The functional requirement is mandatory. Applications that do not implement this functional behavior are considered non-conformant.

The functional requirement is a recommendation. Applications are strongly encouraged to implement this functional behavior, but are still conformant if they do not.

The functional requirement is an option worthy of consideration but there is no expectation or recommendation associated with its use. NOTE: Elements not flagged with any obligation are intrinsically still 'MAY' (unless constraints dictate otherwise), but have not specifically been called out by the author as worthy of consideration.

Resource producers are applications that assembles resources in the first place. Resource producers may be a server, client, sender, receiver or some middleware device, and they may store the resource, or merely hand it on.

Exchangers do not produce or consume resources; they only pass the resource on. They may store the resource in a persistent store between reception and subsequent transfer. The generic FHIR servers are exchangers, as are most middleware systems. Note that Exchanger obligations may also be taken on by Producers or Consumers if they act as intermediaries between other systems or between systems and users.

Resource Consumers are applications that consume resources and do something with them, either displaying them to humans, transferring them to some other format for further re-use, or using them to drive some kind of application logic process AKA decision support. Resource Consumers often store resources, but do not need to, and whether resources are stored or not between receiving them and using them doesn't make any difference to the obligations

Conformant applications producing resources SHALL/SHOULD/MAY be able to correctly populate this element. Notes: Typically, this means that an application needs to demonstrate during some conformance testing process that there are some conditions under which it populates the element with a correct value. (i.e. not a data-absent-reason or equivalent.) This obligation does not impose expectations on the circumstances in which the element will be sent, only that it can be in at least some situations.

Conformant applications producing resources SHALL/SHOULD correctly populate this element if they know a value for the element, but it is acceptable if the system is unable to ever know a value for the element. Notes: This obligation does not impose a requirement to be able to know a value, unlike populate and able-to-populate which do. 'Knowing' an element means that a value for the element is available in memory, persistent store, or is otherwise available within the system claiming conformance.

Conformant applications producing resources SHALL/SHOULD include this element if a value is known and allowed to be shared. Notes: This implementation obligation means that whenever the producer knows the correct value for an element, it populates it. This is NOT the same as cardinality, as a 'populate' element can be omitted if no data exists or the data that exists is prohibited from being shared. Organizations might be required to formally document their rules for determining when they are 'able to share' as part of conformance testing processes. (e.g. regulatory, consent, etc.)

Conformant applications SHALL/SHOULD/MAY ensure that this data element is represented in any human readable representation of a resource. Notes: When no value for an element is known, the producer populates the narrative with the content of any nested ElementDefinition.valueAlternatives extensions such as DataAbsentReason. If no particular reason is known or reportable, the element can simply be indicated as 'unknown' in the narrative.

Conformant applications SHALL/SHOULD ensure that this data element is NOT represented in any human readable representation of a resource. Notes: This may be useful for profiles related to de-identified records

Conformant applications SHALL/SHOULD/MAY ensure that users can enter a value for this element during data input/capture. Notes: Exactly what form the input takes is not specified, but the expectation is that this is a value that comes from the user, and not implied internally by the application.

Documentation applicable to Conformant applications SHALL/SHOULD explain how this element is handled. Notes: this is really a rule about specifications, implying that another specification (which might be application documentation) either makes this element populate, or explains how the use cases that involve this element do not arise, or how they are handled. An example: IPA marks Patient.active must-handle and must-explain. Client applications must process Patient.active correctly if they see it, but many (though not all) specifications and/or applications ensure that Patient.active will never be false, and so it will never be populated e.g. MedMij in Netherlands prohibits use of Patient.active, and explains that it is never false.

