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-client"/>
<text>
<status value="extensions"/>
<div xmlns="http://www.w3.org/1999/xhtml">
<p>These requirements apply to the actor: <i><strong>US Core Requestor (Clients including Certifying Systems)</strong></i></p>
<table class="grid">
<thead>
<tr>
<th>Key</th>
<th>Conformance</th>
<th>Requirement</th>
</tr>
</thead>
<tbody>
<tr>
<td>CONF-0022</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>[When populating a coded element with a <a href="http://hl7.org/fhir/R4/terminologies.html#required">required binding</a> to a ValueSet definition] US Core Requestors <strong>SHALL</strong> be capable of processing the code [from the required binding ValueSet]</p>
</div></td>
</tr>
<tr>
<td>CONF-0028</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>US Core Requestors <strong>SHALL</strong> be capable of processing the code in ['DataElement.code.code' or text in 'DataElement.code.text' for a DataElement.code that has an extensible binding]</p>
</div></td>
</tr>
<tr>
<td>CONF-0032</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>Clients <strong>SHALL</strong> be able to process [elements that are] <a href="https://hl7.org/fhir/us/core/must-support.html">Mandatory</a> or <a href="https://hl7.org/fhir/us/core/must-support.html">Must Support elements</a></p>
</div></td>
</tr>
<tr>
<td>CONF-0035</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>receivers SHOULD accept instances that ... contain unexpected data elements [<a href="http://hl7.org/fhir/R4/conformance-rules.html#isModifier">definition</a>]</p>
</div></td>
</tr>
<tr>
<td>CONF-0036</td>
<td style="text-align: center;">SHOULD-NOT</td>
<td><div><p>receivers SHOULD [NOT] accept instances that ... contain unexpected data elements … when those elements are modifier elements [<a href="http://hl7.org/fhir/R4/conformance-rules.html#isModifier">definition</a>]</p>
</div></td>
</tr>
<tr>
<td>CONF-0037</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>Unless a Client determines they can process [a resource with a modifier] safely, rejection is typically the only safe action if unexpected modifier elements are present.</p>
</div></td>
</tr>
<tr>
<td>CONF-0053</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>When searching using the <code>token</code> type searchparameter <a href="http://hl7.org/fhir/R4/search.html#token">(how to search by token)</a> The Client <strong>SHALL</strong> provide at least a code value</p>
</div></td>
</tr>
<tr>
<td>CONF-0054</td>
<td style="text-align: center;">MAY</td>
<td><div><p>When searching using the <code>token</code> type searchparameter <a href="http://hl7.org/fhir/R4/search.html#token">(how to search by token)</a> The Client … <strong>MAY</strong> provide both the system and code values.</p>
</div></td>
</tr>
<tr>
<td>CONF-0056</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>When searching using the <code>reference</code> type searchparameter <a href="http://hl7.org/fhir/R4/search.html#reference">(how to search by reference)</a> The Client <strong>SHALL</strong> provide at least an id value</p>
</div></td>
</tr>
<tr>
<td>CONF-0057</td>
<td style="text-align: center;">MAY</td>
<td><div><p>When searching using the <code>reference</code> type searchparameter <a href="http://hl7.org/fhir/R4/search.html#reference">(how to search by reference)</a> The Client … <strong>MAY</strong> provide both the Type and id values.</p>
</div></td>
</tr>
<tr>
<td>CONF-0059</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>When searching using the <code>date</code> type searchparameter <a href="http://hl7.org/fhir/R4/search.html#date">(how to search by date)</a> The Client <strong>SHALL</strong> provide values precise to the day for elements of datatype <code>date</code></p>
</div></td>
</tr>
<tr>
<td>CONF-0060</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>When searching using the <code>date</code> type searchparameter <a href="http://hl7.org/fhir/R4/search.html#date">(how to search by date)</a> The Client <strong>SHALL</strong> provide values precise … to the second + time offset for elements of datatype <code>dateTime</code>.</p>
</div></td>
</tr>
<tr>
<td>CONF-0076</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>For querying and reading US Core Profiles, Must Support on any profile data element <strong>SHALL</strong> be interpreted as follows…:</p>
<p>US Core Requestors <strong>SHALL</strong> be capable of processing resource instances containing the data elements without generating an error or causing the application to fail.</p>
</div></td>
</tr>
<tr>
<td>CONF-0079</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>For querying and reading US Core Profiles, Must Support on any profile data element <strong>SHALL</strong> be interpreted as follows…:</p>
<p>When querying US Core Responders, US Core Requestors <strong>SHALL</strong> interpret missing data elements within resource instances as data not present in the US Core Responder’s system.</p>
</div></td>
</tr>
<tr>
<td>CONF-0082</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>For querying and reading US Core Profiles, Must Support on any profile data element <strong>SHALL</strong> be interpreted as follows…:</p>
<p>US Core Requestors <strong>SHALL</strong> be able to process resource instances containing data elements asserting missing information.</p>
</div></td>
</tr>
<tr>
<td>CONF-0083</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>Implementors [US Core Requestors] seeking ONC certification [in the ONC IT Health Certification program] <strong>SHALL</strong> interpret Additional USCDI Requirements as Must Support elements as documented above and below;</p>
</div></td>
</tr>
<tr>
<td>CONF-0085</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>Implementors [US Core Requestors] [not] seeking ONC certification [in the ONC IT Health Certification program] <strong>SHALL</strong> interpret Additional USCDI Requirements as … optional.</p>
</div></td>
</tr>
<tr>
<td>CONF-0092</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>[W]hen claiming conformance [to a profile with a must support primitive element] … US Core requestors <strong>SHALL</strong> be capable of processing the value [of the primitive element]</p>
</div></td>
</tr>
<tr>
<td>CONF-0098</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>When claiming conformance [to a must support complex element with no must support sub-elements] … US Core Requestors <strong>SHALL</strong> be capable of processing a value in [the complex element]</p>
</div></td>
</tr>
<tr>
<td>CONF-0100</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>When claiming conformance [to a must support complex element with one or more must support sub-elements] … US Core Requestors <strong>SHALL</strong> be capable of processing a values in [each must support sub-element]</p>
</div></td>
</tr>
<tr>
<td>CONF-0102</td>
<td style="text-align: center;">MAY</td>
<td><div><p>Systems [US Core Requestors] can support the other elements [of a complex element, not labeled as a Must Support], but this is not a requirement of US Core</p>
</div></td>
</tr>
<tr>
<td>CONF-0104</td>
<td style="text-align: center;">MAY</td>
<td><div><p>The U.S. Core Data for Interoperability (USCDI) may require additional elements, [which is a requirement for certification in the ONC IT Health Certification program, but not a requirement of US Core conformance for US Core Requestors]</p>
</div></td>
</tr>
<tr>
<td>CONF-0106</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>In certain profiles, only specific resource references are labeled as Must Support.</p>
<p>...</p>
<ul>
<li>US Core Requestors <strong>SHALL</strong> be capable of processing [such an element] with a valid reference to [all listed Must Support profile(s).]</li>
