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-server"/>
<text>
<status value="extensions"/>
<div xmlns="http://www.w3.org/1999/xhtml">
<p>These requirements apply to the actor: <i><strong>US Core Requestor (Server)</strong></i></p>
<table class="grid">
<thead>
<tr>
<th>Key</th>
<th>Conformance</th>
<th>Requirement</th>
</tr>
</thead>
<tbody>
<tr>
<td>CONF-0001</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>To support a US Core Profile, a Server: <strong>SHALL</strong> Be able to populate all profile data elements that are mandatory and/or flagged as Must Support as defined by that profile’s StructureDefinition.</p>
</div></td>
</tr>
<tr>
<td>CONF-0002</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>To support a US Core Profile, a Server: <strong>SHOULD</strong> declare support for a US Core Profile by including its official URL in the Server’s <code>CapabilityStatement.rest.resource.supportedProfile</code> element.</p>
</div></td>
</tr>
<tr>
<td>CONF-0003</td>
<td style="text-align: center;">MAY</td>
<td><div><p>Servers may deploy and support one or more US Core Profiles to represent clinical information</p>
</div></td>
</tr>
<tr>
<td>CONF-0004</td>
<td style="text-align: center;">MAY</td>
<td><div><p>Server may deploy and support ... the following US Core interaction: “Quick Start” defined for each Profile</p>
</div></td>
</tr>
<tr>
<td>CONF-0005</td>
<td style="text-align: center;">MAY</td>
<td><div><p>Server may deploy and support ... the following US Core interaction: <a href="https://hl7.org/fhir/us/core/clinical-notes.html">Clinical Notes</a></p>
</div></td>
</tr>
<tr>
<td>CONF-0006</td>
<td style="text-align: center;">MAY</td>
<td><div><p>Server may deploy and support ... the following US Core interaction: <a href="https://hl7.org/fhir/us/core/medication-list.html">Medication List</a></p>
</div></td>
</tr>
<tr>
<td>CONF-0007</td>
<td style="text-align: center;">MAY</td>
<td><div><p>Server may deploy and support ... the following US Core interaction: <a href="https://hl7.org/fhir/us/core/basic-provenance.html">Basic Provenance</a></p>
</div></td>
</tr>
<tr>
<td>CONF-0008</td>
<td style="text-align: center;">MAY</td>
<td><div><p>Server may deploy and support ... the following US Core interaction: <a href="https://hl7.org/fhir/us/core/screening-and-assessments.html">Screening and Assessments</a></p>
</div></td>
</tr>
<tr>
<td>CONF-0009</td>
<td style="text-align: center;">MAY</td>
<td><div><p>Servers implementing ... [clinical information representation] can claim conformance to the US Core Profile content structure ... by implementing all or parts of the US Core CapabilityStatement into their capabilities.</p>
</div></td>
</tr>
<tr>
<td>CONF-0010</td>
<td style="text-align: center;">MAY</td>
<td><div><p>Servers implementing ... [interactions] can claim conformance to the ... RESTful interactions defined by implementing all or parts of the US Core CapabilityStatement into their capabilities</p>
</div></td>
</tr>
<tr>
<td>CONF-0013</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>[To claim conformance to a US Core Profile] a conformant Server:</p>
<p><strong>SHALL</strong> Be able to populate all profile data elements that are mandatory and/or flagged as Must Support as defined by that profile’s StructureDefinition.</p>
</div></td>
</tr>
<tr>
<td>CONF-0014</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>[To claim conformance to a US Core Profile] a conformant Server:</p>
<p><strong>SHOULD</strong> declare conformance with the US <a href="https://hl7.org/fhir/us/core/CapabilityStatement-us-core-Server.html">Core Server Capability Statement</a> by including its official URL in the Server’s <code>CapabilityStatement.instantiates</code> element: <code>http://hl7.org/fhir/us/core/CapabilityStatement/us-core-Server</code></p>
</div></td>
</tr>
<tr>
<td>CONF-0015</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>[To claim conformance to a US Core Profile] a conformant Server:</p>
<p><strong>SHALL</strong> specify the full capability details from the US Core CapabilityStatement it claims to implement.</p>
</div></td>
</tr>
<tr>
<td>CONF-0016</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>[To claim conformance to a US Core Profile] a conformant Server:</p>
<p><strong>SHALL</strong>… Declare support for the US Core Profile by including its official URL in the Server’s CapabilityStatement.rest.resource.supportedProfile element.</p>
</div></td>
</tr>
<tr>
<td>CONF-0017</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>[To claim conformance to a US Core Profile] a conformant Server:</p>
<p><strong>SHALL</strong>… Declare support for the US Core Profile’s FHIR RESTful transactions.</p>
</div></td>
</tr>
<tr>
<td>CONF-0018</td>
<td style="text-align: center;">SHALL</td>
<td><div><p><a href="http://hl7.org/fhir/R4/terminologies.html#required">Required binding</a> to a ValueSet definition means that one of the codes from the specified ValueSet <strong>SHALL</strong> be used.</p>
</div></td>
</tr>
<tr>
<td>CONF-0019</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>For <code>CodeableConcept</code>, which permits multiple codings and a text element, this [<a href="http://hl7.org/fhir/R4/terminologies.html#required">Required binding</a> to a ValueSet definition] rule applies to at least one of the codings</p>
</div></td>
</tr>
<tr>
<td>CONF-0020</td>
<td style="text-align: center;">SHALL-NOT</td>
<td><div><p>For a [<a href="http://hl7.org/fhir/R4/terminologies.html#required">required binding</a> to a ValueSet definition], a <code>CodeableConcept</code>which permits multiple codings and a text element … [using] only text is not valid.</p>
</div></td>
</tr>
<tr>
<td>CONF-0021</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>[When populating a coded element with a [required binding](http://hl7.org/fhir/R4/terminologies.html#required] to a ValueSet definition] US Core Responders <strong>SHALL</strong> provide a code exclusively from [the required binding] ValueSet</p>
</div></td>
</tr>
<tr>
<td>CONF-0023</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>[Extensible binding] (http://hl7.org/fhir/R4/terminologies.html#extensible) means that one of the codes from the specified ValueSet <strong>SHALL</strong> be used if an applicable concept is present.</p>
</div></td>
</tr>
<tr>
<td>CONF-0024</td>
<td style="text-align: center;">MAY</td>
<td><div><p>[When using an [extensible Binding] (http://hl7.org/fhir/R4/terminologies.html#extensible)] If no suitable code exists in the [extensible] ValueSet, alternate code(s) may be provided.</p>
</div></td>
</tr>
<tr>
<td>CONF-0026</td>
<td style="text-align: center;">MAY</td>
<td><div><p>For <code>CodeableConcept</code> [with an [extensible binding] (http://hl7.org/fhir/R4/terminologies.html#extensible) … If only text is available and it has no conceptual overlap with the bound coded values, then just text may be used.</p>
</div></td>
</tr>
<tr>
<td>CONF-0027</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>When claiming conformance to ... [to a US Core profile extensible binding rule, a] US Core Responders Shall provide:
A code from … [the] valueset 'DataElement.code.code' if the concept exists in the valueset [for a DataElement.code that has an extensible binding]
Or an alternative code if the concept does not exist in the valueset [for a DataElement.code that has an extensible binding]
Or text in ... `[DataElement.code.text]’ if only text is available [for a DataElement.code that has an extensible binding]</p>
</div></td>
</tr>
<tr>
<td>CONF-0029</td>
<td style="text-align: center;">MAY</td>
<td><div><p>Alternate codes may be provided in addition to the standard codes defined in required or extensible ValueSets. These alternate codes are called "additional codings".</p>
</div></td>
</tr>
<tr>
<td>CONF-0030</td>
<td style="text-align: center;">MAY</td>
<td><div><p>[The additional codings] may be equivalent to or narrower in meaning than the standard concept code.</p>
</div></td>
</tr>
<tr>
<td>CONF-0033</td>
<td style="text-align: center;">MAY</td>
<td><div><p>Not all modifier elements are Mandatory or Must Support, and there is no requirement for supporting them</p>
</div></td>
</tr>
<tr>
<td>CONF-0034</td>
<td style="text-align: center;">MAY</td>
<td><div><p>Servers <strong>MAY</strong> communicate a system-wide profile in their CapabilityStatement to identify which additional elements, including modifier elements, they support</p>
</div></td>
</tr>
<tr>
<td>CONF-0039</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>If the source system does not have data for an element with a minimum cardinality = 0 (including elements labeled Must Support), the data element <strong>SHALL</strong> be omitted from the resource.</p>
</div></td>
</tr>
<tr>
<td>CONF-0040</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>If the data element is a Mandatory element (in other words, where the minimum cardinality is > 0), it <strong>SHALL</strong> be present even if the source system does not have data.</p>
</div></td>
</tr>
<tr>
<td>CONF-0041</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>For [mandatory] non-coded data elements [where data is not available], use the <a href="http://hl7.org/fhir/R4/extension-data-absent-reason.html">DataAbsentReason Extension</a> in the data type ... [with] the code <code>unknown</code> - The value is expected to exist but is not known.</p>
</div></td>
</tr>
<tr>
<td>CONF-0042</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>[In situations where data is not available] for [mandatory] coded data elements … [with] <em>example</em>, <em>preferred</em>, or <em>extensible</em> binding strengths (CodeableConcept or Coding datatypes) If the source system has text but no coded data, only the text element is used.</p>
</div></td>
</tr>
<tr>
<td>CONF-0043</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>[In situations where data is not available] for [mandatory] coded data elements… [with] <em>example</em>, <em>preferred</em>, or <em>extensible</em> binding strengths (CodeableConcept or Coding datatypes):
For Coding datatypes, the text-only data is represented as a display element</p>
</div></td>
</tr>
<tr>
<td>CONF-0044</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>[In situations where data is not available] for [mandatory] coded data elements… [with] <em>example</em>, <em>preferred</em>, or <em>extensible</em> binding strengths (CodeableConcept or Coding datatypes): … If there is neither text nor coded data ... [then] use the appropriate “unknown” concept code from the ValueSet if available.</p>
</div></td>
</tr>
<tr>
<td>CONF-0045</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>[In situations where data is not available] for [mandatory] coded data elements… [with] <em>example</em>, <em>preferred</em>, or <em>extensible</em> binding strengths (CodeableConcept or Coding datatypes): … If there is neither text nor coded data ... [then] if the ValueSet does not have the appropriate “unknown” concept code, use unknown from the <a href="http://hl7.org/fhir/R4/codesystem-data-absent-reason.html">DataAbsentReason Code System</a>.</p>
</div></td>
</tr>
<tr>
<td>CONF-0046</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>[In situations where data is not available] for [mandatory] coded data elements… [with] <em>required</em> binding strength (CodeableConcept or code datatypes): use the appropriate “unknown” concept code from the ValueSet if available</p>
</div></td>
</tr>
<tr>
<td>CONF-0047</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>[In situations where data is not available] for [mandatory] coded data elements… [with] <em>required</em> binding strength (CodeableConcept or code datatypes): If the ValueSet does not have the appropriate “unknown” concept code, you must use a concept from the ValueSet. Otherwise, the instance will not be conformant</p>
</div></td>
</tr>
<tr>
<td>CONF-0048</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>[If the source system does not have data for a Mandatory element for a coded data element with <em>required</em> binding strength] If any of these status codes is missing [meaning it lacks an "unknown" or otherwise appropriate concept code from the ValueSet, a] 404 HTTP error code and an OperationOutcome <strong>SHALL</strong> be returned in response to a read transaction on the resource.</p>
</div></td>
</tr>
<tr>
<td>CONF-0049</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>[If the source system does not have data for a Mandatory element for a coded data element with <em>required</em> binding strength, and the ValueSet does not have the appropriate "unknown" concept code, then] if returning a response to a search, the problematic resource <strong>SHALL</strong> be excluded from the search set</p>
</div></td>
</tr>
<tr>
<td>CONF-0050</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>[If the source system does not have data for a Mandatory element for a coded data element with <em>required</em> binding strength, and the ValueSet does not have the appropriate "unknown" concept code, then] if returning a response to a search, … a <em>warning</em> OperationOutcome <strong>SHOULD</strong> be included indicating that other search results were found but could not be compliantly expressed and have been suppressed.</p>
</div></td>
</tr>
<tr>
<td>CONF-0051</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The <a href="http://hl7.org/fhir/R4/http.html#search">FHIR RESTful Search API</a> requires that Servers that support search <strong>SHALL</strong> support the HTTP <code>POST</code>-based search.</p>
</div></td>
</tr>
<tr>
<td>CONF-0052</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>For all the supported search interactions in this guide, Servers <strong>SHALL</strong> also support the <code>GET</code>-based search.</p>
</div></td>
</tr>
<tr>
<td>CONF-0055</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 Server <strong>SHALL</strong> support both [system and code values]</p>
</div></td>
</tr>
<tr>
<td>CONF-0058</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 Server <strong>SHALL</strong> support both [id and Type values]</p>
</div></td>
</tr>
<tr>
<td>CONF-0061</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 Server <strong>SHALL</strong> support values precise to the day for elements of datatype <code>date</code></p>
</div></td>
</tr>
<tr>
<td>CONF-0062</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 Server <strong>SHALL</strong> support values precise … to the second + time offset for elements of <code>datatype</code> dateTime</p>
</div></td>
</tr>
<tr>
<td>CONF-0063</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>Servers are strongly encouraged to support a query for resources without requiring a status parameter.</p>
</div></td>
</tr>
<tr>
<td>CONF-0064</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>If business requirements prohibit [querying a resource without a status parameter], they <strong>SHALL</strong> follow the guidelines here.</p>
</div></td>
</tr>
<tr>
<td>CONF-0065</td>
<td style="text-align: center;">MAY</td>
<td><div><p>For searches where the Client does not supply a status parameter, an implementation’s business rules may override the FHIR RESTful search expectations and require a status parameter to be provided</p>
</div></td>
</tr>
<tr>
<td>CONF-0066</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>For searches where the Client does not supply a status parameter, … systems [that require a status parameter to be provided] are allowed to reject such requests as follows:</p>
<p><strong>SHALL</strong> return an HTTP 400 status</p>
</div></td>
</tr>
<tr>
<td>CONF-0067</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>For searches where the Client does not supply a status parameter, … systems [that require a status parameter to be provided] are allowed to reject such requests as follows:</p>
<p><strong>SHALL</strong> return an <a href="http://hl7.org/fhir/R4/operationoutcome.html">OperationOutcome</a> specifying that status(es) must be present.</p>
</div></td>
</tr>
<tr>
<td>CONF-0068</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>For searches where the Client does not supply a status parameter, … systems [that require a status parameter to be provided] are allowed to reject such requests as follows:</p>
<p><strong>SHALL</strong> support search with status if status required</p>
</div></td>
</tr>
<tr>
<td>CONF-0069</td>
<td style="text-align: center;">SHALL-NOT</td>
<td><div><p><strong>SHALL NOT</strong> restrict search results ( i.e., apply ‘hidden’ filters) when a Client includes status parameters in the query.</p>
</div></td>
</tr>
<tr>
<td>CONF-0070</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>[For systems that require a status parameter to be provided,] if a system doesn’t support a specific status code value that is queried, it <strong>SHOULD</strong> return an HTTP 200 status with a search bundle.</p>
</div></td>
</tr>
<tr>
<td>CONF-0071</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>[For systems that require a status parameter to be provided,] if a system doesn’t support a specific status code value that is queried [and returns a search bundle],... [t]he search bundle <strong>SHOULD</strong> contain resources matching the search criteria</p>
</div></td>
</tr>
<tr>
<td>CONF-0072</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>[For systems that require a status parameter to be provided,] if a system doesn’t support a specific status code value that is queried [and returns a search bundle],... [t]he search bundle <strong>SHOULD</strong> contain ... an OperationOutcome warning the Client which status code value is not supported.</p>
</div></td>
</tr>
<tr>
<td>CONF-0073</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>For searches where the Client does not supply a status parameter, … systems [that require a status parameter to be provided] are allowed to reject such requests as follows:...</p>
<p><strong>SHALL</strong> document this behavior in its CapabilityStatement for the “search-type” interaction in <code>CapabilityStatement.rest.resource.interaction.documentation.</code></p>
</div></td>
</tr>
<tr>
<td>CONF-0074</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>When an element is Mandatory, the data is expected always to be present.</p>
</div></td>
</tr>
<tr>
<td>CONF-0075</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 Responders <strong>SHALL</strong> be capable of populating all data elements as part of the query results specified by the <a href="https://hl7.org/fhir/us/core/STU8/CapabilityStatement-us-core-Server.html">US Core Server Capability Statement</a>.</p>
</div></td>
</tr>
<tr>
<td>CONF-0078</td>
<td style="text-align: center;">SHALL-NOT</td>
<td><div><p><strong>SHALL NOT</strong> include the data elements in the resource instance returned as part of the query results.</p>
</div></td>
</tr>
<tr>
<td>CONF-0080</td>
<td style="text-align: center;">SHOULD</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>In cases where information on a specific data element is missing, and the US Core Responder knows the precise reason for the absence of data (other than suppressed data), US Core Responders <strong>SHOULD</strong> send the reason for the missing information.</p>
</div></td>
</tr>
<tr>
<td>CONF-0081</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>[When sending reason for missing information, follow] the same methdology outlined in the <a href="https://hl7.org/fhir/us/core/STU8/general-requirements.html#missing-data">Missing Data</a> section but using the appropriate reason code instead of unknown [reason code].</p>
</div></td>
</tr>
<tr>
<td>CONF-0084</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>Implementors [US Core Responders] 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-0086</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>Implementors [US Core Responders] [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-0087</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>If an element is marked as Must Support 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 and element values that the Server <strong>SHALL</strong> be capable of providing.</p>
</div></td>
</tr>
<tr>
<td>CONF-0090</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 Must Support, then the Server <strong>SHALL</strong> be capable of providing the element value to meet the Must Support requirement.</p>
</div></td>
</tr>
<tr>
<td>CONF-0091</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 responders <strong>SHALL</strong> be capable of providing the value [of the primitive element]</p>
</div></td>
</tr>
<tr>
<td>CONF-0093</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>For any complex element marked as Must Support, the Server <strong>SHALL</strong> be capable of providing at least one of the sub-element values.</p>
</div></td>
</tr>
<tr>
<td>CONF-0094</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>If any sub-element is marked as Must Support [for a complex element], it must also meet the Must Support requirements and satisfy the Must Support requirements for the parent element.</p>
</div></td>
</tr>
<tr>
<td>CONF-0095</td>
<td style="text-align: center;">MAY</td>
<td><div><p>[I]f any sub-element is marked as Must Support or Additional USCDI [for a complex element] and the parent element is not, there is no expectation that you must support the parent.</p>
</div></td>
</tr>
<tr>
<td>CONF-0096</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>[I]f any sub-element is marked as Must Support [for a complex element] and the parent element is not… [and] the parent element is represented in the structure, Servers <strong>SHALL</strong> support the sub-element(s) marked as Must Support.</p>
</div></td>
</tr>
<tr>
<td>CONF-0097</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 Responders <strong>SHALL</strong> be capable of providing a value in [the] sub-element</p>
</div></td>
</tr>
<tr>
<td>CONF-0099</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 Responders <strong>SHALL</strong> be capable of providing a value in [each must support sub-element]</p>
</div></td>
</tr>
<tr>
<td>CONF-0101</td>
<td style="text-align: center;">MAY</td>
<td><div><p>Systems [US Core Responders] 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-0103</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 Responders]</p>
</div></td>
</tr>
<tr>
<td>CONF-0105</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 Responders <strong>SHALL</strong> be capable of providing [such an element] with a valid reference to [all listed Must Support profile(s).]</li>
</ul>
</div></td>
</tr>
<tr>
<td>CONF-0107</td>
<td style="text-align: center;">MAY</td>
<td><div><p>Systems [US Core Responders] 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-0109</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 Responders <strong>SHALL</strong> be capable of providing [such an element] with a valid reference to [the Must Support Profile.]</li>
</ul>
</div></td>
</tr>
<tr>
<td>CONF-0111</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 Responders <strong>SHALL</strong> be capable of populating [the Must Support data type choice]</li>
</ul>
</div></td>
</tr>
<tr>
<td>CONF-0114</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 Responders] <strong>MAY</strong> support populating ... 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-0115</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 Server or Certifying System <strong>SHALL</strong> support at least one element.</p>
</div></td>
</tr>
<tr>
<td>CONF-0117</td>
<td style="text-align: center;">MAY</td>
<td><div><p>An individual SMART Server will publish a granular list of its capabilities, and a set of these capabilities is combined to support a specific use, a Capability Set. See SMART App Launch’s <a href="http://hl7.org/fhir/smart-app-launch/STU2/conformance.html#smart-on-fhir-oauth-authorization-endpoints-and-capabilities">FHIR OAuth authorization Endpoints and Capabilities</a> for more details. Servers <strong>MAY</strong> support ... [any] SMART on FHIR Capability Sets and capabilities [(see <a href="http://hl7.org/fhir/smart-app-launch/STU2/conformance.html#smart-on-fhir-oauth-authorization-endpoints-and-capabilities">FHIR OAuth authorization Endpoints and Capabilities</a>)]</p>
</div></td>
</tr>
<tr>
<td>CONF-0118</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>At least one of the following SMART on FHIR Capability Sets <strong>SHOULD</strong> be supported for US Core Servers that support User-Facing Applications ...
<a href="http://hl7.org/fhir/smart-app-launch/STU2/conformance.html#patient-access-for-standalone-apps">Patient Access Standalone Apps</a>
<a href="http://hl7.org/fhir/smart-app-launch/STU2/conformance.html#clinician-access-for-standalone">Clinician Access for EHR Launch</a></p>
</div></td>
</tr>
<tr>
<td>CONF-0119</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>For certified systems[, those participating in the ONC IT Health Certification program], both <strong>SHALL</strong> be supported:
<a href="http://hl7.org/fhir/smart-app-launch/STU2/conformance.html#patient-access-for-standalone-apps">Patient Access Standalone Apps</a>
<a href="http://hl7.org/fhir/smart-app-launch/STU2/conformance.html#clinician-access-for-standalone">Clinician Access for EHR Launch</a></p>
</div></td>
</tr>
<tr>
<td>CONF-0120</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>Implementations [US Core Responders] supporting Backend Services ... <strong>SHALL</strong> include support for the Client-confidential-asymmetric capability.</p>
</div></td>
</tr>
<tr>
<td>CONF-0121</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>Implementations [US Core Responders] supporting Backend Services ... <strong>SHALL</strong> include support for the ... system/scopes.</p>
</div></td>
</tr>
<tr>
<td>CONF-0123</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>US Core Server[s] <strong>SHALL</strong> support token introspection defined by the SMART App Launch Guide. For more details and additional consideration, see SMART App Launch’s <a href="http://hl7.org/fhir/smart-app-launch/STU2/token-introspection.html#token-introspection">Token Introspection</a>.</p>
</div></td>
</tr>
<tr>
<td>CONF-0125</td>
<td style="text-align: center;">MAY</td>
<td><div><p>Other systems only need to support scopes for the US Core APIs they support [instead of all US Core's required scopes]</p>
</div></td>
</tr>
<tr>
<td>CONF-0126</td>
<td style="text-align: center;">MAY</td>
<td><div><p>Servers <strong>MAY</strong> support other scopes in addition to those listed below and in the Quick Start sections.</p>
</div></td>
</tr>
<tr>
<td>CONF-0128</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>For “User-Facing Applications”, a system’s support for patient-level (patient) or user-level (user) scopes depends on its published list of SMART on FHIR capabilities (see the <a href="https://hl7.org/fhir/us/core/STU8/scopes.html#capability-sets">capability sets</a> above). For example, if a Server lists permission-patient and permission-user in its capabilities, it <strong>SHALL</strong> support both patient-level and user-level required scopes</p>
</div></td>
</tr>
<tr>
<td>CONF-0129</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>For “User-Facing Applications”, a system’s support for patient-level (patient) or user-level (user) scopes depends on its published list of SMART on FHIR capabilities (see the <a href="https://hl7.org/fhir/us/core/STU8/scopes.html#capability-sets">capability sets</a> above). For example, if a Server lists permission-patient and permission-user in its capabilities, it ... <strong>SHOULD</strong> support both patient-level and user-level recommended best-practice scopes</p>
</div></td>
</tr>
<tr>
<td>CONF-0130</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>For “Backend-Services”, System-level scopes (system) describe data that a Client system is directly authorized to access. Systems that support system-level (system) scopes <strong>SHALL</strong> support the required US Core scopes</p>
</div></td>
</tr>
<tr>
<td>CONF-0131</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>For “Backend-Services”, System-level scopes (system) describe data that a Client system is directly authorized to access. Systems that support system-level (system) scopes <strong>SHOULD</strong> support the recommended US Core scopes</p>
</div></td>
</tr>
<tr>
<td>CONF-0132</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The following scopes that correspond directly to FHIR resource types <strong>SHALL</strong> be supported
...
[For] AllergyIntolerance [the] <patient|user|system>/AllergyIntolerance.rs [see <a href="https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax">SMART Clinical Scope Syntax</a> for details on clinical data scopes]</p>
</div></td>
</tr>
<tr>
<td>CONF-0133</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The following scopes that correspond directly to FHIR resource types <strong>SHALL</strong> be supported
...
[For] CarePlan [the] <patient|user|system>/CarePlan.rs [see <a href="https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax">SMART Clinical Scope Syntax</a> for details on clinical data scopes]</p>
</div></td>
</tr>
<tr>
<td>CONF-0134</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The following scopes that correspond directly to FHIR resource types <strong>SHALL</strong> be supported
...
[For] CareTeam [the] <patient|user|system>/CareTeam.rs [see <a href="https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax">SMART Clinical Scope Syntax</a> for details on clinical data scopes]</p>
</div></td>
</tr>
<tr>
<td>CONF-0135</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The following scopes that correspond directly to FHIR resource types <strong>SHALL</strong> be supported
...
[For] Condition [the] <patient|user|system>/Condition.rs [see <a href="https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax">SMART Clinical Scope Syntax</a> for details on clinical data scopes]</p>
</div></td>
</tr>
<tr>
<td>CONF-0136</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The following scopes that correspond directly to FHIR resource types <strong>SHALL</strong> be supported
...
[For] Coverage [the] <patient|user|system>/Coverage.rs [see <a href="https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax">SMART Clinical Scope Syntax</a> for details on clinical data scopes]</p>
</div></td>
</tr>
<tr>
<td>CONF-0137</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The following scopes that correspond directly to FHIR resource types <strong>SHALL</strong> be supported
...
[For] Device [the] <patient|user|system>/Device.rs [see <a href="https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax">SMART Clinical Scope Syntax</a> for details on clinical data scopes]</p>
</div></td>
</tr>
<tr>
<td>CONF-0138</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The following scopes that correspond directly to FHIR resource types <strong>SHALL</strong> be supported
...
[For] DiagnosticReport [the] <patient|user|system>/DiagnosticReport.rs [see <a href="https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax">SMART Clinical Scope Syntax</a> for details on clinical data scopes]</p>
</div></td>
</tr>
<tr>
<td>CONF-0139</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The following scopes that correspond directly to FHIR resource types <strong>SHALL</strong> be supported
...
[For] DocumentReference [the] <patient|user|system>/DocumentReference.rs [see <a href="https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax">SMART Clinical Scope Syntax</a> for details on clinical data scopes]</p>
</div></td>
</tr>
<tr>
<td>CONF-0140</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The following scopes that correspond directly to FHIR resource types <strong>SHALL</strong> be supported
...
[For] Encounter [the] <patient|user|system>/Encounter.rs [see <a href="https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax">SMART Clinical Scope Syntax</a> for details on clinical data scopes]</p>
</div></td>
</tr>
<tr>
<td>CONF-0141</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The following scopes that correspond directly to FHIR resource types <strong>SHALL</strong> be supported
...
[For] Goal [the] <patient|user|system>/Goal.rs [see <a href="https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax">SMART Clinical Scope Syntax</a> for details on clinical data scopes]</p>
</div></td>
</tr>
<tr>
<td>CONF-0142</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The following scopes that correspond directly to FHIR resource types <strong>SHALL</strong> be supported
...
[For] Immunization [the] <patient|user|system>/Immunization.rs [see <a href="https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax">SMART Clinical Scope Syntax</a> for details on clinical data scopes]</p>
</div></td>
</tr>
<tr>
<td>CONF-0143</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The following scopes that correspond directly to FHIR resource types <strong>SHALL</strong> be supported
...
[For] MedicationDispense [the] <patient|user|system>/MedicationDispense.rs [see <a href="https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax">SMART Clinical Scope Syntax</a> for details on clinical data scopes]</p>
</div></td>
</tr>
<tr>
<td>CONF-0144</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The following scopes that correspond directly to FHIR resource types <strong>SHALL</strong> be supported
...
[For] MedicationRequest [the] <patient|user|system>/MedicationRequest.rs [see <a href="https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax">SMART Clinical Scope Syntax</a> for details on clinical data scopes]</p>
</div></td>
</tr>
<tr>
<td>CONF-0145</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The following scopes that correspond directly to FHIR resource types <strong>SHALL</strong> be supported
...
[For] Observation [the] <patient|user|system>/Observation.rs [see <a href="https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax">SMART Clinical Scope Syntax</a> for details on clinical data scopes]</p>
</div></td>
</tr>
<tr>
<td>CONF-0146</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The following scopes that correspond directly to FHIR resource types <strong>SHALL</strong> be supported
...
[For] Organization [the] <patient|user|system>/Organization.rs [see <a href="https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax">SMART Clinical Scope Syntax</a> for details on clinical data scopes]</p>
</div></td>
</tr>
<tr>
<td>CONF-0147</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The following scopes that correspond directly to FHIR resource types <strong>SHALL</strong> be supported
...
[For] Patient [the] <patient|user|system>/Patient.rs [see <a href="https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax">SMART Clinical Scope Syntax</a> for details on clinical data scopes]</p>
</div></td>
</tr>
<tr>
<td>CONF-0148</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The following scopes that correspond directly to FHIR resource types <strong>SHALL</strong> be supported
...
[For] Practitioner [the] <patient|user|system>/Practitioner.rs [see <a href="https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax">SMART Clinical Scope Syntax</a> for details on clinical data scopes]</p>
</div></td>
</tr>
<tr>
<td>CONF-0149</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The following scopes that correspond directly to FHIR resource types <strong>SHALL</strong> be supported
...
[For] PractitionerRole [the] <patient|user|system>/PractitionerRole.rs [see <a href="https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax">SMART Clinical Scope Syntax</a> for details on clinical data scopes]</p>
</div></td>
</tr>
<tr>
<td>CONF-0150</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The following scopes that correspond directly to FHIR resource types <strong>SHALL</strong> be supported
...
[For] Procedure [the] <patient|user|system>/Procedure.rs [see <a href="https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax">SMART Clinical Scope Syntax</a> for details on clinical data scopes]</p>
</div></td>
</tr>
<tr>
<td>CONF-0151</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The following scopes that correspond directly to FHIR resource types <strong>SHALL</strong> be supported
...
[For] Provenance [the] <patient|user|system>/Provenance.rs [see <a href="https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax">SMART Clinical Scope Syntax</a> for details on clinical data scopes]</p>
</div></td>
</tr>
<tr>
<td>CONF-0152</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The following scopes that correspond directly to FHIR resource types <strong>SHALL</strong> be supported
...
[For] QuestionnaireResponse [the] <patient|user|system>/QuestionnaireResponse.rs [see <a href="https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax">SMART Clinical Scope Syntax</a> for details on clinical data scopes]</p>
</div></td>
</tr>
<tr>
<td>CONF-0153</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The following scopes that correspond directly to FHIR resource types <strong>SHALL</strong> be supported
...
[For] RelatedPerson [the] <patient|user|system>/RelatedPerson.rs [see <a href="https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax">SMART Clinical Scope Syntax</a> for details on clinical data scopes]</p>
</div></td>
</tr>
<tr>
<td>CONF-0154</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The following scopes that correspond directly to FHIR resource types <strong>SHALL</strong> be supported
...
[For] ServiceRequest [the] <patient|user|system>/ServiceRequest.rs [see <a href="https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax">SMART Clinical Scope Syntax</a> for details on clinical data scopes]</p>
</div></td>
</tr>
<tr>
<td>CONF-0155</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The following scopes that correspond directly to FHIR resource types <strong>SHALL</strong> be supported
...
[For] Specimen [the] <patient|user|system>/Specimen.rs [see <a href="https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax">SMART Clinical Scope Syntax</a> for details on clinical data scopes]</p>
</div></td>
</tr>
<tr>
<td>CONF-0156</td>
<td style="text-align: center;">MAY</td>
<td><div><p>The following scopes that correspond directly to FHIR resource types <strong>MAY</strong> be supported
...
[For] Location [the] <patient|user|system>/Location.rs [see <a href="https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax">SMART Clinical Scope Syntax</a> for details on clinical data scopes]</p>
</div></td>
</tr>
<tr>
<td>CONF-0157</td>
<td style="text-align: center;">MAY</td>
<td><div><p>The following scopes that correspond directly to FHIR resource types <strong>MAY</strong> be supported
...
[For] Medication [the] <patient|user|system>/Medication.rs [see <a href="https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax">SMART Clinical Scope Syntax</a> for details on clinical data scopes]</p>
</div></td>
</tr>
<tr>
<td>CONF-0158</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The following granular scopes <strong>SHALL</strong> be supported
...