Conformant applications SHALL/SHOULD/MAY ensure that the value for this element is stored in a persistent data store. Notes: Exactly what the data store is not specified, nor how long it is stored for, but it is understood that the same value will be available in later exchanges

Conformant applications SHALL/SHOULD ensure that this element does not change between receiving and transfer. Notes: This does not mean that the element value cannot change, only that changing the element value for an element marked with this obligation moves an application from being an exchanger to a Consumer and a Producer, and those obligations apply

Conformant applications SHALL/SHOULD accept resources containing any valid value for the element without error. Notes: Applications are still able to inform the user that a value cannot be processed correctly and may ignore the data, but applications aren't able to reject an instance merely because the element is present (which would be allowed for elements that do not have this obligation). A system MAY raise an error if the value provided is not valid or violates specific business rules. This obligation also applies to elements that only contain an extension in place of a value where (or equivalent), should either of these be allowed on the consumer obligations

Conformant applications SHALL/SHOULD check that values for this element meet all data constraints asserted within the profile declaring this obligation. If validity issues are found, the system SHALL/SHOULD not accept the instance. Notes: This applies to validating the element with the obligation, but not resources referenced by it.

Conformant applications SHALL/SHOULD accept data that does not meet all data constraints asserted within the profile declaring this obligation. This applies to non-valid constraints, not to non-valid syntax or failure to meet base resource validity expectations. Typically used when a system needs to be able to handle data that does not adhere to desired expectations (legacy data, test data, data undergoing authorship that is not yet complete, etc.)

Conformant applications SHALL/SHOULD handle the meaning of this element correctly. Notes: this rule is vague in that doesn't specify any particular handling of the element. But it's important because an application that ignores this element is non-conformant. A good example would be a status code of 'entered-in-error' - how exactly a Resource Consumer handles this depends on the use case etc., but the application can never simply ignore such a status code. Note that whether the resource or information from it is stored for later use is irrelevant - when the resource or information in it is processed, the consequences of the element are considered. That may mean not retaining the information for later use, or informing the user, etc. Typically, this obligation marks that there are known patient safety issues that can arise if the element is ignored. Implementers should pay particular attention to the possible range of values for the element from a safety perspective.

Conformant applications SHALL/SHOULD/MAY display the value of this element when presenting the data from the resource to a human user. Notes: exactly how it is displayed is not specified, but it means that a human looking at the content of the resource is made aware of the value of the element so that they can consider the meaning of the resource

Conformant applications SHALL/SHOULD/MAY consider the value of this element when processing the resource as specified by the IG. Notes: this implies that the IG that specifies this obligation provides details about what processing is to be performed, and the obligation specifially relates to the processing specified in the IG of any ElementDefinition.valueAlternatives extensions as well as the value (or other extensions explicitly declared beneath the element in the profile containing the obligation. Examples might include consideration in decision support, consideration in claims evaluation, etc.

Conformant applications SHALL/SHOULD/MAY print the value of this element somewhere. Notes: The form of the printing is not specified. A profile using this value SHALL explain the nature of the printing requirement somehow

Conformant applications SHALL/SHOULD/MAY not make any use of the value of this element if received.

Conformant applications producing resources SHALL be able to correctly populate this element. Notes: Typically, this means that an application needs to demonstrate during some conformance testing process that there are some conditions under which it populates the element with a correct value. (i.e. not a data-absent-reason or equivalent.) This obligation does not impose expectations on the circumstances in which the element will be sent, only that it can be in at least some situations.

Conformant applications producing resources SHOULD be able to correctly populate this element. Notes: Typically, this means that an application needs to demonstrate during some conformance testing process that there are some conditions under which it populates the element with a correct value. (i.e. not a data-absent-reason or equivalent.) This obligation does not impose expectations on the circumstances in which the element will be sent, only that it shold be in at least some situations.

Conformant applications producing resources MAY be able to correctly populate this element. Notes: Typically, this means that an application needs to demonstrate during some conformance testing process that there are some conditions under which it populates the element with a correct value. (i.e. not a data-absent-reason or equivalent.) This obligation does not impose expectations on the circumstances in which the element will be sent, only that it may be in at least some situations. This is a null statement and is the default behavior for originating systems if other obligations are not specified.