</ul>
</div></td>
</tr>
<tr>
<td>CONF-0108</td>
<td style="text-align: center;">MAY</td>
<td><div><p>Systems [US Core Requestors] can support other [resource] references [other than those labeled as Must Support], but this is not a requirement of US Core</p>
</div></td>
</tr>
<tr>
<td>CONF-0110</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>In specific profiles, only a single resource reference is present on an element labeled Must Support.</p>
<p>…</p>
<ul>
<li>US Core Requestors <strong>SHALL</strong> be capable of processing [such an element] with a valid reference to [the Must Support Profile.]</li>
</ul>
</div></td>
</tr>
<tr>
<td>CONF-0112</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>[If a profile has] a Must Support element [with] a choice of datatypes for its content [and some of] the datatypes … are labeled as Must Support
… When claiming conformance to [such a] profile:</p>
<ul>
<li>US Core Requestors <strong>SHALL</strong> be capable of processing [the Must Support data type choice]</li>
</ul>
</div></td>
</tr>
<tr>
<td>CONF-0113</td>
<td style="text-align: center;">MAY</td>
<td><div><p>[If a profile has] a Must Support element [with] a choice of datatypes for its content [and some of] the datatypes … are labeled as Must Support[, or a profile has] an Additional USCDI element [with] a choice of datatypes for its content [and some of] the datatypes … are labeled as Additional USCDI</p>
<p>…</p>
<p>[US Core Requestors] <strong>MAY</strong> support ... processing other [data type] choice elements (such as Observation.effectivePeriod), but this is not a requirement of US Core.</p>
</div></td>
</tr>
<tr>
<td>CONF-0116</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>There are several instances in this Guide where there is a choice of supporting one or another profile element to meet the Must Support or Additional USCDI requirement. In such cases, … the Client application <strong>SHALL</strong> support all elements.</p>
</div></td>
</tr>
<tr>
<td>CONF-0122</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>Implementations [US Core Requestors] supporting Backend Services – for example, to meet US EHR certification requirements [of the ONC IT Health Certification program]- <strong>SHALL</strong> include support for the Client-confidential-asymmetric capability and system/scopes.</p>
</div></td>
</tr>
<tr>
<td>CONF-0127</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>US Core Clients should follow the <a href="https://en.wikipedia.org/wiki/Principle_of_least_privilege">principle of least privilege</a> and access only the necessary resources.</p>
</div></td>
</tr>
<tr>
<td>CONF-0172</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>US Core requires ... additional metadata [to be available through the Server's <a href="https://hl7.org/fhir/smart-app-launch/STU2/conformance.html#using-well-known">Well-Known Uniform Resource Identifier (URI)</a>]: ... [in] <code>scopes_supported</code> [the] array of scopes a Client may request. The app <strong>SHOULD</strong> inspect the returned scopes and accommodate the differences from the scopes it asked for and registered.</p>
</div></td>
</tr>
<tr>
<td>CONF-0194</td>
<td style="text-align: center;">MAY</td>
<td><div><p>[When Clients request a resource in a specific language] Clients <strong>MAY</strong> request language/locale using the http <a href="https://www.ietf.org/rfc/rfc2616.txt">Accept-Language</a> header.</p>
</div></td>
</tr>
<tr>
<td>CONF-0226</td>
<td style="text-align: center;">MAY</td>
<td><div><p>Systems [Clients] may support other [DiagnosticReport] categories as well.</p>
</div></td>
</tr>
<tr>
<td>CONF-0232</td>
<td style="text-align: center;">MAY</td>
<td><div><p>a Client can determine the note and report types supported by a Server by invoking the standard FHIR Value Set Expansion (<a href="http://hl7.org/fhir/R4/valueset-operation-expand.html">$expand</a>) operation defined in the FHIR R4 specification.</p>
</div></td>
</tr>
<tr>
<td>CONF-0251</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The Client application MUST support all methods [for referencing a medication resource: returned bundle, as an external resource, or as a <a href="http://hl7.org/fhir/R4/references.html#contained">contained</a> resource]</p>
</div></td>
</tr>
<tr>
<td>CONF-0264</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>To provide a list of a patient’s medications, it may be necessary to “de-duplicate” them. The de-duplication activity ... <strong>SHOULD</strong> be provided by the Client.</p>
</div></td>
</tr>
<tr>
<td>CONF-0275</td>
<td style="text-align: center;">MAY</td>
<td><div><p>API consumers can query by category when accessing patient information.</p>
</div></td>
</tr>
<tr>
<td>CONF-0286</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>Therefore, Client applications must plan on deduplication methods that rely on something other than a common identifier across FHIR versions.</p>
</div></td>
</tr>
<tr>
<td>CONF-0292</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>The FHIR RESTful resource types supported in a DSTU2 implementation <strong>SHOULD</strong> be supported in a R4 implementation</p>
</div></td>
</tr>
<tr>
<td>CONF-0293</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>The FHIR RESTful resource types supported in a DSTU2 implementation <strong>SHOULD</strong> be supported in a R4 implementation [with the] exception [of]
MedicationStatement may be deprecated, and the data <strong>SHOULD</strong> be mapped to MedicationRequest.</p>
</div></td>
</tr>
<tr>
<td>CONF-0294</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>The FHIR RESTful resource types supported in a DSTU2 implementation <strong>SHOULD</strong> be supported in a R4 implementation [with the] exception [of]
Care teams as represented by CarePlan in DSTU2 <strong>SHOULD</strong> be replaced by and the data mapped to CareTeam in R4</p>
</div></td>
</tr>
<tr>
<td>CONF-0299</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>When updating between versions, Clients <strong>SHOULD</strong> consider the impact of any changes to data visualization on the usability for the end user and the maintenance of data integrity.</p>
</div></td>
</tr>
<tr>
<td>CONF-0314</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>[C]lient application[s conforming to the US Core CareTeam profile] <strong>SHALL</strong> support [US Core Practitioner Profile]</p>
</div></td>
</tr>
<tr>
<td>CONF-0315</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>[C]lient application[s conforming to the US Core CareTeam profile] <strong>SHALL</strong> support [US Core PractitionerRole Profile]</p>
</div></td>
</tr>
<tr>
<td>CONF-0316</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>[C]lient application[s conforming to the US Core CareTeam profile] <strong>SHALL</strong> support [US Core RelatedPerson Profile]</p>
</div></td>
</tr>
<tr>
<td>CONF-0369</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The Client application <strong>SHALL</strong> support [DocumentReference.attachment.url]</p>
</div></td>
</tr>
<tr>
<td>CONF-0370</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The Client application <strong>SHALL</strong> support [DocumentReference.attachment.data]</p>
</div></td>
</tr>
<tr>
<td>CONF-0376</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The Client application <strong>SHALL</strong> support [ Encounter.reasonCode]</p>
</div></td>
</tr>
<tr>
<td>CONF-0377</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The Client application <strong>SHALL</strong> support [Encounter.reasonReference]</p>
</div></td>
</tr>
<tr>
