US Core Implementation Guide
9.0.0 - CI Build
US Core Implementation Guide
9.0.0 - CI Build
US Core Implementation Guide, published by HL7 International / Cross-Group Projects. This guide is not an authorized publication; it is the continuous build for version 9.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/US-Core/ and changes regularly. See the Directory of published versions
| Page standards status: Trial-use | Maturity Level: 3 |
<Requirements xmlns="http://hl7.org/fhir">
<id value="us-core-certifying-system"/>
<text>
<status value="extensions"/>
<div xmlns="http://www.w3.org/1999/xhtml">
<p>These requirements apply to the actor: <i><strong>US Core Certifying System</strong></i></p>
<table class="grid">
<thead>
<tr>
<th>Key</th>
<th>Conformance</th>
<th>Requirement</th>
</tr>
</thead>
<tbody>
<tr>
<td>CONF-0011</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>A Server that certifies to the <a href="https://www.federalregister.gov/d/2020-07419/p-1177">21st Century Cures Act for accessing patient data</a> <strong>SHALL</strong> implement all components in the USCDI [<a href="https://www.healthit.gov/isp/united-states-core-data-interoperability-uscdi">USCDI link</a>]</p>
</div></td>
</tr>
<tr>
<td>CONF-0012</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>A Server that certifies to the <a href="https://www.federalregister.gov/d/2020-07419/p-1177">21st Century Cures Act for accessing patient data</a> <strong>SHALL</strong> implement all components in the ... the US Core CapabilityStatement [<a href="https://hl7.org/fhir/us/core/CapabilityStatement-us-core-Server.html">Definition</a>] .</p>
</div></td>
</tr>
<tr>
<td>CONF-0124</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>Implementations meeting US EHR certification [of the ONC IT Health Certification program] requirements must support all US Core’s required scopes.</p>
</div></td>
</tr>
<tr>
<td>CONF-0465</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>Although Patient.deceased[x] is marked as additional USCDI, certifying systems are not required to support both [boolean and dateTime data types], but <strong>SHALL</strong> support [at] least Patient.deceasedDateTime</p>
</div></td>
</tr>
<tr>
<td>CONF-0469</td>
<td style="text-align: center;">SHALL</td>
<td><div><p><a href="https://www.healthit.gov/topic/certification-ehrs/about-onc-health-it-certification-program">Certifying systems</a> [, those that are participating in the ONC Health IT certification program,] <strong>SHALL</strong>... follow the <a href="https://asapnet.org/wp-content/uploads/2022/03/Project_US_FINAL_Technical_Specification_Version_1.0.pdf">Project US@ Technical Specification for Patient Addresses Final Version 1.0</a> as the standard style guide for Patient.address.line and Patient.address.city for new and updated records.</p>
</div></td>
</tr>
<tr>
<td>CONF-0801</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>If an element is marked as <em>Additional USCDI</em> and defined by a pattern [as described by <a href="http://hl7.org/fhir/R4/elementdefinition-definitions.html#ElementDefinition.pattern_x_">ElementDefinition.pattern</a>], then the pattern defines the elements <em>and</em> element values that the Certifying System <strong>SHALL</strong> be capable of providing.</p>
</div></td>
</tr>
<tr>
<td>CONF-0802</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>Primitive elements are single elements with a primitive value…. If they are marked as <em>Additional USCDI</em>, then the Certifying System <strong>SHALL</strong> be capable of providing the element value to meet the <em>Additional USCDI</em> requirement.</p>
</div></td>
</tr>
<tr>
<td>CONF-0803</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>For any complex element marked as <em>Additional USCDI</em>, the Certifying System <strong>SHALL</strong> be capable of providing at least one of the sub-element values.</p>
</div></td>
</tr>
<tr>
<td>CONF-0805</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>[I]f any sub-element is marked as <em>Additional USCDI</em> [for a complex element] and the parent element is not… [and] the parent element is represented in the structure, Certifying System <strong>SHALL</strong> support the sub-elements labeled as <em>Additional USCDI</em>.</p>
</div></td>
</tr>
<tr>
<td>CONF-0809</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>When a Reference type element is labeled as Additional USCDI and has a single target profile referenced, the target profile <strong>SHALL</strong> be supported for Certifying Systems.</p>
</div></td>
</tr>
<tr>
<td>CONF-0811</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>When a Reference type element labeled as Additional USCDI, has multiple target profiles referenced, and specific targets are labeled as Must Support, the Must Support target profile(s) <strong>SHALL</strong> be supported by Certifying Systems.</p>
