FHIR Extensions Pack, published by HL7 International / FHIR Infrastructure. This guide is not an authorized publication; it is the continuous build for version 5.4.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/fhir-extensions/ and changes regularly. See the Directory of published versions
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Home Page
Official URL: http://hl7.org/fhir/extensions/ImplementationGuide/hl7.fhir.uv.extensions
The Extension Pack defines the FHIR extensions that are globally defined and available in
all implementation contexts. Prior to R5
these extensions were defined in the core specification, but starting from R5
they have been moved out of the specification into a separate extensions pack
so that the extensions can be updated more often than the base specification.
This extension pack also defines some search parameters for the extensions.
The FHIR Extension Pack is intended for use with
all supported versions of FHIR.
While the Extension Pack definitions are based on R5, most of the extensions can
be used as-is or with a little modification with earlier versions of the
specification:
There is information on each extension description describing the use of the extension with other FHIR Versions
A very few extensions can't be used in earlier versions
There are packages for use with older versions with tooling based packages: hl7.fhir.uv.extensions.r4 and hl7.fhir.uv.extensions.r3
The version of the Extensions Pack (5.3.0) is not the same as the FHIR version, since it applies equally to
FHIR versions R5, R4, R4B, and R3
Changes in this version
This is the May 2026 release (5.3.0) of the Extension Pack. The following is a summary of major changes since the last release:
The conversion maps have been removed from this release - they have moved to the cross-extensions publications
A significant new feature in this release is that extensions are transformed to R4 and R3 versions, so that the
extension definitions found in the .r4 and .r3 packages are fully valid. This involves: making sure that appropriate
CodeSystem and ValueSet resources are included, and using sets of extensions in place of data types defined in
later versions. A summary of this work is provided.
References to the extensions defined in this extension pack are found in Extension.url
or in profile references to defined extensions in ElementDefinition.type.profile.
While the profile references may be versioned using canonical versioned references,
the most important references are in Extension.url and these are version-less.
For this reason, the extensions defined in this extension pack are managed very conservatively with regard to
breaking changes:
Extensions that are active are not subject to breaking changes. New extensions will be introduced if necessary
Extensions labelled 'draft' may have breaking changes if the FHIR Management Group is satisfied that they are not in
use in production, or if all the existing users agree to making the change. The exact rules and processes are still
being discussed, but not all 'draft' extensions are subject to change
In this regard, the definitions for breaking change to Normative artifacts
apply. Note that the focus of these rules is preserving the validity and meaning of existing extensions, not preventing applications
processing extensions from having to change
The extensions all have the status of 'trial-use' but once they are active they are treated as normative. The FHIR
Management Group has not yet decided how these extensions will be balloted in the future
If a breaking change needs to be introduced to an extension, the original extension will be marked as deprecated and a new one will be created. If the scope of the extension has significantly changed, it may be given a completely new URL. If the scope is largely the same, the url will remain the same, except that a version will be appended. E.g. "[original url]-v2". The deprecated extension will have a note added that points to the replacing extension.
These extensions are defined for use across multiple versions - all versions from R3 forwards.
The base definitions are based on R5. Where the extensions use R5 features, notes about how the
extensions work in previous versions can be found as part of the extension definition.
Some extensions are not appropriate for use with some versions of FHIR. This typically
arises where an extension is defined for use in R4, but in a later version (R5 or R6), a
specific element is introduced to carry the data the extension is defined for. In such cases,
the extensions are labelled with which versions of FHIR they are appropriate for use with.
Intellectual Property Considerations
This implementation guide and the underlying FHIR specification are licensed as public domain under the FHIR license. The
license page also describes rules for the use of the FHIR name and logo.
This guide includes extensions making use of terminologies such
as LOINC and SNOMED CT that have more restrictive licensing requirements. Implementers should make themselves familiar with licensing and
any other constraints of terminologies used as part of their implementation process.
Licencing requirements may limit the systems to which data recorded using certain codes may be shared.
This publication includes IP covered under the following statements.
National Uniform Claim Committee (NUCC) Copyright 2026 American Medical Association. The National Uniform Claim Committee (NUCC) maintains the Health Insurance Claim Form (1500 Claim Form), the 1500 Health Insurance Claim Form Reference Instruction Manual (NUCC 1500 Instruction Manual) and two NUCC Data Sets, the Health Care Provider Taxonomy Code Set and the Provider Characteristics and Resources code set. As the NUCC Secretariat, the AMA holds the intellectual property on behalf of the NUCC and maintains the copyright of materials developed by the NUCC. For commercial use, including sales and redistribution, a license must be obtained.
These codes are excerpted from ASTM Standard, E1762-95(2013) - Standard Guide for Electronic Authentication of Health Care Information, Copyright by ASTM International, 100 Barr Harbor Drive, West Conshohocken, PA 19428. Copies of this standard are available through the ASTM Web Site at www.astm.org.
These codes are excerpted from ETSI Standard for Digital Signatures and XAdES, Copyright by ETSI International. Copies of this standard are available through the ETSI Web Site at www.etsi.org.
These codes are excerpted from ISO Standard, TS 21089-2017 - Health Informatics - Trusted End-to-End Information Flows, Copyright by ISO International. Copies of this standard are available through the ISO Web Site at www.iso.org.
This material contains content that is copyright of SNOMED International. Implementers of these specifications must have the appropriate SNOMED CT Affiliate license - for more information contact https://www.snomed.org/get-snomed or info@snomed.org.
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