Conformant applications producing resources SHALL correctly populate this element if they know a value for the element, but it is acceptable if the system is unable to ever know a value for the element. Notes: This obligation does not impose a requirement to be able to know a value, unlike populate and able-to-populate which do. 'Knowing' an element means that a value for the element is available in memory, persistent store, or is otherwise available within the system claiming conformance.

Conformant applications producing resources SHOULD correctly populate this element if they know a value for the element, but it is acceptable if the system is unable to ever know a value for the element. Notes: This obligation does not impose a requirement to be able to know a value, unlike populate and able-to-populate which do. 'Knowing' an element means that a value for the element is available in memory, persistent store, or is otherwise available within the system claiming conformance.

Conformant applications producing resources SHALL include this element if a value is known and allowed to be shared. Notes: This implementation obligation means that whenever the producer knows the correct value for an element, it populates it. This is NOT the same as cardinality, as a 'populate' element can be omitted if no data exists or the data that exists is prohibited from being shared. Organizations might be required to formally document their rules for determining when they are 'able to share' as part of conformance testing processes. (e.g. regulatory, consent, etc.)

Conformant applications producing resources SHOULD include this element if a value is known and allowed to be shared. Notes: This implementation obligation means that whenever the producer knows the correct value for an element, it should populate it. This is NOT the same as cardinality, as a 'populate' element can be omitted if no data exists or the data that exists is prohibited from being shared. Organizations might be required to formally document their rules for determining when they are 'able to share' as part of conformance testing processes. (e.g. regulatory, consent, etc.)

Conformant applications SHALL ensure that this data element is represented in any human readable representation of a resource. Notes: When no value for an element is known, the producer populates the narrative with the content of any nested ElementDefinition.valueAlternatives extensions such as DataAbsentReason. If no particular reason is known or reportable, the element can simply be indicated as 'unknown' in the narrative.

Conformant applications SHOULD ensure that this data element is represented in any human readable representation of a resource. Notes: When no value for an element is known, the producer populates the narrative with the content of any nested ElementDefinition.valueAlternatives extensions such as DataAbsentReason. If no particular reason is known or reportable, the element can simply be indicated as 'unknown' in the narrative.

Conformant applications MAY ensure that this data element is represented in any human readable representation of a resource. Notes: When no value for an element is known, the producer populates the narrative with the content of any nested ElementDefinition.valueAlternatives extensions such as DataAbsentReason. If no particular reason is known or reportable, the element can simply be indicated as 'unknown' in the narrative.

Conformant applications SHALL ensure that this data element is NOT represented in any human readable representation of a resource. Notes: This may be useful for profiles related to de-identified records

Conformant applications SHOULD ensure that this data element is NOT represented in any human readable representation of a resource. Notes: This may be useful for profiles related to de-identified records

Conformant applications SHALL ensure that users can enter a value for this element during data input/capture. Notes: Exactly what form the input takes is not specified, but the expectation is that this is a value that comes from the user, and not implied internally by the application.

Conformant applications SHOULD ensure that users can enter a value for this element during data input/capture. Notes: Exactly what form the input takes is not specified, but the expectation is that this is a value that comes from the user, and not implied internally by the application.

Conformant applications MAY ensure that users can enter a value for this element during data input/capture. Notes: Exactly what form the input takes is not specified, but the expectation is that this is a value that comes from the user, and not implied internally by the application.

Documentation applicable to Conformant applications SHALL explain how this element is handled. Notes: this is really a rule about specifications, implying that another specification (which might be application documentation) either makes this element populate, or explains how the use cases that involve this element do not arise, or how they are handled. An example: IPA marks Patient.active must-handle and must-explain. Client applications must process Patient.active correctly if they see it, but many (though not all) specifications and/or applications ensure that Patient.active will never be false, and so it will never be populated e.g. MedMij in Netherlands prohibits use of Patient.active, and explains that it is never false.

