US Quality Core Implementation Guide, published by HL7 International / Clinical Quality Information. This guide is not an authorized publication; it is the continuous build for version 1.0.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/fhir-us-quality-core/ and changes regularly. See the Directory of published versions

US Quality Core Downloads

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Full Implementation Guide

The following file contains the complete, downloadable implementation guide:

• Full IG

IG Package

The following file is the FHIR IG Package NPM Subset:

• package.tgz

Definitions

In addition to the above, format-specific definitions are provided:

• XML
• JSON
• TTL

These files should be the first choice whenever generating any implementation artifacts since they contain all of the rules about what makes these US Quality Core profiles valid. Implementers will still need to be familiar with the content of the specification and profiles that apply in order to make a conformant implementation. See the overview on validating FHIR profiles and resources for more information about validating profiles and how to use these artifacts.

Examples

All examples used in this Implementation Guide:

• XML
• JSON
• TTL

Dependencies

Package hl7.fhir.uv.extensions.r4#5.2.0 This IG defines the global extensions - the ones defined for everyone. These extensions are always in scope wherever FHIR is being used (built Mon, Feb 10, 2025 21:45+1100+11:00)

Package hl7.fhir.uv.extensions.r4#1.0.0 This IG defines the global extensions - the ones defined for everyone. These extensions are always in scope wherever FHIR is being used (built Sun, Mar 26, 2023 08:46+1100+11:00)

Package hl7.fhir.uv.xver-r5.r4#0.1.0 Extensions for Using Data Elements from FHIR R5 in FHIR R4 (built Fri, Mar 20, 2026 15:40+1100+11:00)

Package hl7.fhir.uv.tools.r4#1.1.2 This IG defines the extensions that the tools use internally. Some of these extensions are content that are being evaluated for elevation into the main spec, and others are tooling concerns (built Tue, Mar 24, 2026 11:13+1100+11:00)

Package hl7.fhir.uv.extensions.r4#5.3.0-ballot-tc1 This IG defines the global extensions - the ones defined for everyone. These extensions are always in scope wherever FHIR is being used (built Sun, Aug 3, 2025 06:28+1000+10:00)

Package hl7.fhir.uv.sdc#4.0.0 The SDC specification provides an infrastructure to standardize the capture and expanded use of patient-level data collected within an EHR. (built Tue, Mar 24, 2026 16:16+1100+11:00)

Package hl7.fhir.uv.extensions.r4#5.3.0 This IG defines the global extensions - the ones defined for everyone. These extensions are always in scope wherever FHIR is being used (built Sat, May 16, 2026 18:32+1000+10:00)

Package hl7.fhir.us.core#9.0.0 The US Core Implementation Guide defines the minimum set of FHIR RESTful interactions for each of the US Core Profiles to access patient data. The Data Access Framework and the Argonaut DSTU2 guides initially formed the basis for US Core. The Profiles are updated annually to support the latest requirements from The Office of the National Coordinator for Health Information Technology (ONC) U.S. Core Data for Interoperability (USCDI). For a summary of significant changes and a detailed list of the changes between versions, see the Change Notes at https://hl7.org/fhir/us/core/changes.html (built Sun, May 31, 2026 03:27+1000+10:00)

Cross Version Analysis

This is an R4 IG. None of the features it uses are changed in R4B, so it can be used as is with R4B systems. Packages for both R4 (hl7.fhir.us.quality-core.r4) and R4B (hl7.fhir.us.quality-core.r4b) are available.

Global Profiles

Global Profiles:

Type	Source	Profile
Encounter		US Quality Core Encounter
Immunization		US Quality Core Immunization
Observation		US Quality Core Simple Observation
Organization		US Quality Core Organization
Patient		US Quality Core Patient
Practitioner		US Quality Core Practitioner
PractitionerRole		US Quality Core PractitionerRole

All resources of these types must conform to these profiles.

IP Statements

This publication includes IP covered under the following statements.

