the content as inline base64 encoded data using `DocumentReference.attachment.data`. * Although both are marked as must support, the server system is not required to support an address, and inline base64 encoded data, but **SHALL** support at least one of these elements. * The client application **SHALL** support both elements. * The `content.attachment.url` may refer to a FHIR Binary Resource (i.e. [base]/Binary/[id]), FHIR Document Bundle (i.e [base]/Bundle/[id] or another endpoint. * If there are multiple `DocumentReference.content` element repetitions, these **SHALL** all represent the same document in different format or attachment metadata. The content element **SHALL NOT** contain different versions of the same content. For version handling use multiple DocumentReferences with `DocumentReference.relatesTo` * Every DocumentReference must have a responsible Organization. The organization responsible for the DocumentReference **SHALL** be present either in `DocumentReference.custodian` or accessible in the Provenance resource targeting the DocumentReference using `Provenance.agent.who` or `Provenance.agent.onBehalfOf`.
A server **SHALL** be capable of responding to a $docref operation and capable of returning at least a reference to a generated CCD document, if available. **MAY** provide references to other 'on-demand' and 'stable' documents (or 'delayed/deferred assembly') that meet the query parameters as well. If a context date range is supplied the server ** SHOULD** provide references to any document that falls within the date range. If no date range is supplied, then the server **SHALL** provide references to last or current document(s). **SHOULD** document what resources, if any, are returned as included resources `GET [base]/DocumentReference/$docref?patient=[id]`
* The Encounter resource can represent a reason using either a code with `Encounter.reasonCode`, or a reference with `Encounter.reasonReference` to Condition or other resource. * Although both are marked as must support, the server systems are not required to support both a code and a reference, but they **SHALL** support *at least one* of these elements. * The client application **SHALL** support both elements. * if `Encounter.reasonReference` references an Observation, it **SHOULD** conform to a US Core Observation if applicable. (for example, a laboratory result should conform to the US Core Laboratory Result Observation Profile) * The location address can be represented by either by the Location referenced by `Encounter.location.location` or indirectly through the Organization referenced by `Encounter.serviceProvider`. * Although both are marked as must support, the server systems are not required to support both `Encounter.location.location` and `Encounter.serviceProvider`, but they **SHALL** support *at least one* of these elements. * The client application **SHALL** support both elements. * If the event facility/location differs from the `Encounter.location`, systems **SHOULD** reference it directly: * Servers can use the US Core Interpreter Needed Extension on this profile or the [US Core Patient Profile] to communicate whether a patient needs an interpreter. Although the extension is marked as an *Additional USCDI Requirements* on both US Core Patient and US Core Encounter Profiles, the certifying Server system is not required to support the extension on both profiles, but **SHALL** support the extension on at least one. The certifying Client application **SHALL** support the extension on both profiles. - Systems **SHOULD** designate the patient's preferred language in the `Patient.communication.preferred` element. * Updates to `.meta.lastUpdated` **SHOULD** reflect: - New encounters/visits - Changes in the status of encounters, including events that trigger the same status (e.g., in-progress → in-progress). These status changes correspond to events that can initiate [HL7 V2] ADT messages.
The Media Resource is a Must Support referenced resource when using the US Core PractitionerRole Profile.
* Although both `Goal.startDate` and `Goal.target.dueDate` are marked as must support, the server system is not required to support both, but **SHALL** support at least one of these elements. The client application **SHALL** support both elements.
A client **SHALL** provide a value precise to the *day*. A server **SHALL** support a value a value precise to the *day*.
The HealthcareService Resource is a referenced resource when using the US Core PractitionerRole Profile and subject to constraint us-core-13: "SHALL have a practitioner, an organization, a healthcare service, or a location."
* Based upon the ASTP U.S. Core Data for Interoperability (USCDI) requirements, CVX vaccine codes are required and the NDC vaccine codes **SHOULD** be supported as an additional code.