[For] Condition [the] <patient|user|system>/Condition.rs?category=http://hl7.org/fhir/us/core/CodeSystem/condition-category|health-concern [see <a href="https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax">SMART Clinical Scope Syntax</a> for details on clinical data scopes]</p>
</div></td>
</tr>
<tr>
<td>CONF-0159</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The following granular scopes <strong>SHALL</strong> be supported
...
[For] Condition [the] <patient|user|system>/Condition.rs?category=http://terminology.hl7.org/CodeSystem/condition-category|encounter-diagnosis [see <a href="https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax">SMART Clinical Scope Syntax</a> for details on clinical data scopes]</p>
</div></td>
</tr>
<tr>
<td>CONF-0160</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The following granular scopes <strong>SHALL</strong> be supported
...
[For] Condition [the] <patient|user|system>/Condition.rs?category=http://terminology.hl7.org/CodeSystem/condition-category|problem-list-item [see <a href="https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax">SMART Clinical Scope Syntax</a> for details on clinical data scopes]</p>
</div></td>
</tr>
<tr>
<td>CONF-0161</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The following granular scopes <strong>SHALL</strong> be supported
...
[For] Observation [the] <patient|user|system>/Observation.rs?category=http://hl7.org/fhir/us/core/CodeSystem/us-core-category|sdoh [see <a href="https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax">SMART Clinical Scope Syntax</a> for details on clinical data scopes]</p>
</div></td>
</tr>
<tr>
<td>CONF-0162</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The following granular scopes <strong>SHALL</strong> be supported
...
[For] Observation [the] <patient|user|system>/Observation.rs?category=http://terminology.hl7.org//CodeSystem-observation-category|social-history [see <a href="https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax">SMART Clinical Scope Syntax</a> for details on clinical data scopes]</p>
</div></td>
</tr>
<tr>
<td>CONF-0163</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The following granular scopes <strong>SHALL</strong> be supported
...
[For] Observation [the] <patient|user|system>/Observation.rs?category=http://terminology.hl7.org/CodeSystem/observation-category|laboratory [see <a href="https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax">SMART Clinical Scope Syntax</a> for details on clinical data scopes]</p>
</div></td>
</tr>
<tr>
<td>CONF-0164</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The following granular scopes <strong>SHALL</strong> be supported
...
[For] Observation [the] <patient|user|system>/Observation.rs?category=http://terminology.hl7.org/CodeSystem/observation-category|survey [see <a href="https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax">SMART Clinical Scope Syntax</a> for details on clinical data scopes]</p>
</div></td>
</tr>
<tr>
<td>CONF-0165</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The following granular scopes <strong>SHALL</strong> be supported
...
[For] Observation [the] <patient|user|system>/Observation.rs?category=http://terminology.hl7.org/CodeSystem/observation-category|vital-signs [see <a href="https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax">SMART Clinical Scope Syntax</a> for details on clinical data scopes]</p>
</div></td>
</tr>
<tr>
<td>CONF-0166</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>The following granular scopes <strong>SHOULD</strong> be supported
...
[For] DocumentReference [the] <patient|user|system>/DocumentReference.rs?category=http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category|clinical-note [see <a href="https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax">SMART Clinical Scope Syntax</a> for details on clinical data scopes]</p>
</div></td>
</tr>
<tr>
<td>CONF-0167</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>In addition to the capabilities defined in the Server’s CapabilityStatement, Servers <strong>SHALL</strong> document their SMART capabilities in their <a href="https://hl7.org/fhir/smart-app-launch/STU2/conformance.html#using-well-known">Well-Known Uniform Resource Identifiers (URIs)</a> JSON file.</p>
</div></td>
</tr>
<tr>
<td>CONF-0168</td>
<td style="text-align: center;">SHALL</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 Server <strong>SHALL</strong> list all the required US Core Scopes for the US Core Profiles they support in the scopes_supported array</p>
</div></td>
</tr>
<tr>
<td>CONF-0169</td>
<td style="text-align: center;">MAY</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 Server [MAY support] additional scopes (so Clients should not consider … [the required scopes] an exhaustive list).</p>
</div></td>
</tr>
<tr>
<td>CONF-0170</td>
<td style="text-align: center;">MAY</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. Servers <strong>MAY</strong> limit Clients’ scopes to those configured at registration time.</p>
</div></td>
</tr>
<tr>
<td>CONF-0171</td>
<td style="text-align: center;">SHALL</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. … Servers <strong>SHALL</strong> allow users to select a subset of the requested scopes at the approval time.</p>
</div></td>
</tr>
<tr>
<td>CONF-0173</td>
<td style="text-align: center;">SHALL</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>introspection_endpoint</code> the URL to a Server’s introspection endpoint. ... Servers <strong>SHALL</strong> document this endpoint in the file</p>
</div></td>
</tr>
<tr>
<td>CONF-0174</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>Therefore, a <a href="http://hl7.org/fhir/R4/references.html">reference</a> to a US Core resource <strong>SHOULD</strong> include a logical id (Reference.reference), not an identifier (Reference.identifier).</p>
</div></td>
</tr>
<tr>
<td>CONF-0175</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>For all references, US Core Responders <strong>SHOULD</strong> return resources that conform to a US Core profile if a US Core profile exists for the resource type.</p>
</div></td>
</tr>
<tr>
<td>CONF-0176</td>
<td style="text-align: center;">SHOULD-NOT</td>
<td><div><p>When responding to a query, Servers <strong>SHOULD</strong> not use inline <a href="http://hl7.org/fhir/R4/references.html#contained">contained</a> resources to represent the returned data.</p>
</div></td>
</tr>
<tr>
<td>CONF-0177</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>[I]f referencing a contained resource in a US Core Profile, the contained resource <strong>SHOULD</strong> be a US Core Profile if a US Core Profile exists for the resource type.</p>
</div></td>
</tr>
<tr>
<td>CONF-0178</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>[M]asking data [where a specific piece of data is hidden for security and privacy reasons] <strong>SHOULD</strong> be handled based on implemented policies.</p>
</div></td>
</tr>
<tr>
<td>CONF-0179</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>[When masking data] elements with a minimum cardinality = 0 (including elements labeled Must Support) [for security and privacy reasons], the element <strong>SHOULD</strong> be omitted from the resource.</p>
</div></td>
</tr>
<tr>
<td>CONF-0180</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>[When masking] Mandatory elements (in other words, where the minimum cardinality is > 0) [for security and privacy reasons, use the code “unknown” following the guidance on Missing Data in the Conformance Sections.</p>
</div></td>
</tr>
<tr>
<td>CONF-0181</td>
<td style="text-align: center;">MAY</td>
<td><div><p>[When using SNOMED codes in US Core Profiles I]mplementers <strong>MAY</strong> use the default system URI [of <a href="http://snomed.info/sct">SNOMED CT</a>], which refers to an unspecified edition/version [of SNOMED]</p>
</div></td>
</tr>
<tr>
<td>CONF-0182</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>[To enable] terminology Servers to be able to validate US Edition-only codes [of <a href="http://snomed.info/sct">SNOMED CT</a>], implementers <strong>SHOULD</strong> provide the accompanying system URI to describe the edition [see example 2 on <a href="https://hl7.org/fhir/us/core/STU8/general-guidance.html#snomed-ct-united-states-edition">US Core general guidance</a>]</p>
</div></td>
</tr>
<tr>
<td>CONF-0183</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>[If a] US Core Profiles binds the Quantity.code element in the Quantity datatype to the <a href="http://unitsofmeasure.org/">UCUM</a> code system, [then] systems should also use UCUM for the optional valueRange and valueRatio datatypes (which are complex datatypes with Quantity elements)</p>
</div></td>
</tr>
<tr>
<td>CONF-0184</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>[If a] US Core Profiles binds the Quantity.code element in the Quantity datatype to the <a href="http://unitsofmeasure.org/">UCUM</a> code system, [when] UCUM code [is] provided [it <strong>SHOULD</strong> be indicated in the Quantity.unit and Quantity.code elements with Quantity.system = "http://unitsofmeasure.org"]</p>
</div></td>
</tr>
<tr>
<td>CONF-0185</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>[If a] US Core Profiles binds the Quantity.code element in the Quantity datatype to the <a href="http://unitsofmeasure.org/">UCUM</a> code system, [then] if UCUM units are unavailable, represent units in the unit element</p>
</div></td>
</tr>
<tr>
<td>CONF-0186</td>
<td style="text-align: center;">SHOULD-NOT</td>
<td><div><p><strong>SHOULD NOT</strong> supply the unit field]</p>
</div></td>
</tr>
<tr>
<td>CONF-0187</td>
<td style="text-align: center;">SHOULD-NOT</td>
<td><div><p>A FHIR Server <strong>SHOULD</strong> not delete records.</p>
</div></td>
</tr>
<tr>
<td>CONF-0188</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>A FHIR Server <strong>SHOULD</strong> update the appropriate resource status to entered-in-error or inactive [when requested to delete records]</p>
</div></td>
</tr>
<tr>
<td>CONF-0189</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>If a system supports the deletion of records, they <strong>SHOULD</strong> refer to the <a href="http://hl7.org/fhir/R4/safety.html#conformance">Deletion Safety Checks</a> in the FHIR specification.</p>
</div></td>
</tr>
<tr>
<td>CONF-0190</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>A FHIR Server <strong>SHOULD</strong> allow these resources [those entered in error] to be searchable by Client applications.</p>
</div></td>
</tr>
<tr>
<td>CONF-0191</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>If the FHIR Server has updated the resource status to entered-in-error:
For patient facing applications, A FHIR Server <strong>SHOULD</strong> remove the resource’s contents, leaving only an id and status. Note that this typically will not conform to the US Core or FHIR StructureDefinitions.</p>
</div></td>
</tr>
<tr>
<td>CONF-0192</td>
<td style="text-align: center;">MAY</td>
<td><div><p>If the FHIR Server has updated the resource status to entered-in-error:
...
For provider-facing applications, the content may be supplied with content and additional detail (such as the reason for the status change) that the patient viewing system would typically not have access to.</p>
</div></td>
</tr>
<tr>
<td>CONF-0193</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>the data provider <strong>SHOULD</strong> do their best to translate (safely) to the requested language [when accessing records in a native or requested language]</p>
</div></td>
</tr>
<tr>
<td>CONF-0195</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>[When Clients request a resource in a specific language] Servers <strong>SHOULD</strong> make reasonable efforts to translate what can be safely translated.</p>
</div></td>
</tr>
<tr>
<td>CONF-0196</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>[When Clients request a resource in a specific language] Servers <strong>SHOULD</strong> populate the Resource’s language element with a code based on the underlying language of record, not the requested language.</p>
</div></td>
</tr>
<tr>
<td>CONF-0197</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>[When Clients request a resource in a specific language] Servers <strong>SHOULD</strong> … [use] the <a href="http://hl7.org/fhir/R4/extension-language.html">Human Language</a> Extension when the language of a display, etc, is known to differ from the stated (or inferred) language.</p>
</div></td>
</tr>
<tr>
<td>CONF-0198</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>[When Clients request a resource in a specific language] [Servers <strong>SHOULD</strong> use] the <a href="http://hl7.org/fhir/R4/extension-translation.html">Translation</a> Extension when the Server provides additional translations by its own choice or in response to a different Accept-Language than what the resource is stored in.</p>
</div></td>
</tr>
<tr>
<td>CONF-0199</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>[When Clients request a resource in a specific language] Servers <strong>SHOULD</strong> make it known what languages are supported in their CapabilityStatement(s) using this extension:
http://hl7.org/fhir/5.0/StructureDefinition/extension-CapablilityStatement.acceptLanguage [<a href="https://hl7.org/fhir/R5/capabilitystatement-definitions.html#CapabilityStatement.acceptLanguage">definition</a>]</p>
</div></td>
</tr>
<tr>
<td>CONF-0200</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>Servers <strong>SHOULD</strong> support the <a href="http://hl7.org/fhir/R4/search.html#lastUpdated">_lastUpdated</a> search parameter for US Core Profiles</p>
</div></td>
</tr>
<tr>
<td>CONF-0201</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>Servers ... <strong>SHOULD</strong> populate <a href="http://hl7.org/fhir/R4/resource.html#Meta">Resource.meta.lastUpdated</a> for US Core Profiles as accurately as possible.</p>
</div></td>
</tr>
<tr>
<td>CONF-0202</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>Servers <strong>SHALL</strong> document in CapabilityStatement.rest.resource.searchParam.documentation the types of changes that can be detected using the _lastUpdated search parameter</p>
</div></td>
</tr>
<tr>
<td>CONF-0203</td>
<td style="text-align: center;">MAY</td>
<td><div><p>US Core Servers [MAY support compartment based searchs, but] are not required to support patient <a href="http://hl7.org/fhir/R4/compartmentdefinition.html">compartment</a> based searches.</p>
</div></td>
</tr>
<tr>
<td>CONF-0204</td>
<td style="text-align: center;">MAY</td>
<td><div><p>US Core Servers [MAY resolve absolute URLs, but] are not required to resolve absolute URLs external to their environment.</p>
</div></td>
</tr>
<tr>
<td>CONF-0205</td>
<td style="text-align: center;">MAY</td>
<td><div><p>Servers can [MAY] choose to return the results in a series of pages to manage the number of search results returned.</p>
</div></td>
</tr>
<tr>
<td>CONF-0206</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>Servers <strong>SHALL</strong> support, at minimum, these … "Common Clinical Notes":
<a href="https://loinc.org/11488-4.html">Consultation Note (11488-4)</a></p>
</div></td>
</tr>
<tr>
<td>CONF-0207</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>Servers <strong>SHALL</strong> support, at minimum, these … "Common Clinical Notes":
<a href="https://loinc.org/18842-5.html">Discharge Summary (18842-5)</a></p>
</div></td>
</tr>
<tr>
<td>CONF-0208</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>Servers <strong>SHALL</strong> support, at minimum, these … "Common Clinical Notes":
<a href="https://loinc.org/34117-2.html">History & Physical Note (34117-2)</a></p>
</div></td>
</tr>
<tr>
<td>CONF-0209</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>Servers <strong>SHALL</strong> support, at minimum, these … "Common Clinical Notes":
<a href="https://loinc.org/28570-0.html">Procedures Note (28570-0)</a></p>
</div></td>
</tr>
<tr>
<td>CONF-0210</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>Servers <strong>SHALL</strong> support, at minimum, these … "Common Clinical Notes":
<a href="https://loinc.org/11506-3.html">Progress Note (11506-3)</a></p>
</div></td>
</tr>
<tr>
<td>CONF-0211</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>Servers <strong>SHALL</strong> support, at minimum, these … "Common Clinical Notes":
<a href="https://loinc.org/18748-4.html">Imaging Narrative (18748-4)</a></p>
</div></td>
</tr>
<tr>
<td>CONF-0212</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>Servers <strong>SHALL</strong> support, at minimum, these … "Common Clinical Notes":
<a href="https://loinc.org/11502-2.html">Laboratory Report Narrative (11502-2)</a></p>
</div></td>
</tr>
<tr>
<td>CONF-0213</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>Servers <strong>SHALL</strong> support, at minimum, these … "Common Clinical Notes":
<a href="https://loinc.org/11526-1.html">Pathology Report Narrative (11526-1)</a></p>
</div></td>
</tr>
<tr>
<td>CONF-0214</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>Servers <strong>SHALL</strong> support, at minimum, these … DiagnosticReport categories:
<a href="https://loinc.org/LP29708-2">Cardiology (LP29708-2)</a></p>
</div></td>
</tr>
<tr>
<td>CONF-0215</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>Servers <strong>SHALL</strong> support, at minimum, these … DiagnosticReport categories:
<a href="https://loinc.org/LP7839-6">Pathology (LP7839-6)</a></p>
</div></td>
</tr>
<tr>
<td>CONF-0216</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>Servers <strong>SHALL</strong> support, at minimum, these … DiagnosticReport categories:
<a href="https://loinc.org/LP29684-5">Radiology (LP29684-5)</a></p>
</div></td>
</tr>
<tr>
<td>CONF-0217</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>systems are encouraged to support other common notes types, such as:
<a href="https://loinc.org/57133-1.html">Referral Note (57133-1)</a></p>
</div></td>
</tr>
<tr>
<td>CONF-0219</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>systems are encouraged to support other common notes types, such as:
<a href="https://loinc.org/34746-8.html">Nurse Note (34746-8)</a></p>
</div></td>
</tr>
<tr>
<td>CONF-0220</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>To enable consistent access to scanned DiagnosticReport clinical reports, the FHIR Server <strong>SHALL</strong> expose these overlapping scanned or narrative-only reports through both DiagnosticReport and DocumentReference by representing the same attachment URL [as] DocumentReference.content.attachment.url [and]
DiagnosticReport.presentedForm.url</p>
</div></td>
</tr>
<tr>
<td>CONF-0221</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>when DiagnosticReport.presentedForm.url references a Scan (PDF), that Attachment <strong>SHALL</strong> also be accessible through DocumentReference.content.attachment.url</p>
</div></td>
</tr>
<tr>
<td>CONF-0222</td>
<td style="text-align: center;">MAY</td>
<td><div><p>Systems [Servers] may extend their capabilities [around types of clinical notes] to the complete US Core DocumentReference Type Value Set.</p>
</div></td>
</tr>
<tr>
<td>CONF-0223</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>This guide requires [Server] systems to implement the <a href="https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-documentreference.html">US Core DocumentReference Profile</a></p>
</div></td>
</tr>
<tr>
<td>CONF-0224</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>This guide requires [Server] systems to implement the <a href="https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-diagnosticreport-note.html">US Core DiagnosticReport Profile for Report and Note exchange</a></p>
</div></td>
</tr>
<tr>
<td>CONF-0225</td>
<td style="text-align: center;">MAY</td>
<td><div><p>Systems [Servers] may support other [DiagnosticReport] categories as well.</p>
</div></td>
</tr>
<tr>
<td>CONF-0227</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>The following <strong>SHOULD</strong> be exposed via DiagnosticReport: Imaging Narrative</p>
</div></td>
</tr>
<tr>
<td>CONF-0228</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>The following <strong>SHOULD</strong> be exposed via DiagnosticReport: Laboratory Report Narrative</p>
</div></td>
</tr>
<tr>
<td>CONF-0229</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>The following <strong>SHOULD</strong> be exposed via DiagnosticReport: Pathology Report Narrative</p>
</div></td>
</tr>
<tr>
<td>CONF-0230</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>The following <strong>SHOULD</strong> be exposed via DiagnosticReport: Procedure Note</p>
</div></td>
</tr>
<tr>
<td>CONF-0231</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>Servers that support DiagnosticReport will include the clinical note narrative content in <code>DiagnosticReport.presentedForm</code></p>
</div></td>
</tr>
<tr>
<td>CONF-0233</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>FHIR Server claiming support to this guide <strong>SHOULD</strong> support the $expand operation [<a href="http://hl7.org/fhir/R4/valueset-operation-expand.html">operation link</a> to provide information to Clients requesting information on the note and report types the Server supports]</p>
</div></td>
</tr>
<tr>
<td>CONF-0234</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>[If Servers support the [$expand] (http://hl7.org/fhir/R4/valueset-operation-expand.html) operation for discovering note and report types, then Servers <strong>SHALL</strong> support] the #expand operation as follows:
GET [base]/ValueSet/$expand?context=http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note#DiagnosticReport.category&contextDirection=outgoing for DiagnosticReport report category discovery [for read operations]</p>
</div></td>
</tr>
<tr>
<td>CONF-0235</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>[If Servers support the [$expand] (http://hl7.org/fhir/R4/valueset-operation-expand.html) operation for discovering note and report types, then Servers <strong>SHALL</strong> support] the #expand operation as follows:
GET [base]/ValueSet/$expand?context=http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note#DiagnosticReport.category&contextDirection=incoming for DiagnosticReport report category discovery [for write operations]</p>
</div></td>
</tr>
<tr>
<td>CONF-0236</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>[If Servers support the [$expand] (http://hl7.org/fhir/R4/valueset-operation-expand.html) operation for discovering note and report types, then Servers <strong>SHALL</strong> support] the #expand operation as follows:
GET [base]/ValueSet/$expand?context=http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note#DiagnosticReport.code&contextDirection=outgoing for DiagnosticReport report type discovery [for read operations]</p>
</div></td>
</tr>
<tr>
<td>CONF-0237</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>[If Servers support the [$expand] (http://hl7.org/fhir/R4/valueset-operation-expand.html) operation for discovering note and report types, then Servers <strong>SHALL</strong> support] the #expand operation as follows:
GET [base]/ValueSet/$expand?context=http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note#DiagnosticReport.code&contextDirection=incoming for DiagnosticReport report type discovery [for write operations]</p>
</div></td>
</tr>
<tr>
<td>CONF-0238</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>[If Servers support the [$expand] (http://hl7.org/fhir/R4/valueset-operation-expand.html) operation for discovering note and report types, then Servers <strong>SHALL</strong> support] the #expand operation as follows:
GET [base]/ValueSet/$expand?context=http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference#DocumentReference.category&contextDirection=outgoing for DocumentReference note category discovery [for read operations]</p>
</div></td>
</tr>
<tr>
<td>CONF-0239</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>[If Servers support the [$expand] (http://hl7.org/fhir/R4/valueset-operation-expand.html) operation for discovering note and report types, then Servers <strong>SHALL</strong> support] the #expand operation as follows:
GET [base]/ValueSet/$expand?context=http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference#DocumentReference.category&contextDirection=incoming for DocumentReference note category discovery [for write operations]</p>
</div></td>
</tr>
<tr>
<td>CONF-0240</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>[If Servers support the [$expand] (http://hl7.org/fhir/R4/valueset-operation-expand.html) operation for discovering note and report types, then Servers <strong>SHALL</strong> support] the #expand operation as follows:
GET [base]/ValueSet/$expand?context=http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference#DocumentReference.type&contextDirection=outgoing for DocumentReference note type discovery [for read operations]</p>
</div></td>
</tr>
<tr>
<td>CONF-0241</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>[If Servers support the [$expand] (http://hl7.org/fhir/R4/valueset-operation-expand.html) operation for discovering note and report types, then Servers <strong>SHALL</strong> support] the #expand operation as follows:
GET [base]/ValueSet/$expand?context=http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference#DocumentReference.type&contextDirection=incoming for DocumentReference note type discovery [for write operations]</p>
</div></td>
</tr>
<tr>
<td>CONF-0242</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>[If Servers support the [$expand] (http://hl7.org/fhir/R4/valueset-operation-expand.html) operation then] the note and report types for a particular Server [SHOULD be] discovered by invoking the #expand operation as follows:
GET [base]/ValueSet/$expand?context=http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note#DiagnosticReport.presentedForm.contentType&contextDirection=outgoing for DiagnosticReport report content type discovery [for read operations]</p>
</div></td>
</tr>
<tr>
<td>CONF-0243</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>[If Servers support the [$expand] (http://hl7.org/fhir/R4/valueset-operation-expand.html) operation then] the note and report types for a particular Server [SHOULD be] discovered by invoking the #expand operation as follows:
GET [base]/ValueSet/$expand?context=http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note#DiagnosticReport.presentedForm.contentType&contextDirection=incoming for DiagnosticReport report content type discovery [for write operations]</p>
</div></td>
</tr>
<tr>
<td>CONF-0244</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>[If Servers support the [$expand] (http://hl7.org/fhir/R4/valueset-operation-expand.html) operation then] the note and report types for a particular Server [SHOULD be] discovered by invoking the #expand operation as follows:
GET [base]/ValueSet/$expand?context=http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference#DocumentReference.content.attachment.contentType&contextDirection=outgoing for DocumentReference note content type discovery [for read operations]</p>
</div></td>
</tr>
<tr>
<td>CONF-0245</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>[If Servers support the [$expand] (http://hl7.org/fhir/R4/valueset-operation-expand.html) operation then] the note and report types for a particular Server [SHOULD be] discovered by invoking the #expand operation as follows:
GET [base]/ValueSet/$expand?context=http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference#DocumentReference.content.attachment.contentType&contextDirection=incoming for DocumentReference note content type discovery [for write operations]</p>
</div></td>
</tr>
<tr>
<td>CONF-0246</td>
<td style="text-align: center;">MAY</td>
<td><div><p>[The <a href="http://hl7.org/fhir/R4/medicationadministration.html">MedicationAdministration</a> and <a href="http://hl7.org/fhir/R4/medicationstatement.html">MedicationStatement</a>] medication resources are not profiled by US Core, and systems that support US Core are permitted to use them</p>
</div></td>
</tr>
<tr>
<td>CONF-0247</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>When using a code [to represent a medication][, the code <strong>SHALL</strong> follow the <a href="http://hl7.org/fhir/R4/terminologies.html#extensible">extensible</a> binding rules to <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1010.4/expansion">Medication Clinical Drug (RxNorm)</a> - i.e., unless RxNorm does not cover the concept, the RxNorm code <strong>SHALL</strong> be used.</p>
</div></td>
</tr>
<tr>
<td>CONF-0248</td>
<td style="text-align: center;">MAY</td>
<td><div><p>USCDI recommends the <a href="https://www.fda.gov/drugs/drug-approvals-and-databases/national-drug-code-directory">National Drug Codes (NDC)</a> as an optional medication terminology. They can be supplied as an additional coding element [when representing a medication]</p>
</div></td>
</tr>
<tr>
<td>CONF-0249</td>
<td style="text-align: center;">MAY</td>
<td><div><p>When referencing the Medication resource, the resource may be included in the returned bundle, as an external resource, or as a <a href="http://hl7.org/fhir/R4/references.html#contained">contained</a> resource if it can’t stand alone. … The Server application <strong>MAY</strong> choose any combination of these methods</p>
</div></td>
</tr>
<tr>
<td>CONF-0250</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>if an external reference to Medication is used, the Server <strong>SHALL</strong> support the <a href="http://hl7.org/fhir/R4/search.html#include">_include</a> parameter for searching this element</p>
</div></td>
</tr>
<tr>
<td>CONF-0252</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>Requirements to access “all medications” [all historical, active, and future prescribed medications and medications entered in error and whose status is unknown.] and “all active medications” [all medications with an active status. Active medications do not include past, future, unknown status, and entered-in-error medications.] for a patient:
A MedicationRequest resource query <strong>SHALL</strong> be all that is required to access "all medications" or "all active medications" for a patient. (In other words, no other medication resource type needs to be fetched)</p>
</div></td>
</tr>
<tr>
<td>CONF-0253</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>Requirements to access “all medications” [all historical, active, and future prescribed medications and medications entered in error and whose status is unknown.] and “all active medications” [all medications with an active status. Active medications do not include past, future, unknown status, and entered-in-error medications.] for a patient:
The [MedicationRequest resource] query result <strong>SHALL</strong> include all MedicationRequest resources with a <code>MedicationRequest.intent</code> = "order" representing authorized medication orders directly derived from the system's orders.</p>
</div></td>
</tr>
<tr>
<td>CONF-0254</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>Requirements to access “all medications” [all historical, active, and future prescribed medications and medications entered in error and whose status is unknown.] and “all active medications” [all medications with an active status. Active medications do not include past, future, unknown status, and entered-in-error medications.] for a patient:
The [MedicationRequest resource] query result <strong>SHALL</strong> include all prescribed and "self-prescribed" MedicationRequest resources with a <code>MedicationRequest.intent</code> = "plan" representing reported medications.</p>
</div></td>
</tr>
<tr>
<td>CONF-0256</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>Requirements to access “all medications” [all historical, active, and future prescribed medications and medications entered in error and whose status is unknown.] and “all active medications” [all medications with an active status. Active medications do not include past, future, unknown status, and entered-in-error medications.] for a patient:
Servers <strong>SHALL</strong> use the <code>MedicationRequest.reported[x]</code> element to indicate that the MedicationRequest record was captured as a secondary "reported" record rather than an original primary source-of-truth record.</p>
</div></td>
</tr>
<tr>
<td>CONF-0257</td>
<td style="text-align: center;">MAY</td>
<td><div><p>Requirements to access “all medications” [all historical, active, and future prescribed medications and medications entered in error and whose status is unknown.] and “all active medications” [all medications with an active status. Active medications do not include past, future, unknown status, and entered-in-error medications.] for a patient:
Servers [MAY] use the <code>MedicationRequest.reported[x]</code> element to indicate ... the source of the report.</p>
</div></td>
</tr>
<tr>
<td>CONF-0258</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>Requirements to access “all medications” [all historical, active, and future prescribed medications and medications entered in error and whose status is unknown.] and “all active medications” [all medications with an active status. Active medications do not include past, future, unknown status, and entered-in-error medications.] for a patient:
When recording "self-prescribed" medication, Servers <strong>SHOULD</strong> use the <code>MedicationRequest.requester</code> element to indicate the Patient or RelatedPerson is the prescriber.</p>
</div></td>
</tr>
<tr>
<td>CONF-0259</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>Requirements to access “all medications” [all historical, active, and future prescribed medications and medications entered in error and whose status is unknown.] and “all active medications” [all medications with an active status. Active medications do not include past, future, unknown status, and entered-in-error medications.] for a patient:
Servers <strong>SHOULD</strong> support the encounter search parameter.</p>
</div></td>
</tr>
<tr>
<td>CONF-0260</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>Requirements to access “all medications” [all historical, active, and future prescribed medications and medications entered in error and whose status is unknown.] and “all active medications” [all medications with an active status. Active medications do not include past, future, unknown status, and entered-in-error medications.] for a patient:
[If Servers support the encounter search parameter, s]earching by encounter will return all medications ordered during that encounter, including medications administered in the hospital and prescribed or discharge medications intended to be taken at home.</p>
</div></td>
</tr>
<tr>
<td>CONF-0262</td>
<td style="text-align: center;">MAY</td>
<td><div><p>Requirements to access “all medications” [all historical, active, and future prescribed medications and medications entered in error and whose status is unknown.] and “all active medications” [all medications with an active status. Active medications do not include past, future, unknown status, and entered-in-error medications.] for a patient:
Servers <strong>MAY</strong> support the search parameters <code>category</code>and <code>encounter</code>. This search will return all medications ordered during an encounter for a given MedicationRequest.category such as "inpatient".</p>
</div></td>
</tr>
<tr>
<td>CONF-0263</td>
<td style="text-align: center;">MAY</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>MAY</strong> be supplied by the Server</p>
</div></td>
</tr>
<tr>
<td>CONF-0267</td>
<td style="text-align: center;">MAY</td>
<td><div><p>An agent.type=”assembler”, agent.type=”transmitter”, or other agents from <a href="https://hl7.org/fhir/us/core/STU8/ValueSet-us-core-provenance-participant-type.html">Provenance Agent Type</a> value set <strong>MAY</strong> also be included.</p>
</div></td>
</tr>
<tr>
<td>CONF-0268</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>implementers [of US Core's framework of Screening and Assessments] <strong>SHOULD</strong> consider more constrained, domain-specific profiles derived from the US Core Profiles to meet the needs of their respective use cases.</p>
</div></td>
</tr>
<tr>
<td>CONF-0269</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>Every Server that supports the USDCI Data Class “Health Status/Assessments”:</p>
<p><strong>SHALL</strong> support representing clinical judgments using <a href="https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-condition-problems-health-concerns.html">US Core Condition Problems and Health Concerns Profile</a> or <a href="https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-simple-observation.html">US Core Simple Observation Profile</a>.</p>
</div></td>
</tr>
<tr>
<td>CONF-0270</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>Every Server that supports the USDCI Data Class “Health Status/Assessments”:
...