• ISO maintains the copyright on the country codes, and controls its use carefully. For further details see the ISO 3166 web page: https://www.iso.org/iso-3166-country-codes.html
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  • ISO 3166-1 Codes for the representation of names of countries and their subdivisions — Part 1: Country code: USQualityCore, USQualityCoreAdverseEvent... Show 128 more, USQualityCoreAdverseEventEvent, USQualityCoreAdverseEventRecordedDate, USQualityCoreAdverseEventSubject, USQualityCoreAllergyIntolerance, USQualityCoreAllergyIntolerancePatient, USQualityCoreCarePlan, USQualityCoreCarePlanCategory, USQualityCoreCarePlanPatient, USQualityCoreCareTeam, USQualityCoreCareTeamPatient, USQualityCoreCareTeamStatus, USQualityCoreClientCapabilityStatement, USQualityCoreCommunication, USQualityCoreCommunicationDone, USQualityCoreCommunicationNotDone, USQualityCoreCommunicationStatus, USQualityCoreCommunicationSubject, USQualityCoreCommunicationTopic, USQualityCoreConditionCategory, USQualityCoreConditionCode, USQualityCoreConditionEncounterDiagnosis, USQualityCoreConditionPatient, USQualityCoreConditionProblemsHealthConcerns, USQualityCoreCoverage, USQualityCoreCoveragePatient, USQualityCoreDeviceProhibited, USQualityCoreDeviceRequest, USQualityCoreDeviceRequestCode, USQualityCoreDeviceRequestDoNotPerform, USQualityCoreDeviceRequestPatient, USQualityCoreDeviceRequested, USQualityCoreDiagnosisPresentOnAdmission, USQualityCoreDiagnosticReportCategory, USQualityCoreDiagnosticReportCode, USQualityCoreDiagnosticReportDate, USQualityCoreDiagnosticReportLab, USQualityCoreDiagnosticReportNote, USQualityCoreDiagnosticReportPatient, USQualityCoreEncounter, USQualityCoreEncounterDate, USQualityCoreEncounterId, USQualityCoreEncounterPatient, USQualityCoreEncounterType, USQualityCoreGoal, USQualityCoreGoalPatient, USQualityCoreImagingStudy, USQualityCoreImagingStudySubject, USQualityCoreImmunization, USQualityCoreImmunizationDone, USQualityCoreImmunizationNotDone, USQualityCoreImmunizationPatient, USQualityCoreImmunizationStatus, USQualityCoreLocation, USQualityCoreMedication, USQualityCoreMedicationAdministration, USQualityCoreMedicationAdministrationCode, USQualityCoreMedicationAdministrationDone, USQualityCoreMedicationAdministrationEffectiveTime, USQualityCoreMedicationAdministrationNotDone, USQualityCoreMedicationAdministrationPatient, USQualityCoreMedicationAdministrationStatus, USQualityCoreMedicationCode, USQualityCoreMedicationDispense, USQualityCoreMedicationDispenseDeclined, USQualityCoreMedicationDispenseDone, USQualityCoreMedicationDispensePatient, USQualityCoreMedicationDispenseStatus, USQualityCoreMedicationDoseType, USQualityCoreMedicationProhibited, USQualityCoreMedicationRequest, USQualityCoreMedicationRequestDoNotPerform, USQualityCoreMedicationRequestIntent, USQualityCoreMedicationRequestPatient, USQualityCoreMedicationRequested, USQualityCoreNegationReasonCodes, USQualityCoreNutritionOrder, USQualityCoreNutritionOrderPatient, USQualityCoreObservationBodyPosition, USQualityCoreObservationCategory, USQualityCoreObservationClinicalResult, USQualityCoreObservationCode, USQualityCoreObservationDate, USQualityCoreObservationLab, USQualityCoreObservationPatient, USQualityCoreObservationScreeningAssessment, USQualityCoreObservationStatus, USQualityCoreOrganization, USQualityCorePatient, USQualityCorePatientId, USQualityCorePositiveEventStatus, USQualityCorePositiveMedicationAdministrationStatus, USQualityCorePositiveMedicationDispenseStatus, USQualityCorePositiveMedicationRequestStatus, USQualityCorePositiveRequestStatus, USQualityCorePositiveTaskStatus, USQualityCorePractitioner, USQualityCorePractitionerRole, USQualityCorePresentOnAdmission, USQualityCoreProcedure, USQualityCoreProcedureDate, USQualityCoreProcedureDone, USQualityCoreProcedureNotDone, USQualityCoreProcedurePatient, USQualityCoreProcedureStatus, USQualityCoreQuestionnaireResponse, USQualityCoreQuestionnaireResponsePatient, USQualityCoreQuestionnaireResponseQuestionnaire, USQualityCoreRelatedPerson, USQualityCoreRelatedPersonId, USQualityCoreRelatedPersonPatient, USQualityCoreServerCapabilityStatement, USQualityCoreServiceProhibited, USQualityCoreServiceRequest, USQualityCoreServiceRequestAuthored, USQualityCoreServiceRequestCategory, USQualityCoreServiceRequestCode, USQualityCoreServiceRequestDoNotPerform, USQualityCoreServiceRequestId, USQualityCoreServiceRequestPatient, USQualityCoreServiceRequested, USQualityCoreSimpleObservation, USQualityCoreTask, USQualityCoreTaskCode, USQualityCoreTaskDone, USQualityCoreTaskPatient, USQualityCoreTaskRejected, USQualityCoreTaskStatus