</div></td>
</tr>
<tr>
<td>CONF-0812</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>[I]f a slice is labeled as ... Additional USCDI and the slicer element is not labeled as ... Additional USCDI, then if the ... certifying system supports the element, it must support the slice's definition. There are no examples of this structure in US Core.</p>
</div></td>
</tr>
<tr>
<td>CONF-0814</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>[I]f a slice is labeled as … Additional USCDI and the slicer element is ... labeled as … Additional USCDI, then … certifying system [<strong>SHALL</strong> support] the element[ and] the slice's definition.</p>
</div></td>
</tr>
<tr>
<td>CONF-0833</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>Certifying Systems <strong>SHALL</strong> support, a category of "sdoh"</p>
</div></td>
</tr>
<tr>
<td>CONF-0834</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>Certifying Systems ... <strong>SHOULD</strong> support the ... <a href="https://hl7.org/fhir/us/core/STU8/ValueSet-us-core-simple-observation-category.html">US Core Simple Observation Category</a> codes</p>
</div></td>
</tr>
<tr>
<td>CONF-0835</td>
<td style="text-align: center;">MAY</td>
<td><div><p>Certifying Systems ... <strong>MAY</strong> support other categories</p>
</div></td>
</tr>
<tr>
<td>CONF-0846</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>[For the US Core Observation Screening Assessment Profile,] Certifying Systems <strong>SHALL</strong> support, the <a href="https://hl7.org/fhir/us/core/STU8/ValueSet-us-core-screening-assessment-observation-category.html">US Core Screening Assessment Observation Category</a> codes</p>
</div></td>
</tr>
<tr>
<td>CONF-0847</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>[For the US Core Observation Screening Assessment Profile,] Certifying Systems <strong>SHOULD</strong> support, the <a href="https://hl7.org/fhir/us/core/STU8/ValueSet-us-core-screening-assessment-observation-maximum-category.html">US Core Screening Assessment Observation Maximum Category</a> codes</p>
</div></td>
</tr>
<tr>
<td>CONF-0848</td>
<td style="text-align: center;">MAY</td>
<td><div><p>[For the US Core Observation Screening Assessment Profile,] Certifying Systems <strong>MAY</strong> support other codes.</p>
</div></td>
</tr>
<tr>
<td>CONF-0861</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>[For <a href="https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-simple-observation.html">US Core Simple Observation Profile</a>, ]Certifying Systems ... <strong>SHOULD</strong> support the other <a href="https://hl7.org/fhir/us/core/STU8/ValueSet-us-core-simple-observation-category.html">US Core Simple Observation Category codes</a> [in addition to the <a href="https://hl7.org/fhir/us/core/STU8/ValueSet-us-core-screening-assessment-observation-category.html">US Core Screening Assessment Observation Category codes</a>]</p>
</div></td>
</tr>
<tr>
<td>CONF-0862</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>[For <a href="https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-simple-observation.html">US Core Simple Observation Profile</a>, ]Certifying Systems <strong>SHALL</strong> support, the <a href="https://hl7.org/fhir/us/core/STU8/ValueSet-us-core-screening-assessment-observation-category.html">US Core Screening Assessment Observation Category codes</a></p>
</div></td>
</tr>
<tr>
<td>CONF-0863</td>
<td style="text-align: center;">MAY</td>
<td><div><p>[For <a href="https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-simple-observation.html">US Core Simple Observation Profile</a>, ]Certifying Systems ... <strong>MAY</strong> support other categories [in addition to <a href="https://hl7.org/fhir/us/core/STU8/ValueSet-us-core-screening-assessment-observation-category.html">US Core Screening Assessment Observation Category codes</a> and <a href="https://hl7.org/fhir/us/core/STU8/ValueSet-us-core-simple-observation-category.html">US Core Simple Observation Category codes</a>].</p>
</div></td>
</tr>
<tr>
<td>CONF-0873</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>If an element is marked as <em>Additional USCDI</em> and defined by a pattern [as described by <a href="http://hl7.org/fhir/R4/elementdefinition-definitions.html#ElementDefinition.pattern_x_">ElementDefinition.pattern</a>], then the pattern defines the elements <em>and</em> element values that the Certifying System <strong>SHALL</strong> be capable of providing.</p>
</div></td>
</tr>
<tr>
<td>CONF-0874</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>If [an element is] ... marked as <em>Additional USCDI</em>, then the Certifying System <strong>SHALL</strong> be capable of providing the element value to meet the <em>Additional USCDI</em> requirement.</p>