The US Core Simple Observation Profile's Observation.derivedFrom element <strong>SHOULD</strong> reference the <a href="https://hl7.org/fhir/us/core/STU8/screening-and-assessments.html#structured-screening-and-assessments">Structured Screening and Assessment</a> upon which clinical judgment observations are made</p>
</div></td>
</tr>
<tr>
<td>CONF-0271</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>Every Server that supports the USDCI Data Class “Health Status/Assessments”:
...
the US Core Condition Profile's Condition.evidence.detail element <strong>SHOULD</strong> reference the <a href="https://hl7.org/fhir/us/core/STU8/screening-and-assessments.html#structured-screening-and-assessments">Structured Screening and Assessment</a> which assist in diagnosing problems or health concerns.</p>
</div></td>
</tr>
<tr>
<td>CONF-0272</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>For API developers using US Core, it’s important to understand when to use the QuestionnaireResponse versus Observation to represent structured assessments and surveys. Here are some guidelines to help choose the appropriate profile:
Observations represent specific point-in-time facts that need to be searched, trended, the subject of statistical analysis, and directly referenced in support of other actions ... anything that meets one of the preceding criteria must be surfaced as an Observation.</p>
</div></td>
</tr>
<tr>
<td>CONF-0280</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>Implementers <strong>SHOULD</strong> treat these [USCDI Health Status Assessments Data Element] value sets as having an <a href="http://hl7.org/fhir/R4/terminologies.html#extensible">extensible</a> binding.</p>
</div></td>
</tr>
<tr>
<td>CONF-0281</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>when recording SDOH data [with] US Core Profiles, Servers <strong>SHOULD</strong> use … <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1196.788/expansion">Social Determinants of Health Conditions Value Set</a>, <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1196.789/expansion">Social Determinants of Health Procedures Value Set</a>, <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1247.71/expansion">Social Determinants of Health Goals Value Set</a>, [and] <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1196.790/expansion">Social Determinants of Health Service Requests Value Set</a></p>
</div></td>
</tr>
<tr>
<td>CONF-0287</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>Servers <strong>SHOULD</strong> maintain a stable common identifier for a resource across [FHIR] versions.</p>
</div></td>
</tr>
<tr>
<td>CONF-0288</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>In an upgraded R4 endpoint, any data in FHIR DSTU2 <strong>SHOULD</strong> be in FHIR R4.</p>
</div></td>
</tr>
<tr>
<td>CONF-0289</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-0290</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-0291</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-0295</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>Servers <strong>SHOULD</strong> make available the same information in DSTU2 and R4 where the more recent standard allows.</p>
</div></td>
</tr>
<tr>
<td>CONF-0296</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>Servers <strong>SHOULD</strong> make available the same information in DSTU2 and R4 where the more recent standard allows … [with the] exception [of]
MedicationStatement data [should be] mapped to MedicationRequest</p>
</div></td>
</tr>
<tr>
<td>CONF-0297</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>Servers <strong>SHOULD</strong> make available the same information in DSTU2 and R4 where the more recent standard allows … [with the] exception [of]
care teams, as represented by CarePlan, <strong>SHOULD</strong> be mapped to CareTeam in R4</p>
</div></td>
</tr>
<tr>
<td>CONF-0298</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>Data <strong>SHOULD</strong> be maintained between [FHIR] versions (i.e., not be degraded).</p>
</div></td>
</tr>
<tr>
<td>CONF-0300</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>To allow Clients to use a single authorization token when accessing resources from multiple version-specific endpoints, Servers <strong>SHOULD</strong> use the same base authorization endpoint across versions.</p>
</div></td>
</tr>
<tr>
<td>CONF-0302</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>[The clinical status of the allergy] <strong>SHALL</strong> be present if verification status is not “entered-in-error”</p>
</div></td>
</tr>
<tr>
<td>CONF-0303</td>
<td style="text-align: center;">SHALL-NOT</td>
<td><div><p>[The clinical status of the allergy] <strong>SHALL NOT</strong> be present if verification Status is “entered-in-error”</p>
</div></td>
</tr>
<tr>
<td>CONF-0305</td>
<td style="text-align: center;">MAY</td>
<td><div><p>Profile Specific Implementation Guidance:</p>
<p>No Known Allergies may be represented using the US Core-AllergyIntolerance profile</p>
</div></td>
</tr>
<tr>
<td>CONF-0306</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>[When used No Known Allergies is documented the system Shall use an] appropriate negation code in AllergyIntolerence.code</p>
</div></td>
</tr>
<tr>
<td>CONF-0307</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>[When used No Known Allergies is documented the system Shall use an] verification status in AllergyIntolerance.verificationStatus</p>
</div></td>
</tr>
<tr>
<td>CONF-0308</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>If a patient has not been asked about their allergies, this would be represented as:
AllergyIntolerance.code = “1631000175102” (Patient not asked (contextual qualifier) (qualifier value))
AllergyIntolerance.verificationStatus = “unconfirmed” or empty (in other words, then element omitted)</p>
</div></td>
</tr>
<tr>
<td>CONF-0309</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>If a patient has been asked, but has indicated they have no known allergies, this would be represented as:
AllergyIntolerance.code = “716186003” (No known allergy (situation))
AllergyIntolerance.verificationStatus = “confirmed”</p>
</div></td>
</tr>
<tr>
<td>CONF-0310</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>Considerations for systems aligning with <a href="http://www.hl7.org/implement/standards/product_brief.cfm?product_id=492">HL7 Consolidated (C-CDA)</a> Care Plan requirements: US Core Goal <strong>SHOULD</strong> be present in CarePlan.goal</p>
</div></td>
</tr>
<tr>
<td>CONF-0311</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>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 Condition <strong>SHOULD</strong> be present in CarePlan.addresses</p>
</div></td>
</tr>
<tr>
<td>CONF-0312</td>
<td style="text-align: center;">MAY</td>
<td><div><p>Considerations for systems aligning with [HL7 Consolidated (C-CDA)] (http://www.hl7.org/implement/standards/product_brief.cfm?product_id=492) Care Plan requirements: Assessment and Plan <strong>MAY</strong> be included as narrative in CarePlan.text</p>
</div></td>
</tr>
<tr>
<td>CONF-0313</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>Although both US Core Practitioner Profile and US Core PractitionerRole are Must Support, ... Server system[s conforming to the US Core CareTeam profile are] ... not required to support references to both, but <strong>SHALL</strong> support at least one of them</p>
</div></td>
</tr>
<tr>
<td>CONF-0317</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>[When conforming to the US Core CareTeam profile] Because the US Core PractitionerRole Profile supplies the provider’s location and contact information and a reference to the Practitioner, Server systems [conforming to the US Core CareTeam profile] <strong>SHOULD</strong> reference it instead of the US Core Practitioner Profile [when conforming to the US Core CareTeam profile] .</p>
</div></td>
</tr>
<tr>
<td>CONF-0318</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>Servers [conforming to the US Core CareTeam profile] that support only US Core Practitioner Profile and do not support the US Core PractitionerRole Profile <strong>SHALL</strong> provide implementation-specific guidance on how to access a provider’s location ... information using only the Practitioner resource.</p>
</div></td>
</tr>
<tr>
<td>CONF-0319</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>Servers [conforming to the US Core CareTeam profile] that support only US Core Practitioner Profile and do not support the US Core PractitionerRole Profile <strong>SHALL</strong> provide implementation-specific guidance on how to access a provider’s ... contact information using only the Practitioner resource.</p>
</div></td>
</tr>
<tr>
<td>CONF-0320</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>For Problems and Health Concerns [records, systems <strong>SHOULD</strong>] use the <a href="https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-condition-problems-health-concerns.html">US Core Condition Problems and Health Concerns Profile</a>.</p>
</div></td>
</tr>
<tr>
<td>CONF-0321</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>[Newly created Encounter Diagnosis records <strong>SHALL</strong> have a] Condition.code … [from the] <a href="https://hl7.org/fhir/R5/terminologies.html#binding">“current”</a> … [value set] binding.</p>
</div></td>
</tr>
<tr>
<td>CONF-0322</td>
<td style="text-align: center;">MAY</td>
<td><div><p>[Historical Encounter Diagnosis records <strong>MAY</strong> have a] Condition.code … [from the] base “preferred” … [value set] binding.</p>
</div></td>
</tr>
<tr>
<td>CONF-0323</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>USCDI’s applicable vocabulary standards for Encounter Diagnosis are SNOMED CT and ICD-10-CM. The US Core Condition Codes only supports ICD-9-CM for historical purposes. When using ICD codes, only non-header ICD-10-CM codes <strong>SHOULD</strong> be used as the primary code for current encounter diagnoses.</p>
</div></td>
</tr>
<tr>
<td>CONF-0324</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>[A US Core Condition Encounter Diagnosis] encounter <strong>SHOULD</strong> always be referenced in Condition.encounter.</p>
</div></td>
</tr>
<tr>
<td>CONF-0330</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>For Encounter Diagnosis [records, systems <strong>SHOULD</strong>] use the <a href="https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-condition-encounter-diagnosis.html">US Core Condition Encounter Diagnosis Profile</a>.</p>
</div></td>
</tr>
<tr>
<td>CONF-0331</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>If the category is "problem-list-item", Condition.clinicalStatus <strong>SHOULD</strong> be present.</p>
</div></td>
</tr>
<tr>
<td>CONF-0332</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>Updates to .meta.lastUpdated <strong>SHOULD</strong> reflect: New problems and health concerns</p>
</div></td>
</tr>
<tr>
<td>CONF-0333</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>Updates to .meta.lastUpdated <strong>SHOULD</strong> reflect:
Changes in the clinical status or verifications status of problems or health concerns.</p>
</div></td>
</tr>
<tr>
<td>CONF-0334</td>
<td style="text-align: center;">MAY</td>
<td><div><p>A coverage.type of “81” (Self-pay) <strong>MAY</strong> be used to imply that the patient has no coverage or that an individual or organization other than an insurer is taking responsibility for payment for a portion of the health care costs.</p>
</div></td>
</tr>
<tr>
<td>CONF-0335</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>Implementers should refer to the <a href="https://www.nahdo.org/sites/default/files/2020-12/SourceofPaymentTypologyUsersGuideVersion9.2December2020.pdf">PHDSC Payer Type Committee User’s Guide</a> for the Source of Payment Typology when selecting codes.</p>
</div></td>
</tr>
<tr>
<td>CONF-0336</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>To differentiate Medicare Parts A, B, C, and D systems can use the following codes [when sending Coverage.type]: [For] Part A and B [use] 121 (Medicare Fee For Service)</p>
</div></td>
</tr>
<tr>
<td>CONF-0337</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>To differentiate Medicare Parts A, B, C, and D systems can use the following codes: [For] Part C (Medicare Advantage Plan) [use] 111 (Medicare HMO), 112 (Medicare PPO), 113 (Medicare POS)</p>
</div></td>
</tr>
<tr>
<td>CONF-0338</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>To differentiate Medicare Parts A, B, C, and D systems can use the following codes: [For] Part D [use] 122 (Medicare Drug Benefit)</p>
</div></td>
</tr>
<tr>
<td>CONF-0339</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>If Insurers issue unique member IDs for dependents, then the memberId Coverage.identifier should be used [with the unique dependent ID] instead of Coverage.dependent to uniquely refer to the dependent with respect to their insurance.</p>
</div></td>
</tr>
<tr>
<td>CONF-0340</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>For non-implantable devices (for example, software or crutches), use the base FHIR Device resource or other use case-specific Device profiles.</p>
</div></td>
</tr>
<tr>
<td>CONF-0341</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>Implementers are encouraged to use the FDA Global UDI Database (GUDID) and associated APIs to parse and validate the [unique device ID] UDI</p>
</div></td>
</tr>
<tr>
<td>CONF-0342</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>Implantable medical devices with UDI information <strong>SHALL</strong> represent the UDI code in Device.udiCarrier.carrierHRF</p>
</div></td>
</tr>
<tr>
<td>CONF-0343</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>UDI-PI elements present [in Device.udiCarrier.carrierHRF] <strong>SHALL</strong> be represented in the corresponding US Core Implantable Device Profile elements</p>
</div></td>
</tr>
<tr>
<td>CONF-0344</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>If UDI is not present and the manufacturer … is available, … [it] <strong>SHOULD</strong> be included to support historical reports of implantable medical devices [where] manufacturer [is sent in] Device.manufacturer</p>
</div></td>
</tr>
<tr>
<td>CONF-0345</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>If UDI is not present and the ... model number information is available, … [it] <strong>SHOULD</strong> be included to support historical reports of implantable medical devices [where] model [is sent in] Device.model</p>
</div></td>
</tr>
<tr>
<td>CONF-0346</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>Servers SHOULD support query by Device.type to allow Clients to request the patient’s devices by a specific type.</p>
</div></td>
</tr>
<tr>
<td>CONF-0347</td>
<td style="text-align: center;">MAY</td>
<td><div><p>Records of implanted devices <strong>MAY</strong> be queried against UDI data, including: UDI HRF string (udi-carrier)</p>
</div></td>
</tr>
<tr>
<td>CONF-0348</td>
<td style="text-align: center;">MAY</td>
<td><div><p>Records of implanted devices <strong>MAY</strong> be queried against UDI data, including:UDI Device Identifier (udi-di)</p>
</div></td>
</tr>
<tr>
<td>CONF-0349</td>
<td style="text-align: center;">MAY</td>
<td><div><p>Records of implanted devices <strong>MAY</strong> be queried against UDI data, including: Manufacturer (manufacturer)</p>
</div></td>
</tr>
<tr>
<td>CONF-0350</td>
<td style="text-align: center;">MAY</td>
<td><div><p>Records of implanted devices <strong>MAY</strong> be queried against UDI data, including: Model number (model)</p>
</div></td>
</tr>
<tr>
<td>CONF-0351</td>
<td style="text-align: center;">MAY</td>
<td><div><p>Implementers <strong>MAY</strong> also adopt custom SearchParameters for searching by lot numbers</p>
</div></td>
</tr>
<tr>
<td>CONF-0352</td>
<td style="text-align: center;">MAY</td>
<td><div><p>Implementers <strong>MAY</strong> also adopt custom SearchParameters for searching by serial number</p>
</div></td>
</tr>
<tr>
<td>CONF-0353</td>
<td style="text-align: center;">MAY</td>
<td><div><p>Implementers <strong>MAY</strong> also adopt custom SearchParameters for searching by expiration date</p>
</div></td>
</tr>
<tr>
<td>CONF-0354</td>
<td style="text-align: center;">MAY</td>
<td><div><p>Implementers <strong>MAY</strong> also adopt custom SearchParameters for searching by manufacture date</p>
</div></td>
</tr>
<tr>
<td>CONF-0355</td>
<td style="text-align: center;">MAY</td>
<td><div><p>Implementers <strong>MAY</strong> also adopt custom SearchParameters for searching by distinct identifier</p>
</div></td>
</tr>
<tr>
<td>CONF-0356</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The diagnostically relevant time (known as the “effective time” and typically the time of specimen collection) … <strong>SHALL</strong> be present if status [of the diagnostic report] is ‘partial’, ‘preliminary’, ‘final’, ‘amended’, ‘corrected’, or ‘appended’.</p>
</div></td>
</tr>
<tr>
<td>CONF-0357</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>When the report was released … <strong>SHALL</strong> be present if status [of the diagnostic report] is ‘partial’, ‘preliminary’, ‘final’, ‘amended’, ‘corrected’, or ‘appended’.</p>
</div></td>
</tr>
<tr>
<td>CONF-0358</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>Updates to .meta.lastUpdated <strong>SHOULD</strong> reflect New laboratory reports.</p>
</div></td>
</tr>
<tr>
<td>CONF-0359</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>Updates to .meta.lastUpdated <strong>SHOULD</strong> reflect changes in the status of laboratory reports, including events that trigger the same status (e.g., amended → amended).</p>
</div></td>
</tr>
<tr>
<td>CONF-0360</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The DiagnosticReport.category binding Must Support, at a minimum, the US Core DiagnosticReport Category Codes of Cardiology, Radiology, and Pathology</p>
</div></td>
</tr>
<tr>
<td>CONF-0361</td>
<td style="text-align: center;">MAY</td>
<td><div><p>Other [diagnostic report] categories may be supported [when using US Core DiagnosticReport Profile for Report and Note Exchange]</p>
</div></td>
</tr>
<tr>
<td>CONF-0362</td>
<td style="text-align: center;">MAY</td>
<td><div><p>[L]inkages between specific LOINC codes and the LP-type codes may be used as guidance [for a Server's categorization of diagnostic reports]</p>
</div></td>
</tr>
<tr>
<td>CONF-0364</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>For Diagnostic Imaging Reports systems <strong>SHOULD</strong> support using the subset of LOINC codes defined in CONF-DIR-19 in HL7 Implementation Guide for CDA Release 2: Imaging Integration, Levels 1, 2, and 3, Basic Imaging Reports in CDA and DICOM Diagnostic Imaging Reports (DIR) - Universal Realm, Release 1.0.</p>
</div></td>
</tr>
<tr>
<td>CONF-0365</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The DocumentReference.type binding Must Support, at a minimum, the 10 <a href="https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-documentreference.html#mandatory-and-must-support-data-elements">Common Clinical Notes</a></p>
</div></td>
</tr>
<tr>
<td>CONF-0366</td>
<td style="text-align: center;">MAY</td>
<td><div><p>The DocumentReference.type binding may extend to the whole <a href="https://hl7.org/fhir/us/core/STU8/ValueSet-us-core-documentreference-type.html">US Core DocumentReference Type Value Set</a></p>
</div></td>
</tr>
<tr>
<td>CONF-0367</td>
<td style="text-align: center;">MAY</td>
<td><div><p>[DocumentReference.type may also use] other category schemes such as the LOINC-based <a href="http://hl7.org/fhir/R4/valueset-document-classcodes.html">Document Class Value Set</a> and <a href="https://wiki.ihe.net/index.php/XDS_classCode_Metadata_Coding_System">IHE XDSclassCode</a></p>
</div></td>
</tr>
<tr>
<td>CONF-0368</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>Although both [DocumentReference.attachment.url and DocumentReference.attachment.data] are marked as Must Support, the Server system is not required to support an address and inline base64 encoded data, but <strong>SHALL</strong> support at least one of these elements.</p>
</div></td>
</tr>
<tr>
<td>CONF-0372</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>If there are multiple DocumentReference.content element repetitions, these <strong>SHALL</strong> all represent the same document in different formats or attachment metadata</p>
</div></td>
</tr>
<tr>
<td>CONF-0373</td>
<td style="text-align: center;">SHALL-NOT</td>
<td><div><p>The [documentReference.content] element <strong>SHALL NOT</strong> contain different versions of the same content.</p>
</div></td>
</tr>
<tr>
<td>CONF-0374</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The organization responsible for the DocumentReference <strong>SHALL</strong> be present either in DocumentReference.custodian or accessible in the Provenance resource targeting the DocumentReference using Provenance.agent.who or Provenance.agent.onBehalfOf</p>
</div></td>
</tr>
<tr>
<td>CONF-0375</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>Although ... marked as Must Support, Servers are not required to support both [an Encounter.reasonCode or a reference with Encounter.reasonReference], but they <strong>SHALL</strong> support at least one of these elements.</p>
</div></td>
</tr>
<tr>
<td>CONF-0378</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>If Encounter.reasonReference references an Observation, it <strong>SHOULD</strong> conform to a US Core Observation [profile applicable to the observation being made]</p>
</div></td>
</tr>
<tr>
<td>CONF-0379</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>Although … marked as Must Support, Servers are not required to support both Encounter.location.location and Encounter.serviceProvider, but they <strong>SHALL</strong> support at least one of these elements.</p>
</div></td>
</tr>
<tr>
<td>CONF-0382</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>If the event facility/location differs from the Encounter.location, systems <strong>SHOULD</strong> reference it directly</p>
</div></td>
</tr>
<tr>
<td>CONF-0383</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>If the event facility/location differs from the Encounter.location, … systems <strong>SHALL</strong> use the location element for all resources where the element is available.</p>
</div></td>
</tr>
<tr>
<td>CONF-0384</td>
<td style="text-align: center;">MAY</td>
<td><div><p>If the event facility/location differs from the Encounter.location … systems <strong>MAY</strong> use the standard <a href="http://hl7.org/fhir/StructureDefinition/event-location">Event Location Extension</a> for US Core DiagnosticReport Profile for Laboratory Results Reporting and US Core Observation Clinical Result Profile.</p>
</div></td>
</tr>
<tr>
<td>CONF-0385</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>Updates to .meta.lastUpdated <strong>SHOULD</strong> reflect New encounters/visits</p>
</div></td>
</tr>
<tr>
<td>CONF-0386</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>Updates to .meta.lastUpdated <strong>SHOULD</strong> reflect changes in the status of encounters, including events that trigger the same status (e.g., in-progress → in-progress).</p>
</div></td>
</tr>
<tr>
<td>CONF-0387</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>Although both Goal.startDate and Goal.target.dueDate are marked as Must Support, the Server system is not required to support both, but <strong>SHALL</strong> support at least one of these elements.</p>
</div></td>
</tr>
<tr>
<td>CONF-0390</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>[Servers shall] use the status code: not-done to represent that an immunization was not given.</p>
</div></td>
</tr>
<tr>
<td>CONF-0391</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>[For organization participating in the ONC Health IT Certification program] <a href="https://www2a.cdc.gov/vaccines/iis/iisstandards/ndc_crosswalk.asp">CVX vaccine codes</a> are required</p>
</div></td>
</tr>
<tr>
<td>CONF-0392</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p><a href="http://www2a.cdc.gov/vaccines/iis/iisstandards/ndc_crosswalk.asp">NDC vaccine codes</a> <strong>SHOULD</strong> be supported as an additional code [of <a href="https://www2a.cdc.gov/vaccines/iis/iisstandards/ndc_crosswalk.asp">CVX Vaccine Codes</a>]</p>
</div></td>
</tr>
<tr>
<td>CONF-0393</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>The preferred code system identifier … is <a href="http://hl7.org/fhir/sid/cvx">http://hl7.org/fhir/sid/cvx</a> for CVX [vaccine codes]</p>
</div></td>
</tr>
<tr>
<td>CONF-0394</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>The preferred code system identifier … is <a href="http://hl7.org/fhir/sid/ndc">http://hl7.org/fhir/sid/ndc</a> for NDC vaccine codes]</p>
</div></td>
</tr>
<tr>
<td>CONF-0395</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>Systems <strong>SHOULD</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 Location.address.line</p>
</div></td>
</tr>
<tr>
<td>CONF-0396</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>Systems <strong>SHOULD</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 Location.address.city</p>
</div></td>
</tr>
<tr>
<td>CONF-0397</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>When using a code [to represent a medication for a medication dispense], RXNorm concepts are used.</p>
</div></td>
</tr>
<tr>
<td>CONF-0398</td>
<td style="text-align: center;">MAY</td>
<td><div><p>When using a code [to represent a medication for a medication dispense], <a href="https://www.fda.gov/drugs/drug-approvals-and-databases/national-drug-code-directory">National Drug Codes (NDC)</a> can be supplied as an additional coding element.</p>
</div></td>
</tr>
<tr>
<td>CONF-0399</td>
<td style="text-align: center;">MAY</td>
<td><div><p>When referencing a Medication resource in .medicationReference, the resource may be <a href="http://hl7.org/fhir/R4/references.html#contained">contained</a></p>
</div></td>
</tr>
<tr>
<td>CONF-0400</td>
<td style="text-align: center;">MAY</td>
<td><div><p>When referencing a Medication resource in .medicationReference, the resource may be an external resource</p>
</div></td>
</tr>
<tr>
<td>CONF-0401</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The Server systems are not required to support both a [medication] code and a reference [when sending medicationDispense], but <strong>SHALL</strong> support at least one of these methods</p>
</div></td>
</tr>
<tr>
<td>CONF-0402</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>If an external reference to a Medication resource is used, the Server <strong>SHALL</strong> support the <a href="http://hl7.org/fhir/R4/search.html#include">_include</a> parameter for searching this element.</p>
</div></td>
</tr>
<tr>
<td>CONF-0405</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>[For organization participating in the ONC Health IT Certification program Servers <strong>SHALL</strong> support the <a href="https://hl7.org/fhir/us/core/STU8/must-support.html#additional-uscdi-requirements">additional USCDI requirement</a>:], The reason or indication for the prescription</p>
</div></td>
</tr>
<tr>
<td>CONF-0406</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>[For organization participating in the ONC Health IT Certification program Servers <strong>SHALL</strong> support the <a href="https://hl7.org/fhir/us/core/STU8/must-support.html#additional-uscdi-requirements">additional USCDI requirement</a>:] reported adherence to prescribed medication instructions</p>
</div></td>
</tr>
<tr>
<td>CONF-0407</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>When recording “self-prescribed” medication, requester <strong>SHOULD</strong> be used to indicate the Patient or RelatedPerson as the prescriber</p>
</div></td>
</tr>
<tr>
<td>CONF-0408</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>Although [medicationRequest.reportedBoolean and MedicationRequest.reportedReference] are both marked as Must Support, the Server system is not required to support both, but <strong>SHALL</strong> support at least one of these elements</p>
</div></td>
</tr>
<tr>
<td>CONF-0411</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>Although both MedicationRequest.reasonCode and MedicationRequest.reasonReference are marked as Additional USCDI Requirements [which are required for organizations participating in the ONC Health IT Certification program]. The certifying Server system is not required to support both, but <strong>SHALL</strong> support at least one of these elements</p>
</div></td>
</tr>
<tr>
<td>CONF-0414</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>[For organizations participating in the ONC Health IT Certification program and supporting MedicationRequest.reasonReference,] Servers <strong>SHALL</strong> support at least one target resource in MedicationRequest.reasonReference</p>
</div></td>
</tr>
<tr>
<td>CONF-0416</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>[For organizations participating in the ONC Health IT Certification program,] the referenced resources <strong>SHOULD</strong> be a US Core Profile as documented in <a href="https://hl7.org/fhir/us/core/STU8/general-guidance.html#referencing-us-core-profiles">Referencing US Core Profiles</a>.</p>
</div></td>
</tr>
<tr>
<td>CONF-0417</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>Source EHR identifiers <strong>SHOULD</strong> be included to support deduplication across MedicationRequest resources.</p>
</div></td>
</tr>
<tr>
<td>CONF-0419</td>
<td style="text-align: center;">MAY</td>
<td><div><p>The observations <strong>MAY</strong> have additional codes that translate or map to the Observation code or category codes [such as] … local system-specific codes [and] …more specific codes</p>
</div></td>
</tr>
<tr>
<td>CONF-0420</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>[For an Observation a] code system value <strong>SHOULD</strong> be supplied for each additional code</p>
</div></td>
</tr>
<tr>
<td>CONF-0421</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>Because the blood pressure values are communicated in the mandatory systolic and diastolic components [when using the US Core Average Blood Pressure Profile,] the Observation.value[x] element <strong>SHALL</strong> be omitted</p>
</div></td>
</tr>
<tr>
<td>CONF-0422</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>The context or precondition of a patient’s [care experience] preference <strong>SHOULD</strong> be supplied in the Observation.valueString or in an extension</p>
</div></td>
</tr>
<tr>
<td>CONF-0423</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>Servers <strong>SHOULD</strong> use the base FHIR [Observation Category Codes] (http://hl7.org/fhir/R4/valueset-observation-category.html) [in Observation.category]</p>
</div></td>
</tr>
<tr>
<td>CONF-0424</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>Systems <strong>SHOULD</strong> support Observation.effectivePeriod to accurately represent measurements over time</p>
</div></td>
</tr>
<tr>
<td>CONF-0425</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>An Observation.component without a value, <strong>SHALL</strong> include a reason why the data is absent</p>
</div></td>
</tr>
<tr>
<td>CONF-0426</td>
<td style="text-align: center;">MAY</td>
<td><div><p>Systems that never provide a component observation without a component value … [MAY choose not] to support Observation.component.dataAbsentReason</p>
</div></td>
</tr>
<tr>
<td>CONF-0427</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>An Observation without a value, <strong>SHALL</strong> include a reason why the data is absent</p>
</div></td>
</tr>
<tr>
<td>CONF-0428</td>
<td style="text-align: center;">MAY</td>
<td><div><p>[For] an Observation without a value … [Systems <strong>MAY</strong> choose not to] include a reason why the data is absent … [if] there are component observations or … reporting panel observations using Observation.hasMember</p>
</div></td>
</tr>
<tr>
<td>CONF-0429</td>
<td style="text-align: center;">MAY</td>
<td><div><p>Systems that never provide an observation without a value ... [MAY choose not] to support Observation.dataAbsentReason</p>
</div></td>
</tr>
<tr>
<td>CONF-0430</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>[When sending US Core Laboratory Results Observation Profile] updates to .meta.lastUpdated <strong>SHOULD</strong> reflect new laboratory observations</p>
</div></td>
</tr>
<tr>
<td>CONF-0431</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>[When sending US Core Laboratory Results Observation Profile] updates to .meta.lastUpdated <strong>SHOULD</strong> reflect changes in the status of laboratory observations, including events that trigger the same status (e.g., amended → amended)</p>
</div></td>
</tr>
<tr>
<td>CONF-0432</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>[When sending US Core Observation Occupation Profile] for … [a] current job, [Servers SHALL] omit observation.effectivePeriod.end to indicate it is ongoing.</p>
</div></td>
</tr>
<tr>
<td>CONF-0433</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>When the industry is known, but the occupation is not, [Servers SHALL] use the value “unknown” from the <a href="http://hl7.org/fhir/R4/codesystem-data-absent-reason.html">DataAbsentReason Code System</a></p>
</div></td>
</tr>
<tr>
<td>CONF-0434</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>when the occupation is known but the industry is not, [Servers SHALL] omit the industry Observation.component</p>
</div></td>
</tr>
<tr>
<td>CONF-0435</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>To represent the patient’s pregnancy status, [Servers SHALL] use the <a href="https://hl7.org/fhir/us/core/StructureDefinition-us-core-observation-pregnancystatus.html">US Core Observation Pregnancy Status Profile</a>.</p>
</div></td>
</tr>
<tr>
<td>CONF-0436</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>To represent the patient’s intent to become pregnant, [Servers SHALL] use the <a href="https://hl7.org/fhir/us/core/StructureDefinition-us-core-observation-pregnancyintent.html">US Core Observation Pregnancy Intent Profile</a>.</p>
</div></td>
</tr>
<tr>
<td>CONF-0437</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>[For] multi-question surveys or assessments Observation.code is an overarching assessment or screening code, and the Observation.value element <strong>SHOULD</strong> be empty</p>
</div></td>
</tr>
<tr>
<td>CONF-0438</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>A practitioner’s clinical observation or assertion about a patient’s health status, which is not a response to a screening or assessment question,SHOULD use the <a href="https://hl7.org/fhir/us/core/StructureDefinition-us-core-simple-observation.html">US Core Simple Observation Profile</a> instead [of the US Core Observation Screening Assessment Profile]</p>
</div></td>
</tr>
<tr>
<td>CONF-0439</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>the Server system ... <strong>SHALL</strong> support [either] Reference(US Core Observation Screening Assessment Profile) or Reference(US Core QuestionnaireResponse Profile) for Observation.derivedFrom</p>
</div></td>
</tr>
<tr>
<td>CONF-0440</td>
<td style="text-align: center;">MAY</td>
<td><div><p>Additional codes that translate or map to the Observation code (e.g., local codes) are allowed [when using US Core Observation Sexual Orientation Profile]</p>
</div></td>
</tr>
<tr>
<td>CONF-0441</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>Observations formally part of an assessment tool or survey <strong>SHOULD</strong> use the <a href="https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-observation-screening-assessment.html">US Core Observation Screening Assessment Profile</a>.</p>
</div></td>
</tr>
<tr>
<td>CONF-0442</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>An assertion or determination derived from screening and assessment tools <strong>SHOULD</strong> reference them using Observation.derivedFrom</p>
</div></td>
</tr>
<tr>
<td>CONF-0443</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>When using `Observation.derivedFrom’ to reference an Observation, the referenced Observation <strong>SHOULD</strong> be a US Core Observation</p>
</div></td>
</tr>
<tr>
<td>CONF-0444</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>Although none of the Observation.derivedFrom <a href="https://hl7.org/fhir/us/core/STU8/must-support.html#must-support---resource-references">references are flagged as Must Support</a>, the Server <strong>SHALL</strong> support at least one of them</p>
</div></td>
</tr>
<tr>
<td>CONF-0445</td>
<td style="text-align: center;">MAY</td>
<td><div><p>[US Core] treatment intervention preferences expressed by a patient may be documented in narrative (text) form or the result of selecting from a list of options provided by the content creator/implementer.</p>
</div></td>
</tr>
<tr>
<td>CONF-0446</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>[When using US Core Treatment Intervention Preference Profile] the context or precondition of a patient’s preference <strong>SHOULD</strong> be supplied in the Observation.valueString ... or an extension</p>
</div></td>
</tr>
<tr>
<td>CONF-0447</td>
<td style="text-align: center;">MAY</td>
<td><div><p>[US Core Vital Signs] observations <strong>MAY</strong> have <a href="http://hl7.org/fhir/R4/observation.html#gr-comp">component</a> observations … [see] FHIR core specification <a href="http://hl7.org/fhir/R4/observation-vitalsigns.html#vitals-table">vital signs table</a> for examples</p>
</div></td>
</tr>
<tr>
<td>CONF-0448</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>Information about the growth chart tables used to determine percentiles <strong>SHOULD</strong> be supplied in Observation.note.text</p>
</div></td>
</tr>
<tr>
<td>CONF-0449</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>[In the US Core Blood Pressure Profile] because the blood pressure values are communicated in the mandatory systolic and diastolic components[,] the Observation.value[x] element <strong>SHOULD</strong> be omitted</p>
</div></td>
</tr>
<tr>
<td>CONF-0450</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>[In the US Core Blood Pressure Profile] because the blood pressure values are communicated in the mandatory systolic and diastolic components[,] an Observation without a systolic or diastolic result value, <strong>SHALL</strong> include a reason why the data is absent in Observation.component.dataAbsentReason</p>
</div></td>
</tr>
<tr>
<td>CONF-0451</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>[In the US Core Blood Pressure Profile] because the blood pressure values are communicated in the mandatory systolic and diastolic components[,] All Server systems - including those that never provide a component observation without a value - <strong>SHALL</strong> support Observation.component.dataAbsentReason for the components.</p>
</div></td>
</tr>
<tr>
<td>CONF-0452</td>
<td style="text-align: center;">MAY</td>
<td><div><p>Inspired oxygen therapy may be represented with <a href="http://hl7.org/fhir/R4/observation.html#gr-comp">component</a> observations when measured at the same time as the pulse oximetry measurements [in the US Core Pulse Oximetry profile]</p>
</div></td>
</tr>
<tr>
<td>CONF-0453</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>Many pulse oximetry readings are taken while the patient is breathing room air. The concept of “room air” (unmodified, ambient air) <strong>SHOULD</strong> be represented as an inhaled oxygen flow rate of 0 liters/min</p>
</div></td>
</tr>
<tr>