Documentation applicable to Conformant applications SHOULD explain how this element is handled. Notes: this is really a rule about specifications, implying that another specification (which might be application documentation) either makes this element populate, or explains how the use cases that involve this element do not arise, or how they are handled. An example: IPA marks Patient.active must-handle and must-explain. Client applications must process Patient.active correctly if they see it, but many (though not all) specifications and/or applications ensure that Patient.active will never be false, and so it will never be populated e.g. MedMij in Netherlands prohibits use of Patient.active, and explains that it is never false.

Conformant applications SHALL ensure that the value for this element is stored in a persistent data store. Notes: Exactly what the data store is not specified, nor how long it is stored for, but it is understood that the same value will be available in later exchanges

Conformant applications SHOULD ensure that the value for this element is stored in a persistent data store. Notes: Exactly what the data store is not specified, nor how long it is stored for, but it is understood that the same value will be available in later exchanges

Conformant applications MAY ensure that the value for this element is stored in a persistent data store. Notes: Exactly what the data store is not specified, nor how long it is stored for, but it is understood that the same value will be available in later exchanges

Conformant applications SHALL ensure that this element does not change between receiving and transfer. Notes: This does not mean that the element value cannot change, only that changing the element value for an element marked with this obligation moves an application from being an exchanger to a Consumer and a Producer, and those obligations apply

Conformant applications SHOULD ensure that this element does not change between receiving and transfer. Notes: This does not mean that the element value cannot change, only that changing the element value for an element marked with this obligation moves an application from being an exchanger to a Consumer and a Producer, and those obligations apply

Conformant applications MAY choose to alter this element value. Notes: this is really a null-statement - it's the default rule for an application. It's defined here to allow a specification to be explicit that it isn't conveying obligations for resource producers

Conformant applications SHALL accept resources containing any valid value for the element without error. Notes: Applications are still able to inform the user that a value cannot be processed correctly and may ignore the data, but applications aren't able to reject an instance merely because the element is present (which would be allowed for elements that do not have this obligation). A system MAY raise an error if the value provided is not valid or violates specific business rules. This obligation also applies to elements that only contain an extension in place of a value where (or equivalent), should either of these be allowed on the consumer obligations

Conformant applications SHOULD accept resources containing any valid value for the element without error. Notes: Applications are still able to inform the user that a value cannot be processed correctly and may ignore the data, but applications aren't able to reject an instance merely because the element is present (which would be allowed for elements that do not have this obligation). A system MAY raise an error if the value provided is not valid or violates specific business rules. This obligation also applies to elements that only contain an extension in place of a value where (or equivalent), should either of these be allowed on the consumer obligations

Conformant applications SHALL check that values for this element meet all data constraints asserted within the profile declaring this obligation. If validity issues are found, the system SHALL not accept the instance. Notes: This applies to validating the element with the obligation, but not resources referenced by it.

Conformant applications SHOULD check that values for this element meet all data constraints asserted within the profile declaring this obligation. If validity issues are found, the system SHOULD not accept the instance. Notes: This applies to validating the element with the obligation, but not resources referenced by it.

Conformant applications SHALL accept data that does not meet all data constraints asserted within the profile declaring this obligation. This applies to non-valid constraints, not to non-valid syntax or failure to meet base resource validity expectations. Typically used when a system needs to be able to handle data that does not adhere to desired expectations (legacy data, test data, data undergoing authorship that is not yet complete, etc.)

Conformant applications SHOULD accept data that does not meet all data constraints asserted within the profile declaring this obligation. This applies to non-valid constraints, not to non-valid syntax or failure to meet base resource validity expectations. Typically used when a system ought to be able to handle data that does not adhere to desired expectations (legacy data, test data, data undergoing authorship that is not yet complete, etc.)