* Systems **SHOULD** follow the Project US@ Technical Specification for Patient Addresses Final Version 1.0 as the standard style guide for `Location.address.line` and `Location.address.city`.
The Media Resource is a Must Support referenced resource when using the US Core DiagnosticReport Profile for Report and Note Exchange.
* The MedicationRequest resource can represent a medication, using an external reference to a Medication resource. If an external Medication Resource is used in a MedicationRequest, then the READ **SHALL** be supported.
* This Profile can represent a medication using a code or reference a Medication resource. * The Server systems are not required to support both a code and a reference, but **SHALL** support at least one of these methods. * The Client application **SHALL** support all methods. * Systems that primarily rely on NDC codes instead of RxNorm to represent medications can use the National Library of Medicine's (NLM) NDC to RxNorm mappings to aid in additional codings. * When referencing a Medication resource in `.medicationReference`, the resource may be contained or an external resource. If an external reference to a Medication resource is used, the Server **SHALL** support the `_include` parameter for searching this element.
* This Profile can represent a medication using a code or reference a Medication resource. * The Server systems are not required to support both a code and a reference, but **SHALL** support at least one of these methods. * The Client application **SHALL** support all methods. * Systems that primarily rely on NDC codes instead of RxNorm to represent medications can use the National Library of Medicine's (NLM) NDC to RxNorm mappings to aid in additional codings. * When referencing a Medication resource in `.medicationReference`, the resource may be contained or an external resource. If an external reference to a Medication resource is used, the Server **SHALL** support the `_include` parameter for searching this element. * The MedicationRequest resource can represent that information is from a secondary source using either a boolean flag or reference in `MedicationRequest.reportedBoolean`, or a reference using `MedicationRequest.reportedReference` to Practitioner or other resource. * Although both are marked as must support, the server systems are not required to support both a boolean and a reference, but **SHALL** choose to support at least one of these elements. * The client application **SHALL** support both elements. * When recording “self-prescribed” medication, requester **SHOULD** be used to indicate the Patient or RelatedPerson as the prescriber. (See the Medication List section for guidance on accessing a patient medications including over the counter (OTC) medication and other substances taken for medical and recreational use.) * The MedicationRequest resource can communicate the reason or indication for treatment using either a code in MedicationRequest.reasonCode or a reference using MedicationRequest.reasonReference. * Although both `MedicationRequest.reasonCode` and `MedicationRequest.reasonReference` are marked as Additional USCDI Requirements. The certifying server system is not required to support both but **SHALL** support at least one of these elements. The certifying client application **SHALL** support both elements. * when using MedicationRequest.reasonReference: * Servers **SHALL** support at least one target resource in `MedicationRequest.reasonReference`. Clients **SHALL** support all target resources. * The referenced resources **SHOULD** be a US Core Profile as documented in Referencing US Core Profiles.
* Systems **SHOULD** support `Observation.effectivePeriod` to accurately represent tests that are collected over a period of time (for example, a 24-Hour Urine Collection test). * An Observation without a value, **SHALL** include a reason why the data is absent unless there are component observations, or references to other Observations that are grouped within it * Systems that never provide an observation without a value are not required to support `Observation.dataAbsentReason` * An `Observation.component` without a value, **SHALL** include a reason why the data is absent. * Systems that never provide an component observation without a component value are not required to support `Observation.component.dataAbsentReason`. * There are multiple Observation profiles. Refer to the specific profile page for profile specific conformance rules and guidance
* Systems **SHALL** support National Provider Identifier (NPI) for organizations and **SHOULD** support Clinical Laboratory Improvement Amendments (CLIA) and the National Association of Insurance Commissioners NAIC Company code (sometimes called "NAIC Number" or "cocode") for `Organization.Identifier`. * Systems **SHOULD** follow the Project US@ Technical Specification for Patient Addresses Final Version 1.0 as the standard style guide for `Organization.address.line` and `Organization.address.city`.