<td>CONF-0454</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>A pulse oximetry reading without inspired oxygen component observations may imply that the measurement was performed while the patient was breathing room air or that the inspired oxygen reading was omitted. To remove this uncertainty, the inspired oxygen <a href="http://hl7.org/fhir/R4/observation.html#gr-comp">component</a> observations <strong>SHOULD</strong> be used [when using the US Core Pulse Oximetry profile.]</p>
</div></td>
</tr>
<tr>
<td>CONF-0455</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>Systems <strong>SHALL</strong> support National Provider Identifier (NPI) for organizations</p>
</div></td>
</tr>
<tr>
<td>CONF-0456</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>Systems … <strong>SHOULD</strong> the National Association of Insurance Commissioners NAIC Company code (sometimes called “NAIC Number” or “cocode”) for payers.</p>
</div></td>
</tr>
<tr>
<td>CONF-0457</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>Systems … <strong>SHOULD</strong> support Clinical Laboratory Improvement Amendments (CLIA) for laboratories</p>
</div></td>
</tr>
<tr>
<td>CONF-0458</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>Systems <strong>SHOULD</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 Organization.address.line and Organization.address.city</p>
</div></td>
</tr>
<tr>
<td>CONF-0459</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The Complex [Extension] for Race ... allow[s] for one or more codes of which <a href="https://hl7.org/fhir/us/core/STU8/must-support.html">Must Support</a> at least one category code from the OMB Race ... Category Value Sets that draw from the <a href="https://phinvads.cdc.gov/vads/ViewCodeSystem.action?id=2.16.840.1.113883.6.238">Race & Ethnicity - CDC (CDCREC)</a> code system [for the [US Core Race Extension] (https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-race.html)].</p>
</div></td>
</tr>
<tr>
<td>CONF-0460</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The Complex [Extension] for ... Ethnicity allow[s] for one or more codes of which <a href="https://hl7.org/fhir/us/core/STU8/must-support.html">Must Support</a> at least one category code from the OMB ... Ethnicity Category Value Sets that draw from the <a href="https://phinvads.cdc.gov/vads/ViewCodeSystem.action?id=2.16.840.1.113883.6.238">Race & Ethnicity - CDC (CDCREC)</a> code system [for the [US Core Ethnicity Extension] (https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-ethnicity.html)].</p>
</div></td>
</tr>
<tr>
<td>CONF-0461</td>
<td style="text-align: center;">MAY</td>
<td><div><p>The Complex [Extension] for Race ... allow[s] for one or more codes of which <strong>MAY</strong> include additional codes from the detailed ethnicity ... value sets drawn from the <a href="https://phinvads.cdc.gov/vads/ViewCodeSystem.action?id=2.16.840.1.113883.6.238">Race & Ethnicity - CDC (CDCREC)</a> code system [when using the [US Core Race Extension] (https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-race.html)]</p>
</div></td>
</tr>
<tr>
<td>CONF-0462</td>
<td style="text-align: center;">MAY</td>
<td><div><p>The Complex [Extension] for Race ... allow[s] for one or more codes of which <strong>SHALL</strong> include a text description [of category codes when using the [US Core Race Extension] (https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-race.html)]</p>
</div></td>
</tr>
<tr>
<td>CONF-0463</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The Complex [Extension] for ... Ethnicity allow[s] for one or more codes of which <strong>MAY</strong> include additional codes from the detailed ... race value sets drawn from the <a href="https://phinvads.cdc.gov/vads/ViewCodeSystem.action?id=2.16.840.1.113883.6.238">Race & Ethnicity - CDC (CDCREC)</a> code system [when using the [US Core Race Extension] (https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-race.html)]</p>
</div></td>
</tr>
<tr>
<td>CONF-0464</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The Complex [Extension] for ... Ethnicity allow[s] for one or more codes of which <strong>SHALL</strong> include a text description [of category codes when using the [US Core Ethnicity Extension] (https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-ethnicity.html)]</p>
</div></td>
</tr>
<tr>
<td>CONF-0466</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>Previous name is represented by setting Patient.name.use to “old” or providing an end date in Patient.name.period or doing both</p>
</div></td>
</tr>
<tr>
<td>CONF-0467</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>Previous address is represented by setting Patient.address.use to “old” or providing an end date in Patient.address.period or doing both.</p>
</div></td>
</tr>
<tr>
<td>CONF-0470</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>Non-certifying systems[, systems that are not participating in the ONC Health IT certification program,] <strong>SHOULD</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-0471</td>
<td style="text-align: center;">MAY</td>
<td><div><p>[For systems participating in the ONC Health IT certification program,] this requirement [to 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> for Patient.address.line and Patient.address.city] does not apply to historical records or documents that are exposed through FHIR-based APIs. [Organizations <strong>MAY</strong> choose not to use use Project US@ Technical Specification for Patient Addresses Final Version 1.0 when sending historical records]</p>
</div></td>
</tr>
<tr>
<td>CONF-0472</td>
<td style="text-align: center;">SHOULD-NOT</td>
<td><div><p><strong>SHOULD NOT</strong> be used as a patient identifier in Patient.identifier.value</p>
</div></td>
</tr>
<tr>
<td>CONF-0473</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>Servers that support only the US Core Practitioner Profile and do not support the <a href="https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-practitionerrole.html">US Core PractitionerRole Profile</a> <strong>SHALL</strong> provide implementation-specific guidance on how to access a provider’s location and contact information using only the Practitioner resource.</p>
</div></td>
</tr>
<tr>
<td>CONF-0474</td>
<td style="text-align: center;">MAY</td>
<td><div><p>Although Practitioner.address is marked as Must Support, the Server system … [MAY choose not to] support it if they support the US Core PractitionerRole Profile</p>
</div></td>
</tr>
<tr>
<td>CONF-0475</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>[When using the US Core Practioner Profile] Practitioner.address … <strong>SHALL</strong>[be supported] if … [the Server does] not support the US Core PractitionerRole Profile</p>
</div></td>
</tr>
<tr>
<td>CONF-0477</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>Only professional/work contact information about the practitioner <strong>SHOULD</strong> be available to the patient</p>
</div></td>
</tr>
<tr>
<td>CONF-0478</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>Systems <strong>SHOULD</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 Practitioner.address.line and Practitioner.address.city.</p>
</div></td>
</tr>
<tr>
<td>CONF-0479</td>
<td style="text-align: center;">MAY</td>
<td><div><p>Procedure codes … [MAY] be taken from SNOMED-CT, CPT, HCPCS II, ICD-10-PCS, CDT, or LOINC [for procedure.code]</p>
</div></td>
</tr>
<tr>
<td>CONF-0480</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>[If using LOINC codes in procedure.code] only LOINC concepts that reflect actual procedures <strong>SHOULD</strong> be used</p>
</div></td>
</tr>
<tr>
<td>CONF-0481</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>communication.preferred <strong>MAY</strong> designate a preferred language when multiple languages are represented</p>
</div></td>
</tr>
<tr>
<td>CONF-0482</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>[For organizations participating in the ONC Health IT Certification program] Servers … <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-0484</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>[For organizations participating in the ONC Health IT Certification program,] although both Procedure.reasonCode and Procedure.reasonReference are marked as Additional USCDI Requirements, the certifying Server system is not required to support both, but <strong>SHALL</strong> support at least one of these elements.</p>
</div></td>
</tr>
<tr>
<td>CONF-0486</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 Servers <strong>SHALL</strong> support at least one target resource in Procedure.reasonReference</p>
</div></td>
</tr>
<tr>
<td>CONF-0488</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>[For organizations participating in the ONC Health IT Certification program,] when using Procedure.reasonReference …The referenced resources <strong>SHOULD</strong> be a US Core Profile as documented in <a href="https://hl7.org/fhir/us/core/STU8/general-guidance.html#referencing-us-core-profiles">Referencing US Core Profiles</a></p>
</div></td>
</tr>
<tr>
<td>CONF-0489</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The US Core Provenance resource <strong>SHALL</strong> be supported for … [this] US Core resource type AllergyIntolerance</p>
</div></td>
</tr>
<tr>
<td>CONF-0490</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The US Core Provenance resource <strong>SHALL</strong> be supported for … [this] US Core resource type CarePlan</p>
</div></td>
</tr>
<tr>
<td>CONF-0491</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The US Core Provenance resource <strong>SHALL</strong> be supported for … [this] US Core resource type CareTeam</p>
</div></td>
</tr>
<tr>
<td>CONF-0492</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The US Core Provenance resource <strong>SHALL</strong> be supported for … [this] US Core resource type Condition</p>
</div></td>
</tr>
<tr>
<td>CONF-0493</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The US Core Provenance resource <strong>SHALL</strong> be supported for … [this] US Core resource type Coverage</p>
</div></td>
</tr>
<tr>
<td>CONF-0494</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The US Core Provenance resource <strong>SHALL</strong> be supported for … [this] US Core resource type Device</p>
</div></td>
</tr>
<tr>
<td>CONF-0495</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The US Core Provenance resource <strong>SHALL</strong> be supported for … [this] US Core resource type DiagnosticReport</p>
</div></td>
</tr>
<tr>
<td>CONF-0496</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The US Core Provenance resource <strong>SHALL</strong> be supported for … [this] US Core resource type Document Reference</p>
</div></td>
</tr>
<tr>
<td>CONF-0497</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The US Core Provenance resource <strong>SHALL</strong> be supported for … [this] US Core resource type Encounter</p>
</div></td>
</tr>
<tr>
<td>CONF-0498</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The US Core Provenance resource <strong>SHALL</strong> be supported for … [this] US Core resource type Goal</p>
</div></td>
</tr>
<tr>
<td>CONF-0499</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The US Core Provenance resource <strong>SHALL</strong> be supported for … [this] US Core resource type Immunization</p>
</div></td>
</tr>
<tr>
<td>CONF-0500</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The US Core Provenance resource <strong>SHALL</strong> be supported for … [this] US Core resource type MedicationDispense</p>
</div></td>
</tr>
<tr>
<td>CONF-0501</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The US Core Provenance resource <strong>SHALL</strong> be supported for … [this] US Core resource type MedicationRequest</p>
</div></td>
</tr>
<tr>
<td>CONF-0502</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The US Core Provenance resource <strong>SHALL</strong> be supported for … [this] US Core resource type Observation</p>
</div></td>
</tr>
<tr>
<td>CONF-0503</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The US Core Provenance resource <strong>SHALL</strong> be supported for … [this] US Core resource type Patient</p>
</div></td>
</tr>
<tr>
<td>CONF-0504</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The US Core Provenance resource <strong>SHALL</strong> be supported for … [this] US Core resource type Procedure</p>
</div></td>
</tr>
<tr>
<td>CONF-0505</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The US Core Provenance resource <strong>SHALL</strong> be supported for … [this] US Core resource type QuestionnaireResponse</p>
</div></td>
</tr>
<tr>
<td>CONF-0506</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The US Core Provenance resource <strong>SHALL</strong> be supported for … [this] US Core resource type RelatedPerson</p>
</div></td>
</tr>
<tr>
<td>CONF-0507</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The US Core Provenance resource <strong>SHALL</strong> be supported for … [this] US Core resource type ServiceRequest</p>
</div></td>
</tr>
<tr>
<td>CONF-0508</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>If a system receives a provider in Provenance.agent.who as free text, they must capture [the organization] who sent them the information [and upon] request ... <strong>SHALL</strong> provide this organization as the source</p>
</div></td>
</tr>
<tr>
<td>CONF-0509</td>
<td style="text-align: center;">MAY</td>
<td><div><p>If a system receives a provider in Provenance.agent.who as free text, … [upon request they] <strong>MAY</strong> include the free text provider.</p>
</div></td>
</tr>
<tr>
<td>CONF-0510</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>Systems that need to know the activity has occurred <strong>SHOULD</strong> populate the activity [Provenance.activity]</p>
</div></td>
</tr>
<tr>
<td>CONF-0511</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>If the QuestionnaireResponse is based on a non-FHIR form [then a] ... FHIR Questionnaire [needs to] represent at least the relevant metadata</p>
</div></td>
</tr>
<tr>
<td>CONF-0512</td>
<td style="text-align: center;">MAY</td>
<td><div><p>If the QuestionnaireResponse is based on a non-FHIR form [then a] … FHIR Questionnaire's questions may be omitted</p>
</div></td>
</tr>
<tr>
<td>CONF-0513</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>Systems <strong>SHOULD</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 RelatedPerson.address.line and RelatedPerson.address.city</p>
</div></td>
</tr>
<tr>
<td>CONF-0514</td>
<td style="text-align: center;">MAY</td>
<td><div><p>The Must Support <code>ServiceRequest.category</code> is bound, at a minimum, to the <a href="https://hl7.org/fhir/us/core/STU8/ValueSet-us-core-servicerequest-category.html">US Core ServiceRequest Category Codes</a>, and other category codes can be used.</p>
</div></td>
</tr>
<tr>
<td>CONF-0515</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>The ServiceRequest.code value ... <strong>SHOULD</strong> be constrained to a subset for a particular use case or domain</p>
</div></td>
</tr>
<tr>
<td>CONF-0516</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>[For organizations participating in the ONC Health IT Certification program] Servers … <strong>SHALL</strong> support ... US Core Service Request Profile for communicating the reason or justification for a referral as Additional USCDI Requirements</p>
</div></td>
</tr>
<tr>
<td>CONF-0518</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>[For organizations participating in the ONC Health IT Certification program,] although both ServiceRequest.reasonCode and ServiceRequest.reasonReference are marked as Additional USCDI Requirements, the certifying Server system is not required to support both, but <strong>SHALL</strong> support at least one of these elements.</p>
</div></td>
</tr>
<tr>
<td>CONF-0520</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 Servers <strong>SHALL</strong> support at least one target resource in ServiceRequest.reasonReference</p>
</div></td>
</tr>
<tr>
<td>CONF-0522</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>[For organizations participating in the ONC Health IT Certification program,] when using ServiceRequest.reasonReference …The referenced resources <strong>SHOULD</strong> be a US Core Profile as documented in <a href="https://hl7.org/fhir/us/core/STU8/general-guidance.html#referencing-us-core-profiles">Referencing US Core Profiles</a></p>
</div></td>
</tr>
<tr>
<td>CONF-0523</td>
<td style="text-align: center;">MAY</td>
<td><div><p>Since the binding [for Specimen.type and additional USCDI elements] is <a href="http://hl7.org/fhir/R4/terminologies.html#extensible">extensible</a> when a code is unavailable, just text is allowed [and conformant].</p>
</div></td>
</tr>
<tr>
<td>CONF-0524</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>Although both Specimen.identifier and Specimen.accessionIdentifier are marked as Must Support, the Server system is not required to support both, but <strong>SHALL</strong> support at least one of these elements.</p>
</div></td>
</tr>
<tr>
<td>CONF-0532</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>[Servers] <strong>SHOULD</strong> Support the ...
<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-0533</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>US Core Server <strong>SHALL</strong> support the US Core Patient resource profile</p>
</div></td>
</tr>
<tr>
<td>CONF-0534</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>US Core Server <strong>SHALL</strong> support … at least one additional resource profile [in addition to the US Core Patient resource profile] from the list of US Core Profiles</p>
</div></td>
</tr>
<tr>
<td>CONF-0535</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>US Core Server <strong>SHALL</strong>… Implement the RESTful behavior according to the FHIR specification.</p>
</div></td>
</tr>
<tr>
<td>CONF-0536</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>US Core Server <strong>SHALL</strong>… return the following response class (Status 400) [for] invalid parameters</p>
</div></td>
</tr>
<tr>
<td>CONF-0537</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>US Core Server <strong>SHALL</strong>… return the following response class (Status 401/4xx) [for] unauthorized request</p>
</div></td>
</tr>
<tr>
<td>CONF-0538</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>US Core Server <strong>SHALL</strong>… return the following response class (Status 403) [for] insufficient scopes</p>
</div></td>
</tr>
<tr>
<td>CONF-0539</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>US Core Server <strong>SHALL</strong>… return the following response class (Status 404) [for] unknown resource</p>
</div></td>
</tr>
<tr>
<td>CONF-0540</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>US Core Server <strong>SHALL</strong>… support JSON source formats for all US Core interactions.</p>
</div></td>
</tr>
<tr>
<td>CONF-0541</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>US Core Server <strong>SHOULD</strong> … support XML source formats for all US Core interactions.</p>
</div></td>
</tr>
<tr>
<td>CONF-0542</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>US Core Server <strong>SHOULD</strong> … identify the US Core profiles supported as part of the FHIR meta.profile attribute for each instance.</p>
</div></td>
</tr>
<tr>
<td>CONF-0543</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>A Server <strong>SHALL</strong> reject any unauthorized requests by returning an HTTP 401 "Unauthorized", HTTP 403 "Forbidden", or HTTP 404 "Not Found"</p>
</div></td>
</tr>
<tr>
<td>CONF-0548</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>[US Core Servers] <strong>SHOULD</strong> support <a href="http://hl7.org/fhir/OperationDefinition/ValueSet-expand">$expand</a> operation</p>
</div></td>
</tr>
<tr>
<td>CONF-0549</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>If a Server supports DocumentReference for creating, using, and sharing clinical notes, it <strong>SHOULD</strong> also support the context and contextdirection parameters of the $expand operation</p>
</div></td>
</tr>
<tr>
<td>CONF-0550</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-0552</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-0554</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-0556</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-0558</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-0560</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-0562</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-0564</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-0566</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-0568</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-0570</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 2.0.0</a> for Client <-> Server interactions.</p>
</div></td>
</tr>
<tr>
<td>CONF-0572</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-0574</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-0576</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-0578</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-0580</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-0583</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-0584</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>If the QuestionnaireResponse is based on a non-FHIR form [then a] ... FHIR Questionnaire [will communicate] the identifier of the non-FHIR form instead of the canonical URI using the US Core Extension Questionnaire URI extension.</p>
</div></td>
</tr>
<tr>
<td>CONF-0587</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>Each AllergyIntolerance Must Support: a verification status</p>
</div></td>
</tr>
<tr>
<td>CONF-0588</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>Each AllergyIntolerance Must Support: a reaction manifestation</p>
</div></td>
</tr>
<tr>
<td>CONF-0804</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>If any sub-element is marked as <em>Additional USCDI</em> [for a complex element], it must also 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-0808</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>When a Reference type element is labeled as Must Support and has a single target profile referenced, the target profile <strong>SHALL</strong> be supported.</p>
</div></td>
</tr>
<tr>
<td>CONF-0810</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>When a Reference type element is labeled as Must Support, has multiple target profiles referenced, and specific targets are labeled as Must Support, the Must Support target profile(s) <strong>SHALL</strong> be supported.</p>
</div></td>
</tr>
<tr>
<td>CONF-0813</td>
<td style="text-align: center;">MAY</td>
<td><div><p>[If a] slicer's Must Support property only defines the element level … Additional USCDI property[, i.e.,] no … Additional USCDI property is defined for the slice, then support for that slice's definition is optional.</p>
</div></td>
</tr>
<tr>
<td>CONF-0818</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>Servers <strong>SHALL</strong> support, at minimum, these … "Common Clinical Notes":
<a href="https://loinc.org/11504-8.html">Surgical Operation Note (11504-8)</a></p>
</div></td>
</tr>
<tr>
<td>CONF-0819</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>Servers <strong>SHALL</strong> support, at minimum, these … "Common Clinical Notes":
<a href="https://loinc.org/34111-5.html">Emergency Department Note (34111-5)</a></p>
</div></td>
</tr>
<tr>
<td>CONF-0820</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>Servers that support the USCDI Health Status/Assessments Data Class <strong>SHALL</strong> support the US Core Observation Screening Assessment Profile</p>
</div></td>
</tr>
<tr>
<td>CONF-0821</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>Servers that support the USCDI Health Status/Assessments Data Class ... <strong>SHOULD</strong> support the SDC Base Questionnaire and the US Core QuestionnaireResponse Profile."</p>
</div></td>
</tr>
<tr>
<td>CONF-0822</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>For the US Core Simple Observation Profile, Servers <strong>SHALL</strong> support all the category codes <a href="https://hl7.org/fhir/us/core/STU8/screening-and-assessments.html#category-codes">listed</a>.</p>
</div></td>
</tr>
<tr>
<td>CONF-0823</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>For the … US Core Observation Screening Assessment Profiles, Servers <strong>SHALL</strong> support all the category codes <a href="https://hl7.org/fhir/us/core/STU8/screening-and-assessments.html#category-codes">listed</a>.</p>
</div></td>
</tr>
<tr>
<td>CONF-0824</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>For the US Core Condition Problems and Health Concerns Profile, Servers <strong>SHALL</strong> support the code ,"sdoh"</p>
</div></td>
</tr>
<tr>
<td>CONF-0825</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>For the US Core Condition Problems and Health Concerns Profile, Servers <strong>SHOULD</strong> support the other category codes <a href="https://hl7.org/fhir/us/core/STU8/screening-and-assessments.html#category-codes">listed</a>.</p>
</div></td>
</tr>
<tr>
<td>CONF-0826</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>For the US Core ServiceRequest Profile, Servers <strong>SHOULD</strong> support all the [<a href="https://hl7.org/fhir/us/core/STU8/screening-and-assessments.html#category-codes">listed</a>] category codes.</p>
</div></td>
</tr>
<tr>
<td>CONF-0827</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-0828</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>Servers ... <strong>SHOULD</strong> use the standard FHIR SearchParameters.</p>
</div></td>
</tr>
<tr>
<td>CONF-0831</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>[The Server <strong>SHALL</strong> support the] category of "problem-list-item"</p>
</div></td>
</tr>
<tr>
<td>CONF-0832</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>[The Server <strong>SHALL</strong> support the] category of "health-concern"</p>
</div></td>
</tr>
<tr>
<td>CONF-0836</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>The <code>DiagnosticRequest.basedOn</code> element connects the DiagnosticReport to the originating order in the EHR. Systems that initiate the order <strong>SHOULD</strong> use this element when reporting the results.</p>
</div></td>
</tr>
<tr>
<td>CONF-0837</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>The <code>DiagnosticReport.media.link</code> element <strong>SHOULD</strong> 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).</p>
</div></td>
</tr>
<tr>
<td>CONF-0838</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>The <code>DiagnosticReport.imagingStudy</code> element <strong>SHOULD</strong> 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 -<a href="http://hl7.org/fhir/R4/imagingstudy.html">ImagingStudy</a> resource.</p>
</div></td>
</tr>
<tr>
<td>CONF-0839</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>If the referenced a document or file [referenced by <code>DocumentReference.content.attachment.url</code>] is hosted on a Server outside the FHIR Server, it should be securely accessible using the same authorization credentials that were used to access the FHIR Server. This reduces complexity for the Client and improves the user experience.</p>
</div></td>
</tr>
<tr>
<td>CONF-0840</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>Although the [US Core Interpreter Needed] 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 <strong>SHALL</strong> support the extension on at least one.</p>
</div></td>
</tr>
<tr>
<td>CONF-0841</td>
<td style="text-align: center;">MAY</td>
<td><div><p>There is no guarantee that vaccine lot numbers are globally unique, and they are not recommended for matching or de-duplication across systems unless used with other data elements such as a vaccine product code, manufacturer code, or date of administration. Implementers <strong>MAY</strong> communicate the <code>Immunization.manufacturer</code> to ensure global uniqueness to lot numbers.</p>
</div></td>
</tr>
<tr>
<td>CONF-0842</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>Servers <strong>SHALL</strong> return all active medications following the <a href="https://hl7.org/fhir/us/core/STU8/medication-list.html#get-all-active-medications">Get All Active Medications</a> guidance.</p>
</div></td>
</tr>
<tr>
<td>CONF-0843</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>[For US Core Laboratory Result Observation Profile, even] when the specimen type is already implied by the LOINC code used in <code>Observation.code</code> (e.g., a LOINC code for Blood Glucose), the <code>Observation.specimen</code> element <strong>SHOULD</strong> also be populated with the referenced Specimen resource to explicitly communicate the collected specimen type.</p>
</div></td>
</tr>
<tr>
<td>CONF-0844</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>[For US Core Laboratory Result Observation Profile, the] type of specimen [in <code>Observation.specimen</code>] <strong>SHOULD</strong> not conflict with the LOINC code [in <code>Observation.code</code>].</p>
</div></td>
</tr>
<tr>
<td>CONF-0845</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>[For the US Core Observation Screening Assessment Profile, the] category type "survey" is required.</p>
</div></td>
</tr>
<tr>
<td>CONF-0850</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>[For the US Core Observation Screening Assessment Profile,] when using Observation.derivedFrom to reference an Observation, the referenced Observation <strong>SHOULD</strong> be a US Core Observation.</p>
</div></td>
</tr>
<tr>
<td>CONF-0851</td>
<td style="text-align: center;">MAY</td>
<td><div><p>Servers can use 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>] or the <a href="https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-encounter.html">US Core Encounter Profile</a> to communicate whether a patient needs an interpreter.</p>
</div></td>
</tr>
<tr>
<td>CONF-0852</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>Although the [<a href="https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-interpreter-needed.html">US Core Interpreter Needed Extension</a>] 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 <strong>SHALL</strong> support the extension on at least one.</p>
</div></td>
</tr>
<tr>
<td>CONF-0855</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>Systems <strong>SHOULD</strong> designate the patient's preferred language in the Patient.communication.preferred element.</p>
</div></td>
</tr>
<tr>
<td>CONF-0856</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>The <code>Procedure.performed</code> is mandatory if <code>Procedure.status</code> is "completed" or "in-progress".</p>
</div></td>
</tr>
<tr>
<td>CONF-0857</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>[In the <a href="https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-servicerequest.html">US Core ServiceRequest Profile</a>, for] the USCDI Laboratory Order, ... implementers <strong>SHOULD</strong> use the corresponding category codes listed ... below:</p>
<ul>
<li><a href="https://browser.ihtsdotools.org/?perspective=full&conceptId1=108252007&edition=MAIN/2024-10-01&release=&languages=en&latestRedirect=false">108252007 Laboratory procedure (procedure)</a></li>
</ul>
</div></td>
</tr>
<tr>
<td>CONF-0858</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>[In the <a href="https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-servicerequest.html">US Core ServiceRequest Profile</a>, for] the USCDI ... Clinical Test Order, ... implementers <strong>SHOULD</strong> use the corresponding category codes listed ... below:</p>
<ul>
<li><a href="https://browser.ihtsdotools.org/?perspective=full&conceptId1=386053000&edition=MAIN/2024-10-01&release=&languages=en&latestRedirect=false">386053000 Evaluation procedure (procedure)</a></li>
<li><a href="https://browser.ihtsdotools.org/?perspective=full&conceptId1=410606002&edition=MAIN/2024-10-01&release=&languages=en&latestRedirect=false">410606002 Social service procedure (procedure)</a></li>
<li><a href="https://browser.ihtsdotools.org/?perspective=full&conceptId1=387713003&edition=MAIN/2024-10-01&release=&languages=en&latestRedirect=false">387713003 Surgical procedure (procedure)</a></li>
</ul>
</div></td>
</tr>
<tr>
<td>CONF-0859</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>[In the <a href="https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-servicerequest.html">US Core ServiceRequest Profile</a>, for] the USCDI ... Imaging Order, ... implementers <strong>SHOULD</strong> use the corresponding category codes listed ... below:</p>
<ul>
<li><a href="https://browser.ihtsdotools.org/?perspective=full&conceptId1=363679005&edition=MAIN/2024-10-01&release=&languages=en&latestRedirect=false">363679005 Imaging (procedure)</a></li>
</ul>
</div></td>
</tr>
<tr>
<td>CONF-0860</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>[In the <a href="https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-servicerequest.html">US Core ServiceRequest Profile</a>, for] the USCDI ... Procedure Order Data Elements, implementers <strong>SHOULD</strong> use the corresponding category codes listed ... below:</p>
<ul>
<li><a href="https://browser.ihtsdotools.org/?perspective=full&conceptId1=386053000&edition=MAIN/2024-10-01&release=&languages=en&latestRedirect=false">386053000 Evaluation procedure (procedure)</a></li>
<li><a href="https://browser.ihtsdotools.org/?perspective=full&conceptId1=410606002&edition=MAIN/2024-10-01&release=&languages=en&latestRedirect=false">410606002 Social service procedure (procedure)</a></li>
<li><a href="https://browser.ihtsdotools.org/?perspective=full&conceptId1=387713003&edition=MAIN/2024-10-01&release=&languages=en&latestRedirect=false">387713003 Surgical procedure (procedure)</a></li>
</ul>
</div></td>
</tr>
<tr>
<td>CONF-0864</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>An Observation without a value, <strong>SHALL</strong> include a reason why the data is absent unless there are 1) component observations, or 2) reporting panel observations using Observation.hasMember.</p>
</div></td>
</tr>
<tr>
<td>CONF-0865</td>
<td style="text-align: center;">MAY</td>
<td><div><p>Systems that never provide an observation without a value are not required to support <code>Observation.dataAbsentReason</code>.</p>
</div></td>
</tr>
<tr>
<td>CONF-0866</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>An <code>Observation.component</code> without a value, <strong>SHALL</strong> include a reason why the data is absent.</p>
</div></td>
</tr>
<tr>
<td>CONF-0867</td>
<td style="text-align: center;">MAY</td>
<td><div><p>Systems that never provide a component observation without a component value are not required to support <code>Observation.component.dataAbsentReason</code>.</p>
</div></td>
</tr>
<tr>
<td>CONF-0868</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>Although '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. Servers are not required to support both, but <strong>SHALL</strong> support at least one.</p>
</div></td>
</tr>
<tr>
<td>CONF-0870</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>[I]f a slice is labeled as Must Support... and the slicer element is not labeled as Must Support..., then if the Server... 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-0871</td>
<td style="text-align: center;">MAY</td>
<td><div><p>[If a] slicer's Must Support property only defines the element level Must Support...[, i.e.,] no Must Support... property is defined for the slice, then support for that slice's definition is optional.</p>
</div></td>
</tr>
<tr>
<td>CONF-0872</td>
<td style="text-align: center;">SHALL</td>
<td><div><p>[I]f a slice is labeled as Must Support... and the slicer element is ... labeled as Must Support..., then ... the Server... [<strong>SHALL</strong> support] the element[ and] the slice's definition.</p>
</div></td>
</tr>
<tr>
<td>CONF-0881</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 Responders <strong>SHALL</strong> be capable of providing [such an element] with a valid reference to <em>at least one</em> target profile.</li>
</ul>
</div></td>
</tr>
<tr>
<td>CONF-0885</td>
<td style="text-align: center;">SHOULD</td>
<td><div><p>The author is communicated by the elements and the author's role by the referenced target resource (for example, Patient, Practitioner/PractitionerRole, RelatedPerson, Device). Details about the author's role are contained in the target resource's contents. Many of these elements are labeled Must Support or Additional USCDI Requirements. However,[even if they are not labeled Must Support or Additional USCDI Requirements] all of these elements and target resources <strong>SHOULD</strong> be supported in the profiles if the system captures the data.</p>
</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-server"/>
<identifier>
<system value="urn:ietf:rfc:3986"/>
<value value="urn:oid:2.16.840.1.113883.4.642.40.2.36.3"/>
</identifier>
<version value="9.0.0"/>
<name value="USCoreServerRequirements"/>
<title value="US Core Server 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 Responder (Server) 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. See the [US Core Certifying System Requirements](Requirements-us-core-certifying-system.html) for the *additional requirements* for systems certifying for ASTP Health IT Certification (g(10) certification."/>
<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 (Server)"/>
</extension>
</actor>
<statement>
<key value="CONF-0001"/>
<conformance value="SHALL"/>
<requirement
value="To support a US Core Profile, a Server: **SHALL** Be able to populate all profile data elements that are mandatory and/or flagged as Must Support as defined by that profile’s StructureDefinition."/>
</statement>
<statement>
<key value="CONF-0002"/>
<conformance value="SHOULD"/>
<requirement
value="To support a US Core Profile, a Server: **SHOULD** declare support for a US Core Profile by including its official URL in the Server’s `CapabilityStatement.rest.resource.supportedProfile` element."/>
</statement>
<statement>
<key value="CONF-0003"/>
<conformance value="MAY"/>
<conditionality value="true"/>
<requirement
value="Servers may deploy and support one or more US Core Profiles to represent clinical information"/>
</statement>
<statement>
<key value="CONF-0004"/>
<conformance value="MAY"/>
<conditionality value="true"/>
<requirement
value="Server may deploy and support ... the following US Core interaction: “Quick Start” defined for each Profile"/>
</statement>
<statement>
<key value="CONF-0005"/>
<conformance value="MAY"/>
<conditionality value="true"/>
<requirement
value="Server may deploy and support ... the following US Core interaction: [Clinical Notes](https://hl7.org/fhir/us/core/clinical-notes.html)"/>
</statement>
<statement>
<key value="CONF-0006"/>
<conformance value="MAY"/>
<conditionality value="true"/>
<requirement
value="Server may deploy and support ... the following US Core interaction: [Medication List](https://hl7.org/fhir/us/core/medication-list.html)"/>
</statement>
<statement>
<key value="CONF-0007"/>
<conformance value="MAY"/>
<conditionality value="true"/>
<requirement
value="Server may deploy and support ... the following US Core interaction: [Basic Provenance](https://hl7.org/fhir/us/core/basic-provenance.html)"/>
</statement>
<statement>
<key value="CONF-0008"/>
<conformance value="MAY"/>
<conditionality value="true"/>
<requirement
value="Server may deploy and support ... the following US Core interaction: [Screening and Assessments](https://hl7.org/fhir/us/core/screening-and-assessments.html)"/>
</statement>
<statement>
<key value="CONF-0009"/>
<conformance value="MAY"/>
<conditionality value="true"/>
<requirement