Conformant applications SHALL handle the meaning of this element correctly. Notes: this rule is vague in that doesn't specify any particular handling of the element. But it's important because an application that ignores this element is non-conformant. A good example would be a status code of 'entered-in-error' - how exactly a Resource Consumer handles this depends on the use case etc., but the application can never simply ignore such a status code. Note that whether the resource or information from it is stored for later use is irrelevant - when the resource or information in it is processed, the consequences of the element are considered. That may mean not retaining the information for later use, or informing the user, etc. Typically, this obligation marks that there are known patient safety issues that can arise if the element is ignored. Implementers should pay particular attention to the possible range of values for the element from a safety perspective.

Conformant applications SHOULD handle the meaning of this element correctly. Notes: this rule is vague in that doesn't specify any particular handling of the element. But it's important because an application that ignores this element is non-conformant. A good example would be a status code of 'entered-in-error' - how exactly a Resource Consumer handles this depends on the use case etc., but the application can never simply ignore such a status code. Note that whether the resource or information from it is stored for later use is irrelevant - when the resource or information in it is processed, the consequences of the element are considered. That may mean not retaining the information for later use, or informing the user, etc. Typically, this obligation marks that there are known patient safety issues that can arise if the element is ignored. Implementers should pay particular attention to the possible range of values for the element from a safety perspective.

Conformant applications SHALL display the value of this element when presenting the data from the resource to a human user. Notes: exactly how it is displayed is not specified, but it means that a human looking at the content of the resource is made aware of the value of the element so that they can consider the meaning of the resource

Conformant applications SHOULD display the value of this element when presenting the data from the resource to a human user. Notes: exactly how it is displayed is not specified, but it means that a human looking at the content of the resource is made aware of the value of the element so that they can consider the meaning of the resource

Conformant applications MAY display the value of this element when presenting the data from the resource to a human user. Notes: exactly how it is displayed is not specified, but it means that a human looking at the content of the resource is made aware of the value of the element so that they can consider the meaning of the resource

Conformant applications SHALL consider the value of this element when processing the resource as specified by the IG. Notes: this implies that the IG that specifies this obligation provides details about what processing is to be performed, and the obligation specifially relates to the processing specified in the IG of any ElementDefinition.valueAlternatives extensions as well as the value (or other extensions explicitly declared beneath the element in the profile containing the obligation. Examples might include consideration in decision support, consideration in claims evaluation, etc.

Conformant applications SHOULD consider the value of this element when processing the resource as specified by the IG. Notes: this implies that the IG that specifies this obligation provides details about what processing is to be performed, and the obligation specifially relates to the processing specified in the IG of any ElementDefinition.valueAlternatives extensions as well as the value (or other extensions explicitly declared beneath the element in the profile containing the obligation. Examples might include consideration in decision support, consideration in claims evaluation, etc.

Conformant applications MAY consider the value of this element when processing the resource as specified by the IG. Notes: this implies that the IG that specifies this obligation provides details about what processing is to be performed, and the obligation specifially relates to the processing specified in the IG of any ElementDefinition.valueAlternatives extensions as well as the value (or other extensions explicitly declared beneath the element in the profile containing the obligation. Examples might include consideration in decision support, consideration in claims evaluation, etc.

Conformant applications SHALL print the value of this element somewhere. Notes: The form of the printing is not specified. A profile using this value SHALL explain the nature of the printing requirement somehow

Conformant applications SHOULD print the value of this element somewhere. Notes: The form of the printing is not specified. A profile using this value SHALL explain the nature of the printing requirement somehow

Conformant applications MAY print the value of this element somewhere. Notes: The form of the printing is not specified. A profile using this value SHALL explain the nature of the printing requirement somehow

Conformant applications SHALL not make any use of the value of this element if received.

Conformant applications SHOULD not make any use of the value of this element if received.

Conformant applications MAY not make any use of the value of this element if received. This is a null statement and is the default behavior or consuming systems if other obligations are not specified.

RE as defined in chapter 2 of the v2 specification

R2 as defined in IHE Appendix Z

The standard recommended set of obligations for IGs to use unless they know they want something different. Note that the standard codes don't include use-dar, use-dar-nf, use-dar-if-allowed / use-reason - that gets put on specific elements that justify this handling