and USQualityCoreUSCDIQualityExtension
• Most of the information on the CDC and ATSDR websites is not subject to copyright, is in the public domain, and may be freely used or reproduced without obtaining copyright permission. For information and exceptions regarding use of CDC material please see https://www.cdc.gov/other/agencymaterials.html
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  • Vaccine Administered Code Set (CVX): Immunization/done-example, Immunization/example and Immunization/negation-example-code
• The POA Indicator Codes are in the public domain and are free to use without restriction.
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  • CMS Present on Admission (POA) Indicator: Encounter/example, USQualityCoreDiagnosisPresentOnAdmission and USQualityCorePresentOnAdmission
• The UCUM codes, UCUM table (regardless of format), and UCUM Specification are copyright 1999-2009, Regenstrief Institute, Inc. and the Unified Codes for Units of Measures (UCUM) Organization. All rights reserved. https://ucum.org/trac/wiki/TermsOfUse
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  • Unified Code for Units of Measure (UCUM): Goal/example, Immunization/done-example... Show 19 more, Immunization/example, Medication/example, MedicationAdministration/done-example, MedicationAdministration/example, MedicationAdministration/negation-example, MedicationAdministration/negation-with-code-example, MedicationDispense/done-example, MedicationDispense/example, MedicationDispense/negation-example, MedicationDispense/negation-with-code-example, MedicationRequest/example, MedicationRequest/patient-reported-example, MedicationRequest/patient-requester-example, MedicationRequest/practitioner-ordered-example, MedicationRequest/requested-example, NutritionOrder/example, Observation/example, Observation/example-gestation and Observation/laboratory-result-observation-example-blood-glucose
• These codes are excerpted from Digital Imaging and Communications in Medicine (DICOM) Standard, Part 16: Content Mapping Resource, Copyright © 2011 by the National Electrical Manufacturers Association.
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  • DICOM Controlled Terminology Definitions: ImagingStudy/example and ImagingStudy/portable-cxr-study
• This material contains content from LOINC. LOINC is copyright © 1995-2020, Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee and is available at no cost under the license. LOINC® is a registered United States trademark of Regenstrief Institute, Inc.
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  • LOINC: DiagnosticReport/example, DiagnosticReport/note-example... Show 18 more, Goal/example, Observation/clinical-result-heart-rate-rhythm, Observation/cxr-finding-lung-fields, Observation/example, Observation/example-births, Observation/example-delivery-date-estimate, Observation/example-frailty, Observation/example-gestation, Observation/example-obstetric-delivery, Observation/example-odh, Observation/example-parity, Observation/example-pregnancies, Observation/example-preterm-births, Observation/example-screening-assessment-10-minute-apgar-heart-rate, Observation/laboratory-result-observation-example-blood-glucose, QuestionnaireResponse/phq-9-example, USQualityCoreObservationClinicalResult and USQualityCoreSimpleObservation