value="Servers implementing ... [clinical information representation] can claim conformance to the US Core Profile content structure ... by implementing all or parts of the US Core CapabilityStatement into their capabilities."/>
</statement>
<statement>
<key value="CONF-0010"/>
<conformance value="MAY"/>
<conditionality value="true"/>
<requirement
value="Servers implementing ... [interactions] can claim conformance to the ... RESTful interactions defined by implementing all or parts of the US Core CapabilityStatement into their capabilities"/>
</statement>
<statement>
<key value="CONF-0013"/>
<conformance value="SHALL"/>
<requirement
value="[To claim conformance to a US Core Profile] a conformant Server:
**SHALL** Be able to populate all profile data elements that are mandatory and/or flagged as Must Support as defined by that profile’s StructureDefinition."/>
</statement>
<statement>
<key value="CONF-0014"/>
<conformance value="SHOULD"/>
<requirement
value="[To claim conformance to a US Core Profile] a conformant Server:
**SHOULD** declare conformance with the US [Core Server Capability Statement](https://hl7.org/fhir/us/core/CapabilityStatement-us-core-Server.html) by including its official URL in the Server’s `CapabilityStatement.instantiates` element: `http://hl7.org/fhir/us/core/CapabilityStatement/us-core-Server`"/>
</statement>
<statement>
<key value="CONF-0015"/>
<conformance value="SHALL"/>
<requirement
value="[To claim conformance to a US Core Profile] a conformant Server:
**SHALL** specify the full capability details from the US Core CapabilityStatement it claims to implement."/>
</statement>
<statement>
<key value="CONF-0016"/>
<conformance value="SHALL"/>
<requirement
value="[To claim conformance to a US Core Profile] a conformant Server:
**SHALL**… Declare support for the US Core Profile by including its official URL in the Server’s CapabilityStatement.rest.resource.supportedProfile element."/>
</statement>
<statement>
<key value="CONF-0017"/>
<conformance value="SHALL"/>
<requirement
value="[To claim conformance to a US Core Profile] a conformant Server:
**SHALL**… Declare support for the US Core Profile’s FHIR RESTful transactions."/>
</statement>
<statement>
<key value="CONF-0018"/>
<conformance value="SHALL"/>
<requirement
value="[Required binding](http://hl7.org/fhir/R4/terminologies.html#required) to a ValueSet definition means that one of the codes from the specified ValueSet **SHALL** be used."/>
</statement>
<statement>
<key value="CONF-0019"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="For `CodeableConcept`, which permits multiple codings and a text element, this [[Required binding](http://hl7.org/fhir/R4/terminologies.html#required) to a ValueSet definition] rule applies to at least one of the codings"/>
</statement>
<statement>
<extension
url="http://hl7.org/fhir/tools/StructureDefinition/requirements-statementshallnot">
<valueBoolean value="true"/>
</extension>
<key value="CONF-0020"/>
<requirement
value="For a [[required binding](http://hl7.org/fhir/R4/terminologies.html#required) to a ValueSet definition], a `CodeableConcept`which permits multiple codings and a text element … [using] only text is not valid."/>
</statement>
<statement>
<key value="CONF-0021"/>
<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 Responders **SHALL** provide a code exclusively from [the required binding] ValueSet"/>
</statement>
<statement>
<key value="CONF-0023"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="[Extensible binding] (http://hl7.org/fhir/R4/terminologies.html#extensible) means that one of the codes from the specified ValueSet **SHALL** be used if an applicable concept is present."/>
</statement>
<statement>
<key value="CONF-0024"/>
<conformance value="MAY"/>
<conditionality value="true"/>
<requirement
value="[When using an [extensible Binding] (http://hl7.org/fhir/R4/terminologies.html#extensible)] If no suitable code exists in the [extensible] ValueSet, alternate code(s) may be provided."/>
</statement>
<statement>
<key value="CONF-0026"/>
<conformance value="MAY"/>
<conditionality value="true"/>
<requirement
value="For `CodeableConcept` [with an [extensible binding] (http://hl7.org/fhir/R4/terminologies.html#extensible) … If only text is available and it has no conceptual overlap with the bound coded values, then just text may be used."/>
</statement>
<statement>
<key value="CONF-0027"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="When claiming conformance to ... [to a US Core profile extensible binding rule, a] US Core Responders Shall provide:
A code from … [the] valueset 'DataElement.code.code' if the concept exists in the valueset [for a DataElement.code that has an extensible binding]
Or an alternative code if the concept does not exist in the valueset [for a DataElement.code that has an extensible binding]
Or text in ... `[DataElement.code.text]’ if only text is available [for a DataElement.code that has an extensible binding]"/>
</statement>
<statement>
<key value="CONF-0029"/>
<conformance value="MAY"/>
<requirement
value="Alternate codes may be provided in addition to the standard codes defined in required or extensible ValueSets. These alternate codes are called "additional codings"."/>
</statement>
<statement>
<key value="CONF-0030"/>
<conformance value="MAY"/>
<requirement
value="[The additional codings] may be equivalent to or narrower in meaning than the standard concept code."/>
</statement>
<statement>
<key value="CONF-0033"/>
<conformance value="MAY"/>
<requirement
value="Not all modifier elements are Mandatory or Must Support, and there is no requirement for supporting them"/>
</statement>
<statement>
<key value="CONF-0034"/>
<conformance value="MAY"/>
<requirement
value="Servers **MAY** communicate a system-wide profile in their CapabilityStatement to identify which additional elements, including modifier elements, they support"/>
</statement>
<statement>
<key value="CONF-0039"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="If the source system does not have data for an element with a minimum cardinality = 0 (including elements labeled Must Support), the data element **SHALL** be omitted from the resource."/>
</statement>
<statement>
<key value="CONF-0040"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="If the data element is a Mandatory element (in other words, where the minimum cardinality is > 0), it **SHALL** be present even if the source system does not have data."/>
</statement>
<statement>
<key value="CONF-0041"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="For [mandatory] non-coded data elements [where data is not available], use the [DataAbsentReason Extension](http://hl7.org/fhir/R4/extension-data-absent-reason.html) in the data type ... [with] the code `unknown` - The value is expected to exist but is not known."/>
</statement>
<statement>
<key value="CONF-0042"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="[In situations where data is not available] for [mandatory] coded data elements … [with] *example*, *preferred*, or *extensible* binding strengths (CodeableConcept or Coding datatypes) If the source system has text but no coded data, only the text element is used."/>
</statement>
<statement>
<key value="CONF-0043"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="[In situations where data is not available] for [mandatory] coded data elements… [with] *example*, *preferred*, or *extensible* binding strengths (CodeableConcept or Coding datatypes):
For Coding datatypes, the text-only data is represented as a display element"/>
</statement>
<statement>
<key value="CONF-0044"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="[In situations where data is not available] for [mandatory] coded data elements… [with] *example*, *preferred*, or *extensible* binding strengths (CodeableConcept or Coding datatypes): … If there is neither text nor coded data ... [then] use the appropriate “unknown” concept code from the ValueSet if available."/>
</statement>
<statement>
<key value="CONF-0045"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="[In situations where data is not available] for [mandatory] coded data elements… [with] *example*, *preferred*, or *extensible* binding strengths (CodeableConcept or Coding datatypes): … If there is neither text nor coded data ... [then] if the ValueSet does not have the appropriate “unknown” concept code, use unknown from the [DataAbsentReason Code System](http://hl7.org/fhir/R4/codesystem-data-absent-reason.html)."/>
</statement>
<statement>
<key value="CONF-0046"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="[In situations where data is not available] for [mandatory] coded data elements… [with] *required* binding strength (CodeableConcept or code datatypes): use the appropriate “unknown” concept code from the ValueSet if available"/>
</statement>
<statement>
<key value="CONF-0047"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="[In situations where data is not available] for [mandatory] coded data elements… [with] *required* binding strength (CodeableConcept or code datatypes): If the ValueSet does not have the appropriate “unknown” concept code, you must use a concept from the ValueSet. Otherwise, the instance will not be conformant"/>
</statement>
<statement>
<key value="CONF-0048"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="[If the source system does not have data for a Mandatory element for a coded data element with *required* binding strength] If any of these status codes is missing [meaning it lacks an "unknown" or otherwise appropriate concept code from the ValueSet, a] 404 HTTP error code and an OperationOutcome **SHALL** be returned in response to a read transaction on the resource."/>
</statement>
<statement>
<key value="CONF-0049"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="[If the source system does not have data for a Mandatory element for a coded data element with *required* binding strength, and the ValueSet does not have the appropriate "unknown" concept code, then] if returning a response to a search, the problematic resource **SHALL** be excluded from the search set"/>
</statement>
<statement>
<key value="CONF-0050"/>
<conformance value="SHOULD"/>
<conditionality value="true"/>
<requirement
value="[If the source system does not have data for a Mandatory element for a coded data element with *required* binding strength, and the ValueSet does not have the appropriate "unknown" concept code, then] if returning a response to a search, … a *warning* OperationOutcome **SHOULD** be included indicating that other search results were found but could not be compliantly expressed and have been suppressed."/>
</statement>
<statement>
<key value="CONF-0051"/>
<conformance value="SHALL"/>
<requirement
value="The [FHIR RESTful Search API](http://hl7.org/fhir/R4/http.html#search) requires that Servers that support search **SHALL** support the HTTP `POST`-based search."/>
</statement>
<statement>
<key value="CONF-0052"/>
<conformance value="SHALL"/>
<requirement
value="For all the supported search interactions in this guide, Servers **SHALL** also support the `GET`-based search."/>
</statement>
<statement>
<key value="CONF-0055"/>
<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 Server **SHALL** support both [system and code values]"/>
</statement>
<statement>
<key value="CONF-0058"/>
<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 Server **SHALL** support both [id and Type values]"/>
</statement>
<statement>
<key value="CONF-0061"/>
<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 Server **SHALL** support values precise to the day for elements of datatype `date`"/>
</statement>
<statement>
<key value="CONF-0062"/>
<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 Server **SHALL** support values precise … to the second + time offset for elements of `datatype` dateTime"/>
</statement>
<statement>
<key value="CONF-0063"/>
<conformance value="SHOULD"/>
<requirement
value="Servers are strongly encouraged to support a query for resources without requiring a status parameter."/>
</statement>
<statement>
<key value="CONF-0064"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="If business requirements prohibit [querying a resource without a status parameter], they **SHALL** follow the guidelines here."/>
</statement>
<statement>
<key value="CONF-0065"/>
<conformance value="MAY"/>
<requirement
value="For searches where the Client does not supply a status parameter, an implementation’s business rules may override the FHIR RESTful search expectations and require a status parameter to be provided"/>
</statement>
<statement>
<key value="CONF-0066"/>
<conformance value="SHALL"/>
<requirement
value="For searches where the Client does not supply a status parameter, … systems [that require a status parameter to be provided] are allowed to reject such requests as follows:
**SHALL** return an HTTP 400 status"/>
</statement>
<statement>
<key value="CONF-0067"/>
<conformance value="SHALL"/>
<requirement
value="For searches where the Client does not supply a status parameter, … systems [that require a status parameter to be provided] are allowed to reject such requests as follows:
**SHALL** return an [OperationOutcome](http://hl7.org/fhir/R4/operationoutcome.html) specifying that status(es) must be present."/>
</statement>
<statement>
<key value="CONF-0068"/>
<conformance value="SHALL"/>
<requirement
value="For searches where the Client does not supply a status parameter, … systems [that require a status parameter to be provided] are allowed to reject such requests as follows:
**SHALL** support search with status if status required"/>
</statement>
<statement>
<extension
url="http://hl7.org/fhir/tools/StructureDefinition/requirements-statementshallnot">
<valueBoolean value="true"/>
</extension>
<key value="CONF-0069"/>
<requirement
value=" **SHALL NOT** restrict search results ( i.e., apply ‘hidden’ filters) when a Client includes status parameters in the query."/>
</statement>
<statement>
<key value="CONF-0070"/>
<conformance value="SHOULD"/>
<conditionality value="true"/>
<requirement
value="[For systems that require a status parameter to be provided,] if a system doesn’t support a specific status code value that is queried, it **SHOULD** return an HTTP 200 status with a search bundle."/>
</statement>
<statement>
<key value="CONF-0071"/>
<conformance value="SHOULD"/>
<conditionality value="true"/>
<requirement
value="[For systems that require a status parameter to be provided,] if a system doesn’t support a specific status code value that is queried [and returns a search bundle],... [t]he search bundle **SHOULD** contain resources matching the search criteria"/>
</statement>
<statement>
<key value="CONF-0072"/>
<conformance value="SHOULD"/>
<conditionality value="true"/>
<requirement
value="[For systems that require a status parameter to be provided,] if a system doesn’t support a specific status code value that is queried [and returns a search bundle],... [t]he search bundle **SHOULD** contain ... an OperationOutcome warning the Client which status code value is not supported."/>
</statement>
<statement>
<key value="CONF-0073"/>
<conformance value="SHALL"/>
<requirement
value="For searches where the Client does not supply a status parameter, … systems [that require a status parameter to be provided] are allowed to reject such requests as follows:...
**SHALL** document this behavior in its CapabilityStatement for the “search-type” interaction in `CapabilityStatement.rest.resource.interaction.documentation.`"/>
</statement>
<statement>
<key value="CONF-0074"/>
<conformance value="SHALL"/>
<requirement
value="When an element is Mandatory, the data is expected always to be present."/>
</statement>
<statement>
<key value="CONF-0075"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="For querying and reading US Core Profiles, Must Support on any profile data element **SHALL** be interpreted as follows…:
US Core Responders **SHALL** be capable of populating all data elements as part of the query results specified by the [US Core Server Capability Statement](https://hl7.org/fhir/us/core/STU8/CapabilityStatement-us-core-Server.html)."/>
</statement>
<statement>
<extension
url="http://hl7.org/fhir/tools/StructureDefinition/requirements-statementshallnot">
<valueBoolean value="true"/>
</extension>
<key value="CONF-0078"/>
<conditionality value="true"/>
<requirement
value=" **SHALL NOT** include the data elements in the resource instance returned as part of the query results."/>
</statement>
<statement>
<key value="CONF-0080"/>
<conformance value="SHOULD"/>
<conditionality value="true"/>
<requirement
value="For querying and reading US Core Profiles, Must Support on any profile data element **SHALL** be interpreted as follows…:
In cases where information on a specific data element is missing, and the US Core Responder knows the precise reason for the absence of data (other than suppressed data), US Core Responders **SHOULD** send the reason for the missing information."/>
</statement>
<statement>
<key value="CONF-0081"/>
<conformance value="SHOULD"/>
<conditionality value="true"/>
<requirement
value="[When sending reason for missing information, follow] the same methdology outlined in the [Missing Data](https://hl7.org/fhir/us/core/STU8/general-requirements.html#missing-data) section but using the appropriate reason code instead of unknown [reason code]."/>
</statement>
<statement>
<key value="CONF-0084"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="Implementors [US Core Responders] 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-0086"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="Implementors [US Core Responders] [not] seeking ONC certification [in the ONC IT Health Certification program] **SHALL** interpret Additional USCDI Requirements as … optional."/>
</statement>
<statement>
<key value="CONF-0087"/>
<conformance value="SHALL"/>
<requirement
value="If an element is marked as Must Support 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 Server **SHALL** be capable of providing."/>
</statement>
<statement>
<key value="CONF-0090"/>
<conformance value="SHALL"/>
<requirement
value="Primitive elements are single elements with a primitive value. If they are marked as Must Support, then the Server **SHALL** be capable of providing the element value to meet the Must Support requirement."/>
</statement>
<statement>
<key value="CONF-0091"/>
<conformance value="SHALL"/>
<requirement
value="[W]hen claiming conformance [to a profile with a must support primitive element] … US Core responders **SHALL** be capable of providing the value [of the primitive element]"/>
</statement>
<statement>
<key value="CONF-0093"/>
<conformance value="SHALL"/>
<requirement
value="For any complex element marked as Must Support, the Server **SHALL** be capable of providing at least one of the sub-element values."/>
</statement>
<statement>
<key value="CONF-0094"/>
<conformance value="SHALL"/>
<requirement
value="If any sub-element is marked as Must Support [for a complex element], it must also meet the Must Support requirements and satisfy the Must Support requirements for the parent element."/>
</statement>
<statement>
<key value="CONF-0095"/>
<conformance value="MAY"/>
<requirement
value="[I]f any sub-element is marked as Must Support or Additional USCDI [for a complex element] and the parent element is not, there is no expectation that you must support the parent."/>
</statement>
<statement>
<key value="CONF-0096"/>
<conformance value="SHALL"/>
<requirement
value="[I]f any sub-element is marked as Must Support [for a complex element] and the parent element is not… [and] the parent element is represented in the structure, Servers **SHALL** support the sub-element(s) marked as Must Support."/>
</statement>
<statement>
<key value="CONF-0097"/>
<conformance value="SHALL"/>
<requirement
value="When claiming conformance [to a must support complex element with no must support sub-elements] … US Core Responders **SHALL** be capable of providing a value in [the] sub-element"/>
</statement>
<statement>
<key value="CONF-0099"/>
<conformance value="SHALL"/>
<requirement
value="When claiming conformance [to a must support complex element with one or more must support sub-elements] … US Core Responders **SHALL** be capable of providing a value in [each must support sub-element]"/>
</statement>
<statement>
<key value="CONF-0101"/>
<conformance value="MAY"/>
<requirement
value="Systems [US Core Responders] 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-0103"/>
<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 Responders]"/>
</statement>
<statement>
<key value="CONF-0105"/>
<conformance value="SHALL"/>
<requirement
value="In certain profiles, only specific resource references are labeled as Must Support.
...
- US Core Responders **SHALL** be capable of providing [such an element] with a valid reference to [all listed Must Support profile(s).]"/>
</statement>
<statement>
<key value="CONF-0107"/>
<conformance value="MAY"/>
<requirement
value="Systems [US Core Responders] 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-0109"/>
<conformance value="SHALL"/>
<requirement
value="In specific profiles, only a single resource reference is present on an element labeled Must Support.
...
- US Core Responders **SHALL** be capable of providing [such an element] with a valid reference to [the Must Support Profile.]"/>
</statement>
<statement>
<key value="CONF-0111"/>
<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 Responders **SHALL** be capable of populating [the Must Support data type choice]"/>
</statement>
<statement>
<key value="CONF-0114"/>
<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 Responders] **MAY** support populating ... other [data type] choice elements (such as Observation.effectivePeriod), but this is not a requirement of US Core."/>
</statement>
<statement>
<key value="CONF-0115"/>
<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 Server or Certifying System **SHALL** support at least one element."/>
</statement>
<statement>
<key value="CONF-0117"/>
<conformance value="MAY"/>
<requirement
value="An individual SMART Server will publish a granular list of its capabilities, and a set of these capabilities is combined to support a specific use, a Capability Set. See SMART App Launch’s [FHIR OAuth authorization Endpoints and Capabilities](http://hl7.org/fhir/smart-app-launch/STU2/conformance.html#smart-on-fhir-oauth-authorization-endpoints-and-capabilities) for more details. Servers **MAY** support ... [any] SMART on FHIR Capability Sets and capabilities [(see [FHIR OAuth authorization Endpoints and Capabilities](http://hl7.org/fhir/smart-app-launch/STU2/conformance.html#smart-on-fhir-oauth-authorization-endpoints-and-capabilities))]"/>
</statement>
<statement>
<key value="CONF-0118"/>
<conformance value="SHOULD"/>
<conditionality value="true"/>
<requirement
value="At least one of the following SMART on FHIR Capability Sets **SHOULD** be supported for US Core Servers that support User-Facing Applications ...
[Patient Access Standalone Apps](http://hl7.org/fhir/smart-app-launch/STU2/conformance.html#patient-access-for-standalone-apps)
[Clinician Access for EHR Launch](http://hl7.org/fhir/smart-app-launch/STU2/conformance.html#clinician-access-for-standalone)"/>
</statement>
<statement>
<key value="CONF-0119"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="For certified systems[, those participating in the ONC IT Health Certification program], both **SHALL** be supported:
[Patient Access Standalone Apps](http://hl7.org/fhir/smart-app-launch/STU2/conformance.html#patient-access-for-standalone-apps)
[Clinician Access for EHR Launch](http://hl7.org/fhir/smart-app-launch/STU2/conformance.html#clinician-access-for-standalone)"/>
</statement>
<statement>
<key value="CONF-0120"/>
<conformance value="SHALL"/>
<requirement
value="Implementations [US Core Responders] supporting Backend Services ... **SHALL** include support for the Client-confidential-asymmetric capability."/>
</statement>
<statement>
<key value="CONF-0121"/>
<conformance value="SHALL"/>
<requirement
value="Implementations [US Core Responders] supporting Backend Services ... **SHALL** include support for the ... system/scopes."/>
</statement>
<statement>
<key value="CONF-0123"/>
<conformance value="SHALL"/>
<requirement
value="US Core Server[s] **SHALL** support token introspection defined by the SMART App Launch Guide. For more details and additional consideration, see SMART App Launch’s [Token Introspection](http://hl7.org/fhir/smart-app-launch/STU2/token-introspection.html#token-introspection)."/>
</statement>
<statement>
<key value="CONF-0125"/>
<conformance value="MAY"/>
<requirement
value="Other systems only need to support scopes for the US Core APIs they support [instead of all US Core's required scopes]"/>
</statement>
<statement>
<key value="CONF-0126"/>
<conformance value="MAY"/>
<requirement
value="Servers **MAY** support other scopes in addition to those listed below and in the Quick Start sections."/>
</statement>
<statement>
<key value="CONF-0128"/>
<conformance value="SHALL"/>
<requirement
value="For “User-Facing Applications”, a system’s support for patient-level (patient) or user-level (user) scopes depends on its published list of SMART on FHIR capabilities (see the [capability sets](https://hl7.org/fhir/us/core/STU8/scopes.html#capability-sets) above). For example, if a Server lists permission-patient and permission-user in its capabilities, it **SHALL** support both patient-level and user-level required scopes"/>
</statement>
<statement>
<key value="CONF-0129"/>
<conformance value="SHOULD"/>
<requirement
value="For “User-Facing Applications”, a system’s support for patient-level (patient) or user-level (user) scopes depends on its published list of SMART on FHIR capabilities (see the [capability sets](https://hl7.org/fhir/us/core/STU8/scopes.html#capability-sets) above). For example, if a Server lists permission-patient and permission-user in its capabilities, it ... **SHOULD** support both patient-level and user-level recommended best-practice scopes"/>
</statement>
<statement>
<key value="CONF-0130"/>
<conformance value="SHALL"/>
<requirement
value="For “Backend-Services”, System-level scopes (system) describe data that a Client system is directly authorized to access. Systems that support system-level (system) scopes **SHALL** support the required US Core scopes"/>
</statement>
<statement>
<key value="CONF-0131"/>
<conformance value="SHOULD"/>
<requirement
value="For “Backend-Services”, System-level scopes (system) describe data that a Client system is directly authorized to access. Systems that support system-level (system) scopes **SHOULD** support the recommended US Core scopes"/>
</statement>
<statement>
<key value="CONF-0132"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="The following scopes that correspond directly to FHIR resource types **SHALL** be supported
...
[For] AllergyIntolerance [the] <patient|user|system>/AllergyIntolerance.rs [see [SMART Clinical Scope Syntax](https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax) for details on clinical data scopes]
"/>
</statement>
<statement>
<key value="CONF-0133"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="The following scopes that correspond directly to FHIR resource types **SHALL** be supported
...
[For] CarePlan [the] <patient|user|system>/CarePlan.rs [see [SMART Clinical Scope Syntax](https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax) for details on clinical data scopes]
"/>
</statement>
<statement>
<key value="CONF-0134"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="The following scopes that correspond directly to FHIR resource types **SHALL** be supported
...
[For] CareTeam [the] <patient|user|system>/CareTeam.rs [see [SMART Clinical Scope Syntax](https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax) for details on clinical data scopes]"/>
</statement>
<statement>
<key value="CONF-0135"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="The following scopes that correspond directly to FHIR resource types **SHALL** be supported
...
[For] Condition [the] <patient|user|system>/Condition.rs [see [SMART Clinical Scope Syntax](https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax) for details on clinical data scopes]"/>
</statement>
<statement>
<key value="CONF-0136"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="The following scopes that correspond directly to FHIR resource types **SHALL** be supported
...
[For] Coverage [the] <patient|user|system>/Coverage.rs [see [SMART Clinical Scope Syntax](https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax) for details on clinical data scopes]"/>
</statement>
<statement>
<key value="CONF-0137"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="The following scopes that correspond directly to FHIR resource types **SHALL** be supported
...
[For] Device [the] <patient|user|system>/Device.rs [see [SMART Clinical Scope Syntax](https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax) for details on clinical data scopes]"/>
</statement>
<statement>
<key value="CONF-0138"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="The following scopes that correspond directly to FHIR resource types **SHALL** be supported
...
[For] DiagnosticReport [the] <patient|user|system>/DiagnosticReport.rs [see [SMART Clinical Scope Syntax](https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax) for details on clinical data scopes]"/>
</statement>
<statement>
<key value="CONF-0139"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="The following scopes that correspond directly to FHIR resource types **SHALL** be supported
...
[For] DocumentReference [the] <patient|user|system>/DocumentReference.rs [see [SMART Clinical Scope Syntax](https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax) for details on clinical data scopes]"/>
</statement>
<statement>
<key value="CONF-0140"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="The following scopes that correspond directly to FHIR resource types **SHALL** be supported
...
[For] Encounter [the] <patient|user|system>/Encounter.rs [see [SMART Clinical Scope Syntax](https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax) for details on clinical data scopes]"/>
</statement>
<statement>
<key value="CONF-0141"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="The following scopes that correspond directly to FHIR resource types **SHALL** be supported
...
[For] Goal [the] <patient|user|system>/Goal.rs [see [SMART Clinical Scope Syntax](https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax) for details on clinical data scopes]"/>
</statement>
<statement>
<key value="CONF-0142"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="The following scopes that correspond directly to FHIR resource types **SHALL** be supported
...
[For] Immunization [the] <patient|user|system>/Immunization.rs [see [SMART Clinical Scope Syntax](https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax) for details on clinical data scopes]"/>
</statement>
<statement>
<key value="CONF-0143"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="The following scopes that correspond directly to FHIR resource types **SHALL** be supported
...
[For] MedicationDispense [the] <patient|user|system>/MedicationDispense.rs [see [SMART Clinical Scope Syntax](https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax) for details on clinical data scopes]"/>
</statement>
<statement>
<key value="CONF-0144"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="The following scopes that correspond directly to FHIR resource types **SHALL** be supported
...
[For] MedicationRequest [the] <patient|user|system>/MedicationRequest.rs [see [SMART Clinical Scope Syntax](https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax) for details on clinical data scopes]"/>
</statement>
<statement>
<key value="CONF-0145"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="The following scopes that correspond directly to FHIR resource types **SHALL** be supported
...
[For] Observation [the] <patient|user|system>/Observation.rs [see [SMART Clinical Scope Syntax](https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax) for details on clinical data scopes]"/>
</statement>
<statement>
<key value="CONF-0146"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="The following scopes that correspond directly to FHIR resource types **SHALL** be supported
...
[For] Organization [the] <patient|user|system>/Organization.rs [see [SMART Clinical Scope Syntax](https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax) for details on clinical data scopes]"/>
</statement>
<statement>
<key value="CONF-0147"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="The following scopes that correspond directly to FHIR resource types **SHALL** be supported
...
[For] Patient [the] <patient|user|system>/Patient.rs [see [SMART Clinical Scope Syntax](https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax) for details on clinical data scopes]"/>
</statement>
<statement>
<key value="CONF-0148"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="The following scopes that correspond directly to FHIR resource types **SHALL** be supported
...
[For] Practitioner [the] <patient|user|system>/Practitioner.rs [see [SMART Clinical Scope Syntax](https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax) for details on clinical data scopes]"/>
</statement>
<statement>
<key value="CONF-0149"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="The following scopes that correspond directly to FHIR resource types **SHALL** be supported
...
[For] PractitionerRole [the] <patient|user|system>/PractitionerRole.rs [see [SMART Clinical Scope Syntax](https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax) for details on clinical data scopes]"/>
</statement>
<statement>
<key value="CONF-0150"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="The following scopes that correspond directly to FHIR resource types **SHALL** be supported
...
[For] Procedure [the] <patient|user|system>/Procedure.rs [see [SMART Clinical Scope Syntax](https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax) for details on clinical data scopes]"/>
</statement>
<statement>
<key value="CONF-0151"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="The following scopes that correspond directly to FHIR resource types **SHALL** be supported
...
[For] Provenance [the] <patient|user|system>/Provenance.rs [see [SMART Clinical Scope Syntax](https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax) for details on clinical data scopes]"/>
</statement>
<statement>
<key value="CONF-0152"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="The following scopes that correspond directly to FHIR resource types **SHALL** be supported
...
[For] QuestionnaireResponse [the] <patient|user|system>/QuestionnaireResponse.rs [see [SMART Clinical Scope Syntax](https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax) for details on clinical data scopes]"/>
</statement>
<statement>
<key value="CONF-0153"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="The following scopes that correspond directly to FHIR resource types **SHALL** be supported
...
[For] RelatedPerson [the] <patient|user|system>/RelatedPerson.rs [see [SMART Clinical Scope Syntax](https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax) for details on clinical data scopes]"/>
</statement>
<statement>
<key value="CONF-0154"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="The following scopes that correspond directly to FHIR resource types **SHALL** be supported
...
[For] ServiceRequest [the] <patient|user|system>/ServiceRequest.rs [see [SMART Clinical Scope Syntax](https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax) for details on clinical data scopes]"/>
</statement>
<statement>
<key value="CONF-0155"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="The following scopes that correspond directly to FHIR resource types **SHALL** be supported
...
[For] Specimen [the] <patient|user|system>/Specimen.rs [see [SMART Clinical Scope Syntax](https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax) for details on clinical data scopes]"/>
</statement>
<statement>
<key value="CONF-0156"/>
<conformance value="MAY"/>
<requirement
value="The following scopes that correspond directly to FHIR resource types **MAY** be supported
...
[For] Location [the] <patient|user|system>/Location.rs [see [SMART Clinical Scope Syntax](https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax) for details on clinical data scopes]"/>
</statement>
<statement>
<key value="CONF-0157"/>
<conformance value="MAY"/>
<requirement
value="The following scopes that correspond directly to FHIR resource types **MAY** be supported
...
[For] Medication [the] <patient|user|system>/Medication.rs [see [SMART Clinical Scope Syntax](https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax) for details on clinical data scopes]"/>
</statement>
<statement>
<key value="CONF-0158"/>
<conformance value="SHALL"/>
<requirement
value="The following granular scopes **SHALL** be supported
...
[For] Condition [the] <patient|user|system>/Condition.rs?category=http://hl7.org/fhir/us/core/CodeSystem/condition-category|health-concern [see [SMART Clinical Scope Syntax](https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax) for details on clinical data scopes]"/>
</statement>
<statement>
<key value="CONF-0159"/>
<conformance value="SHALL"/>
<requirement
value="The following granular scopes **SHALL** be supported
...
[For] Condition [the] <patient|user|system>/Condition.rs?category=http://terminology.hl7.org/CodeSystem/condition-category|encounter-diagnosis [see [SMART Clinical Scope Syntax](https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax) for details on clinical data scopes]"/>
</statement>
<statement>
<key value="CONF-0160"/>
<conformance value="SHALL"/>
<requirement
value="The following granular scopes **SHALL** be supported
...
[For] Condition [the] <patient|user|system>/Condition.rs?category=http://terminology.hl7.org/CodeSystem/condition-category|problem-list-item [see [SMART Clinical Scope Syntax](https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax) for details on clinical data scopes]"/>
</statement>
<statement>
<key value="CONF-0161"/>
<conformance value="SHALL"/>
<requirement
value="The following granular scopes **SHALL** be supported
...
[For] Observation [the] <patient|user|system>/Observation.rs?category=http://hl7.org/fhir/us/core/CodeSystem/us-core-category|sdoh [see [SMART Clinical Scope Syntax](https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax) for details on clinical data scopes]"/>
</statement>
<statement>
<key value="CONF-0162"/>
<conformance value="SHALL"/>
<requirement
value="The following granular scopes **SHALL** be supported
...
[For] Observation [the] <patient|user|system>/Observation.rs?category=http://terminology.hl7.org//CodeSystem-observation-category|social-history [see [SMART Clinical Scope Syntax](https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax) for details on clinical data scopes]"/>
</statement>
<statement>
<key value="CONF-0163"/>
<conformance value="SHALL"/>
<requirement
value="The following granular scopes **SHALL** be supported
...
[For] Observation [the] <patient|user|system>/Observation.rs?category=http://terminology.hl7.org/CodeSystem/observation-category|laboratory [see [SMART Clinical Scope Syntax](https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax) for details on clinical data scopes]"/>
</statement>
<statement>
<key value="CONF-0164"/>
<conformance value="SHALL"/>
<requirement
value="The following granular scopes **SHALL** be supported
...
