# US Core Observation Patient Accommodation Profile - Health eData 1 Sandbox v0.1.0

* [**Table of Contents**](toc.md)
* [**Artifacts Summary**](artifacts.md)
* **US Core Observation Patient Accommodation Profile**

## Resource Profile: US Core Observation Patient Accommodation Profile 

| | | |
| :--- | :--- | :--- |
| *Official URL*:http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-accommodation | *Version*:0.1.0 | |
| Active as of 2026-05-13 | [Maturity Level](http://hl7.org/fhir/versions.html#maturity): 3 | *Computable Name*:USCoreObservationAccommodationProfile |
| *Other Identifiers:*OID:2.16.840.1.113883.4.642.40.2.42.73 | | |
| **Copyright/Legal**: Used by permission of HL7 International, all rights reserved Creative Commons License | | |

 
The US Core Observation Patient Accommodation Profile inherits from the FHIR [Observation](https://hl7.org/fhir/R4/observation.html) resource; refer to it for scope and usage definitions. This profile meets the requirements of the U.S. Core Data for Interoperability (USCDI) **Accommodation Data Element of the Patient Demographics/Information Data Class**. It sets minimum expectations for the Observation resource to record, search, and fetch information about modifications, tools, technologies, and other supports necessary to enable a patient to access care. Examples include, but are not limited to, sign language interpreters, wheelchair accessibility requirements, and sensory accommodation. It specifies which core elements, extensions, vocabularies, and value sets **SHALL** be present in the resource and constrains how the elements are used. Providing the floor for standards development for specific use cases promotes interoperability and adoption. 

**Example Usage Scenarios:**

The following are example usage scenarios for the US Core Observation profile:

* Query for Observation resources belonging to a Patient
* [Record or update] a Patient Observation

### Mandatory and Must Support Data Elements

The following data elements must always be present ([Mandatory] definition) or must be supported if the data is present in the sending system ([Must Support] definition). They are presented below in a simple human-readable explanation. Profile specific guidance and examples are provided as well. The [Formal Views] below provides the formal summary, definitions, and terminology requirements.

**Each Observation Must Have:**

1. a status
1. patient accommodation code
1. a patient

**Each Observation Must Support:**

1. classification of type of observation
1. clinically relevant time or time period for the observation
1. coded or free text patient accommodation

**Additional USCDI Requirements:**

These [Additional USCDI Requirements] elements are not Mandatory or Must Support but are required for ONC Health IT certification testing and are included in the formal definition of the profile and the Observation examples.

1. 𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: who is responsible for the observation

### Profile Specific Implementation Guidance

This section provides detailed implementation guidance for the US Core Profile to support implementation and certification.

### Liquid Script to Generate StructureDefinition All Nice N Pretty Like

{% include structure-table.md sd=sd source="differential" show_must_support=true show_uscdi=true %}

## USCoreObservationAccommodationProfile — US Core Observation Patient Accommodation Profile

The US Core Observation Patient Accommodation Profile inherits from the FHIR [Observation](https://hl7.org/fhir/R4/observation.html) resource; refer to it for scope and usage definitions. This profile meets the requirements of the U.S. Core Data for Interoperability (USCDI) **Accommodation Data Element of the Patient Demographics/Information Data Class**. It sets minimum expectations for the Observation resource to record, search, and fetch information about modifications, tools, technologies, and other supports necessary to enable a patient to access care. Examples include, but are not limited to, sign language interpreters, wheelchair accessibility requirements, and sensory accommodation. It specifies which core elements, extensions, vocabularies, and value sets **SHALL** be present in the resource and constrains how the elements are used. Providing the floor for standards development for specific use cases promotes interoperability and adoption.