* The Patient's Social Security Numbers **SHOULD NOT** be used as a patient identifier in `Patient.identifier.value`. * The Complex Extensions for Race and Ethnicity allow for one or more codes of which: Must Support at least one category code from the OMB Race and Ethnicity Category Value Sets that draw from the Race & Ethnicity - CDC (CDCREC] code system. - **MAY** include additional codes from the detailed ethnicity and detailed race value sets drawn from the Race & Ethnicity - CDC (CDCREC) code system - **SHALL** include a text description * Although Patient.deceased[x] is marked as 𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜, certifying systems are not required to support both choices, but **SHALL** support at least `Patient.deceasedDateTime`. * Servers can use the US Core Interpreter Needed Extension on this profile or the US Core Encounter Profile to communicate whether a patient needs an interpreter. Although the extension is marked as an *Additional USCDI Requirement* on both US Core Patient and US Core Encounter Profiles, the certifying Server system is not required to support the extension on both profiles but **SHALL** support the extension on at least one. The certifying Client application **SHALL** support the extension on both profiles. - Systems **SHOULD** designate the patient's preferred language in the `Patient.communication.preferred` element. * Certifying systems **SHALL** and non-certifying systems **SHOULD** follow the Project US@ Technical Specification for Patient Addresses Final Version 1.0 as the standard style guide for `Patient.address.line` and `Patient.address.city` for new and updated records.
A server **SHALL** support a value precise to the *day*.
* Servers that support only US Core Practitioner Profile and do not support the US Core PractitionerRole Profile **SHALL** provide implementation specific guidance how to access a provider’s location and contact information using only the Practitioner resource. * Although Practitioner.address is marked as Must Support, the server system is not required to support it if they support the US Core PractitionerRole Profile, but **SHALL** support it if they do not support the US Core PractitionerRole Profile. The client application **SHALL** support both. * To balance the privacy of healthcare workers with the patient's right to access information. Only professional/work contact information about the practitioner **SHOULD** be available to the patient (such as a work address or office telephone number). * Systems **SHOULD** follow the Project US@ Technical Specification for Patient Addresses Final Version 1.0 as the standard style guide for `Practitioner.address.line` and `Practitioner.address.city`.
* Due to implementer feedback, some US Core Profiles reference the PractitionerRole resource instead of the US Core PractitionerRole Profile. However the US Core PractitionerRole Profile **SHOULD** be used as the default profile if referenced by another US Core profile.
* Procedure codes can be taken from SNOMED-CT, CPT, HCPCS II, ICD-10-PCS, CDT. LOINC. * Only LOINC concepts that reflect actual procedures **SHOULD** be used * A procedure including an implantable device **SHOULD** use `Procedure.focalDevice` with a reference to the *US Core Implantable Device Profile*. * Servers and Clients **SHALL** support both US Core ServiceRequest and US Core Procedure Profiles for communicating the reason or justification for a referral as Additional USCDI Requirements. Typically, the reason or justification for a referral or consultation is communicated through `Procedure.basedOn` linking the Procedure to the US Core ServiceRequest Profile that includes either `ServiceRequest.reasonCode` or `ServiceRequest.reasonReference`. When the Procedure does not have an associated ServiceRequest, it is communicated through the US Core Procedure Profile's `Procedure.reasonCode` or `Procedure.reasonReference`. Depending on the procedure being documented, a server will select the appropriate Profile to use. * Although both `Procedure.reasonCode` and `Procedure.reasonReference` are marked as Additional USCDI Requirements. The certifying server system is not required to support both but **SHALL** support at least one of these elements. The certifying client application **SHALL** support both elements. * when using `Procedure.reasonReference`: * Servers **SHALL** support *at least one* target resource in `Procedure.reasonReference`. Clients **SHALL** support all target resources . * The referenced resources **SHOULD** be a US Core Profile.