[For] Observation [the] <patient|user|system>/Observation.rs?category=http://terminology.hl7.org/CodeSystem/observation-category|survey [see [SMART Clinical Scope Syntax](https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax) for details on clinical data scopes]"/>
</statement>
<statement>
<key value="CONF-0165"/>
<conformance value="SHALL"/>
<requirement
value="The following granular scopes **SHALL** be supported
...
[For] Observation [the] <patient|user|system>/Observation.rs?category=http://terminology.hl7.org/CodeSystem/observation-category|vital-signs [see [SMART Clinical Scope Syntax](https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax) for details on clinical data scopes]"/>
</statement>
<statement>
<key value="CONF-0166"/>
<conformance value="SHOULD"/>
<requirement
value="The following granular scopes **SHOULD** be supported
...
[For] DocumentReference [the] <patient|user|system>/DocumentReference.rs?category=http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category|clinical-note [see [SMART Clinical Scope Syntax](https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax) for details on clinical data scopes]"/>
</statement>
<statement>
<key value="CONF-0167"/>
<conformance value="SHALL"/>
<requirement
value="In addition to the capabilities defined in the Server’s CapabilityStatement, Servers **SHALL** document their SMART capabilities in their [Well-Known Uniform Resource Identifiers (URIs)](https://hl7.org/fhir/smart-app-launch/STU2/conformance.html#using-well-known) JSON file."/>
</statement>
<statement>
<key value="CONF-0168"/>
<conformance value="SHALL"/>
<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 Server **SHALL** list all the required US Core Scopes for the US Core Profiles they support in the scopes_supported array"/>
</statement>
<statement>
<key value="CONF-0169"/>
<conformance value="MAY"/>
<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 Server [MAY support] additional scopes (so Clients should not consider … [the required scopes] an exhaustive list)."/>
</statement>
<statement>
<key value="CONF-0170"/>
<conformance value="MAY"/>
<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. Servers **MAY** limit Clients’ scopes to those configured at registration time."/>
</statement>
<statement>
<key value="CONF-0171"/>
<conformance value="SHALL"/>
<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. … Servers **SHALL** allow users to select a subset of the requested scopes at the approval time."/>
</statement>
<statement>
<key value="CONF-0173"/>
<conformance value="SHALL"/>
<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] `introspection_endpoint` the URL to a Server’s introspection endpoint. ... Servers **SHALL** document this endpoint in the file"/>
</statement>
<statement>
<key value="CONF-0174"/>
<conformance value="SHOULD"/>
<requirement
value="Therefore, a [reference](http://hl7.org/fhir/R4/references.html) to a US Core resource **SHOULD** include a logical id (Reference.reference), not an identifier (Reference.identifier)."/>
</statement>
<statement>
<key value="CONF-0175"/>
<conformance value="SHOULD"/>
<requirement
value="For all references, US Core Responders **SHOULD** return resources that conform to a US Core profile if a US Core profile exists for the resource type."/>
</statement>
<statement>
<key value="CONF-0176"/>
<conformance value="SHOULD-NOT"/>
<requirement
value="When responding to a query, Servers **SHOULD** not use inline [contained](http://hl7.org/fhir/R4/references.html#contained) resources to represent the returned data."/>
</statement>
<statement>
<key value="CONF-0177"/>
<conformance value="SHOULD"/>
<requirement
value="[I]f referencing a contained resource in a US Core Profile, the contained resource **SHOULD** be a US Core Profile if a US Core Profile exists for the resource type."/>
</statement>
<statement>
<key value="CONF-0178"/>
<conformance value="SHOULD"/>
<requirement
value="[M]asking data [where a specific piece of data is hidden for security and privacy reasons] **SHOULD** be handled based on implemented policies."/>
</statement>
<statement>
<key value="CONF-0179"/>
<conformance value="SHOULD"/>
<conditionality value="true"/>
<requirement
value="[When masking data] elements with a minimum cardinality = 0 (including elements labeled Must Support) [for security and privacy reasons], the element **SHOULD** be omitted from the resource."/>
</statement>
<statement>
<key value="CONF-0180"/>
<conformance value="SHOULD"/>
<conditionality value="true"/>
<requirement
value="[When masking] Mandatory elements (in other words, where the minimum cardinality is > 0) [for security and privacy reasons, use the code “unknown” following the guidance on Missing Data in the Conformance Sections."/>
</statement>
<statement>
<key value="CONF-0181"/>
<conformance value="MAY"/>
<conditionality value="true"/>
<requirement
value="[When using SNOMED codes in US Core Profiles I]mplementers **MAY** use the default system URI [of [SNOMED CT](http://snomed.info/sct)], which refers to an unspecified edition/version [of SNOMED]"/>
</statement>
<statement>
<key value="CONF-0182"/>
<conformance value="SHOULD"/>
<requirement
value="[To enable] terminology Servers to be able to validate US Edition-only codes [of [SNOMED CT](http://snomed.info/sct)], implementers **SHOULD** provide the accompanying system URI to describe the edition [see example 2 on [US Core general guidance](https://hl7.org/fhir/us/core/STU8/general-guidance.html#snomed-ct-united-states-edition)]"/>
</statement>
<statement>
<key value="CONF-0183"/>
<conformance value="SHOULD"/>
<conditionality value="true"/>
<requirement
value="[If a] US Core Profiles binds the Quantity.code element in the Quantity datatype to the [UCUM](http://unitsofmeasure.org/) code system, [then] systems should also use UCUM for the optional valueRange and valueRatio datatypes (which are complex datatypes with Quantity elements)"/>
</statement>
<statement>
<key value="CONF-0184"/>
<conformance value="SHOULD"/>
<conditionality value="true"/>
<requirement
value="[If a] US Core Profiles binds the Quantity.code element in the Quantity datatype to the [UCUM](http://unitsofmeasure.org/) code system, [when] UCUM code [is] provided [it **SHOULD** be indicated in the Quantity.unit and Quantity.code elements with Quantity.system = "http://unitsofmeasure.org"]"/>
</statement>
<statement>
<key value="CONF-0185"/>
<conformance value="SHOULD"/>
<conditionality value="true"/>
<requirement
value="[If a] US Core Profiles binds the Quantity.code element in the Quantity datatype to the [UCUM](http://unitsofmeasure.org/) code system, [then] if UCUM units are unavailable, represent units in the unit element"/>
</statement>
<statement>
<key value="CONF-0186"/>
<conformance value="SHOULD-NOT"/>
<conditionality value="true"/>
<requirement value=" **SHOULD NOT** supply the unit field]"/>
</statement>
<statement>
<key value="CONF-0187"/>
<conformance value="SHOULD-NOT"/>
<requirement value="A FHIR Server **SHOULD** not delete records."/>
</statement>
<statement>
<key value="CONF-0188"/>
<conformance value="SHOULD"/>
<requirement
value="A FHIR Server **SHOULD** update the appropriate resource status to entered-in-error or inactive [when requested to delete records]"/>
</statement>
<statement>
<key value="CONF-0189"/>
<conformance value="SHOULD"/>
<conditionality value="true"/>
<requirement
value="If a system supports the deletion of records, they **SHOULD** refer to the [Deletion Safety Checks](http://hl7.org/fhir/R4/safety.html#conformance) in the FHIR specification."/>
</statement>
<statement>
<key value="CONF-0190"/>
<conformance value="SHOULD"/>
<conditionality value="true"/>
<requirement
value="A FHIR Server **SHOULD** allow these resources [those entered in error] to be searchable by Client applications."/>
</statement>
<statement>
<key value="CONF-0191"/>
<conformance value="SHOULD"/>
<conditionality value="true"/>
<requirement
value="If the FHIR Server has updated the resource status to entered-in-error:
For patient facing applications, A FHIR Server **SHOULD** remove the resource’s contents, leaving only an id and status. Note that this typically will not conform to the US Core or FHIR StructureDefinitions."/>
</statement>
<statement>
<key value="CONF-0192"/>
<conformance value="MAY"/>
<conditionality value="true"/>
<requirement
value="If the FHIR Server has updated the resource status to entered-in-error:
...
For provider-facing applications, the content may be supplied with content and additional detail (such as the reason for the status change) that the patient viewing system would typically not have access to."/>
</statement>
<statement>
<key value="CONF-0193"/>
<conformance value="SHOULD"/>
<requirement
value="the data provider **SHOULD** do their best to translate (safely) to the requested language [when accessing records in a native or requested language]"/>
</statement>
<statement>
<key value="CONF-0195"/>
<conformance value="SHOULD"/>
<conditionality value="true"/>
<requirement
value="[When Clients request a resource in a specific language] Servers **SHOULD** make reasonable efforts to translate what can be safely translated."/>
</statement>
<statement>
<key value="CONF-0196"/>
<conformance value="SHOULD"/>
<conditionality value="true"/>
<requirement
value="[When Clients request a resource in a specific language] Servers **SHOULD** populate the Resource’s language element with a code based on the underlying language of record, not the requested language.
"/>
</statement>
<statement>
<key value="CONF-0197"/>
<conformance value="SHOULD"/>
<conditionality value="true"/>
<requirement
value="[When Clients request a resource in a specific language] Servers **SHOULD** … [use] the [Human Language](http://hl7.org/fhir/R4/extension-language.html) Extension when the language of a display, etc, is known to differ from the stated (or inferred) language."/>
</statement>
<statement>
<key value="CONF-0198"/>
<conformance value="SHOULD"/>
<conditionality value="true"/>
<requirement
value="[When Clients request a resource in a specific language] [Servers **SHOULD** use] the [Translation](http://hl7.org/fhir/R4/extension-translation.html) Extension when the Server provides additional translations by its own choice or in response to a different Accept-Language than what the resource is stored in."/>
</statement>
<statement>
<key value="CONF-0199"/>
<conformance value="SHOULD"/>
<conditionality value="true"/>
<requirement
value="[When Clients request a resource in a specific language] Servers **SHOULD** make it known what languages are supported in their CapabilityStatement(s) using this extension:
http://hl7.org/fhir/5.0/StructureDefinition/extension-CapablilityStatement.acceptLanguage [[definition](https://hl7.org/fhir/R5/capabilitystatement-definitions.html#CapabilityStatement.acceptLanguage)]"/>
</statement>
<statement>
<key value="CONF-0200"/>
<conformance value="SHOULD"/>
<requirement
value="Servers **SHOULD** support the [_lastUpdated](http://hl7.org/fhir/R4/search.html#lastUpdated) search parameter for US Core Profiles"/>
</statement>
<statement>
<key value="CONF-0201"/>
<conformance value="SHOULD"/>
<requirement
value="Servers ... **SHOULD** populate [Resource.meta.lastUpdated](http://hl7.org/fhir/R4/resource.html#Meta) for US Core Profiles as accurately as possible."/>
</statement>
<statement>
<key value="CONF-0202"/>
<conformance value="SHALL"/>
<requirement
value="Servers **SHALL** document in CapabilityStatement.rest.resource.searchParam.documentation the types of changes that can be detected using the _lastUpdated search parameter"/>
</statement>
<statement>
<key value="CONF-0203"/>
<conformance value="MAY"/>
<requirement
value="US Core Servers [MAY support compartment based searchs, but] are not required to support patient [compartment](http://hl7.org/fhir/R4/compartmentdefinition.html) based searches."/>
</statement>
<statement>
<key value="CONF-0204"/>
<conformance value="MAY"/>
<requirement
value="US Core Servers [MAY resolve absolute URLs, but] are not required to resolve absolute URLs external to their environment."/>
</statement>
<statement>
<key value="CONF-0205"/>
<conformance value="MAY"/>
<requirement
value="Servers can [MAY] choose to return the results in a series of pages to manage the number of search results returned."/>
</statement>
<statement>
<key value="CONF-0206"/>
<conformance value="SHALL"/>
<requirement
value="Servers **SHALL** support, at minimum, these … "Common Clinical Notes":
[Consultation Note (11488-4)](https://loinc.org/11488-4.html)"/>
</statement>
<statement>
<key value="CONF-0207"/>
<conformance value="SHALL"/>
<requirement
value="Servers **SHALL** support, at minimum, these … "Common Clinical Notes":
[Discharge Summary (18842-5)](https://loinc.org/18842-5.html)"/>
</statement>
<statement>
<key value="CONF-0208"/>
<conformance value="SHALL"/>
<requirement
value="Servers **SHALL** support, at minimum, these … "Common Clinical Notes":
[History & Physical Note (34117-2)](https://loinc.org/34117-2.html)"/>
</statement>
<statement>
<key value="CONF-0209"/>
<conformance value="SHALL"/>
<requirement
value="Servers **SHALL** support, at minimum, these … "Common Clinical Notes":
[Procedures Note (28570-0)](https://loinc.org/28570-0.html)"/>
</statement>
<statement>
<key value="CONF-0210"/>
<conformance value="SHALL"/>
<requirement
value="Servers **SHALL** support, at minimum, these … "Common Clinical Notes":
[Progress Note (11506-3)](https://loinc.org/11506-3.html)"/>
</statement>
<statement>
<key value="CONF-0211"/>
<conformance value="SHALL"/>
<requirement
value="Servers **SHALL** support, at minimum, these … "Common Clinical Notes":
[Imaging Narrative (18748-4)](https://loinc.org/18748-4.html)"/>
</statement>
<statement>
<key value="CONF-0212"/>
<conformance value="SHALL"/>
<requirement
value="Servers **SHALL** support, at minimum, these … "Common Clinical Notes":
[Laboratory Report Narrative (11502-2)](https://loinc.org/11502-2.html)"/>
</statement>
<statement>
<key value="CONF-0213"/>
<conformance value="SHALL"/>
<requirement
value="Servers **SHALL** support, at minimum, these … "Common Clinical Notes":
[Pathology Report Narrative (11526-1)](https://loinc.org/11526-1.html)"/>
</statement>
<statement>
<key value="CONF-0214"/>
<conformance value="SHALL"/>
<requirement
value="Servers **SHALL** support, at minimum, these … DiagnosticReport categories:
[Cardiology (LP29708-2)](https://loinc.org/LP29708-2)"/>
</statement>
<statement>
<key value="CONF-0215"/>
<conformance value="SHALL"/>
<requirement
value="Servers **SHALL** support, at minimum, these … DiagnosticReport categories:
[Pathology (LP7839-6)](https://loinc.org/LP7839-6)"/>
</statement>
<statement>
<key value="CONF-0216"/>
<conformance value="SHALL"/>
<requirement
value="Servers **SHALL** support, at minimum, these … DiagnosticReport categories:
[Radiology (LP29684-5)](https://loinc.org/LP29684-5)"/>
</statement>
<statement>
<key value="CONF-0217"/>
<conformance value="SHOULD"/>
<requirement
value="systems are encouraged to support other common notes types, such as:
[Referral Note (57133-1)](https://loinc.org/57133-1.html)"/>
</statement>
<statement>
<key value="CONF-0219"/>
<conformance value="SHOULD"/>
<requirement
value="systems are encouraged to support other common notes types, such as:
[Nurse Note (34746-8)](https://loinc.org/34746-8.html)"/>
</statement>
<statement>
<key value="CONF-0220"/>
<conformance value="SHALL"/>
<requirement
value="To enable consistent access to scanned DiagnosticReport clinical reports, the FHIR Server **SHALL** expose these overlapping scanned or narrative-only reports through both DiagnosticReport and DocumentReference by representing the same attachment URL [as] DocumentReference.content.attachment.url [and]
DiagnosticReport.presentedForm.url"/>
</statement>
<statement>
<key value="CONF-0221"/>
<conformance value="SHALL"/>
<requirement
value="when DiagnosticReport.presentedForm.url references a Scan (PDF), that Attachment **SHALL** also be accessible through DocumentReference.content.attachment.url"/>
</statement>
<statement>
<key value="CONF-0222"/>
<conformance value="MAY"/>
<requirement
value="Systems [Servers] may extend their capabilities [around types of clinical notes] to the complete US Core DocumentReference Type Value Set."/>
</statement>
<statement>
<key value="CONF-0223"/>
<conformance value="SHALL"/>
<requirement
value="This guide requires [Server] systems to implement the [US Core DocumentReference Profile](https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-documentreference.html)"/>
</statement>
<statement>
<key value="CONF-0224"/>
<conformance value="SHALL"/>
<requirement
value="This guide requires [Server] systems to implement the [US Core DiagnosticReport Profile for Report and Note exchange](https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-diagnosticreport-note.html)"/>
</statement>
<statement>
<key value="CONF-0225"/>
<conformance value="MAY"/>
<requirement
value="Systems [Servers] may support other [DiagnosticReport] categories as well."/>
</statement>
<statement>
<key value="CONF-0227"/>
<conformance value="SHOULD"/>
<requirement
value="The following **SHOULD** be exposed via DiagnosticReport: Imaging Narrative
"/>
</statement>
<statement>
<key value="CONF-0228"/>
<conformance value="SHOULD"/>
<requirement
value="The following **SHOULD** be exposed via DiagnosticReport: Laboratory Report Narrative
"/>
</statement>
<statement>
<key value="CONF-0229"/>
<conformance value="SHOULD"/>
<requirement
value="The following **SHOULD** be exposed via DiagnosticReport: Pathology Report Narrative
"/>
</statement>
<statement>
<key value="CONF-0230"/>
<conformance value="SHOULD"/>
<requirement
value="The following **SHOULD** be exposed via DiagnosticReport: Procedure Note"/>
</statement>
<statement>
<key value="CONF-0231"/>
<conformance value="SHALL"/>
<requirement
value="Servers that support DiagnosticReport will include the clinical note narrative content in `DiagnosticReport.presentedForm`"/>
</statement>
<statement>
<key value="CONF-0233"/>
<conformance value="SHOULD"/>
<requirement
value="FHIR Server claiming support to this guide **SHOULD** support the $expand operation [[operation link](http://hl7.org/fhir/R4/valueset-operation-expand.html) to provide information to Clients requesting information on the note and report types the Server supports]"/>
</statement>
<statement>
<key value="CONF-0234"/>
<conformance value="SHOULD"/>
<conditionality value="true"/>
<requirement
value="[If Servers support the [$expand] (http://hl7.org/fhir/R4/valueset-operation-expand.html) operation for discovering note and report types, then Servers **SHALL** support] the #expand operation as follows:
GET [base]/ValueSet/$expand?context=http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note#DiagnosticReport.category&contextDirection=outgoing for DiagnosticReport report category discovery [for read operations]"/>
</statement>
<statement>
<key value="CONF-0235"/>
<conformance value="SHOULD"/>
<conditionality value="true"/>
<requirement
value="[If Servers support the [$expand] (http://hl7.org/fhir/R4/valueset-operation-expand.html) operation for discovering note and report types, then Servers **SHALL** support] the #expand operation as follows:
GET [base]/ValueSet/$expand?context=http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note#DiagnosticReport.category&contextDirection=incoming for DiagnosticReport report category discovery [for write operations]"/>
</statement>
<statement>
<key value="CONF-0236"/>
<conformance value="SHOULD"/>
<conditionality value="true"/>
<requirement
value="[If Servers support the [$expand] (http://hl7.org/fhir/R4/valueset-operation-expand.html) operation for discovering note and report types, then Servers **SHALL** support] the #expand operation as follows:
GET [base]/ValueSet/$expand?context=http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note#DiagnosticReport.code&contextDirection=outgoing for DiagnosticReport report type discovery [for read operations]"/>
</statement>
<statement>
<key value="CONF-0237"/>
<conformance value="SHOULD"/>
<conditionality value="true"/>
<requirement
value="[If Servers support the [$expand] (http://hl7.org/fhir/R4/valueset-operation-expand.html) operation for discovering note and report types, then Servers **SHALL** support] the #expand operation as follows:
GET [base]/ValueSet/$expand?context=http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note#DiagnosticReport.code&contextDirection=incoming for DiagnosticReport report type discovery [for write operations]"/>
</statement>
<statement>
<key value="CONF-0238"/>
<conformance value="SHOULD"/>
<conditionality value="true"/>
<requirement
value="[If Servers support the [$expand] (http://hl7.org/fhir/R4/valueset-operation-expand.html) operation for discovering note and report types, then Servers **SHALL** support] the #expand operation as follows:
GET [base]/ValueSet/$expand?context=http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference#DocumentReference.category&contextDirection=outgoing for DocumentReference note category discovery [for read operations]"/>
</statement>
<statement>
<key value="CONF-0239"/>
<conformance value="SHOULD"/>
<conditionality value="true"/>
<requirement
value="[If Servers support the [$expand] (http://hl7.org/fhir/R4/valueset-operation-expand.html) operation for discovering note and report types, then Servers **SHALL** support] the #expand operation as follows:
GET [base]/ValueSet/$expand?context=http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference#DocumentReference.category&contextDirection=incoming for DocumentReference note category discovery [for write operations]"/>
</statement>
<statement>
<key value="CONF-0240"/>
<conformance value="SHOULD"/>
<conditionality value="true"/>
<requirement
value="[If Servers support the [$expand] (http://hl7.org/fhir/R4/valueset-operation-expand.html) operation for discovering note and report types, then Servers **SHALL** support] the #expand operation as follows:
GET [base]/ValueSet/$expand?context=http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference#DocumentReference.type&contextDirection=outgoing for DocumentReference note type discovery [for read operations]"/>
</statement>
<statement>
<key value="CONF-0241"/>
<conformance value="SHOULD"/>
<conditionality value="true"/>
<requirement
value="[If Servers support the [$expand] (http://hl7.org/fhir/R4/valueset-operation-expand.html) operation for discovering note and report types, then Servers **SHALL** support] the #expand operation as follows:
GET [base]/ValueSet/$expand?context=http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference#DocumentReference.type&contextDirection=incoming for DocumentReference note type discovery [for write operations]"/>
</statement>
<statement>
<key value="CONF-0242"/>
<conformance value="SHOULD"/>
<conditionality value="true"/>
<requirement
value="[If Servers support the [$expand] (http://hl7.org/fhir/R4/valueset-operation-expand.html) operation then] the note and report types for a particular Server [SHOULD be] discovered by invoking the #expand operation as follows:
GET [base]/ValueSet/$expand?context=http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note#DiagnosticReport.presentedForm.contentType&contextDirection=outgoing for DiagnosticReport report content type discovery [for read operations]"/>
</statement>
<statement>
<key value="CONF-0243"/>
<conformance value="SHOULD"/>
<conditionality value="true"/>
<requirement
value="[If Servers support the [$expand] (http://hl7.org/fhir/R4/valueset-operation-expand.html) operation then] the note and report types for a particular Server [SHOULD be] discovered by invoking the #expand operation as follows:
GET [base]/ValueSet/$expand?context=http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note#DiagnosticReport.presentedForm.contentType&contextDirection=incoming for DiagnosticReport report content type discovery [for write operations]"/>
</statement>
<statement>
<key value="CONF-0244"/>
<conformance value="SHOULD"/>
<conditionality value="true"/>
<requirement
value="[If Servers support the [$expand] (http://hl7.org/fhir/R4/valueset-operation-expand.html) operation then] the note and report types for a particular Server [SHOULD be] discovered by invoking the #expand operation as follows:
GET [base]/ValueSet/$expand?context=http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference#DocumentReference.content.attachment.contentType&contextDirection=outgoing for DocumentReference note content type discovery [for read operations]"/>
</statement>
<statement>
<key value="CONF-0245"/>
<conformance value="SHOULD"/>
<conditionality value="true"/>
<requirement
value="[If Servers support the [$expand] (http://hl7.org/fhir/R4/valueset-operation-expand.html) operation then] the note and report types for a particular Server [SHOULD be] discovered by invoking the #expand operation as follows:
GET [base]/ValueSet/$expand?context=http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference#DocumentReference.content.attachment.contentType&contextDirection=incoming for DocumentReference note content type discovery [for write operations]"/>
</statement>
<statement>
<key value="CONF-0246"/>
<conformance value="MAY"/>
<requirement
value="[The [MedicationAdministration](http://hl7.org/fhir/R4/medicationadministration.html) and [MedicationStatement](http://hl7.org/fhir/R4/medicationstatement.html)] medication resources are not profiled by US Core, and systems that support US Core are permitted to use them"/>
</statement>
<statement>
<key value="CONF-0247"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="When using a code [to represent a medication][, the code **SHALL** follow the [extensible](http://hl7.org/fhir/R4/terminologies.html#extensible) binding rules to [Medication Clinical Drug (RxNorm)](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1010.4/expansion) - i.e., unless RxNorm does not cover the concept, the RxNorm code **SHALL** be used."/>
</statement>
<statement>
<key value="CONF-0248"/>
<conformance value="MAY"/>
<requirement
value="USCDI recommends the [National Drug Codes (NDC)](https://www.fda.gov/drugs/drug-approvals-and-databases/national-drug-code-directory) as an optional medication terminology. They can be supplied as an additional coding element [when representing a medication]"/>
</statement>
<statement>
<key value="CONF-0249"/>
<conformance value="MAY"/>
<conditionality value="true"/>
<requirement
value="When referencing the Medication resource, the resource may be included in the returned bundle, as an external resource, or as a [contained](http://hl7.org/fhir/R4/references.html#contained) resource if it can’t stand alone. … The Server application **MAY** choose any combination of these methods"/>
</statement>
<statement>
<key value="CONF-0250"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="if an external reference to Medication is used, the Server **SHALL** support the [_include](http://hl7.org/fhir/R4/search.html#include) parameter for searching this element"/>
</statement>
<statement>
<key value="CONF-0252"/>
<conformance value="SHALL"/>
<requirement
value="Requirements to access “all medications” [all historical, active, and future prescribed medications and medications entered in error and whose status is unknown.] and “all active medications” [all medications with an active status. Active medications do not include past, future, unknown status, and entered-in-error medications.] for a patient:
A MedicationRequest resource query **SHALL** be all that is required to access "all medications" or "all active medications" for a patient. (In other words, no other medication resource type needs to be fetched)"/>
</statement>
<statement>
<key value="CONF-0253"/>
<conformance value="SHALL"/>
<requirement
value="Requirements to access “all medications” [all historical, active, and future prescribed medications and medications entered in error and whose status is unknown.] and “all active medications” [all medications with an active status. Active medications do not include past, future, unknown status, and entered-in-error medications.] for a patient:
The [MedicationRequest resource] query result **SHALL** include all MedicationRequest resources with a `MedicationRequest.intent` = "order" representing authorized medication orders directly derived from the system's orders."/>
</statement>
<statement>
<key value="CONF-0254"/>
<conformance value="SHALL"/>
<requirement
value="Requirements to access “all medications” [all historical, active, and future prescribed medications and medications entered in error and whose status is unknown.] and “all active medications” [all medications with an active status. Active medications do not include past, future, unknown status, and entered-in-error medications.] for a patient:
The [MedicationRequest resource] query result **SHALL** include all prescribed and "self-prescribed" MedicationRequest resources with a `MedicationRequest.intent` = "plan" representing reported medications."/>
</statement>
<statement>
<key value="CONF-0256"/>
<conformance value="SHALL"/>
<requirement
value="Requirements to access “all medications” [all historical, active, and future prescribed medications and medications entered in error and whose status is unknown.] and “all active medications” [all medications with an active status. Active medications do not include past, future, unknown status, and entered-in-error medications.] for a patient:
Servers **SHALL** use the `MedicationRequest.reported[x]` element to indicate that the MedicationRequest record was captured as a secondary "reported" record rather than an original primary source-of-truth record."/>
</statement>
<statement>
<key value="CONF-0257"/>
<conformance value="MAY"/>
<requirement
value="Requirements to access “all medications” [all historical, active, and future prescribed medications and medications entered in error and whose status is unknown.] and “all active medications” [all medications with an active status. Active medications do not include past, future, unknown status, and entered-in-error medications.] for a patient:
Servers [MAY] use the `MedicationRequest.reported[x]` element to indicate ... the source of the report."/>
</statement>
<statement>
<key value="CONF-0258"/>
<conformance value="SHOULD"/>
<requirement
value="Requirements to access “all medications” [all historical, active, and future prescribed medications and medications entered in error and whose status is unknown.] and “all active medications” [all medications with an active status. Active medications do not include past, future, unknown status, and entered-in-error medications.] for a patient:
When recording "self-prescribed" medication, Servers **SHOULD** use the `MedicationRequest.requester` element to indicate the Patient or RelatedPerson is the prescriber."/>
</statement>
<statement>
<key value="CONF-0259"/>
<conformance value="SHOULD"/>
<requirement
value="Requirements to access “all medications” [all historical, active, and future prescribed medications and medications entered in error and whose status is unknown.] and “all active medications” [all medications with an active status. Active medications do not include past, future, unknown status, and entered-in-error medications.] for a patient:
Servers **SHOULD** support the encounter search parameter. "/>
</statement>
<statement>
<key value="CONF-0260"/>
<conformance value="SHOULD"/>
<conditionality value="true"/>
<requirement
value="Requirements to access “all medications” [all historical, active, and future prescribed medications and medications entered in error and whose status is unknown.] and “all active medications” [all medications with an active status. Active medications do not include past, future, unknown status, and entered-in-error medications.] for a patient:
[If Servers support the encounter search parameter, s]earching by encounter will return all medications ordered during that encounter, including medications administered in the hospital and prescribed or discharge medications intended to be taken at home."/>
</statement>
<statement>
<key value="CONF-0262"/>
<conformance value="MAY"/>
<requirement
value="Requirements to access “all medications” [all historical, active, and future prescribed medications and medications entered in error and whose status is unknown.] and “all active medications” [all medications with an active status. Active medications do not include past, future, unknown status, and entered-in-error medications.] for a patient:
Servers **MAY** support the search parameters `category`and `encounter`. This search will return all medications ordered during an encounter for a given MedicationRequest.category such as "inpatient"."/>
</statement>
<statement>
<key value="CONF-0263"/>
<conformance value="MAY"/>
<requirement
value="To provide a list of a patient’s medications, it may be necessary to “de-duplicate” them. The de-duplication activity **MAY** be supplied by the Server"/>
</statement>
<statement>
<key value="CONF-0267"/>
<conformance value="MAY"/>
<requirement
value="An agent.type=”assembler”, agent.type=”transmitter”, or other agents from [Provenance Agent Type](https://hl7.org/fhir/us/core/STU8/ValueSet-us-core-provenance-participant-type.html) value set **MAY** also be included."/>
</statement>
<statement>
<key value="CONF-0268"/>
<conformance value="SHOULD"/>
<requirement
value="implementers [of US Core's framework of Screening and Assessments] **SHOULD** consider more constrained, domain-specific profiles derived from the US Core Profiles to meet the needs of their respective use cases."/>
</statement>
<statement>
<key value="CONF-0269"/>
<conformance value="SHALL"/>
<requirement
value="Every Server that supports the USDCI Data Class “Health Status/Assessments”:
**SHALL** support representing clinical judgments using [US Core Condition Problems and Health Concerns Profile](https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-condition-problems-health-concerns.html) or [US Core Simple Observation Profile](https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-simple-observation.html)."/>
</statement>
<statement>
<key value="CONF-0270"/>
<conformance value="SHOULD"/>
<requirement
value="Every Server that supports the USDCI Data Class “Health Status/Assessments”:
...