* **URL:** `http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-accommodation`
* **Version:** 0.1.0
* **Status:** active
* **Kind:** resource
* **Type:** `Observation`
* **Base Definition:** `http://hl7.org/fhir/StructureDefinition/Observation`
* **Derivation:** constraint

### Elements (differential)

| | | | | | |
| :--- | :--- | :--- | :--- | :--- | :--- |
| `Observation` |   |   | 0..* |   | **US Core Observation Patient Accommodation Profile**Measurements and simple assertions made about a patient, device or other subject. |
| ↳`status` | ✅ |   | 1..1 | `code` | **registered | preliminary | final | amended +**The status of the result value.**Binding:** `http://hl7.org/fhir/ValueSet/observation-status\|4.0.1` (required) — Codes providing the status of an observation. |
| ↳`category` | ✅ |   | 0..* | `CodeableConcept` | **Classification of type of observation**A code that classifies the general type of observation being made.**Binding:** `http://hl7.org/fhir/us/core/ValueSet/us-core-simple-observation-category` (preferred) — FHIR and US Core codes for high level observation categories.**Slicing:** discriminator `value@$this` — rules: open |
| ↳`category`slice: `us-core` | ✅ |   | 0..1 | `CodeableConcept` | **Classification of type of observation**A code that classifies the general type of observation being made.**Binding:** `http://hl7.org/fhir/us/core/ValueSet/us-core-simple-observation-category` (preferred) — FHIR and US Core codes for high level observation categories.**Pattern (CodeableConcept):** `http://hl7.org/fhir/us/core/CodeSystem/us-core-category#accommodation` |
| ↳`code` | ✅ |   | 1..1 | `CodeableConcept` | **Patient accommodation code**Describes what was observed. Sometimes this is called the observation "name".**Binding:** `http://hl7.org/fhir/ValueSet/observation-codes\|4.0.1` (example) — Codes identifying names of simple observations.**Pattern (CodeableConcept):** `http://hl7.org/fhir/us/core/CodeSystem/us-core-category#accommodation` |
| ↳`subject` | ✅ |   | 1..1 | `Reference`target: http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient | **Who and/or what the observation is about**The patient, or group of patients, location, or device this observation is about and into whose record the observation is placed. If the actual focus of the observation is different from the subject (or a sample of, part, or region of the subject), the`focus`element or the`code`itself specifies the actual focus of the observation. |
| ↳`effective[x]` | ✅ |   | 0..1 | `dateTime``Period``Timing``instant` | **Clinically relevant time/time-period for observation**The time or time-period the observed value is asserted as being true. |
| ↳`performer` |   | ✅ | 0..* | `Reference`target: http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitionertarget: http://hl7.org/fhir/us/core/StructureDefinition/us-core-organizationtarget: http://hl7.org/fhir/us/core/StructureDefinition/us-core-patienttarget: http://hl7.org/fhir/StructureDefinition/PractitionerRoletarget: http://hl7.org/fhir/us/core/StructureDefinition/us-core-careteamtarget: http://hl7.org/fhir/us/core/StructureDefinition/us-core-relatedperson | **Who is responsible for the observation**Who was responsible for asserting the observed value as "true". |
| ↳`value[x]` | ✅ |   | 0..1 | `string``CodeableConcept` | **Actual result**The information determined as a result of making the observation, if the information has a simple value. |

```


## USCoreObservationAccommodationProfile — US Core Observation Patient Accommodation Profile

The US Core Observation Patient Accommodation Profile inherits from the FHIR [Observation](https://hl7.org/fhir/R4/observation.html) resource; refer to it for scope and usage definitions. This profile meets the requirements of the U.S. Core Data for Interoperability (USCDI) *Accommodation Data Element of the Patient Demographics/Information Data Class*. It sets minimum expectations for the Observation resource to record, search, and fetch information about modifications, tools, technologies, and other supports necessary to enable a patient to access care. Examples include, but are not limited to, sign language interpreters, wheelchair accessibility requirements, and sensory accommodation. It specifies which core elements, extensions, vocabularies, and value sets **SHALL** be present in the resource and constrains how the elements are used. Providing the floor for standards development for specific use cases promotes interoperability and adoption.