* The US Core Provenance resource **SHALL** be supported for these US Core resources: * AllergyIntolerance * CarePlan * CareTeam * Condition * Coverage * Device * DiagnosticReport * DocumentReference * Encounter * Goal * Immunization * MedicationDispense * MedicationRequest * Observation * Patient * Procedure * QuestionnaireResponse * RelatedPerson * ServiceRequest * If a system receives a provider in `Provenance.agent.who` as free text they must capture who sent them the information as the organization. On request they **SHALL** provide this organization as the source and **MAY** include the free text provider. * Systems that need to know the activity has occurred **SHOULD** populate the activity.
* US Core defines two ways to represent the questions and responses to screening and assessment instruments: - Observation: US Core Observation Screening Assessment Profile - Questionnaire/QuestionnaireResponse: SDC Base Questionnaire/US Core QuestionnaireResponse Profile * US Core Servers **SHALL** support US Core Observation Screening Assessment Profile and **SHOULD** support the SDC Base Questionnaire Profile/US Core QuestionnaireResponse Profile
* Systems **SHOULD** follow the Project US@ Technical Specification for Patient Addresses Final Version 1.0 as the standard style guide for `RelatedPerson.address.line` and `RelatedPerson.address.city`.
* The Must Support `ServiceRequest.category` is bound, *at a minimum*, to the [US Core ServiceRequest Category Codes](ValueSet-us-core-servicerequest-category.html), and other category codes can be used. API consumers can query by category when accessing patient information. For the USCDI *Laboratory Order*, *Imaging Order*, *Clinical Test Order*, and *Procedure Order* Data Elements, implementers **SHOULD** use the corresponding category codes listed in the table on the US Core ServiceRequest Profile page. For example, laboratory orders would have the category code "108252007" (Laboratory procedure). * The `ServiceRequest.code` value set is broad to accommodate a wide variety of use cases and **SHOULD** be constrained to a subset for a particular use case or domain. These value sets contain concepts that span many use cases and are not bound to any USCDI Data Element. However, the table on the US Core ServiceRequest Profile page identifies *additional* value set bindings for the USCDI *Laboratory Order, Imaging Order and Clinical Test Order* Data Elements. Implementers **SHOULD** conform to the binding strengths for each USCDI Order context listed in the table. For example, laboratory orders are extensibly bound to the LOINC Common Laboratory Orders Value Set. Note that the USCDI Class *Procedure Order* Data Element has no additional binding. * Servers and Clients **SHALL** support both US Core ServiceRequest and US Core Procedure Profiles for communicating the reason or justification for a referral as Additional USCDI Requirements. Typically, the reason or justification for a referral or consultation is communicated through `Procedure.basedOn` linking the Procedure to the US Core ServiceRequest Profile that includes either `ServiceRequest.reasonCode` or `ServiceRequest.reasonReference`. When the Procedure does not have an associated ServiceRequest, it is communicated through the US Core Procedure Profile's `Procedure.reasonCode` or `Procedure.reasonReference`. Depending on the procedure being documented, a server will select the appropriate Profile to use. * Although both `ServiceRequest.reasonCode` and `ServiceRequest.reasonReference` are marked as Additional USCDI Requirements, the certifying server system is not required to support both, but **SHALL** support at least one of these elements. The certifying client application **SHALL** support both elements. * when using `ServiceRequest.reasonReference`: * Servers **SHALL** support *at least one* target resource in `ServiceRequest.reasonReference`. Clients **SHALL** support all target resources. * The referenced resources **SHOULD** be a US Core Profile as documented in Referencing US Core Profiles.
* Although both `Specimen.identifier` and `Specimen.accessionIdentifier` are marked as Must Support, the server system is not required to support both, but **SHALL** support at least one of these elements. The client application **SHALL** support both.
If a server supports DocumentReference for creating, using, and sharing clinical notes, it **SHOULD** also support the `context` and `contextdirection` parameters of the $expand operation to enable clients to determine the supported note and report types, as well as the supported read/write formats for notes on the server.