The US Core Simple Observation Profile's Observation.derivedFrom element **SHOULD** reference the [Structured Screening and Assessment](https://hl7.org/fhir/us/core/STU8/screening-and-assessments.html#structured-screening-and-assessments) upon which clinical judgment observations are made"/>
</statement>
<statement>
<key value="CONF-0271"/>
<conformance value="SHOULD"/>
<requirement
value="Every Server that supports the USDCI Data Class “Health Status/Assessments”:
...
the US Core Condition Profile's Condition.evidence.detail element **SHOULD** reference the [Structured Screening and Assessment](https://hl7.org/fhir/us/core/STU8/screening-and-assessments.html#structured-screening-and-assessments) which assist in diagnosing problems or health concerns."/>
</statement>
<statement>
<key value="CONF-0272"/>
<conformance value="SHOULD"/>
<requirement
value="For API developers using US Core, it’s important to understand when to use the QuestionnaireResponse versus Observation to represent structured assessments and surveys. Here are some guidelines to help choose the appropriate profile:
Observations represent specific point-in-time facts that need to be searched, trended, the subject of statistical analysis, and directly referenced in support of other actions ... anything that meets one of the preceding criteria must be surfaced as an Observation."/>
</statement>
<statement>
<key value="CONF-0280"/>
<conformance value="SHOULD"/>
<requirement
value="Implementers **SHOULD** treat these [USCDI Health Status Assessments Data Element] value sets as having an [extensible](http://hl7.org/fhir/R4/terminologies.html#extensible) binding."/>
</statement>
<statement>
<key value="CONF-0281"/>
<conformance value="SHOULD"/>
<requirement
value="when recording SDOH data [with] US Core Profiles, Servers **SHOULD** use … [Social Determinants of Health Conditions Value Set](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1196.788/expansion), [Social Determinants of Health Procedures Value Set](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1196.789/expansion), [Social Determinants of Health Goals Value Set](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1247.71/expansion), [and] [Social Determinants of Health Service Requests Value Set](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1196.790/expansion)"/>
</statement>
<statement>
<key value="CONF-0287"/>
<conformance value="SHOULD"/>
<requirement
value="Servers **SHOULD** maintain a stable common identifier for a resource across [FHIR] versions."/>
</statement>
<statement>
<key value="CONF-0288"/>
<conformance value="SHOULD"/>
<requirement
value="In an upgraded R4 endpoint, any data in FHIR DSTU2 **SHOULD** be in FHIR R4."/>
</statement>
<statement>
<key value="CONF-0289"/>
<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-0290"/>
<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-0291"/>
<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-0295"/>
<conformance value="SHOULD"/>
<conditionality value="true"/>
<requirement
value="Servers **SHOULD** make available the same information in DSTU2 and R4 where the more recent standard allows."/>
</statement>
<statement>
<key value="CONF-0296"/>
<conformance value="SHOULD"/>
<requirement
value="Servers **SHOULD** make available the same information in DSTU2 and R4 where the more recent standard allows … [with the] exception [of]
MedicationStatement data [should be] mapped to MedicationRequest"/>
</statement>
<statement>
<key value="CONF-0297"/>
<conformance value="SHOULD"/>
<requirement
value="Servers **SHOULD** make available the same information in DSTU2 and R4 where the more recent standard allows … [with the] exception [of]
care teams, as represented by CarePlan, **SHOULD** be mapped to CareTeam in R4"/>
</statement>
<statement>
<key value="CONF-0298"/>
<conformance value="SHOULD"/>
<requirement
value="Data **SHOULD** be maintained between [FHIR] versions (i.e., not be degraded)."/>
</statement>
<statement>
<key value="CONF-0300"/>
<conformance value="SHOULD"/>
<requirement
value="To allow Clients to use a single authorization token when accessing resources from multiple version-specific endpoints, Servers **SHOULD** use the same base authorization endpoint across versions."/>
</statement>
<statement>
<key value="CONF-0302"/>
<conformance value="SHALL"/>
<requirement
value="[The clinical status of the allergy] **SHALL** be present if verification status is not “entered-in-error”"/>
</statement>
<statement>
<extension
url="http://hl7.org/fhir/tools/StructureDefinition/requirements-statementshallnot">
<valueBoolean value="true"/>
</extension>
<key value="CONF-0303"/>
<requirement
value="[The clinical status of the allergy] **SHALL NOT** be present if verification Status is “entered-in-error”"/>
</statement>
<statement>
<key value="CONF-0305"/>
<conformance value="MAY"/>
<conditionality value="true"/>
<requirement
value="Profile Specific Implementation Guidance:
No Known Allergies may be represented using the US Core-AllergyIntolerance profile"/>
</statement>
<statement>
<key value="CONF-0306"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="[When used No Known Allergies is documented the system Shall use an] appropriate negation code in AllergyIntolerence.code"/>
</statement>
<statement>
<key value="CONF-0307"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="[When used No Known Allergies is documented the system Shall use an] verification status in AllergyIntolerance.verificationStatus"/>
</statement>
<statement>
<key value="CONF-0308"/>
<conformance value="SHOULD"/>
<conditionality value="true"/>
<requirement
value="If a patient has not been asked about their allergies, this would be represented as:
AllergyIntolerance.code = “1631000175102” (Patient not asked (contextual qualifier) (qualifier value))
AllergyIntolerance.verificationStatus = “unconfirmed” or empty (in other words, then element omitted)"/>
</statement>
<statement>
<key value="CONF-0309"/>
<conformance value="SHOULD"/>
<conditionality value="true"/>
<requirement
value="If a patient has been asked, but has indicated they have no known allergies, this would be represented as:
AllergyIntolerance.code = “716186003” (No known allergy (situation))
AllergyIntolerance.verificationStatus = “confirmed”"/>
</statement>
<statement>
<key value="CONF-0310"/>
<conformance value="SHOULD"/>
<requirement
value="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"/>
</statement>
<statement>
<key value="CONF-0311"/>
<conformance value="SHOULD"/>
<requirement
value="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 Condition **SHOULD** be present in CarePlan.addresses"/>
</statement>
<statement>
<key value="CONF-0312"/>
<conformance value="MAY"/>
<requirement
value="Considerations for systems aligning with [HL7 Consolidated (C-CDA)] (http://www.hl7.org/implement/standards/product_brief.cfm?product_id=492) Care Plan requirements: Assessment and Plan **MAY** be included as narrative in CarePlan.text"/>
</statement>
<statement>
<key value="CONF-0313"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="Although both US Core Practitioner Profile and US Core PractitionerRole are Must Support, ... Server system[s conforming to the US Core CareTeam profile are] ... not required to support references to both, but **SHALL** support at least one of them"/>
</statement>
<statement>
<key value="CONF-0317"/>
<conformance value="SHOULD"/>
<requirement
value="[When conforming to the US Core CareTeam profile] Because the US Core PractitionerRole Profile supplies the provider’s location and contact information and a reference to the Practitioner, Server systems [conforming to the US Core CareTeam profile] **SHOULD** reference it instead of the US Core Practitioner Profile [when conforming to the US Core CareTeam profile] ."/>
</statement>
<statement>
<key value="CONF-0318"/>
<conformance value="SHALL"/>
<requirement
value="Servers [conforming to the US Core CareTeam profile] that support only US Core Practitioner Profile and do not support the US Core PractitionerRole Profile **SHALL** provide implementation-specific guidance on how to access a provider’s location ... information using only the Practitioner resource."/>
</statement>
<statement>
<key value="CONF-0319"/>
<conformance value="SHALL"/>
<requirement
value="Servers [conforming to the US Core CareTeam profile] that support only US Core Practitioner Profile and do not support the US Core PractitionerRole Profile **SHALL** provide implementation-specific guidance on how to access a provider’s ... contact information using only the Practitioner resource."/>
</statement>
<statement>
<key value="CONF-0320"/>
<conformance value="SHOULD"/>
<conditionality value="true"/>
<requirement
value="For Problems and Health Concerns [records, systems **SHOULD**] use the [US Core Condition Problems and Health Concerns Profile](https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-condition-problems-health-concerns.html)."/>
</statement>
<statement>
<key value="CONF-0321"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="[Newly created Encounter Diagnosis records **SHALL** have a] Condition.code … [from the] [“current”](https://hl7.org/fhir/R5/terminologies.html#binding) … [value set] binding."/>
</statement>
<statement>
<key value="CONF-0322"/>
<conformance value="MAY"/>
<conditionality value="true"/>
<requirement
value="[Historical Encounter Diagnosis records **MAY** have a] Condition.code … [from the] base “preferred” … [value set] binding."/>
</statement>
<statement>
<key value="CONF-0323"/>
<conformance value="SHOULD"/>
<requirement
value="USCDI’s applicable vocabulary standards for Encounter Diagnosis are SNOMED CT and ICD-10-CM. The US Core Condition Codes only supports ICD-9-CM for historical purposes. When using ICD codes, only non-header ICD-10-CM codes **SHOULD** be used as the primary code for current encounter diagnoses."/>
</statement>
<statement>
<key value="CONF-0324"/>
<conformance value="SHOULD"/>
<requirement
value="[A US Core Condition Encounter Diagnosis] encounter **SHOULD** always be referenced in Condition.encounter."/>
</statement>
<statement>
<key value="CONF-0330"/>
<conformance value="SHOULD"/>
<conditionality value="true"/>
<requirement
value="For Encounter Diagnosis [records, systems **SHOULD**] use the [US Core Condition Encounter Diagnosis Profile](https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-condition-encounter-diagnosis.html)."/>
</statement>
<statement>
<key value="CONF-0331"/>
<conformance value="SHOULD"/>
<conditionality value="true"/>
<requirement
value="If the category is "problem-list-item", Condition.clinicalStatus **SHOULD** be present."/>
</statement>
<statement>
<key value="CONF-0332"/>
<conformance value="SHOULD"/>
<requirement
value="Updates to .meta.lastUpdated **SHOULD** reflect: New problems and health concerns "/>
</statement>
<statement>
<key value="CONF-0333"/>
<conformance value="SHOULD"/>
<requirement
value="Updates to .meta.lastUpdated **SHOULD** reflect:
Changes in the clinical status or verifications status of problems or health concerns."/>
</statement>
<statement>
<key value="CONF-0334"/>
<conformance value="MAY"/>
<requirement
value="A coverage.type of “81” (Self-pay) **MAY** be used to imply that the patient has no coverage or that an individual or organization other than an insurer is taking responsibility for payment for a portion of the health care costs."/>
</statement>
<statement>
<key value="CONF-0335"/>
<conformance value="SHOULD"/>
<requirement
value="Implementers should refer to the [PHDSC Payer Type Committee User’s Guide](https://www.nahdo.org/sites/default/files/2020-12/SourceofPaymentTypologyUsersGuideVersion9.2December2020.pdf) for the Source of Payment Typology when selecting codes."/>
</statement>
<statement>
<key value="CONF-0336"/>
<conformance value="SHOULD"/>
<requirement
value="To differentiate Medicare Parts A, B, C, and D systems can use the following codes [when sending Coverage.type]: [For] Part A and B [use] 121 (Medicare Fee For Service)"/>
</statement>
<statement>
<key value="CONF-0337"/>
<conformance value="SHOULD"/>
<requirement
value="To differentiate Medicare Parts A, B, C, and D systems can use the following codes: [For] Part C (Medicare Advantage Plan) [use] 111 (Medicare HMO), 112 (Medicare PPO), 113 (Medicare POS)"/>
</statement>
<statement>
<key value="CONF-0338"/>
<conformance value="SHOULD"/>
<requirement
value="To differentiate Medicare Parts A, B, C, and D systems can use the following codes: [For] Part D [use] 122 (Medicare Drug Benefit)"/>
</statement>
<statement>
<key value="CONF-0339"/>
<conformance value="SHOULD"/>
<conditionality value="true"/>
<requirement
value="If Insurers issue unique member IDs for dependents, then the memberId Coverage.identifier should be used [with the unique dependent ID] instead of Coverage.dependent to uniquely refer to the dependent with respect to their insurance."/>
</statement>
<statement>
<key value="CONF-0340"/>
<conformance value="SHOULD"/>
<requirement
value="For non-implantable devices (for example, software or crutches), use the base FHIR Device resource or other use case-specific Device profiles."/>
</statement>
<statement>
<key value="CONF-0341"/>
<conformance value="SHOULD"/>
<requirement
value="Implementers are encouraged to use the FDA Global UDI Database (GUDID) and associated APIs to parse and validate the [unique device ID] UDI"/>
</statement>
<statement>
<key value="CONF-0342"/>
<conformance value="SHALL"/>
<requirement
value="Implantable medical devices with UDI information **SHALL** represent the UDI code in Device.udiCarrier.carrierHRF"/>
</statement>
<statement>
<key value="CONF-0343"/>
<conformance value="SHALL"/>
<requirement
value="UDI-PI elements present [in Device.udiCarrier.carrierHRF] **SHALL** be represented in the corresponding US Core Implantable Device Profile elements"/>
</statement>
<statement>
<key value="CONF-0344"/>
<conformance value="SHOULD"/>
<conditionality value="true"/>
<requirement
value="If UDI is not present and the manufacturer … is available, … [it] **SHOULD** be included to support historical reports of implantable medical devices [where] manufacturer [is sent in] Device.manufacturer"/>
</statement>
<statement>
<key value="CONF-0345"/>
<conformance value="SHOULD"/>
<conditionality value="true"/>
<requirement
value="If UDI is not present and the ... model number information is available, … [it] **SHOULD** be included to support historical reports of implantable medical devices [where] model [is sent in] Device.model"/>
</statement>
<statement>
<key value="CONF-0346"/>
<conformance value="SHOULD"/>
<requirement
value="Servers SHOULD support query by Device.type to allow Clients to request the patient’s devices by a specific type."/>
</statement>
<statement>
<key value="CONF-0347"/>
<conformance value="MAY"/>
<requirement
value="Records of implanted devices **MAY** be queried against UDI data, including: UDI HRF string (udi-carrier)"/>
</statement>
<statement>
<key value="CONF-0348"/>
<conformance value="MAY"/>
<requirement
value="Records of implanted devices **MAY** be queried against UDI data, including:UDI Device Identifier (udi-di)"/>
</statement>
<statement>
<key value="CONF-0349"/>
<conformance value="MAY"/>
<requirement
value="Records of implanted devices **MAY** be queried against UDI data, including: Manufacturer (manufacturer)"/>
</statement>
<statement>
<key value="CONF-0350"/>
<conformance value="MAY"/>
<requirement
value="Records of implanted devices **MAY** be queried against UDI data, including: Model number (model)"/>
</statement>
<statement>
<key value="CONF-0351"/>
<conformance value="MAY"/>
<requirement
value="Implementers **MAY** also adopt custom SearchParameters for searching by lot numbers"/>
</statement>
<statement>
<key value="CONF-0352"/>
<conformance value="MAY"/>
<requirement
value="Implementers **MAY** also adopt custom SearchParameters for searching by serial number"/>
</statement>
<statement>
<key value="CONF-0353"/>
<conformance value="MAY"/>
<requirement
value="Implementers **MAY** also adopt custom SearchParameters for searching by expiration date"/>
</statement>
<statement>
<key value="CONF-0354"/>
<conformance value="MAY"/>
<requirement
value="Implementers **MAY** also adopt custom SearchParameters for searching by manufacture date"/>
</statement>
<statement>
<key value="CONF-0355"/>
<conformance value="MAY"/>
<requirement
value="Implementers **MAY** also adopt custom SearchParameters for searching by distinct identifier"/>
</statement>
<statement>
<key value="CONF-0356"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="The diagnostically relevant time (known as the “effective time” and typically the time of specimen collection) … **SHALL** be present if status [of the diagnostic report] is ‘partial’, ‘preliminary’, ‘final’, ‘amended’, ‘corrected’, or ‘appended’."/>
</statement>
<statement>
<key value="CONF-0357"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="When the report was released … **SHALL** be present if status [of the diagnostic report] is ‘partial’, ‘preliminary’, ‘final’, ‘amended’, ‘corrected’, or ‘appended’."/>
</statement>
<statement>
<key value="CONF-0358"/>
<conformance value="SHOULD"/>
<requirement
value="Updates to .meta.lastUpdated **SHOULD** reflect New laboratory reports. "/>
</statement>
<statement>
<key value="CONF-0359"/>
<conformance value="SHOULD"/>
<requirement
value="Updates to .meta.lastUpdated **SHOULD** reflect changes in the status of laboratory reports, including events that trigger the same status (e.g., amended → amended)."/>
</statement>
<statement>
<key value="CONF-0360"/>
<conformance value="SHALL"/>
<requirement
value="The DiagnosticReport.category binding Must Support, at a minimum, the US Core DiagnosticReport Category Codes of Cardiology, Radiology, and Pathology"/>
</statement>
<statement>
<key value="CONF-0361"/>
<conformance value="MAY"/>
<requirement
value="Other [diagnostic report] categories may be supported [when using US Core DiagnosticReport Profile for Report and Note Exchange]"/>
</statement>
<statement>
<key value="CONF-0362"/>
<conformance value="MAY"/>
<requirement
value="[L]inkages between specific LOINC codes and the LP-type codes may be used as guidance [for a Server's categorization of diagnostic reports]"/>
</statement>
<statement>
<key value="CONF-0364"/>
<conformance value="SHOULD"/>
<conditionality value="true"/>
<requirement
value="For Diagnostic Imaging Reports systems **SHOULD** support using the subset of LOINC codes defined in CONF-DIR-19 in HL7 Implementation Guide for CDA Release 2: Imaging Integration, Levels 1, 2, and 3, Basic Imaging Reports in CDA and DICOM Diagnostic Imaging Reports (DIR) - Universal Realm, Release 1.0."/>
</statement>
<statement>
<key value="CONF-0365"/>
<conformance value="SHALL"/>
<requirement
value="The DocumentReference.type binding Must Support, at a minimum, the 10 [Common Clinical Notes](https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-documentreference.html#mandatory-and-must-support-data-elements)"/>
</statement>
<statement>
<key value="CONF-0366"/>
<conformance value="MAY"/>
<requirement
value="The DocumentReference.type binding may extend to the whole [US Core DocumentReference Type Value Set](https://hl7.org/fhir/us/core/STU8/ValueSet-us-core-documentreference-type.html)"/>
</statement>
<statement>
<key value="CONF-0367"/>
<conformance value="MAY"/>
<requirement
value="[DocumentReference.type may also use] other category schemes such as the LOINC-based [Document Class Value Set](http://hl7.org/fhir/R4/valueset-document-classcodes.html) and [IHE XDSclassCode](https://wiki.ihe.net/index.php/XDS_classCode_Metadata_Coding_System)"/>
</statement>
<statement>
<key value="CONF-0368"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="Although both [DocumentReference.attachment.url and DocumentReference.attachment.data] 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."/>
</statement>
<statement>
<key value="CONF-0372"/>
<conformance value="SHALL"/>
<requirement
value="If there are multiple DocumentReference.content element repetitions, these **SHALL** all represent the same document in different formats or attachment metadata"/>
</statement>
<statement>
<extension
url="http://hl7.org/fhir/tools/StructureDefinition/requirements-statementshallnot">
<valueBoolean value="true"/>
</extension>
<key value="CONF-0373"/>
<requirement
value="The [documentReference.content] element **SHALL NOT** contain different versions of the same content."/>
</statement>
<statement>
<key value="CONF-0374"/>
<conformance value="SHALL"/>
<requirement
value="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"/>
</statement>
<statement>
<key value="CONF-0375"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="Although ... marked as Must Support, Servers are not required to support both [an Encounter.reasonCode or a reference with Encounter.reasonReference], but they **SHALL** support at least one of these elements."/>
</statement>
<statement>
<key value="CONF-0378"/>
<conformance value="SHOULD"/>
<conditionality value="true"/>
<requirement
value="If Encounter.reasonReference references an Observation, it **SHOULD** conform to a US Core Observation [profile applicable to the observation being made]"/>
</statement>
<statement>
<key value="CONF-0379"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="Although … marked as Must Support, Servers are not required to support both Encounter.location.location and Encounter.serviceProvider, but they **SHALL** support at least one of these elements."/>
</statement>
<statement>
<key value="CONF-0382"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="If the event facility/location differs from the Encounter.location, systems **SHOULD** reference it directly"/>
</statement>
<statement>
<key value="CONF-0383"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="If the event facility/location differs from the Encounter.location, … systems **SHALL** use the location element for all resources where the element is available."/>
</statement>
<statement>
<key value="CONF-0384"/>
<conformance value="MAY"/>
<conditionality value="true"/>
<requirement
value="If the event facility/location differs from the Encounter.location … systems **MAY** use the standard [Event Location Extension](http://hl7.org/fhir/StructureDefinition/event-location) for US Core DiagnosticReport Profile for Laboratory Results Reporting and US Core Observation Clinical Result Profile."/>
</statement>
<statement>
<key value="CONF-0385"/>
<conformance value="SHOULD"/>
<requirement
value="Updates to .meta.lastUpdated **SHOULD** reflect New encounters/visits"/>
</statement>
<statement>
<key value="CONF-0386"/>
<conformance value="SHOULD"/>
<requirement
value="Updates to .meta.lastUpdated **SHOULD** reflect changes in the status of encounters, including events that trigger the same status (e.g., in-progress → in-progress)."/>
</statement>
<statement>
<key value="CONF-0387"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="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."/>
</statement>
<statement>
<key value="CONF-0390"/>
<conformance value="SHALL"/>
<requirement
value="[Servers shall] use the status code: not-done to represent that an immunization was not given."/>
</statement>
<statement>
<key value="CONF-0391"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="[For organization participating in the ONC Health IT Certification program] [CVX vaccine codes](https://www2a.cdc.gov/vaccines/iis/iisstandards/ndc_crosswalk.asp) are required"/>
</statement>
<statement>
<key value="CONF-0392"/>
<conformance value="SHOULD"/>
<requirement
value="[NDC vaccine codes](http://www2a.cdc.gov/vaccines/iis/iisstandards/ndc_crosswalk.asp) **SHOULD** be supported as an additional code [of [CVX Vaccine Codes](https://www2a.cdc.gov/vaccines/iis/iisstandards/ndc_crosswalk.asp)]"/>
</statement>
<statement>
<key value="CONF-0393"/>
<conformance value="SHOULD"/>
<requirement
value="The preferred code system identifier … is [http://hl7.org/fhir/sid/cvx](http://hl7.org/fhir/sid/cvx) for CVX [vaccine codes]"/>
</statement>
<statement>
<key value="CONF-0394"/>
<conformance value="SHOULD"/>
<requirement
value="The preferred code system identifier … is [http://hl7.org/fhir/sid/ndc](http://hl7.org/fhir/sid/ndc) for NDC vaccine codes]"/>
</statement>
<statement>
<key value="CONF-0395"/>
<conformance value="SHOULD"/>
<requirement
value="Systems **SHOULD** 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 Location.address.line"/>
</statement>
<statement>
<key value="CONF-0396"/>
<conformance value="SHOULD"/>
<requirement
value="Systems **SHOULD** 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 Location.address.city"/>
</statement>
<statement>
<key value="CONF-0397"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="When using a code [to represent a medication for a medication dispense], RXNorm concepts are used."/>
</statement>
<statement>
<key value="CONF-0398"/>
<conformance value="MAY"/>
<conditionality value="true"/>
<requirement
value="When using a code [to represent a medication for a medication dispense], [National Drug Codes (NDC)](https://www.fda.gov/drugs/drug-approvals-and-databases/national-drug-code-directory) can be supplied as an additional coding element."/>
</statement>
<statement>
<key value="CONF-0399"/>
<conformance value="MAY"/>
<requirement
value="When referencing a Medication resource in .medicationReference, the resource may be [contained](http://hl7.org/fhir/R4/references.html#contained)"/>
</statement>
<statement>
<key value="CONF-0400"/>
<conformance value="MAY"/>
<requirement
value="When referencing a Medication resource in .medicationReference, the resource may be an external resource"/>
</statement>
<statement>
<key value="CONF-0401"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="The Server systems are not required to support both a [medication] code and a reference [when sending medicationDispense], but **SHALL** support at least one of these methods"/>
</statement>
<statement>
<key value="CONF-0402"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="If an external reference to a Medication resource is used, the Server **SHALL** support the [_include](http://hl7.org/fhir/R4/search.html#include) parameter for searching this element."/>
</statement>
<statement>
<key value="CONF-0405"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="[For organization participating in the ONC Health IT Certification program Servers **SHALL** support the [additional USCDI requirement](https://hl7.org/fhir/us/core/STU8/must-support.html#additional-uscdi-requirements):], The reason or indication for the prescription"/>
</statement>
<statement>
<key value="CONF-0406"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="[For organization participating in the ONC Health IT Certification program Servers **SHALL** support the [additional USCDI requirement](https://hl7.org/fhir/us/core/STU8/must-support.html#additional-uscdi-requirements):] reported adherence to prescribed medication instructions"/>
</statement>
<statement>
<key value="CONF-0407"/>
<conformance value="SHOULD"/>
<requirement
value="When recording “self-prescribed” medication, requester **SHOULD** be used to indicate the Patient or RelatedPerson as the prescriber"/>
</statement>
<statement>
<key value="CONF-0408"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="Although [medicationRequest.reportedBoolean and MedicationRequest.reportedReference] are both marked as Must Support, the Server system is not required to support both, but **SHALL** support at least one of these elements"/>
</statement>
<statement>
<key value="CONF-0411"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="Although both MedicationRequest.reasonCode and MedicationRequest.reasonReference are marked as Additional USCDI Requirements [which are required for organizations participating in the ONC Health IT Certification program]. The certifying Server system is not required to support both, but **SHALL** support at least one of these elements"/>
</statement>
<statement>
<key value="CONF-0414"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="[For organizations participating in the ONC Health IT Certification program and supporting MedicationRequest.reasonReference,] Servers **SHALL** support at least one target resource in MedicationRequest.reasonReference"/>
</statement>
<statement>
<key value="CONF-0416"/>
<conformance value="SHOULD"/>
<conditionality value="true"/>
<requirement
value="[For organizations participating in the ONC Health IT Certification program,] the referenced resources **SHOULD** be a US Core Profile as documented in [Referencing US Core Profiles](https://hl7.org/fhir/us/core/STU8/general-guidance.html#referencing-us-core-profiles)."/>
</statement>
<statement>
<key value="CONF-0417"/>
<conformance value="SHOULD"/>
<requirement
value="Source EHR identifiers **SHOULD** be included to support deduplication across MedicationRequest resources."/>
</statement>
<statement>
<key value="CONF-0419"/>
<conformance value="MAY"/>
<requirement
value="The observations **MAY** have additional codes that translate or map to the Observation code or category codes [such as] … local system-specific codes [and] …more specific codes"/>
</statement>
<statement>
<key value="CONF-0420"/>
<conformance value="SHOULD"/>
<requirement
value="[For an Observation a] code system value **SHOULD** be supplied for each additional code"/>
</statement>
<statement>
<key value="CONF-0421"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="Because the blood pressure values are communicated in the mandatory systolic and diastolic components [when using the US Core Average Blood Pressure Profile,] the Observation.value[x] element **SHALL** be omitted"/>
</statement>
<statement>
<key value="CONF-0422"/>
<conformance value="SHOULD"/>
<conditionality value="true"/>
<requirement
value="The context or precondition of a patient’s [care experience] preference **SHOULD** be supplied in the Observation.valueString or in an extension"/>
</statement>
<statement>
<key value="CONF-0423"/>
<conformance value="SHOULD"/>
<conditionality value="true"/>
<requirement
value="Servers **SHOULD** use the base FHIR [Observation Category Codes] (http://hl7.org/fhir/R4/valueset-observation-category.html) [in Observation.category]"/>
</statement>
<statement>
<key value="CONF-0424"/>
<conformance value="SHOULD"/>
<conditionality value="true"/>
<requirement
value="Systems **SHOULD** support Observation.effectivePeriod to accurately represent measurements over time"/>
</statement>
<statement>
<key value="CONF-0425"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="An Observation.component without a value, **SHALL** include a reason why the data is absent"/>
</statement>
<statement>
<key value="CONF-0426"/>
<conformance value="MAY"/>
<conditionality value="true"/>
<requirement
value="Systems that never provide a component observation without a component value … [MAY choose not] to support Observation.component.dataAbsentReason"/>
</statement>
<statement>
<key value="CONF-0427"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="An Observation without a value, **SHALL** include a reason why the data is absent"/>
</statement>
<statement>
<key value="CONF-0428"/>
<conformance value="MAY"/>
<conditionality value="true"/>
<requirement
value="[For] an Observation without a value … [Systems **MAY** choose not to] include a reason why the data is absent … [if] there are component observations or … reporting panel observations using Observation.hasMember"/>
</statement>
<statement>
<key value="CONF-0429"/>
<conformance value="MAY"/>
<conditionality value="true"/>
<requirement
value="Systems that never provide an observation without a value ... [MAY choose not] to support Observation.dataAbsentReason"/>
</statement>
<statement>
<key value="CONF-0430"/>
<conformance value="SHOULD"/>
<conditionality value="true"/>
<requirement
value="[When sending US Core Laboratory Results Observation Profile] updates to .meta.lastUpdated **SHOULD** reflect new laboratory observations"/>
</statement>
<statement>
<key value="CONF-0431"/>
<conformance value="SHOULD"/>
<conditionality value="true"/>
<requirement
value="[When sending US Core Laboratory Results Observation Profile] updates to .meta.lastUpdated **SHOULD** reflect changes in the status of laboratory observations, including events that trigger the same status (e.g., amended → amended)"/>
</statement>
<statement>
<key value="CONF-0432"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="[When sending US Core Observation Occupation Profile] for … [a] current job, [Servers SHALL] omit observation.effectivePeriod.end to indicate it is ongoing."/>
</statement>
<statement>
<key value="CONF-0433"/>
<conformance value="SHALL"/>
<requirement
value="When the industry is known, but the occupation is not, [Servers SHALL] use the value “unknown” from the [DataAbsentReason Code System](http://hl7.org/fhir/R4/codesystem-data-absent-reason.html)"/>
</statement>
<statement>
<key value="CONF-0434"/>
<conformance value="SHALL"/>
<requirement
value="when the occupation is known but the industry is not, [Servers SHALL] omit the industry Observation.component"/>
</statement>
<statement>
<key value="CONF-0435"/>
<conformance value="SHALL"/>
<requirement
value="To represent the patient’s pregnancy status, [Servers SHALL] use the [US Core Observation Pregnancy Status Profile](https://hl7.org/fhir/us/core/StructureDefinition-us-core-observation-pregnancystatus.html)."/>
</statement>
<statement>
<key value="CONF-0436"/>
<conformance value="SHALL"/>
<requirement
value="To represent the patient’s intent to become pregnant, [Servers SHALL] use the [US Core Observation Pregnancy Intent Profile](https://hl7.org/fhir/us/core/StructureDefinition-us-core-observation-pregnancyintent.html)."/>
</statement>
<statement>
<key value="CONF-0437"/>
<conformance value="SHOULD"/>
<conditionality value="true"/>
<requirement
value="[For] multi-question surveys or assessments Observation.code is an overarching assessment or screening code, and the Observation.value element **SHOULD** be empty"/>
</statement>
<statement>
<key value="CONF-0438"/>
<conformance value="SHOULD"/>
<conditionality value="true"/>
<requirement
value="A practitioner’s clinical observation or assertion about a patient’s health status, which is not a response to a screening or assessment question,SHOULD use the [US Core Simple Observation Profile](https://hl7.org/fhir/us/core/StructureDefinition-us-core-simple-observation.html) instead [of the US Core Observation Screening Assessment Profile]"/>
</statement>
<statement>
<key value="CONF-0439"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="the Server system ... **SHALL** support [either] Reference(US Core Observation Screening Assessment Profile) or Reference(US Core QuestionnaireResponse Profile) for Observation.derivedFrom"/>
</statement>
<statement>
<key value="CONF-0440"/>
<conformance value="MAY"/>
<conditionality value="true"/>
<requirement
value="Additional codes that translate or map to the Observation code (e.g., local codes) are allowed [when using US Core Observation Sexual Orientation Profile]"/>
</statement>
<statement>
<key value="CONF-0441"/>
<conformance value="SHOULD"/>
<requirement
value="Observations formally part of an assessment tool or survey **SHOULD** use the [US Core Observation Screening Assessment Profile](https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-observation-screening-assessment.html)."/>
</statement>
<statement>
<key value="CONF-0442"/>
<conformance value="SHOULD"/>
<requirement
value="An assertion or determination derived from screening and assessment tools **SHOULD** reference them using Observation.derivedFrom"/>
</statement>
<statement>
<key value="CONF-0443"/>
<conformance value="SHOULD"/>
<requirement
value="When using `Observation.derivedFrom’ to reference an Observation, the referenced Observation **SHOULD** be a US Core Observation"/>
</statement>
<statement>
<key value="CONF-0444"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="Although none of the Observation.derivedFrom [references are flagged as Must Support](https://hl7.org/fhir/us/core/STU8/must-support.html#must-support---resource-references), the Server **SHALL** support at least one of them"/>
</statement>
<statement>
<key value="CONF-0445"/>
<conformance value="MAY"/>
<conditionality value="true"/>
<requirement
value="[US Core] treatment intervention preferences expressed by a patient may be documented in narrative (text) form or the result of selecting from a list of options provided by the content creator/implementer."/>
</statement>
<statement>
<key value="CONF-0446"/>
<conformance value="SHOULD"/>
<conditionality value="true"/>
<requirement
value="[When using US Core Treatment Intervention Preference Profile] the context or precondition of a patient’s preference **SHOULD** be supplied in the Observation.valueString ... or an extension"/>
</statement>
<statement>
<key value="CONF-0447"/>
<conformance value="MAY"/>
<requirement
value="[US Core Vital Signs] observations **MAY** have [component](http://hl7.org/fhir/R4/observation.html#gr-comp) observations … [see] FHIR core specification [vital signs table](http://hl7.org/fhir/R4/observation-vitalsigns.html#vitals-table) for examples"/>
</statement>
<statement>
<key value="CONF-0448"/>
<conformance value="SHOULD"/>
<requirement
value="Information about the growth chart tables used to determine percentiles **SHOULD** be supplied in Observation.note.text"/>
</statement>
<statement>
<key value="CONF-0449"/>
<conformance value="SHOULD"/>
<conditionality value="true"/>
<requirement
value="[In the US Core Blood Pressure Profile] because the blood pressure values are communicated in the mandatory systolic and diastolic components[,] the Observation.value[x] element **SHOULD** be omitted"/>
</statement>
<statement>
<key value="CONF-0450"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="[In the US Core Blood Pressure Profile] because the blood pressure values are communicated in the mandatory systolic and diastolic components[,] an Observation without a systolic or diastolic result value, **SHALL** include a reason why the data is absent in Observation.component.dataAbsentReason"/>
</statement>
<statement>