- **URL:** `http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-accommodation`
- **Version:** 0.1.0
- **Status:** active
- **Kind:** resource
- **Type:** `Observation`
- **Base Definition:** `http://hl7.org/fhir/StructureDefinition/Observation`
- **Derivation:** constraint


### Elements (differential)

| Element | Must Support | Add'l USCDI | Cardinality | Type | Description |
|---|:---:|:---:|---|---|---|
| `Observation` |  |  | 0..* |  | **US Core Observation Patient Accommodation Profile**<br/>Measurements and simple assertions made about a patient, device or other subject. |
| <span style="padding-left: 1.5em;">↳</span> `status` | ✅ |  | 1..1 | `code` | **registered \| preliminary \| final \| amended +**<br/>The status of the result value.<br/><span style="font-size: 0.85em;">**Binding:** `http://hl7.org/fhir/ValueSet/observation-status\|4.0.1` (required) — Codes providing the status of an observation.</span> |
| <span style="padding-left: 1.5em;">↳</span> `category` | ✅ |  | 0..* | `CodeableConcept` | **Classification of  type of observation**<br/>A code that classifies the general type of observation being made.<br/><span style="font-size: 0.85em;">**Binding:** `http://hl7.org/fhir/us/core/ValueSet/us-core-simple-observation-category` (preferred) — FHIR and US Core codes for high level observation categories.</span><br/><span style="font-size: 0.85em;">**Slicing:** discriminator `value@$this` — rules: open</span> |
| <span style="padding-left: 1.5em;">↳</span> `category`<br/><span style="font-size: 0.85em;">slice: `us-core`</span> | ✅ |  | 0..1 | `CodeableConcept` | **Classification of  type of observation**<br/>A code that classifies the general type of observation being made.<br/><span style="font-size: 0.85em;">**Binding:** `http://hl7.org/fhir/us/core/ValueSet/us-core-simple-observation-category` (preferred) — FHIR and US Core codes for high level observation categories.</span><br/><span style="font-size: 0.85em;">**Pattern (CodeableConcept):** `http://hl7.org/fhir/us/core/CodeSystem/us-core-category#accommodation`</span> |
| <span style="padding-left: 1.5em;">↳</span> `code` | ✅ |  | 1..1 | `CodeableConcept` | **Patient accommodation code**<br/>Describes what was observed. Sometimes this is called the observation "name".<br/><span style="font-size: 0.85em;">**Binding:** `http://hl7.org/fhir/ValueSet/observation-codes\|4.0.1` (example) — Codes identifying names of simple observations.</span><br/><span style="font-size: 0.85em;">**Pattern (CodeableConcept):** `http://hl7.org/fhir/us/core/CodeSystem/us-core-category#accommodation`</span> |
| <span style="padding-left: 1.5em;">↳</span> `subject` | ✅ |  | 1..1 | `Reference`<br/><span style="font-size: 0.85em;">target: http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient</span> | **Who and/or what the observation is about**<br/>The patient, or group of patients, location, or device this observation is about and into whose record the observation is placed. If the actual focus of the observation is different from the subject (or a sample of, part, or region of the subject), the `focus` element or the `code` itself specifies the actual focus of the observation. |
| <span style="padding-left: 1.5em;">↳</span> `effective[x]` | ✅ |  | 0..1 | `dateTime`<br/>`Period`<br/>`Timing`<br/>`instant` | **Clinically relevant time/time-period for observation**<br/>The time or time-period the observed value is asserted as being true. |
| <span style="padding-left: 1.5em;">↳</span> `performer` |  | ✅ | 0..* | `Reference`<br/><span style="font-size: 0.85em;">target: http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner</span><br/><span style="font-size: 0.85em;">target: http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization</span><br/><span style="font-size: 0.85em;">target: http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient</span><br/><span style="font-size: 0.85em;">target: http://hl7.org/fhir/StructureDefinition/PractitionerRole</span><br/><span style="font-size: 0.85em;">target: http://hl7.org/fhir/us/core/StructureDefinition/us-core-careteam</span><br/><span style="font-size: 0.85em;">target: http://hl7.org/fhir/us/core/StructureDefinition/us-core-relatedperson</span> | **Who is responsible for the observation**<br/>Who was responsible for asserting the observed value as "true". |
| <span style="padding-left: 1.5em;">↳</span> `value[x]` | ✅ |  | 0..1 | `string`<br/>`CodeableConcept` | **Actual result**<br/>The information determined as a result of making the observation, if the information has a simple value. |