<td>CONF-0380</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The Client application <strong>SHALL</strong> support [Encounter.location.location]</p>
</div></td>
</tr>
<tr>
<td>CONF-0381</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The Client application <strong>SHALL</strong> support [Encounter.serviceProvider]</p>
</div></td>
</tr>
<tr>
<td>CONF-0388</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The Client application <strong>SHALL</strong> support ... Goal.startDate</p>
</div></td>
</tr>
<tr>
<td>CONF-0389</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The Client application <strong>SHALL</strong> support ... Goal.target.dueDate</p>
</div></td>
</tr>
<tr>
<td>CONF-0403</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The Client application <strong>SHALL</strong> support [using a code in .medicationCodeableConcept to represent medications when supporting the US Core MedicationDispense profile]</p>
</div></td>
</tr>
<tr>
<td>CONF-0404</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The Client application <strong>SHALL</strong> support [referencing a Medication resource in .medicationReferencet to represent medications when supporting the US Core MedicationDispense profile]</p>
</div></td>
</tr>
<tr>
<td>CONF-0409</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The Client application <strong>SHALL</strong> support [medicationRequest.reporedtBoolean]</p>
</div></td>
</tr>
<tr>
<td>CONF-0410</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The Client application <strong>SHALL</strong> support [MedicationRequest.reportedReference]</p>
</div></td>
</tr>
<tr>
<td>CONF-0412</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>[For organizations participating in the ONC Health IT Certification program,] the certifying Client application <strong>SHALL</strong> support [MedicationRequest.reasonCode.]</p>
</div></td>
</tr>
<tr>
<td>CONF-0413</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>[For organizations participating in the ONC Health IT Certification program,] the certifying Client application <strong>SHALL</strong> support [MedicationRequest.reasonReference.]</p>
</div></td>
</tr>
<tr>
<td>CONF-0415</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>[For organizations participating in the ONC Health IT Certification program,] Clients <strong>SHALL</strong> support all target resources in MedicationRequest.reasonReference.</p>
</div></td>
</tr>
<tr>
<td>CONF-0476</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The Client application <strong>SHALL</strong> support both [the PractionerRole profile and the Practioner.address element]</p>
</div></td>
</tr>
<tr>
<td>CONF-0483</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>[For organizations participating in the ONC Health IT Certification program] … Clients <strong>SHALL</strong> support ... US Core Procedure Profile for communicating the reason or justification for a referral as Additional USCDI Requirements</p>
</div></td>
</tr>
<tr>
<td>CONF-0485</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>[For organizations participating in the ONC Health IT Certification program,] The certifying Client application <strong>SHALL</strong> support both [Procedure.reasonCode and Procedure.reasonReference]</p>
</div></td>
</tr>
<tr>
<td>CONF-0487</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>[For organizations participating in the ONC Health IT Certification program,] when using Procedure.reasonReference … Clients <strong>SHALL</strong> support all target resources in Procedure.reasonReference</p>
</div></td>
</tr>
<tr>
<td>CONF-0517</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>[For organizations participating in the ONC Health IT Certification program] … Clients <strong>SHALL</strong> support ... US Core ServiceRequest Profile for communicating the reason or justification for a referral as Additional USCDI Requirements</p>
</div></td>
</tr>
<tr>
<td>CONF-0519</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>[For organizations participating in the ONC Health IT Certification program,] The certifying Client application <strong>SHALL</strong> support both [ServiceRequest.reasonCode and ServiceRequest.reasonReference]</p>
</div></td>
</tr>
<tr>
<td>CONF-0521</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>[For organizations participating in the ONC Health IT Certification program,] when using ServiceRequest.reasonReference … Clients <strong>SHALL</strong> support all target resources in ServiceRequest.reasonReference</p>
</div></td>
</tr>
<tr>
<td>CONF-0525</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The Client application <strong>SHALL</strong> support both [ Specimen.identifier and Specimen.accessionIdentifier]</p>
</div></td>
</tr>
<tr>
<td>CONF-0526</td>
<td style="text-align: center;">MAY</td>
<td><div><p>Clients may request Specimen resources be included with the Observation or DiagnosticReport resource query.</p>
</div></td>
</tr>
<tr>
<td>CONF-0527</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>[Clients] <strong>SHOULD</strong> Support the Following Implementation Guide <a href="http://hl7.org/fhir/smart-app-launch/history.html">SMART App Launch version 2.0.0 and later</a></p>
</div></td>
</tr>
<tr>
<td>CONF-0528</td>
<td style="text-align: center;">MAY</td>
<td><div><p>[Clients] <strong>MAY</strong> support the transaction interaction</p>
</div></td>
</tr>
<tr>
<td>CONF-0529</td>
<td style="text-align: center;">MAY</td>
<td><div><p>[Clients] <strong>MAY</strong> support the batch interaction</p>
</div></td>
</tr>
<tr>
<td>CONF-0530</td>
<td style="text-align: center;">MAY</td>
<td><div><p>[Clients] <strong>MAY</strong> support the search-system interaction</p>
</div></td>
</tr>
<tr>
<td>CONF-0531</td>
<td style="text-align: center;">MAY</td>
<td><div><p>[Clients] <strong>MAY</strong> support the history-system interaction</p>
</div></td>
</tr>
<tr>
<td>CONF-0544</td>
<td style="text-align: center;">MAY</td>
<td><div><p>[Server] <strong>MAY</strong> support the transaction interaction</p>
</div></td>
</tr>
<tr>
<td>CONF-0545</td>
<td style="text-align: center;">MAY</td>
<td><div><p>[Server] <strong>MAY</strong> support the batch interaction</p>
</div></td>
</tr>
<tr>
<td>CONF-0546</td>
<td style="text-align: center;">MAY</td>
<td><div><p>[Server] <strong>MAY</strong> support the search-system interaction</p>
</div></td>
</tr>
<tr>
<td>CONF-0547</td>
<td style="text-align: center;">MAY</td>
<td><div><p>[Server] <strong>MAY</strong> support the history-system interaction</p>
</div></td>
</tr>
<tr>
<td>CONF-0551</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>Systems <strong>SHALL</strong> establish a risk analysis and management regime that conforms with HIPAA security regulatory requirements</p>
</div></td>
</tr>
<tr>
<td>CONF-0553</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>US Federal systems <strong>SHOULD</strong> conform with the risk management and mitigation requirements defined in NIST 800 series documents.</p>
</div></td>
</tr>
<tr>
<td>CONF-0555</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>US Federal systems … <strong>SHOULD</strong> include security category assignment following NIST 800-60 vol. 2 Appendix D.14.</p>
</div></td>
</tr>
<tr>
<td>CONF-0557</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>The coordination of risk management and the related security and privacy controls … <strong>SHOULD</strong> be defined in the Business Associate Agreement when available.</p>
</div></td>
</tr>
<tr>
<td>CONF-0559</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>Systems <strong>SHALL</strong> reference a single time source to establish a common time base for security auditing and clinical data records among computing systems.</p>
</div></td>