</div></td>
</tr>
<tr>
<td>CONF-0875</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>For any complex element marked as <em>Additional USCDI</em>, the Certifying System <strong>SHALL</strong> be capable of providing at least one of the sub-element values</p>
</div></td>
</tr>
<tr>
<td>CONF-0876</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>[For any complex element marked as <em>Additional USCDI</em>]. If any sub-element is marked as <em>Additional USCDI</em>, [the Certifying System <strong>SHALL</strong>] ... meet the <em>Additional USCDI</em> requirements and satisfy the <em>Additional USCDI</em> requirements for the parent element.</p>
</div></td>
</tr>
<tr>
<td>CONF-0878</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>When a Reference type element is labeled as <em>Additional USCDI</em> and has a single target profile referenced, the target profile <strong>SHALL</strong> be supported for Certifying Systems.</p>
</div></td>
</tr>
<tr>
<td>CONF-0880</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>When a Reference type element labeled as <em>Additional USCDI</em>, has multiple target profiles referenced, and specific targets are labeled as <em>Must Support</em>, the <em>Must Support</em> target profile(s) <strong>SHALL</strong> be supported by Certifying Systems</p>
</div></td>
</tr>
<tr>
<td>CONF-0883</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>When a Reference element is labeled as <em>Additional USCDI</em> has multiple target profiles referenced, but none are labeled as <em>Must Support</em>, <em>at least one</em> target profile <strong>SHALL</strong> be supported by Certifying Systems.</p>
</div></td>
</tr>
<tr>
<td>CONF-0884</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>If an <em>Additional USCDI</em> element has a choice of datatypes for its content, the datatypes the Certifying System <strong>SHALL</strong> support are labeled as <em>Must Support</em>.</p>
</div></td>
</tr>
</tbody>
</table>
</div>
</text>
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<extension
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<valueInteger value="3">
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom">
<valueCanonical
value="http://hl7.org/fhir/us/core/ImplementationGuide/hl7.fhir.us.core"/>
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<extension
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<valueCode value="trial-use">
<extension
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<valueCanonical
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<url
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<value value="urn:oid:2.16.840.1.113883.4.642.40.2.36.1"/>
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<name value="USCoreCertifyingSystemRequirements"/>
<title value="US Core Certifying System Requirements"/>
<status value="draft"/>
<date value="2026-03-10T21:34:07+00:00"/>
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<description
value="This [Requirements](https://hl7.org/fhir/R5/requirements.html) resource lists the *additional requirements* for systems certifying for ASTP Health IT Certification (g(10) certification. These requirements represent the regulatory and technical specifications that design artifacts must meet to ensure interoperability. See the [US Core Server Requirements](Requirements-us-core-server.html) for the US Core Responder (Server) requirements defined in the US Core Implementation Guide narrative sections."/>
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<code value="US"/>
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<copyright
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<actor>
<extension url="http://hl7.org/fhir/StructureDefinition/display">
<valueString value="US Core Certifying System"/>
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<statement>
<key value="CONF-0011"/>
<conformance value="SHALL"/>
<requirement
value="A Server that certifies to the [21st Century Cures Act for accessing patient data](https://www.federalregister.gov/d/2020-07419/p-1177) **SHALL** implement all components in the USCDI [[USCDI link](https://www.healthit.gov/isp/united-states-core-data-interoperability-uscdi)]"/>
</statement>
<statement>
<key value="CONF-0012"/>
<conformance value="SHALL"/>
<requirement
value="A Server that certifies to the [21st Century Cures Act for accessing patient data](https://www.federalregister.gov/d/2020-07419/p-1177) **SHALL** implement all components in the ... the US Core CapabilityStatement [[Definition](https://hl7.org/fhir/us/core/CapabilityStatement-us-core-Server.html)] ."/>
</statement>
<statement>