```

**Usages:**

* Examples for this Profile: [Observation/accommodation-asl](Observation-accommodation-asl.md), [Observation/accommodation-service-animal](Observation-accommodation-service-animal.md) and [Observation/accommodation-wheelchair](Observation-accommodation-wheelchair.md)

You can also check for [usages in the FHIR IG Statistics](https://packages2.fhir.org/xig/resource/hl7.fhir.us.healthedata1-sandbox|current/StructureDefinition/StructureDefinition-us-core-observation-accommodation.json)

### Formal Views of Profile Content

 [Description of Profiles, Differentials, Snapshots and how the different presentations work](http://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#structure-definitions). 

 

Other representations of profile: [CSV](StructureDefinition-us-core-observation-accommodation.csv), [Excel](StructureDefinition-us-core-observation-accommodation.xlsx), [Schematron](StructureDefinition-us-core-observation-accommodation.sch) 



## Resource Content

```json
{
  "resourceType" : "StructureDefinition",
  "id" : "us-core-observation-accommodation",
  "extension" : [{
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
    "valueInteger" : 3
  }],
  "url" : "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-accommodation",
  "identifier" : [{
    "system" : "urn:ietf:rfc:3986",
    "value" : "urn:oid:2.16.840.1.113883.4.642.40.2.42.73"
  }],
  "version" : "0.1.0",
  "name" : "USCoreObservationAccommodationProfile",
  "title" : "US Core Observation Patient Accommodation Profile",
  "status" : "active",
  "experimental" : false,
  "date" : "2026-05-13",
  "publisher" : "HL7 International / Cross-Group Projects",
  "contact" : [{
    "name" : "HL7 International / Cross-Group Projects",
    "telecom" : [{
      "system" : "url",
      "value" : "http://www.hl7.org/Special/committees/cgp"
    },
    {
      "system" : "email",
      "value" : "cgp@lists.HL7.org"
    }]
  }],
  "description" : "The US Core Observation Patient Accommodation Profile inherits from the FHIR [Observation](https://hl7.org/fhir/R4/observation.html) resource; refer to it for scope and usage definitions. This profile meets the requirements of the U.S. Core Data for Interoperability (USCDI) *Accommodation Data Element of the Patient Demographics/Information Data Class*. It sets minimum expectations for the Observation resource to record, search, and fetch information about modifications, tools, technologies, and other supports necessary to enable a patient to access care. Examples include, but are not limited to, sign language interpreters, wheelchair accessibility requirements, and sensory accommodation. It specifies which core elements, extensions, vocabularies, and value sets **SHALL** be present in the resource and constrains how the elements are used. Providing the floor for standards development for specific use cases promotes interoperability and adoption.",
  "jurisdiction" : [{
    "coding" : [{
      "system" : "urn:iso:std:iso:3166",
      "code" : "US"
    }]
  }],
  "copyright" : "Used by permission of HL7 International, all rights reserved Creative Commons License",
  "fhirVersion" : "4.0.1",
  "mapping" : [{
    "identity" : "workflow",
    "uri" : "http://hl7.org/fhir/workflow",
    "name" : "Workflow Pattern"
  },
  {
    "identity" : "sct-concept",
    "uri" : "http://snomed.info/conceptdomain",
    "name" : "SNOMED CT Concept Domain Binding"
  },
  {
    "identity" : "v2",
    "uri" : "http://hl7.org/v2",
    "name" : "HL7 v2 Mapping"
  },
  {
    "identity" : "rim",
    "uri" : "http://hl7.org/v3",
    "name" : "RIM Mapping"
  },
  {
    "identity" : "w5",
    "uri" : "http://hl7.org/fhir/fivews",
    "name" : "FiveWs Pattern Mapping"
  },
  {
    "identity" : "sct-attr",
    "uri" : "http://snomed.org/attributebinding",
    "name" : "SNOMED CT Attribute Binding"
  }],
  "kind" : "resource",
  "abstract" : false,
  "type" : "Observation",
  "baseDefinition" : "http://hl7.org/fhir/StructureDefinition/Observation",
  "derivation" : "constraint",
  "differential" : {
    "element" : [{
      "id" : "Observation",
      "path" : "Observation",
      "short" : "US Core Observation Patient Accommodation Profile"
    },
    {
      "id" : "Observation.status",
      "path" : "Observation.status",
      "mustSupport" : true
    },
    {
      "id" : "Observation.category",
      "path" : "Observation.category",
      "slicing" : {
        "discriminator" : [{
          "type" : "value",
          "path" : "$this"
        }],
        "rules" : "open"