</tr>
<tr>
<td>CONF-0561</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>The selected time service <strong>SHOULD</strong> be documented in the Business Associate Agreement when available.</p>
</div></td>
</tr>
<tr>
<td>CONF-0563</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>Systems <strong>SHALL</strong> keep audit logs of the various transactions.</p>
</div></td>
</tr>
<tr>
<td>CONF-0565</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>Systems <strong>SHALL</strong> use TLS version 1.2 or higher for all transmissions not taking place over a secure network connection.</p>
</div></td>
</tr>
<tr>
<td>CONF-0567</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>US Federal systems <strong>SHOULD</strong> conform with FIPS PUB 140-2.</p>
</div></td>
</tr>
<tr>
<td>CONF-0569</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>Systems <strong>SHALL</strong> conform to <a href="http://hl7.org/fhir/R4/security.html#http">FHIR Communications Security</a> requirements.</p>
</div></td>
</tr>
<tr>
<td>CONF-0571</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>For Authentication and Authorization, Systems <strong>SHALL</strong> support any <a href="http://hl7.org/fhir/smart-app-launch/history.html">SMART App Launch version</a> for Client <-> Server interactions.</p>
</div></td>
</tr>
<tr>
<td>CONF-0573</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>Systems <strong>SHALL</strong> implement consent requirements per their state, local, and institutional policies.</p>
</div></td>
</tr>
<tr>
<td>CONF-0575</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>The Business Associate Agreements <strong>SHOULD</strong> document systems’ mutual consent requirements.</p>
</div></td>
</tr>
<tr>
<td>CONF-0577</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>Systems <strong>SHOULD</strong> provide Provenance statements using the <a href="https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-provenance.html">US Core Provenance Profile</a> resource and associated requirements.</p>
</div></td>
</tr>
<tr>
<td>CONF-0579</td>
<td style="text-align: center;">MAY</td>
<td><div><p>Systems <strong>MAY</strong> implement the <a href="http://hl7.org/fhir/R4/security.html#digital%20signatures">FHIR Digital Signatures</a></p>
</div></td>
</tr>
<tr>
<td>CONF-0581</td>
<td style="text-align: center;">MAY</td>
<td><div><p>Systems <strong>MAY</strong> protect the confidentiality of data at rest via encryption and associated access controls.</p>
</div></td>
</tr>
<tr>
<td>CONF-0582</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The [additional] current binding [<a href="https://hl7.org/fhir/R5/terminologies.html#binding">FHIR R5 link</a>] requires newly recorded, non-legacy data to be drawn from the [bound] value set.</p>
</div></td>
</tr>
<tr>
<td>CONF-0800</td>
<td style="text-align: center;">MAY</td>
<td><div><p>For querying and reading US Core Profiles, Must Support on any profile data element <strong>SHALL</strong> be interpreted as follows…:</p>
<p>[The US Core Requesters processing of the resource instances] may result in a determination not to use the resource if the resource content does not meet business requirements.</p>
</div></td>
</tr>
<tr>
<td>CONF-0815</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>When the Server supports [ the _include search parameter], Clients <strong>SHOULD</strong> use the _include search parameter to retrieve referenced content instead of searching for a resource and then performing a separate search for other references (for example, Patient, Encounter, and Location) in the result set.</p>
</div></td>
</tr>
<tr>
<td>CONF-0816</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>If the Server does not support the _include search parameter, Clients <strong>SHOULD</strong> consolidate duplicate searches before searching for referenced resources in the result set</p>
</div></td>
</tr>
<tr>
<td>CONF-0817</td>
<td style="text-align: center;">SHOULD-NOT</td>
<td><div><p><strong>SHOULD NOT</strong> search the same data within the time stated in the <code>Cache-Control</code> header.</p>
</div></td>
</tr>
<tr>
<td>CONF-0829</td>
<td style="text-align: center;">SHALL-NOT</td>
<td><div><p><strong>SHALL NOT</strong> be interpreted as search parameters for search.</p>
</div></td>
</tr>
<tr>
<td>CONF-0830</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>Clients <strong>SHOULD</strong> use the standard FHIR SearchParameters.</p>
</div></td>
</tr>
<tr>
<td>CONF-0849</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>[For the US Core Observation Screening Assessment Profile,] the Client system ... <strong>SHALL</strong> support [both] Reference(US Core Observation Screening Assessment Profile) [and] Reference(US Core QuestionnaireResponse Profile) for Observation.derivedFrom</p>
</div></td>
</tr>
<tr>
<td>CONF-0853</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The certifying Client application <strong>SHALL</strong> support the [<a href="https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-interpreter-needed.html">US Core Interpreter Needed Extension</a>] on [the <a href="https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-patient.html">US Core Patient Profile</a>] .</p>
</div></td>
</tr>
<tr>
<td>CONF-0854</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The certifying Client application <strong>SHALL</strong> support the [<a href="https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-interpreter-needed.html">US Core Interpreter Needed Extension</a>] on [the <a href="https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-encounter.html">US Core Encounter Profile</a>].</p>
</div></td>
</tr>
<tr>
<td>CONF-0869</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>'Observation.performer' target profiles <a href="https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-practitioner.html">US Core Practitioner Profile</a> and <a href="https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-patient.html">US Core Patient Profile</a> are labeled Must Support.... Clients <strong>SHALL</strong> support both.</p>
</div></td>
</tr>
<tr>
<td>CONF-0882</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>When a Reference element is labeled as <em>Must Support</em> has multiple target profiles referenced, but none are labeled as <em>Must Support</em></p>
<p>...</p>
<ul>
<li>US Core Requesters <strong>SHALL</strong> be capable of processing [such an element] with a valid reference to <em>at least one</em> target profile.</li>
</ul>
</div></td>
</tr>
</tbody>
</table>
</div>
</text>
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-wg">
<valueCode value="cgp"/>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm">
<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"/>
</extension>
</valueInteger>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status">
<valueCode value="trial-use">
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom">
<valueCanonical
value="http://hl7.org/fhir/us/core/ImplementationGuide/hl7.fhir.us.core"/>
</extension>
</valueCode>
</extension>
<url value="http://hl7.org/fhir/us/core/Requirements/us-core-client"/>
<identifier>
<system value="urn:ietf:rfc:3986"/>
<value value="urn:oid:2.16.840.1.113883.4.642.40.2.36.2"/>
</identifier>
<version value="9.0.0"/>
<name value="USCoreClientRequirements"/>
<title value="US Core Client Requirements"/>
<status value="draft"/>
<date value="2026-03-10T21:34:07+00:00"/>
<publisher value="HL7 International / Cross-Group Projects"/>
<contact>
<name value="HL7 International / Cross-Group Projects"/>
<telecom>
<system value="url"/>
<value value="http://www.hl7.org/Special/committees/cgp"/>
</telecom>
<telecom>
<system value="email"/>
<value value="cgp@lists.HL7.org"/>