<key value="CONF-0124"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="Implementations meeting US EHR certification [of the ONC IT Health Certification program] requirements must support all US Core’s required scopes."/>
</statement>
<statement>
<key value="CONF-0465"/>
<conformance value="SHALL"/>
<requirement
value="Although Patient.deceased[x] is marked as additional USCDI, certifying systems are not required to support both [boolean and dateTime data types], but **SHALL** support [at] least Patient.deceasedDateTime"/>
</statement>
<statement>
<key value="CONF-0469"/>
<conformance value="SHALL"/>
<requirement
value="[Certifying systems](https://www.healthit.gov/topic/certification-ehrs/about-onc-health-it-certification-program) [, those that are participating in the ONC Health IT certification program,] **SHALL**... follow the [Project US@ Technical Specification for Patient Addresses Final Version 1.0](https://asapnet.org/wp-content/uploads/2022/03/Project_US_FINAL_Technical_Specification_Version_1.0.pdf) as the standard style guide for Patient.address.line and Patient.address.city for new and updated records."/>
</statement>
<statement>
<key value="CONF-0801"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="If an element is marked as *Additional USCDI* and defined by a pattern [as described by [ElementDefinition.pattern](http://hl7.org/fhir/R4/elementdefinition-definitions.html#ElementDefinition.pattern_x_)], then the pattern defines the elements *and* element values that the Certifying System **SHALL** be capable of providing."/>
</statement>
<statement>
<key value="CONF-0802"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="
Primitive elements are single elements with a primitive value…. If they are marked as *Additional USCDI*, then the Certifying System **SHALL** be capable of providing the element value to meet the *Additional USCDI* requirement."/>
</statement>
<statement>
<key value="CONF-0803"/>
<conformance value="SHALL"/>
<requirement
value="For any complex element marked as *Additional USCDI*, the Certifying System **SHALL** be capable of providing at least one of the sub-element values. "/>
</statement>
<statement>
<key value="CONF-0805"/>
<conformance value="SHALL"/>
<requirement
value="[I]f any sub-element is marked as *Additional USCDI* [for a complex element] and the parent element is not… [and] the parent element is represented in the structure, Certifying System **SHALL** support the sub-elements labeled as *Additional USCDI*."/>
</statement>
<statement>
<key value="CONF-0809"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="When a Reference type element is labeled as Additional USCDI and has a single target profile referenced, the target profile **SHALL** be supported for Certifying Systems."/>
</statement>
<statement>
<key value="CONF-0811"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="When a Reference type element labeled as Additional USCDI, has multiple target profiles referenced, and specific targets are labeled as Must Support, the Must Support target profile(s) **SHALL** be supported by Certifying Systems."/>
</statement>
<statement>
<key value="CONF-0812"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="[I]f a slice is labeled as ... Additional USCDI and the slicer element is not labeled as ... Additional USCDI, then if the ... certifying system supports the element, it must support the slice's definition. There are no examples of this structure in US Core."/>
</statement>
<statement>
<key value="CONF-0814"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="[I]f a slice is labeled as … Additional USCDI and the slicer element is ... labeled as … Additional USCDI, then … certifying system [**SHALL** support] the element[ and] the slice's definition."/>
</statement>
<statement>
<key value="CONF-0833"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="Certifying Systems **SHALL** support, a category of "sdoh""/>
</statement>
<statement>
<key value="CONF-0834"/>
<conformance value="SHOULD"/>
<requirement
value="Certifying Systems ... **SHOULD** support the ... [US Core Simple Observation Category](https://hl7.org/fhir/us/core/STU8/ValueSet-us-core-simple-observation-category.html) codes"/>
</statement>
<statement>
<key value="CONF-0835"/>
<conformance value="MAY"/>
<requirement
value="Certifying Systems ... **MAY** support other categories"/>
</statement>
<statement>
<key value="CONF-0846"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="[For the US Core Observation Screening Assessment Profile,] Certifying Systems **SHALL** support, the [US Core Screening Assessment Observation Category](https://hl7.org/fhir/us/core/STU8/ValueSet-us-core-screening-assessment-observation-category.html) codes"/>
</statement>
<statement>
<key value="CONF-0847"/>
<conformance value="SHOULD"/>
<requirement