      },
      "mustSupport" : true,
      "binding" : {
        "strength" : "preferred",
        "description" : "FHIR and US Core codes for high level observation categories.",
        "valueSet" : "http://hl7.org/fhir/us/core/ValueSet/us-core-simple-observation-category"
      }
    },
    {
      "id" : "Observation.category:us-core",
      "path" : "Observation.category",
      "sliceName" : "us-core",
      "min" : 0,
      "max" : "1",
      "patternCodeableConcept" : {
        "coding" : [{
          "system" : "http://hl7.org/fhir/us/core/CodeSystem/us-core-category",
          "code" : "accommodation"
        }]
      },
      "mustSupport" : true,
      "binding" : {
        "strength" : "preferred",
        "description" : "FHIR and US Core codes for high level observation categories.",
        "valueSet" : "http://hl7.org/fhir/us/core/ValueSet/us-core-simple-observation-category"
      }
    },
    {
      "id" : "Observation.code",
      "path" : "Observation.code",
      "short" : "Patient accommodation code",
      "type" : [{
        "code" : "CodeableConcept"
      }],
      "patternCodeableConcept" : {
        "coding" : [{
          "system" : "http://hl7.org/fhir/us/core/CodeSystem/us-core-category",
          "code" : "accommodation"
        }]
      },
      "mustSupport" : true
    },
    {
      "id" : "Observation.subject",
      "path" : "Observation.subject",
      "min" : 1,
      "type" : [{
        "code" : "Reference",
        "targetProfile" : ["http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient"]
      }],
      "mustSupport" : true
    },
    {
      "id" : "Observation.effective[x]",
      "path" : "Observation.effective[x]",
      "definition" : "The time or time-period the observed value is asserted as being true.",
      "type" : [{
        "extension" : [{
          "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
          "valueBoolean" : true
        }],
        "code" : "dateTime"
      },
      {
        "code" : "Period"
      },
      {
        "code" : "Timing"
      },
      {
        "code" : "instant"
      }],
      "mustSupport" : true
    },
    {
      "id" : "Observation.performer",
      "extension" : [{
        "url" : "http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement",
        "valueBoolean" : true
      }],
      "path" : "Observation.performer",
      "short" : "𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: Who is responsible for the observation",
      "type" : [{
        "code" : "Reference",
        "targetProfile" : ["http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner",
        "http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization",
        "http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient",
        "http://hl7.org/fhir/StructureDefinition/PractitionerRole",
        "http://hl7.org/fhir/us/core/StructureDefinition/us-core-careteam",
        "http://hl7.org/fhir/us/core/StructureDefinition/us-core-relatedperson"],
        "_targetProfile" : [{
          "extension" : [{
            "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
            "valueBoolean" : false
          }]
        },
        {
          "extension" : [{
            "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
            "valueBoolean" : false
          }]
        },
        {
          "extension" : [{
            "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
            "valueBoolean" : false
          }]
        },
        {
          "extension" : [{
            "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
            "valueBoolean" : false
          }]
        },
        {
          "extension" : [{
            "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
            "valueBoolean" : false
          }]
        },
        {
          "extension" : [{
            "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
            "valueBoolean" : false
          }]
        }]
      }]
    },
    {
      "id" : "Observation.value[x]",
      "path" : "Observation.value[x]",
      "type" : [{
        "extension" : [{
          "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
          "valueBoolean" : true
        }],
        "code" : "string"
      },
      {
        "extension" : [{
          "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
          "valueBoolean" : true
        }],
        "code" : "CodeableConcept"
      }],
      "mustSupport" : true
    }]
  }
}

```