</telecom>
</contact>
<description
value="This [Requirements]](https://hl7.org/fhir/R5/requirements.html) resource lists the US Core Requestor (Client) requirements defined in the US Core Implementation Guide narrative sections. These requirements represent the regulatory, business, functional, and technical specifications that design artifacts must meet to ensure interoperability."/>
<jurisdiction>
<coding>
<system value="urn:iso:std:iso:3166"/>
<code value="US"/>
</coding>
</jurisdiction>
<copyright
value="Used by permission of HL7 International, all rights reserved Creative Commons License"/>
<actor>
<extension url="http://hl7.org/fhir/StructureDefinition/display">
<valueString
value="US Core Requestor (Clients including Certifying Systems)"/>
</extension>
</actor>
<statement>
<key value="CONF-0022"/>
<conformance value="SHALL"/>
<requirement
value="[When populating a coded element with a [required binding](http://hl7.org/fhir/R4/terminologies.html#required) to a ValueSet definition] US Core Requestors **SHALL** be capable of processing the code [from the required binding ValueSet]"/>
</statement>
<statement>
<key value="CONF-0028"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="US Core Requestors **SHALL** be capable of processing the code in ['DataElement.code.code' or text in 'DataElement.code.text' for a DataElement.code that has an extensible binding]"/>
</statement>
<statement>
<key value="CONF-0032"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="Clients **SHALL** be able to process [elements that are] [Mandatory](https://hl7.org/fhir/us/core/must-support.html) or [Must Support elements](https://hl7.org/fhir/us/core/must-support.html)"/>
</statement>
<statement>
<key value="CONF-0035"/>
<conformance value="SHOULD"/>
<conditionality value="true"/>
<requirement
value="receivers SHOULD accept instances that ... contain unexpected data elements [[definition](http://hl7.org/fhir/R4/conformance-rules.html#isModifier)]"/>
</statement>
<statement>
<key value="CONF-0036"/>
<conformance value="SHOULD-NOT"/>
<conditionality value="true"/>
<requirement
value="receivers SHOULD [NOT] accept instances that ... contain unexpected data elements … when those elements are modifier elements [[definition](http://hl7.org/fhir/R4/conformance-rules.html#isModifier)]"/>
</statement>
<statement>
<key value="CONF-0037"/>
<conformance value="SHOULD"/>
<requirement
value="Unless a Client determines they can process [a resource with a modifier] safely, rejection is typically the only safe action if unexpected modifier elements are present."/>
</statement>
<statement>
<key value="CONF-0053"/>
<conformance value="SHALL"/>
<requirement
value="When searching using the `token` type searchparameter [(how to search by token)](http://hl7.org/fhir/R4/search.html#token) The Client **SHALL** provide at least a code value"/>
</statement>
<statement>
<key value="CONF-0054"/>
<conformance value="MAY"/>
<requirement
value="When searching using the `token` type searchparameter [(how to search by token)](http://hl7.org/fhir/R4/search.html#token) The Client … **MAY** provide both the system and code values."/>
</statement>
<statement>
<key value="CONF-0056"/>
<conformance value="SHALL"/>
<requirement
value="When searching using the `reference` type searchparameter [(how to search by reference)](http://hl7.org/fhir/R4/search.html#reference) The Client **SHALL** provide at least an id value"/>
</statement>
<statement>
<key value="CONF-0057"/>
<conformance value="MAY"/>
<requirement
value="When searching using the `reference` type searchparameter [(how to search by reference)](http://hl7.org/fhir/R4/search.html#reference) The Client … **MAY** provide both the Type and id values."/>
</statement>
<statement>
<key value="CONF-0059"/>
<conformance value="SHALL"/>
<requirement
value="When searching using the `date` type searchparameter [(how to search by date)](http://hl7.org/fhir/R4/search.html#date) The Client **SHALL** provide values precise to the day for elements of datatype `date`"/>
</statement>
<statement>
<key value="CONF-0060"/>
<conformance value="SHALL"/>
<requirement
value="When searching using the `date` type searchparameter [(how to search by date)](http://hl7.org/fhir/R4/search.html#date) The Client **SHALL** provide values precise … to the second + time offset for elements of datatype `dateTime`."/>
</statement>
<statement>
<key value="CONF-0076"/>
<conformance value="SHALL"/>
<requirement
value="For querying and reading US Core Profiles, Must Support on any profile data element **SHALL** be interpreted as follows…:
US Core Requestors **SHALL** be capable of processing resource instances containing the data elements without generating an error or causing the application to fail."/>
</statement>
<statement>
<key value="CONF-0079"/>
<conformance value="SHALL"/>
<requirement
value="For querying and reading US Core Profiles, Must Support on any profile data element **SHALL** be interpreted as follows…:
When querying US Core Responders, US Core Requestors **SHALL** interpret missing data elements within resource instances as data not present in the US Core Responder’s system."/>
</statement>
<statement>
<key value="CONF-0082"/>
<conformance value="SHALL"/>
<requirement
value="For querying and reading US Core Profiles, Must Support on any profile data element **SHALL** be interpreted as follows…:
US Core Requestors **SHALL** be able to process resource instances containing data elements asserting missing information."/>
</statement>
<statement>
<key value="CONF-0083"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="Implementors [US Core Requestors] seeking ONC certification [in the ONC IT Health Certification program] **SHALL** interpret Additional USCDI Requirements as Must Support elements as documented above and below;"/>
</statement>
<statement>
<key value="CONF-0085"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="Implementors [US Core Requestors] [not] seeking ONC certification [in the ONC IT Health Certification program] **SHALL** interpret Additional USCDI Requirements as … optional."/>
</statement>
<statement>
<key value="CONF-0092"/>
<conformance value="SHALL"/>
<requirement
value="[W]hen claiming conformance [to a profile with a must support primitive element] … US Core requestors **SHALL** be capable of processing the value [of the primitive element]"/>
</statement>
<statement>
<key value="CONF-0098"/>
<conformance value="SHALL"/>
<requirement
value="When claiming conformance [to a must support complex element with no must support sub-elements] … US Core Requestors **SHALL** be capable of processing a value in [the complex element]"/>
</statement>
<statement>
<key value="CONF-0100"/>
<conformance value="SHALL"/>
<requirement
value="When claiming conformance [to a must support complex element with one or more must support sub-elements] … US Core Requestors **SHALL** be capable of processing a values in [each must support sub-element]"/>
</statement>
<statement>
<key value="CONF-0102"/>
<conformance value="MAY"/>
<requirement
value="Systems [US Core Requestors] can support the other elements [of a complex element, not labeled as a Must Support], but this is not a requirement of US Core"/>
</statement>
<statement>
<key value="CONF-0104"/>
<conformance value="MAY"/>
<requirement
value="The U.S. Core Data for Interoperability (USCDI) may require additional elements, [which is a requirement for certification in the ONC IT Health Certification program, but not a requirement of US Core conformance for US Core Requestors]"/>
</statement>
<statement>
<key value="CONF-0106"/>
<conformance value="SHALL"/>
<requirement
value="In certain profiles, only specific resource references are labeled as Must Support.