• 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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  • SNOMED Clinical Terms® (SNOMED CT®): AdverseEvent/example, AllergyIntolerance/example... Show 71 more, AllergyIntolerance/example-refuted, CarePlan/example, Communication/negation-example, Condition/appendicitis-example, Condition/example, Condition/health-concern-example, DeviceRequest/example, DeviceRequest/negation-example, DeviceRequest/negation-with-code-example, DeviceRequest/requested-example, Encounter/example, ImagingStudy/example, ImagingStudy/portable-cxr-study, Immunization/done-example, Immunization/example, Immunization/negation-example, Immunization/negation-example-code, Medication/example, MedicationAdministration/done-example, MedicationAdministration/example, MedicationAdministration/negation-example, MedicationAdministration/negation-with-code-example, MedicationDispense/done-example, MedicationDispense/example, MedicationDispense/negation-example, MedicationDispense/negation-with-code-example, MedicationRequest/example, MedicationRequest/negation-example, MedicationRequest/negation-example-code, MedicationRequest/patient-reported-example, MedicationRequest/patient-requester-example, MedicationRequest/practitioner-ordered-example, MedicationRequest/requested-example, NutritionOrder/example, Observation/example, Observation/example-frailty, Patient/reproductive-health-example, PractitionerRole/example, Procedure/done-example, Procedure/example, Procedure/negation-example, Procedure/negation-with-code-example, ServiceRequest/appropriateness-example, ServiceRequest/elective-example, ServiceRequest/example, ServiceRequest/myringotomy-example, ServiceRequest/negation-example, ServiceRequest/negation-example-code, ServiceRequest/proposal-example, ServiceRequest/proposal-example-code, ServiceRequest/service-requested-example, Specimen/whole-blood-specimen, Task/negation-example, Task/negation-with-code-example, USQualityCoreAdverseEvent, USQualityCoreCommunicationNotDone, USQualityCoreDeviceProhibited, USQualityCoreDeviceRequest, USQualityCoreGoal, USQualityCoreImmunization, USQualityCoreImmunizationNotDone, USQualityCoreMedicationAdministration, USQualityCoreMedicationAdministrationNotDone, USQualityCoreMedicationDispenseDeclined, USQualityCoreMedicationDoseType, USQualityCoreMedicationProhibited, USQualityCoreNegationReasonCodes, USQualityCoreObservationBodyPosition, USQualityCoreProcedureNotDone, USQualityCoreServiceProhibited and USQualityCoreTaskRejected
• This material derives from the HL7 Terminology (THO). THO is copyright ©1989+ Health Level Seven International and is made available under the CC0 designation. For more licensing information see: https://terminology.hl7.org/license.html
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  • AdverseEventCausalityMethod: USQualityCoreAdverseEvent
  • AdverseEventSeriousness: AdverseEvent/example
  • AdverseEventSeverity: USQualityCoreAdverseEvent
  • AllergyIntolerance Clinical Status Codes: AllergyIntolerance/example and AllergyIntolerance/example-refuted
  • AllergyIntolerance Verification Status: AllergyIntolerance/example and AllergyIntolerance/example-refuted
  • CommunicationCategory: Communication/done-example, Communication/example and Communication/negation-example
  • CommunicationNotDoneReason: Communication/done-example and Communication/example
  • CommunicationTopic: Communication/negation-example and USQualityCoreCommunication
  • Condition Category Codes: Condition/appendicitis-example, Condition/example, USQualityCoreConditionEncounterDiagnosis and USQualityCoreConditionProblemsHealthConcerns
  • Condition Clinical Status Codes: Condition/appendicitis-example, Condition/example and Condition/health-concern-example
  • ConditionVerificationStatus: Condition/appendicitis-example, Condition/example and Condition/health-concern-example
  • Coverage Class Codes: Coverage/example and USQualityCoreCoverage
  • DataAbsentReason: USQualityCoreObservationClinicalResult and USQualityCoreObservationScreeningAssessment
  • Diagnosis Role: Encounter/example
  • Diet: NutritionOrder/example