value="[For the US Core Observation Screening Assessment Profile,] Certifying Systems **SHOULD** support, the [US Core Screening Assessment Observation Maximum Category](https://hl7.org/fhir/us/core/STU8/ValueSet-us-core-screening-assessment-observation-maximum-category.html) codes"/>
</statement>
<statement>
<key value="CONF-0848"/>
<conformance value="MAY"/>
<requirement
value="[For the US Core Observation Screening Assessment Profile,] Certifying Systems **MAY** support other codes."/>
</statement>
<statement>
<key value="CONF-0861"/>
<conformance value="SHOULD"/>
<conditionality value="true"/>
<requirement
value="[For [US Core Simple Observation Profile](https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-simple-observation.html), ]Certifying Systems ... **SHOULD** support the other [US Core Simple Observation Category codes](https://hl7.org/fhir/us/core/STU8/ValueSet-us-core-simple-observation-category.html) [in addition to the [US Core Screening Assessment Observation Category codes](https://hl7.org/fhir/us/core/STU8/ValueSet-us-core-screening-assessment-observation-category.html)]"/>
</statement>
<statement>
<key value="CONF-0862"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="[For [US Core Simple Observation Profile](https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-simple-observation.html), ]Certifying Systems **SHALL** support, the [US Core Screening Assessment Observation Category codes](https://hl7.org/fhir/us/core/STU8/ValueSet-us-core-screening-assessment-observation-category.html)"/>
</statement>
<statement>
<key value="CONF-0863"/>
<conformance value="MAY"/>
<conditionality value="true"/>
<requirement
value="[For [US Core Simple Observation Profile](https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-simple-observation.html), ]Certifying Systems ... **MAY** support other categories [in addition to [US Core Screening Assessment Observation Category codes](https://hl7.org/fhir/us/core/STU8/ValueSet-us-core-screening-assessment-observation-category.html) and [US Core Simple Observation Category codes](https://hl7.org/fhir/us/core/STU8/ValueSet-us-core-simple-observation-category.html)]."/>
</statement>
<statement>
<key value="CONF-0873"/>
<conformance value="SHALL"/>
<requirement
value="If an element is marked as *Additional USCDI* and defined by a pattern [as described by [ElementDefinition.pattern](http://hl7.org/fhir/R4/elementdefinition-definitions.html#ElementDefinition.pattern_x_)], then the pattern defines the elements *and* element values that the Certifying System **SHALL** be capable of providing."/>
</statement>
<statement>
<key value="CONF-0874"/>
<conformance value="SHALL"/>
<requirement
value="If [an element is] ... marked as *Additional USCDI*, then the Certifying System **SHALL** be capable of providing the element value to meet the *Additional USCDI* requirement."/>
</statement>
<statement>
<key value="CONF-0875"/>
<conformance value="SHALL"/>
<requirement
value="For any complex element marked as *Additional USCDI*, the Certifying System **SHALL** be capable of providing at least one of the sub-element values"/>
</statement>
<statement>
<key value="CONF-0876"/>
<conformance value="SHALL"/>
<requirement
value="[For any complex element marked as *Additional USCDI*]. If any sub-element is marked as *Additional USCDI*, [the Certifying System **SHALL**] ... meet the *Additional USCDI* requirements and satisfy the *Additional USCDI* requirements for the parent element."/>
</statement>
<statement>
<key value="CONF-0878"/>
<conformance value="SHALL"/>
<requirement
value="When a Reference type element is labeled as *Additional USCDI* and has a single target profile referenced, the target profile **SHALL** be supported for Certifying Systems."/>
</statement>
<statement>
<key value="CONF-0880"/>
<conformance value="SHALL"/>
<requirement
value="When a Reference type element labeled as *Additional USCDI*, has multiple target profiles referenced, and specific targets are labeled as *Must Support*, the *Must Support* target profile(s) **SHALL** be supported by Certifying Systems"/>
</statement>
<statement>
<key value="CONF-0883"/>
<conformance value="SHALL"/>
<requirement
value="When a Reference element is labeled as *Additional USCDI* has multiple target profiles referenced, but none are labeled as *Must Support*, *at least one* target profile **SHALL** be supported by Certifying Systems."/>
</statement>
<statement>
<key value="CONF-0884"/>
<conformance value="SHALL"/>
<requirement
value="If an *Additional USCDI* element has a choice of datatypes for its content, the datatypes the Certifying System **SHALL** support are labeled as *Must Support*."/>
</statement>
</Requirements>
IG © 2026+ HL7 International / Cross-Group Projects. Package hl7.fhir.us.core#9.0.0 based on FHIR 4.0.1. Generated 2026-03-10
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