...
- US Core Requestors **SHALL** be capable of processing [such an element] with a valid reference to [all listed Must Support profile(s).]"/>
</statement>
<statement>
<key value="CONF-0108"/>
<conformance value="MAY"/>
<requirement
value="Systems [US Core Requestors] can support other [resource] references [other than those labeled as Must Support], but this is not a requirement of US Core"/>
</statement>
<statement>
<key value="CONF-0110"/>
<conformance value="SHALL"/>
<requirement
value="In specific profiles, only a single resource reference is present on an element labeled Must Support.
…
- US Core Requestors **SHALL** be capable of processing [such an element] with a valid reference to [the Must Support Profile.]"/>
</statement>
<statement>
<key value="CONF-0112"/>
<conformance value="SHALL"/>
<requirement
value="[If a profile has] a Must Support element [with] a choice of datatypes for its content [and some of] the datatypes … are labeled as Must Support
… When claiming conformance to [such a] profile:
- US Core Requestors **SHALL** be capable of processing [the Must Support data type choice]"/>
</statement>
<statement>
<key value="CONF-0113"/>
<conformance value="MAY"/>
<requirement
value="[If a profile has] a Must Support element [with] a choice of datatypes for its content [and some of] the datatypes … are labeled as Must Support[, or a profile has] an Additional USCDI element [with] a choice of datatypes for its content [and some of] the datatypes … are labeled as Additional USCDI
…
[US Core Requestors] **MAY** support ... processing other [data type] choice elements (such as Observation.effectivePeriod), but this is not a requirement of US Core."/>
</statement>
<statement>
<key value="CONF-0116"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="There are several instances in this Guide where there is a choice of supporting one or another profile element to meet the Must Support or Additional USCDI requirement. In such cases, … the Client application **SHALL** support all elements."/>
</statement>
<statement>
<key value="CONF-0122"/>
<conformance value="SHALL"/>
<requirement
value="Implementations [US Core Requestors] supporting Backend Services – for example, to meet US EHR certification requirements [of the ONC IT Health Certification program]- **SHALL** include support for the Client-confidential-asymmetric capability and system/scopes."/>
</statement>
<statement>
<key value="CONF-0127"/>
<conformance value="SHOULD"/>
<requirement
value="US Core Clients should follow the [principle of least privilege](https://en.wikipedia.org/wiki/Principle_of_least_privilege) and access only the necessary resources."/>
</statement>
<statement>
<key value="CONF-0172"/>
<conformance value="SHOULD"/>
<requirement
value="US Core requires ... additional metadata [to be available through the Server's [Well-Known Uniform Resource Identifier (URI)](https://hl7.org/fhir/smart-app-launch/STU2/conformance.html#using-well-known)]: ... [in] `scopes_supported` [the] array of scopes a Client may request. The app **SHOULD** inspect the returned scopes and accommodate the differences from the scopes it asked for and registered."/>
</statement>
<statement>
<key value="CONF-0194"/>
<conformance value="MAY"/>
<conditionality value="true"/>
<requirement
value="[When Clients request a resource in a specific language] Clients **MAY** request language/locale using the http [Accept-Language](https://www.ietf.org/rfc/rfc2616.txt) header."/>
</statement>
<statement>
<key value="CONF-0226"/>
<conformance value="MAY"/>
<requirement
value="Systems [Clients] may support other [DiagnosticReport] categories as well."/>
</statement>
<statement>
<key value="CONF-0232"/>
<conformance value="MAY"/>
<requirement
value="a Client can determine the note and report types supported by a Server by invoking the standard FHIR Value Set Expansion ([$expand](http://hl7.org/fhir/R4/valueset-operation-expand.html)) operation defined in the FHIR R4 specification."/>
</statement>
<statement>
<key value="CONF-0251"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="The Client application MUST support all methods [for referencing a medication resource: returned bundle, as an external resource, or as a [contained](http://hl7.org/fhir/R4/references.html#contained) resource]"/>
</statement>
<statement>
<key value="CONF-0264"/>
<conformance value="SHOULD"/>
<requirement
value="To provide a list of a patient’s medications, it may be necessary to “de-duplicate” them. The de-duplication activity ... **SHOULD** be provided by the Client."/>
</statement>
<statement>
<key value="CONF-0275"/>
<conformance value="MAY"/>
<requirement
value="API consumers can query by category when accessing patient information."/>
</statement>
<statement>
<key value="CONF-0286"/>
<conformance value="SHALL"/>
<requirement
value="Therefore, Client applications must plan on deduplication methods that rely on something other than a common identifier across FHIR versions."/>
</statement>
<statement>
<key value="CONF-0292"/>
<conformance value="SHOULD"/>
<conditionality value="true"/>
<requirement
value="The FHIR RESTful resource types supported in a DSTU2 implementation **SHOULD** be supported in a R4 implementation"/>
</statement>
<statement>
<key value="CONF-0293"/>
<conformance value="SHOULD"/>
<requirement
value="The FHIR RESTful resource types supported in a DSTU2 implementation **SHOULD** be supported in a R4 implementation [with the] exception [of]
MedicationStatement may be deprecated, and the data **SHOULD** be mapped to MedicationRequest."/>
</statement>
<statement>
<key value="CONF-0294"/>
<conformance value="SHOULD"/>
<requirement
value="The FHIR RESTful resource types supported in a DSTU2 implementation **SHOULD** be supported in a R4 implementation [with the] exception [of]
Care teams as represented by CarePlan in DSTU2 **SHOULD** be replaced by and the data mapped to CareTeam in R4"/>
</statement>
<statement>
<key value="CONF-0299"/>
<conformance value="SHOULD"/>
<requirement
value="When updating between versions, Clients **SHOULD** consider the impact of any changes to data visualization on the usability for the end user and the maintenance of data integrity."/>
</statement>
<statement>
<key value="CONF-0314"/>
<conformance value="SHALL"/>
<requirement
value="[C]lient application[s conforming to the US Core CareTeam profile] **SHALL** support [US Core Practitioner Profile]"/>
</statement>
<statement>
<key value="CONF-0315"/>
<conformance value="SHALL"/>
<requirement
value="[C]lient application[s conforming to the US Core CareTeam profile] **SHALL** support [US Core PractitionerRole Profile]"/>
</statement>
<statement>
<key value="CONF-0316"/>
<conformance value="SHALL"/>
<requirement
value="[C]lient application[s conforming to the US Core CareTeam profile] **SHALL** support [US Core RelatedPerson Profile]"/>
</statement>
<statement>
<key value="CONF-0369"/>
<conformance value="SHALL"/>
<requirement
value="The Client application **SHALL** support [DocumentReference.attachment.url]"/>
</statement>
<statement>
<key value="CONF-0370"/>
<conformance value="SHALL"/>
<requirement
value="The Client application **SHALL** support [DocumentReference.attachment.data]"/>