  • Discharge disposition: Encounter/example and USQualityCoreEncounter
  • DoseAndRateType: MedicationDispense/done-example, MedicationDispense/example... Show 7 more, MedicationDispense/negation-example, MedicationDispense/negation-with-code-example, MedicationRequest/example, MedicationRequest/patient-reported-example, MedicationRequest/patient-requester-example, MedicationRequest/practitioner-ordered-example and MedicationRequest/requested-example
  • Goal category: Goal/example
  • Goal priority: Goal/example
  • Location type: South Wing, second floor
  • MedicationRequest Category Codes: MedicationRequest/negation-example, MedicationRequest/negation-example-code and USQualityCoreMedicationRequested
  • Observation Category Codes: Observation/clinical-result-heart-rate-rhythm, Observation/cxr-finding-lung-fields... Show 15 more, Observation/example, Observation/example-births, Observation/example-delivery-date-estimate, Observation/example-frailty, Observation/example-gestation, Observation/example-obstetric-delivery, Observation/example-odh, Observation/example-parity, Observation/example-pregnancies, Observation/example-preterm-births, Observation/example-screening-assessment-10-minute-apgar-heart-rate, Observation/laboratory-result-observation-example-blood-glucose, USQualityCoreObservationClinicalResult, USQualityCoreObservationLab and USQualityCoreObservationScreeningAssessment
  • Organization type: Example Hospital, Example Organization and USQualityCoreOrganization
  • Observation Reference Range Meaning Codes: Observation/laboratory-result-observation-example-blood-glucose
  • SubscriberPolicyholder Relationship Codes: Coverage/example
  • diagnosticServiceSectionId: DiagnosticReport/example, DiagnosticReport/note-example and USQualityCoreDiagnosticReportLab
  • contactRole2: Patient/example, Patient/example-2 and RelatedPerson/example
  • identifierType: Coverage/example, Patient/example... Show 4 more, Patient/example-2, Patient/infant-example, Patient/reproductive-health-example and USQualityCoreCoverage
  • degreeLicenseCertificate: Practitioner/example
  • providerRole: Immunization/done-example and Immunization/example
  • ActCode: Encounter/example
  • ActPriority: Encounter/example
  • ActReason: USQualityCoreImmunization
  • ActSite: Immunization/done-example and Immunization/example
  • ObservationInterpretation: Observation/example, Observation/laboratory-result-observation-example-blood-glucose, USQualityCoreObservationLab, USQualityCoreObservationScreeningAssessment and USQualityCoreSimpleObservation
  • ParticipationFunction: CareTeam/example
  • ParticipationMode: Communication/done-example, Communication/example and Communication/negation-example
  • ParticipationType: ImagingStudy/example
  • RoleCode: South Wing, second floor
  • RouteOfAdministration: Immunization/done-example and Immunization/example
  • Substance Admin Substitution: MedicationDispense/done-example and MedicationDispense/example
• Used by permission of HL7 International, all rights reserved Creative Commons License
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  • US Core Condition Category Extension Codes: Condition/health-concern-example
  • US Core Category: USQualityCoreObservationScreeningAssessment
• Using RxNorm codes of type SAB=RXNORM as this specification describes does not require a UMLS license. Access to the full set of RxNorm definitions, and/or additional use of other RxNorm structures and information requires a UMLS license. The use of RxNorm in this specification is pursuant to HL7's status as a licensee of the NLM UMLS. HL7's license does not convey the right to use RxNorm to any users of this specification; implementers must acquire a license to use RxNorm in their own right.
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  • RxNorm: AllergyIntolerance/example, Medication/example... Show 4 more, MedicationAdministration/negation-with-code-example, MedicationDispense/negation-with-code-example, MedicationRequest/negation-example and MedicationRequest/negation-example-code