<key value="CONF-0451"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="[In the US Core Blood Pressure Profile] because the blood pressure values are communicated in the mandatory systolic and diastolic components[,] All Server systems - including those that never provide a component observation without a value - **SHALL** support Observation.component.dataAbsentReason for the components."/>
</statement>
<statement>
<key value="CONF-0452"/>
<conformance value="MAY"/>
<conditionality value="true"/>
<requirement
value="Inspired oxygen therapy may be represented with [component](http://hl7.org/fhir/R4/observation.html#gr-comp) observations when measured at the same time as the pulse oximetry measurements [in the US Core Pulse Oximetry profile]"/>
</statement>
<statement>
<key value="CONF-0453"/>
<conformance value="SHOULD"/>
<conditionality value="true"/>
<requirement
value="Many pulse oximetry readings are taken while the patient is breathing room air. The concept of “room air” (unmodified, ambient air) **SHOULD** be represented as an inhaled oxygen flow rate of 0 liters/min"/>
</statement>
<statement>
<key value="CONF-0454"/>
<conformance value="SHOULD"/>
<conditionality value="true"/>
<requirement
value="A pulse oximetry reading without inspired oxygen component observations may imply that the measurement was performed while the patient was breathing room air or that the inspired oxygen reading was omitted. To remove this uncertainty, the inspired oxygen [component](http://hl7.org/fhir/R4/observation.html#gr-comp) observations **SHOULD** be used [when using the US Core Pulse Oximetry profile.]"/>
</statement>
<statement>
<key value="CONF-0455"/>
<conformance value="SHALL"/>
<requirement
value="Systems **SHALL** support National Provider Identifier (NPI) for organizations"/>
</statement>
<statement>
<key value="CONF-0456"/>
<conformance value="SHOULD"/>
<requirement
value="Systems … **SHOULD** the National Association of Insurance Commissioners NAIC Company code (sometimes called “NAIC Number” or “cocode”) for payers."/>
</statement>
<statement>
<key value="CONF-0457"/>
<conformance value="SHOULD"/>
<requirement
value="Systems … **SHOULD** support Clinical Laboratory Improvement Amendments (CLIA) for laboratories"/>
</statement>
<statement>
<key value="CONF-0458"/>
<conformance value="SHOULD"/>
<requirement
value="Systems **SHOULD** 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 Organization.address.line and Organization.address.city"/>
</statement>
<statement>
<key value="CONF-0459"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="The Complex [Extension] for Race ... allow[s] for one or more codes of which [Must Support](https://hl7.org/fhir/us/core/STU8/must-support.html) at least one category code from the OMB Race ... Category Value Sets that draw from the [Race & Ethnicity - CDC (CDCREC)](https://phinvads.cdc.gov/vads/ViewCodeSystem.action?id=2.16.840.1.113883.6.238) code system [for the [US Core Race Extension] (https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-race.html)]."/>
</statement>
<statement>
<key value="CONF-0460"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="The Complex [Extension] for ... Ethnicity allow[s] for one or more codes of which [Must Support](https://hl7.org/fhir/us/core/STU8/must-support.html) at least one category code from the OMB ... Ethnicity Category Value Sets that draw from the [Race & Ethnicity - CDC (CDCREC)](https://phinvads.cdc.gov/vads/ViewCodeSystem.action?id=2.16.840.1.113883.6.238) code system [for the [US Core Ethnicity Extension] (https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-ethnicity.html)]."/>
</statement>
<statement>
<key value="CONF-0461"/>
<conformance value="MAY"/>
<conditionality value="true"/>
<requirement
value="The Complex [Extension] for Race ... allow[s] for one or more codes of which **MAY** include additional codes from the detailed ethnicity ... value sets drawn from the [Race & Ethnicity - CDC (CDCREC)](https://phinvads.cdc.gov/vads/ViewCodeSystem.action?id=2.16.840.1.113883.6.238) code system [when using the [US Core Race Extension] (https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-race.html)]"/>
</statement>
<statement>
<key value="CONF-0462"/>
<conformance value="MAY"/>
<conditionality value="true"/>
<requirement
value="The Complex [Extension] for Race ... allow[s] for one or more codes of which **SHALL** include a text description [of category codes when using the [US Core Race Extension] (https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-race.html)]"/>
</statement>
<statement>
<key value="CONF-0463"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="The Complex [Extension] for ... Ethnicity allow[s] for one or more codes of which **MAY** include additional codes from the detailed ... race value sets drawn from the [Race & Ethnicity - CDC (CDCREC)](https://phinvads.cdc.gov/vads/ViewCodeSystem.action?id=2.16.840.1.113883.6.238) code system [when using the [US Core Race Extension] (https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-race.html)]"/>
</statement>
<statement>
<key value="CONF-0464"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="The Complex [Extension] for ... Ethnicity allow[s] for one or more codes of which **SHALL** include a text description [of category codes when using the [US Core Ethnicity Extension] (https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-ethnicity.html)]"/>
</statement>
<statement>
<key value="CONF-0466"/>
<conformance value="SHOULD"/>
<conditionality value="true"/>
<requirement
value="Previous name is represented by setting Patient.name.use to “old” or providing an end date in Patient.name.period or doing both"/>
</statement>
<statement>
<key value="CONF-0467"/>
<conformance value="SHOULD"/>
<conditionality value="true"/>
<requirement
value="Previous address is represented by setting Patient.address.use to “old” or providing an end date in Patient.address.period or doing both."/>
</statement>
<statement>
<key value="CONF-0470"/>
<conformance value="SHOULD"/>
<requirement
value="Non-certifying systems[, systems that are not participating in the ONC Health IT certification program,] **SHOULD** 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-0471"/>
<conformance value="MAY"/>
<conditionality value="true"/>
<requirement
value="[For systems participating in the ONC Health IT certification program,] this requirement [to 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) for Patient.address.line and Patient.address.city] does not apply to historical records or documents that are exposed through FHIR-based APIs. [Organizations **MAY** choose not to use use Project US@ Technical Specification for Patient Addresses Final Version 1.0 when sending historical records]"/>
</statement>
<statement>
<key value="CONF-0472"/>
<conformance value="SHOULD-NOT"/>
<requirement
value=" **SHOULD NOT** be used as a patient identifier in Patient.identifier.value"/>
</statement>
<statement>
<key value="CONF-0473"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="Servers that support only the US Core Practitioner Profile and do not support the [US Core PractitionerRole Profile](https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-practitionerrole.html) **SHALL** provide implementation-specific guidance on how to access a provider’s location and contact information using only the Practitioner resource."/>
</statement>
<statement>
<key value="CONF-0474"/>
<conformance value="MAY"/>
<conditionality value="true"/>
<requirement
value="Although Practitioner.address is marked as Must Support, the Server system … [MAY choose not to] support it if they support the US Core PractitionerRole Profile"/>
</statement>
<statement>
<key value="CONF-0475"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="[When using the US Core Practioner Profile] Practitioner.address … **SHALL**[be supported] if … [the Server does] not support the US Core PractitionerRole Profile"/>
</statement>
<statement>
<key value="CONF-0477"/>
<conformance value="SHOULD"/>
<requirement
value="Only professional/work contact information about the practitioner **SHOULD** be available to the patient"/>
</statement>
<statement>
<key value="CONF-0478"/>
<conformance value="SHOULD"/>
<requirement
value="Systems **SHOULD** 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 Practitioner.address.line and Practitioner.address.city."/>
</statement>
<statement>
<key value="CONF-0479"/>
<conformance value="MAY"/>
<requirement
value="Procedure codes … [MAY] be taken from SNOMED-CT, CPT, HCPCS II, ICD-10-PCS, CDT, or LOINC [for procedure.code]"/>
</statement>
<statement>
<key value="CONF-0480"/>
<conformance value="SHOULD"/>
<conditionality value="true"/>
<requirement
value="[If using LOINC codes in procedure.code] only LOINC concepts that reflect actual procedures **SHOULD** be used"/>
</statement>
<statement>
<key value="CONF-0481"/>
<conformance value="SHOULD"/>
<requirement
value="communication.preferred **MAY** designate a preferred language when multiple languages are represented"/>
</statement>
<statement>
<key value="CONF-0482"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="[For organizations participating in the ONC Health IT Certification program] Servers … **SHALL** support ... US Core Procedure Profile for communicating the reason or justification for a referral as Additional USCDI Requirements"/>
</statement>
<statement>
<key value="CONF-0484"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="[For organizations participating in the ONC Health IT Certification program,] 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."/>
</statement>
<statement>
<key value="CONF-0486"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="[For organizations participating in the ONC Health IT Certification program,] when using Procedure.reasonReference Servers **SHALL** support at least one target resource in Procedure.reasonReference"/>
</statement>
<statement>
<key value="CONF-0488"/>
<conformance value="SHOULD"/>
<conditionality value="true"/>
<requirement
value="[For organizations participating in the ONC Health IT Certification program,] when using Procedure.reasonReference …The referenced resources **SHOULD** be a US Core Profile as documented in [Referencing US Core Profiles](https://hl7.org/fhir/us/core/STU8/general-guidance.html#referencing-us-core-profiles)"/>
</statement>
<statement>
<key value="CONF-0489"/>
<conformance value="SHALL"/>
<requirement
value="The US Core Provenance resource **SHALL** be supported for … [this] US Core resource type AllergyIntolerance"/>
</statement>
<statement>
<key value="CONF-0490"/>
<conformance value="SHALL"/>
<requirement
value="The US Core Provenance resource **SHALL** be supported for … [this] US Core resource type CarePlan"/>
</statement>
<statement>
<key value="CONF-0491"/>
<conformance value="SHALL"/>
<requirement
value="The US Core Provenance resource **SHALL** be supported for … [this] US Core resource type CareTeam"/>
</statement>
<statement>
<key value="CONF-0492"/>
<conformance value="SHALL"/>
<requirement
value="The US Core Provenance resource **SHALL** be supported for … [this] US Core resource type Condition"/>
</statement>
<statement>
<key value="CONF-0493"/>
<conformance value="SHALL"/>
<requirement
value="The US Core Provenance resource **SHALL** be supported for … [this] US Core resource type Coverage"/>
</statement>
<statement>
<key value="CONF-0494"/>
<conformance value="SHALL"/>
<requirement
value="The US Core Provenance resource **SHALL** be supported for … [this] US Core resource type Device"/>
</statement>
<statement>
<key value="CONF-0495"/>
<conformance value="SHALL"/>
<requirement
value="The US Core Provenance resource **SHALL** be supported for … [this] US Core resource type DiagnosticReport"/>
</statement>
<statement>
<key value="CONF-0496"/>
<conformance value="SHALL"/>
<requirement
value="The US Core Provenance resource **SHALL** be supported for … [this] US Core resource type Document Reference"/>
</statement>
<statement>
<key value="CONF-0497"/>
<conformance value="SHALL"/>
<requirement
value="The US Core Provenance resource **SHALL** be supported for … [this] US Core resource type Encounter"/>
</statement>
<statement>
<key value="CONF-0498"/>
<conformance value="SHALL"/>
<requirement
value="The US Core Provenance resource **SHALL** be supported for … [this] US Core resource type Goal"/>
</statement>
<statement>
<key value="CONF-0499"/>
<conformance value="SHALL"/>
<requirement
value="The US Core Provenance resource **SHALL** be supported for … [this] US Core resource type Immunization"/>
</statement>
<statement>
<key value="CONF-0500"/>
<conformance value="SHALL"/>
<requirement
value="The US Core Provenance resource **SHALL** be supported for … [this] US Core resource type MedicationDispense"/>
</statement>
<statement>
<key value="CONF-0501"/>
<conformance value="SHALL"/>
<requirement
value="The US Core Provenance resource **SHALL** be supported for … [this] US Core resource type MedicationRequest"/>
</statement>
<statement>
<key value="CONF-0502"/>
<conformance value="SHALL"/>
<requirement
value="The US Core Provenance resource **SHALL** be supported for … [this] US Core resource type Observation"/>
</statement>
<statement>
<key value="CONF-0503"/>
<conformance value="SHALL"/>
<requirement
value="The US Core Provenance resource **SHALL** be supported for … [this] US Core resource type Patient"/>
</statement>
<statement>
<key value="CONF-0504"/>
<conformance value="SHALL"/>
<requirement
value="The US Core Provenance resource **SHALL** be supported for … [this] US Core resource type Procedure"/>
</statement>
<statement>
<key value="CONF-0505"/>
<conformance value="SHALL"/>
<requirement
value="The US Core Provenance resource **SHALL** be supported for … [this] US Core resource type QuestionnaireResponse"/>
</statement>
<statement>
<key value="CONF-0506"/>
<conformance value="SHALL"/>
<requirement
value="The US Core Provenance resource **SHALL** be supported for … [this] US Core resource type RelatedPerson"/>
</statement>
<statement>
<key value="CONF-0507"/>
<conformance value="SHALL"/>
<requirement
value="The US Core Provenance resource **SHALL** be supported for … [this] US Core resource type ServiceRequest"/>
</statement>
<statement>
<key value="CONF-0508"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="If a system receives a provider in Provenance.agent.who as free text, they must capture [the organization] who sent them the information [and upon] request ... **SHALL** provide this organization as the source"/>
</statement>
<statement>
<key value="CONF-0509"/>
<conformance value="MAY"/>
<conditionality value="true"/>
<requirement
value="If a system receives a provider in Provenance.agent.who as free text, … [upon request they] **MAY** include the free text provider."/>
</statement>
<statement>
<key value="CONF-0510"/>
<conformance value="SHOULD"/>
<requirement
value="Systems that need to know the activity has occurred **SHOULD** populate the activity [Provenance.activity]"/>
</statement>
<statement>
<key value="CONF-0511"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="If the QuestionnaireResponse is based on a non-FHIR form [then a] ... FHIR Questionnaire [needs to] represent at least the relevant metadata"/>
</statement>
<statement>
<key value="CONF-0512"/>
<conformance value="MAY"/>
<conditionality value="true"/>
<requirement
value="If the QuestionnaireResponse is based on a non-FHIR form [then a] … FHIR Questionnaire's questions may be omitted"/>
</statement>
<statement>
<key value="CONF-0513"/>
<conformance value="SHOULD"/>
<requirement
value="Systems **SHOULD** 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 RelatedPerson.address.line and RelatedPerson.address.city"/>
</statement>
<statement>
<key value="CONF-0514"/>
<conformance value="MAY"/>
<requirement
value="The Must Support `ServiceRequest.category` is bound, at a minimum, to the [US Core ServiceRequest Category Codes](https://hl7.org/fhir/us/core/STU8/ValueSet-us-core-servicerequest-category.html), and other category codes can be used."/>
</statement>
<statement>
<key value="CONF-0515"/>
<conformance value="SHOULD"/>
<requirement
value="The ServiceRequest.code value ... **SHOULD** be constrained to a subset for a particular use case or domain"/>
</statement>
<statement>
<key value="CONF-0516"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="[For organizations participating in the ONC Health IT Certification program] Servers … **SHALL** support ... US Core Service Request Profile for communicating the reason or justification for a referral as Additional USCDI Requirements"/>
</statement>
<statement>
<key value="CONF-0518"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="[For organizations participating in the ONC Health IT Certification program,] 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."/>
</statement>
<statement>
<key value="CONF-0520"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="[For organizations participating in the ONC Health IT Certification program,] when using ServiceRequest.reasonReference Servers **SHALL** support at least one target resource in ServiceRequest.reasonReference"/>
</statement>
<statement>
<key value="CONF-0522"/>
<conformance value="SHOULD"/>
<conditionality value="true"/>
<requirement
value="[For organizations participating in the ONC Health IT Certification program,] when using ServiceRequest.reasonReference …The referenced resources **SHOULD** be a US Core Profile as documented in [Referencing US Core Profiles](https://hl7.org/fhir/us/core/STU8/general-guidance.html#referencing-us-core-profiles)"/>
</statement>
<statement>
<key value="CONF-0523"/>
<conformance value="MAY"/>
<requirement
value="Since the binding [for Specimen.type and additional USCDI elements] is [extensible](http://hl7.org/fhir/R4/terminologies.html#extensible) when a code is unavailable, just text is allowed [and conformant]."/>
</statement>
<statement>
<key value="CONF-0524"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="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."/>
</statement>
<statement>
<key value="CONF-0532"/>
<conformance value="SHOULD"/>
<requirement
value="[Servers] **SHOULD** Support the ...
[SMART App Launch version 2.0.0 and later](http://hl7.org/fhir/smart-app-launch/history.html)"/>
</statement>
<statement>
<key value="CONF-0533"/>
<conformance value="SHALL"/>
<requirement
value="US Core Server **SHALL** support the US Core Patient resource profile"/>
</statement>
<statement>
<key value="CONF-0534"/>
<conformance value="SHALL"/>
<requirement
value="US Core Server **SHALL** support … at least one additional resource profile [in addition to the US Core Patient resource profile] from the list of US Core Profiles"/>
</statement>
<statement>
<key value="CONF-0535"/>
<conformance value="SHALL"/>
<requirement
value="US Core Server **SHALL**… Implement the RESTful behavior according to the FHIR specification."/>
</statement>
<statement>
<key value="CONF-0536"/>
<conformance value="SHALL"/>
<requirement
value="US Core Server **SHALL**… return the following response class (Status 400) [for] invalid parameters"/>
</statement>
<statement>
<key value="CONF-0537"/>
<conformance value="SHALL"/>
<requirement
value="US Core Server **SHALL**… return the following response class (Status 401/4xx) [for] unauthorized request"/>
</statement>
<statement>
<key value="CONF-0538"/>
<conformance value="SHALL"/>
<requirement
value="US Core Server **SHALL**… return the following response class (Status 403) [for] insufficient scopes"/>
</statement>
<statement>
<key value="CONF-0539"/>
<conformance value="SHALL"/>
<requirement
value="US Core Server **SHALL**… return the following response class (Status 404) [for] unknown resource"/>
</statement>
<statement>
<key value="CONF-0540"/>
<conformance value="SHALL"/>
<requirement
value="US Core Server **SHALL**… support JSON source formats for all US Core interactions."/>
</statement>
<statement>
<key value="CONF-0541"/>
<conformance value="SHOULD"/>
<requirement
value="US Core Server **SHOULD** … support XML source formats for all US Core interactions."/>
</statement>
<statement>
<key value="CONF-0542"/>
<conformance value="SHOULD"/>
<requirement
value="US Core Server **SHOULD** … identify the US Core profiles supported as part of the FHIR meta.profile attribute for each instance."/>
</statement>
<statement>
<key value="CONF-0543"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="A Server **SHALL** reject any unauthorized requests by returning an HTTP 401 "Unauthorized", HTTP 403 "Forbidden", or HTTP 404 "Not Found""/>
</statement>
<statement>
<key value="CONF-0548"/>
<conformance value="SHOULD"/>
<requirement
value="[US Core Servers] **SHOULD** support [$expand](http://hl7.org/fhir/OperationDefinition/ValueSet-expand) operation"/>
</statement>
<statement>
<key value="CONF-0549"/>
<conformance value="SHOULD"/>
<conditionality value="true"/>
<requirement
value="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"/>
</statement>
<statement>
<key value="CONF-0550"/>
<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-0552"/>
<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-0554"/>
<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-0556"/>
<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-0558"/>
<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-0560"/>
<conformance value="SHOULD"/>
<requirement
value="The selected time service **SHOULD** be documented in the Business Associate Agreement when available."/>
</statement>
<statement>
<key value="CONF-0562"/>
<conformance value="SHALL"/>
<requirement
value="Systems **SHALL** keep audit logs of the various transactions."/>
</statement>
<statement>
<key value="CONF-0564"/>
<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-0566"/>
<conformance value="SHOULD"/>
<requirement
value="US Federal systems **SHOULD** conform with FIPS PUB 140-2."/>
</statement>
<statement>
<key value="CONF-0568"/>
<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-0570"/>
<conformance value="SHALL"/>
<requirement
value="For Authentication and Authorization, Systems **SHALL** support any [SMART App Launch Version 2.0.0](http://hl7.org/fhir/smart-app-launch/history.html) for Client <-> Server interactions."/>
</statement>
<statement>
<key value="CONF-0572"/>
<conformance value="SHALL"/>
<requirement
value="Systems **SHALL** implement consent requirements per their state, local, and institutional policies."/>
</statement>
<statement>
<key value="CONF-0574"/>
<conformance value="SHOULD"/>
<requirement
value="The Business Associate Agreements **SHOULD** document systems’ mutual consent requirements."/>
</statement>
<statement>
<key value="CONF-0576"/>
<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-0578"/>
<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-0580"/>
<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-0583"/>
<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-0584"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="If the QuestionnaireResponse is based on a non-FHIR form [then a] ... FHIR Questionnaire [will communicate] the identifier of the non-FHIR form instead of the canonical URI using the US Core Extension Questionnaire URI extension."/>
</statement>
<statement>
<key value="CONF-0587"/>
<conformance value="SHALL"/>
<requirement
value="Each AllergyIntolerance Must Support: a verification status"/>
</statement>
<statement>
<key value="CONF-0588"/>
<conformance value="SHALL"/>
<requirement
value="Each AllergyIntolerance Must Support: a reaction manifestation"/>
</statement>
<statement>
<key value="CONF-0804"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="If any sub-element is marked as *Additional USCDI* [for a complex element], it must also meet the *Additional USCDI* requirements and satisfy the *Additional USCDI* requirements for the parent element."/>
</statement>
<statement>
<key value="CONF-0808"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="When a Reference type element is labeled as Must Support and has a single target profile referenced, the target profile **SHALL** be supported."/>
</statement>
<statement>
<key value="CONF-0810"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="When a Reference type element is labeled as Must Support, has multiple target profiles referenced, and specific targets are labeled as Must Support, the Must Support target profile(s) **SHALL** be supported."/>
</statement>
<statement>
<key value="CONF-0813"/>
<conformance value="MAY"/>
<conditionality value="true"/>
<requirement
value="[If a] slicer's Must Support property only defines the element level … Additional USCDI property[, i.e.,] no … Additional USCDI property is defined for the slice, then support for that slice's definition is optional."/>
</statement>
<statement>
<key value="CONF-0818"/>
<conformance value="SHALL"/>
<requirement
value="Servers **SHALL** support, at minimum, these … "Common Clinical Notes":
[Surgical Operation Note (11504-8)](https://loinc.org/11504-8.html)"/>
</statement>
<statement>
<key value="CONF-0819"/>
<conformance value="SHALL"/>
<requirement
value="Servers **SHALL** support, at minimum, these … "Common Clinical Notes":
[Emergency Department Note (34111-5)](https://loinc.org/34111-5.html)"/>
</statement>
<statement>
<key value="CONF-0820"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="Servers that support the USCDI Health Status/Assessments Data Class **SHALL** support the US Core Observation Screening Assessment Profile"/>
</statement>
<statement>
<key value="CONF-0821"/>
<conformance value="SHOULD"/>
<conditionality value="true"/>
<requirement
value="Servers that support the USCDI Health Status/Assessments Data Class ... **SHOULD** support the SDC Base Questionnaire and the US Core QuestionnaireResponse Profile.""/>
</statement>
<statement>
<key value="CONF-0822"/>
<conformance value="SHALL"/>
<requirement
value="For the US Core Simple Observation Profile, Servers **SHALL** support all the category codes [listed](https://hl7.org/fhir/us/core/STU8/screening-and-assessments.html#category-codes)."/>
</statement>
<statement>
<key value="CONF-0823"/>
<conformance value="SHALL"/>
<requirement
value="For the … US Core Observation Screening Assessment Profiles, Servers **SHALL** support all the category codes [listed](https://hl7.org/fhir/us/core/STU8/screening-and-assessments.html#category-codes)."/>
</statement>
<statement>
<key value="CONF-0824"/>
<conformance value="SHALL"/>
<requirement
value="For the US Core Condition Problems and Health Concerns Profile, Servers **SHALL** support the code ,"sdoh""/>
</statement>
<statement>
<key value="CONF-0825"/>
<conformance value="SHOULD"/>
<requirement
value="For the US Core Condition Problems and Health Concerns Profile, Servers **SHOULD** support the other category codes [listed](https://hl7.org/fhir/us/core/STU8/screening-and-assessments.html#category-codes)."/>
</statement>
<statement>
<key value="CONF-0826"/>
<conformance value="SHOULD"/>
<requirement
value="For the US Core ServiceRequest Profile, Servers **SHOULD** support all the [[listed](https://hl7.org/fhir/us/core/STU8/screening-and-assessments.html#category-codes)] category codes."/>
</statement>
<statement>
<extension
url="http://hl7.org/fhir/tools/StructureDefinition/requirements-statementshallnot">
<valueBoolean value="true"/>
</extension>
<key value="CONF-0827"/>
<requirement
value=" **SHALL NOT** be interpreted as search parameters for search. "/>
</statement>
<statement>
<key value="CONF-0828"/>
<conformance value="SHOULD"/>
<requirement
value="Servers ... **SHOULD** use the standard FHIR SearchParameters."/>
</statement>
<statement>
<key value="CONF-0831"/>
<conformance value="SHALL"/>
<requirement
value="[The Server **SHALL** support the] category of "problem-list-item""/>
</statement>
<statement>
<key value="CONF-0832"/>
<conformance value="SHALL"/>
<requirement
value="[The Server **SHALL** support the] category of "health-concern""/>
</statement>
<statement>
<key value="CONF-0836"/>
<conformance value="SHOULD"/>
<conditionality value="true"/>
<requirement
value="The `DiagnosticRequest.basedOn` element connects the DiagnosticReport to the originating order in the EHR. Systems that initiate the order **SHOULD** use this element when reporting the results."/>
</statement>
<statement>
<key value="CONF-0837"/>
<conformance value="SHOULD"/>
<requirement
value="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)."/>
</statement>
<statement>
<key value="CONF-0838"/>
<conformance value="SHOULD"/>
<requirement
value="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](http://hl7.org/fhir/R4/imagingstudy.html) resource."/>
</statement>
<statement>
<key value="CONF-0839"/>
<conformance value="SHOULD"/>
<conditionality value="true"/>
<requirement
value=" If the referenced a document or file [referenced by `DocumentReference.content.attachment.url`] is hosted on a Server outside the FHIR Server, it should be securely accessible using the same authorization credentials that were used to access the FHIR Server. This reduces complexity for the Client and improves the user experience."/>
</statement>
<statement>
<key value="CONF-0840"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="Although the [US Core Interpreter Needed] 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."/>
</statement>
<statement>
<key value="CONF-0841"/>
<conformance value="MAY"/>
<requirement
value="There is no guarantee that vaccine lot numbers are globally unique, and they are not recommended for matching or de-duplication across systems unless used with other data elements such as a vaccine product code, manufacturer code, or date of administration. Implementers **MAY** communicate the `Immunization.manufacturer` to ensure global uniqueness to lot numbers."/>
</statement>
<statement>
<key value="CONF-0842"/>
<conformance value="SHALL"/>
<requirement
value="Servers **SHALL** return all active medications following the [Get All Active Medications](https://hl7.org/fhir/us/core/STU8/medication-list.html#get-all-active-medications) guidance."/>
</statement>
<statement>
<key value="CONF-0843"/>
<conformance value="SHOULD"/>
<conditionality value="true"/>
<requirement
value="[For US Core Laboratory Result Observation Profile, even] when the specimen type is already implied by the LOINC code used in `Observation.code` (e.g., a LOINC code for Blood Glucose), the `Observation.specimen` element **SHOULD** also be populated with the referenced Specimen resource to explicitly communicate the collected specimen type."/>
</statement>
<statement>
<key value="CONF-0844"/>
<conformance value="SHOULD"/>
<requirement
value="[For US Core Laboratory Result Observation Profile, the] type of specimen [in `Observation.specimen`] **SHOULD** not conflict with the LOINC code [in `Observation.code`]."/>
</statement>
<statement>
<key value="CONF-0845"/>
<conformance value="SHALL"/>
<requirement
value="[For the US Core Observation Screening Assessment Profile, the] category type "survey" is required."/>
</statement>
<statement>
<key value="CONF-0850"/>
<conformance value="SHOULD"/>
<requirement
value="[For the US Core Observation Screening Assessment Profile,] when using Observation.derivedFrom to reference an Observation, the referenced Observation **SHOULD** be a US Core Observation."/>
</statement>
<statement>
<key value="CONF-0851"/>
<conformance value="MAY"/>
<requirement
value="Servers can use 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)] or the [US Core Encounter Profile](https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-encounter.html) to communicate whether a patient needs an interpreter."/>
</statement>
<statement>
<key value="CONF-0852"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="Although the [[US Core Interpreter Needed Extension](https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-interpreter-needed.html)] 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."/>
</statement>
<statement>
<key value="CONF-0855"/>
<conformance value="SHOULD"/>
<requirement
value="Systems **SHOULD** designate the patient's preferred language in the Patient.communication.preferred element."/>
</statement>
<statement>
<key value="CONF-0856"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="The `Procedure.performed` is mandatory if `Procedure.status` is "completed" or "in-progress"."/>
</statement>
<statement>
<key value="CONF-0857"/>
<conformance value="SHOULD"/>
<requirement
value="[In the [US Core ServiceRequest Profile](https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-servicerequest.html), for] the USCDI Laboratory Order, ... implementers **SHOULD** use the corresponding category codes listed ... below:
- [108252007 Laboratory procedure (procedure)](https://browser.ihtsdotools.org/?perspective=full&conceptId1=108252007&edition=MAIN/2024-10-01&release=&languages=en&latestRedirect=false)"/>
</statement>
<statement>
<key value="CONF-0858"/>
<conformance value="SHOULD"/>
<requirement
value="[In the [US Core ServiceRequest Profile](https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-servicerequest.html), for] the USCDI ... Clinical Test Order, ... implementers **SHOULD** use the corresponding category codes listed ... below:
- [386053000 Evaluation procedure (procedure)](https://browser.ihtsdotools.org/?perspective=full&conceptId1=386053000&edition=MAIN/2024-10-01&release=&languages=en&latestRedirect=false)
- [410606002 Social service procedure (procedure)](https://browser.ihtsdotools.org/?perspective=full&conceptId1=410606002&edition=MAIN/2024-10-01&release=&languages=en&latestRedirect=false)
- [387713003 Surgical procedure (procedure)](https://browser.ihtsdotools.org/?perspective=full&conceptId1=387713003&edition=MAIN/2024-10-01&release=&languages=en&latestRedirect=false)"/>
</statement>
<statement>
<key value="CONF-0859"/>
<conformance value="SHOULD"/>
<requirement
value="[In the [US Core ServiceRequest Profile](https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-servicerequest.html), for] the USCDI ... Imaging Order, ... implementers **SHOULD** use the corresponding category codes listed ... below:
- [363679005 Imaging (procedure)](https://browser.ihtsdotools.org/?perspective=full&conceptId1=363679005&edition=MAIN/2024-10-01&release=&languages=en&latestRedirect=false)"/>
</statement>
<statement>
<key value="CONF-0860"/>
<conformance value="SHOULD"/>
<requirement
value="[In the [US Core ServiceRequest Profile](https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-servicerequest.html), for] the USCDI ... Procedure Order Data Elements, implementers **SHOULD** use the corresponding category codes listed ... below:
- [386053000 Evaluation procedure (procedure)](https://browser.ihtsdotools.org/?perspective=full&conceptId1=386053000&edition=MAIN/2024-10-01&release=&languages=en&latestRedirect=false)
- [410606002 Social service procedure (procedure)](https://browser.ihtsdotools.org/?perspective=full&conceptId1=410606002&edition=MAIN/2024-10-01&release=&languages=en&latestRedirect=false)
- [387713003 Surgical procedure (procedure)](https://browser.ihtsdotools.org/?perspective=full&conceptId1=387713003&edition=MAIN/2024-10-01&release=&languages=en&latestRedirect=false)"/>
</statement>
<statement>
<key value="CONF-0864"/>
<conformance value="SHALL"/>
<requirement
value="An Observation without a value, **SHALL** include a reason why the data is absent unless there are 1) component observations, or 2) reporting panel observations using Observation.hasMember. "/>
</statement>
<statement>
<key value="CONF-0865"/>
<conformance value="MAY"/>
<conditionality value="true"/>
<requirement
value="Systems that never provide an observation without a value are not required to support `Observation.dataAbsentReason`."/>
</statement>
<statement>
<key value="CONF-0866"/>
<conformance value="SHALL"/>
<requirement
value="An `Observation.component` without a value, **SHALL** include a reason why the data is absent. "/>
</statement>
<statement>
<key value="CONF-0867"/>
<conformance value="MAY"/>
<conditionality value="true"/>
<requirement
value="Systems that never provide a component observation without a component value are not required to support `Observation.component.dataAbsentReason`."/>
</statement>
<statement>
<key value="CONF-0868"/>
<conformance value="SHALL"/>
<requirement
value="Although '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. Servers are not required to support both, but **SHALL** support at least one."/>
</statement>
<statement>
<key value="CONF-0870"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="[I]f a slice is labeled as Must Support... and the slicer element is not labeled as Must Support..., then if the Server... 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-0871"/>
<conformance value="MAY"/>
<conditionality value="true"/>
<requirement
value="[If a] slicer's Must Support property only defines the element level Must Support...[, i.e.,] no Must Support... property is defined for the slice, then support for that slice's definition is optional."/>
</statement>
<statement>
<key value="CONF-0872"/>
<conformance value="SHALL"/>
<conditionality value="true"/>
<requirement
value="[I]f a slice is labeled as Must Support... and the slicer element is ... labeled as Must Support..., then ... the Server... [**SHALL** support] the element[ and] the slice's definition."/>
</statement>
<statement>
<key value="CONF-0881"/>
<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 Responders **SHALL** be capable of providing [such an element] with a valid reference to *at least one* target profile."/>
</statement>
<statement>
<key value="CONF-0885"/>
<conformance value="SHOULD"/>
<requirement
value="The author is communicated by the elements and the author's role by the referenced target resource (for example, Patient, Practitioner/PractitionerRole, RelatedPerson, Device). Details about the author's role are contained in the target resource's contents. Many of these elements are labeled Must Support or Additional USCDI Requirements. However,[even if they are not labeled Must Support or Additional USCDI Requirements] all of these elements and target resources **SHOULD** be supported in the profiles if the system captures the data."/>
</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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