</statement>
<statement>
<key value="CONF-0376"/>
<conformance value="SHALL"/>
<requirement
value="The Client application **SHALL** support [ Encounter.reasonCode]"/>
</statement>
<statement>
<key value="CONF-0377"/>
<conformance value="SHALL"/>
<requirement
value="The Client application **SHALL** support [Encounter.reasonReference]"/>
</statement>
<statement>
<key value="CONF-0380"/>
<conformance value="SHALL"/>
<requirement
value="The Client application **SHALL** support [Encounter.location.location]"/>
</statement>
<statement>
<key value="CONF-0381"/>
<conformance value="SHALL"/>
<requirement
value="The Client application **SHALL** support [Encounter.serviceProvider]"/>
</statement>
<statement>
<key value="CONF-0388"/>
<conformance value="SHALL"/>
<requirement
value="The Client application **SHALL** support ... Goal.startDate"/>
</statement>
<statement>
<key value="CONF-0389"/>
<conformance value="SHALL"/>
<requirement
value="The Client application **SHALL** support ... Goal.target.dueDate"/>
</statement>
<statement>
<key value="CONF-0403"/>
<conformance value="SHALL"/>
<requirement
value="The Client application **SHALL** support [using a code in .medicationCodeableConcept to represent medications when supporting the US Core MedicationDispense profile]"/>
</statement>
<statement>
<key value="CONF-0404"/>
<conformance value="SHALL"/>
<requirement
value="The Client application **SHALL** support [referencing a Medication resource in .medicationReferencet to represent medications when supporting the US Core MedicationDispense profile]"/>
</statement>
<statement>
<key value="CONF-0409"/>
<conformance value="SHALL"/>
<requirement
value="The Client application **SHALL** support [medicationRequest.reporedtBoolean]"/>
</statement>
<statement>
<key value="CONF-0410"/>
<conformance value="SHALL"/>
<requirement
value="The Client application **SHALL** support [MedicationRequest.reportedReference]"/>
</statement>
<statement>
<key value="CONF-0412"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="[For organizations participating in the ONC Health IT Certification program,] the certifying Client application **SHALL** support [MedicationRequest.reasonCode.]"/>
</statement>
<statement>
<key value="CONF-0413"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="[For organizations participating in the ONC Health IT Certification program,] the certifying Client application **SHALL** support [MedicationRequest.reasonReference.]"/>
</statement>
<statement>
<key value="CONF-0415"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="[For organizations participating in the ONC Health IT Certification program,] Clients **SHALL** support all target resources in MedicationRequest.reasonReference."/>
</statement>
<statement>
<key value="CONF-0476"/>
<conformance value="SHALL"/>
<requirement
value="The Client application **SHALL** support both [the PractionerRole profile and the Practioner.address element]"/>
</statement>
<statement>
<key value="CONF-0483"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="[For organizations participating in the ONC Health IT Certification program] … Clients **SHALL** support ... US Core Procedure Profile for communicating the reason or justification for a referral as Additional USCDI Requirements"/>
</statement>
<statement>
<key value="CONF-0485"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="[For organizations participating in the ONC Health IT Certification program,] The certifying Client application **SHALL** support both [Procedure.reasonCode and Procedure.reasonReference]"/>
</statement>
<statement>
<key value="CONF-0487"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="[For organizations participating in the ONC Health IT Certification program,] when using Procedure.reasonReference … Clients **SHALL** support all target resources in Procedure.reasonReference"/>
</statement>
<statement>
<key value="CONF-0517"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="[For organizations participating in the ONC Health IT Certification program] … Clients **SHALL** support ... US Core ServiceRequest Profile for communicating the reason or justification for a referral as Additional USCDI Requirements"/>
</statement>
<statement>
<key value="CONF-0519"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="[For organizations participating in the ONC Health IT Certification program,] The certifying Client application **SHALL** support both [ServiceRequest.reasonCode and ServiceRequest.reasonReference]"/>
</statement>
<statement>
<key value="CONF-0521"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="[For organizations participating in the ONC Health IT Certification program,] when using ServiceRequest.reasonReference … Clients **SHALL** support all target resources in ServiceRequest.reasonReference"/>
</statement>
<statement>
<key value="CONF-0525"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="The Client application **SHALL** support both [ Specimen.identifier and Specimen.accessionIdentifier]"/>
</statement>
<statement>
<key value="CONF-0526"/>
<conformance value="MAY"/>
<requirement
value="Clients may request Specimen resources be included with the Observation or DiagnosticReport resource query."/>
</statement>
<statement>
<key value="CONF-0527"/>
<conformance value="SHOULD"/>
<requirement
value="[Clients] **SHOULD** Support the Following Implementation Guide [SMART App Launch version 2.0.0 and later](http://hl7.org/fhir/smart-app-launch/history.html)"/>
</statement>
<statement>
<key value="CONF-0528"/>
<conformance value="MAY"/>
<requirement
value="[Clients] **MAY** support the transaction interaction"/>
</statement>
<statement>
<key value="CONF-0529"/>
<conformance value="MAY"/>
<requirement value="[Clients] **MAY** support the batch interaction"/>
</statement>
<statement>
<key value="CONF-0530"/>
<conformance value="MAY"/>
<requirement
value="[Clients] **MAY** support the search-system interaction"/>
</statement>
<statement>
<key value="CONF-0531"/>
<conformance value="MAY"/>
<requirement
value="[Clients] **MAY** support the history-system interaction"/>
</statement>
<statement>
<key value="CONF-0544"/>
<conformance value="MAY"/>
<requirement
value="[Server] **MAY** support the transaction interaction"/>
</statement>
<statement>
<key value="CONF-0545"/>
<conformance value="MAY"/>
<requirement value="[Server] **MAY** support the batch interaction"/>
</statement>
<statement>
<key value="CONF-0546"/>
<conformance value="MAY"/>
<requirement
value="[Server] **MAY** support the search-system interaction"/>
</statement>
<statement>
<key value="CONF-0547"/>
<conformance value="MAY"/>
<requirement
value="[Server] **MAY** support the history-system interaction"/>
</statement>
<statement>
<key value="CONF-0551"/>
<conformance value="SHALL"/>
<requirement
value="Systems **SHALL** establish a risk analysis and management regime that conforms with HIPAA security regulatory requirements"/>
</statement>
<statement>
<key value="CONF-0553"/>
<conformance value="SHOULD"/>
<requirement
value="US Federal systems **SHOULD** conform with the risk management and mitigation requirements defined in NIST 800 series documents."/>
</statement>
<statement>
<key value="CONF-0555"/>
<conformance value="SHOULD"/>
<requirement
value="US Federal systems … **SHOULD** include security category assignment following NIST 800-60 vol. 2 Appendix D.14."/>
</statement>
<statement>
<key value="CONF-0557"/>
<conformance value="SHOULD"/>
<requirement
value="The coordination of risk management and the related security and privacy controls … **SHOULD** be defined in the Business Associate Agreement when available."/>
</statement>
<statement>
<key value="CONF-0559"/>
<conformance value="SHALL"/>
<requirement
value="Systems **SHALL** reference a single time source to establish a common time base for security auditing and clinical data records among computing systems."/>
</statement>
<statement>
<key value="CONF-0561"/>
<conformance value="SHOULD"/>
<requirement
value="The selected time service **SHOULD** be documented in the Business Associate Agreement when available."/>
</statement>
<statement>
<key value="CONF-0563"/>
<conformance value="SHALL"/>
<requirement
value="Systems **SHALL** keep audit logs of the various transactions."/>
</statement>
<statement>
<key value="CONF-0565"/>
<conformance value="SHALL"/>
<requirement
value="Systems **SHALL** use TLS version 1.2 or higher for all transmissions not taking place over a secure network connection."/>
</statement>
<statement>
<key value="CONF-0567"/>
<conformance value="SHOULD"/>
<requirement
value="US Federal systems **SHOULD** conform with FIPS PUB 140-2."/>
</statement>
<statement>
<key value="CONF-0569"/>
<conformance value="SHALL"/>
<requirement
value="Systems **SHALL** conform to [FHIR Communications Security](http://hl7.org/fhir/R4/security.html#http) requirements."/>
</statement>
<statement>
<key value="CONF-0571"/>
<conformance value="SHALL"/>
<requirement
value="For Authentication and Authorization, Systems **SHALL** support any [SMART App Launch version](http://hl7.org/fhir/smart-app-launch/history.html) for Client <-> Server interactions."/>
</statement>
<statement>
<key value="CONF-0573"/>
<conformance value="SHALL"/>
<requirement
value="Systems **SHALL** implement consent requirements per their state, local, and institutional policies."/>
</statement>
<statement>
<key value="CONF-0575"/>
<conformance value="SHOULD"/>
<requirement
value="The Business Associate Agreements **SHOULD** document systems’ mutual consent requirements."/>
</statement>
<statement>
<key value="CONF-0577"/>
<conformance value="SHOULD"/>
<requirement
value="Systems **SHOULD** provide Provenance statements using the [US Core Provenance Profile](https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-provenance.html) resource and associated requirements."/>
</statement>
<statement>
<key value="CONF-0579"/>
<conformance value="MAY"/>
<requirement
value="Systems **MAY** implement the [FHIR Digital Signatures](http://hl7.org/fhir/R4/security.html#digital%20signatures)"/>
</statement>
<statement>
<key value="CONF-0581"/>
<conformance value="MAY"/>
<requirement
value="Systems **MAY** protect the confidentiality of data at rest via encryption and associated access controls."/>
</statement>
<statement>
<key value="CONF-0582"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="The [additional] current binding [[FHIR R5 link](https://hl7.org/fhir/R5/terminologies.html#binding)] requires newly recorded, non-legacy data to be drawn from the [bound] value set."/>
</statement>
<statement>
<key value="CONF-0800"/>
<conformance value="MAY"/>
<requirement
value="For querying and reading US Core Profiles, Must Support on any profile data element **SHALL** be interpreted as follows…:
[The US Core Requesters processing of the resource instances] may result in a determination not to use the resource if the resource content does not meet business requirements."/>
</statement>
<statement>
<key value="CONF-0815"/>
<conformance value="SHOULD"/>
<conditionality value="true"/>
<requirement
value="When the Server supports [ the _include search parameter], Clients **SHOULD** use the _include search parameter to retrieve referenced content instead of searching for a resource and then performing a separate search for other references (for example, Patient, Encounter, and Location) in the result set."/>
</statement>
<statement>
<key value="CONF-0816"/>
<conformance value="SHOULD"/>
<conditionality value="true"/>
<requirement
value="If the Server does not support the _include search parameter, Clients **SHOULD** consolidate duplicate searches before searching for referenced resources in the result set"/>
</statement>
<statement>
<key value="CONF-0817"/>
<conformance value="SHOULD-NOT"/>
<conditionality value="true"/>
<requirement
value=" **SHOULD NOT** search the same data within the time stated in the `Cache-Control` header."/>
</statement>
<statement>
<extension
url="http://hl7.org/fhir/tools/StructureDefinition/requirements-statementshallnot">
<valueBoolean value="true"/>
</extension>
<key value="CONF-0829"/>
<requirement
value=" **SHALL NOT** be interpreted as search parameters for search. "/>
</statement>
<statement>
<key value="CONF-0830"/>
<conformance value="SHOULD"/>
<requirement
value="Clients **SHOULD** use the standard FHIR SearchParameters."/>
</statement>
<statement>
<key value="CONF-0849"/>
<conformance value="SHALL"/>
<requirement
value="[For the US Core Observation Screening Assessment Profile,] the Client system ... **SHALL** support [both] Reference(US Core Observation Screening Assessment Profile) [and] Reference(US Core QuestionnaireResponse Profile) for Observation.derivedFrom"/>
</statement>
<statement>
<key value="CONF-0853"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="The certifying Client application **SHALL** support the [[US Core Interpreter Needed Extension](https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-interpreter-needed.html)] on [the [US Core Patient Profile](https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-patient.html)] ."/>
</statement>
<statement>
<key value="CONF-0854"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="The certifying Client application **SHALL** support the [[US Core Interpreter Needed Extension](https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-interpreter-needed.html)] on [the [US Core Encounter Profile](https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-encounter.html)]. "/>
</statement>
<statement>
<key value="CONF-0869"/>
<conformance value="SHALL"/>
<requirement
value=" 'Observation.performer' target profiles [US Core Practitioner Profile](https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-practitioner.html) and [US Core Patient Profile](https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-patient.html) are labeled Must Support.... Clients **SHALL** support both."/>
</statement>
<statement>
<key value="CONF-0882"/>
<conformance value="SHALL"/>
<requirement
value="When a Reference element is labeled as *Must Support* has multiple target profiles referenced, but none are labeled as *Must Support*
...
- US Core Requesters **SHALL** be capable of processing [such an element] with a valid reference to *at least one* target profile."/>
</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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