US Core Implementation Guide
9.0.0 - STU 9 US

US Core Implementation Guide - Downloaded Version 9.0.0 See the Directory of published versions

## Must Support

Page standards status: Trial-use

The Profile elements consist of Mandatory, Must Support, and Additional USCDI Requirements elements. The sections below define the Server and Client expectations for processing these elements and illustrate how they are displayed and documented.

### Mandatory Elements

Mandatory elements have a minimum cardinality of 1 (min=1). When an element is Mandatory, the data is expected always to be present. However, very rarely it may be missing, and the Missing Data section and the next section provide guidance when the data is missing. The convention in this guide is to mark all min=1 elements as Must Support unless they are nested under an optional element. An example of this is `CarePlan.status`.

### Must Support Elements

For querying and reading US Core Profiles, Must Support on any profile data element SHALL be interpreted as follows (see the US Core Roadmap page for writing and updating US Core Profiles):

- US Core Responders SHALL be capable of populating all data elements as part of the query results specified by the US Core Server CapabilityStatement.§
- US Core Requestors SHALL be capable of processing resource instances containing the data elements without generating an error or causing the application to fail.§ This processing might result in a determination not to use the resource if the resource content does not meet business requirements.
- When information on a particular data element is not present, and the reason for absence is unknown, US Core Responders SHALL NOT include the data elements in the resource instance returned as part of the query results.§
- When querying US Core Responders, US Core Requestors SHALL interpret missing data elements within resource instances as data not present in the US Core Responder's system.§
- When information on a particular data element is missing or suppressed, refer to the guidance for Missing Data and Suppressed Data. 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.§ This is done by following the same methodology outlined in the Missing Data section but using the appropriate reason code instead of `unknown`.§
- US Core Requestors SHALL be able to process resource instances containing data elements asserting missing information.§

The terms US Core Responder Actor and US Core Requestor Actor are used throughout the guide and typically refer to a Server or a Client.

Readers are advised to understand FHIR Terminology requirements, FHIR RESTful API based on the HTTP protocol, FHIR Data Types, FHIR Search, and FHIR Resource formats before implementing US Core requirements.

#### US Core Must Support Summaries

The following summary tables may be useful to testers and analysts to review the Must Support and Mandatory elements across profiles.

- All the profile information for the US Core Implementation Guide is represented in a single CSV or Excel file.
  - CSV
  - Excel
- The Observation Summary Table compares Must Support Elements across all the US Core Observation Profiles.
- The Must Support - Resource References section below lists all the Must Support references to other US Core Profiles and FHIR resources for each US Core Profile.

### Additional USCDI Requirements

The US Core Profiles include requirements from the U.S. Core Data for Interoperability (USCDI). See the USCDI page for more information about the US Core and USCDI relationship and a mapping between US Core Profiles and the USCDI Data Classes and Elements. Some US Core Profile elements needed to represent USCDI Data Elements for ONC Health IT Certification (g(10) certification) are not Mandatory or Must Support because many non-certifying implementers do not need them for their use cases. US Core designates these elements as Additional USCDI Requirements.

Implementers seeking ONC certification SHALL interpret Additional USCDI Requirements as Must Support elements as documented above and below;§,§ otherwise, they are considered optional.§,§ All Mandatory, Must Support, or Additional USCDI Requirements are within the scope of ONC Health IT Certification. Only simple and complex data elements are defined as Additional USCDI Requirements. The Must Support sections below document how the conformance rules are displayed and applied.

The table below lists the Additional USCDI Requirements and their corresponding Profiles and FHIR elements.

Additional USCDI Requirements | Profile | FHIR Element
--- | --- | ---
A Communication Language | US Core Patient Profile | `Patient.communication`
An Interpreter Needed Flag | US Core Patient Profile | `Patient.extension:interpreterRequired`
An Interpreter Needed Flag | US Core Encounter Profile | `Encounter.extension:interpreterRequired`
A Race | US Core Patient Profile | `Patient.extension:race`
An Ethnicity | US Core Patient Profile | `Patient.extension:ethnicity`
A Tribal Affiliation | US Core Patient Profile | `Patient.extension:tribalAffiliation`
A Sex | US Core Patient Profile | `Patient.extension:sex`
Date Of Death | US Core Patient Profile | `Patient.deceased[x]`
Address Use | US Core Patient Profile | `Patient.address.use`
Address Period | US Core Patient Profile | `Patient.address.period`
Previous Name | US Core Patient Profile | `Patient.name.use`
Name Period | US Core Patient Profile | `Patient.name.period`
Suffix | US Core Patient Profile | `Patient.name.suffix`
A Reason Or Indication For Referral Or Consultation | US Core ServiceRequest Profile | `ServiceRequest.reasonCode`
A Reason Or Indication For Referral Or Consultation | US Core ServiceRequest Profile | `ServiceRequest.reasonReference`
A Reason Or Indication For Referral Or Consultation | US Core Procedure Profile | `Procedure.performer`
A Reason Or Indication For Referral Or Consultation | US Core Procedure Profile | `Procedure.performer.actor`
A Reason Or Indication For Referral Or Consultation | US Core Procedure Profile | `Procedure.reasonCode`
A Reason Or Indication For Referral Or Consultation | US Core Procedure Profile | `Procedure.reasonReference`
The Reason Or Indication For The Prescription | US Core MedicationRequest Profile | `MedicationRequest.reasonCode`
The Reason Or Indication For The Prescription | US Core MedicationRequest Profile | `MedicationRequest.reasonReference`
Medication Adherence | US Core MedicationRequest Profile | `MedicationRequest.extension:medicationAdherence`
A Reference To The Request For The Procedure | US Core Procedure Profile | `Procedure.basedOn`
US Core Document Category | US Core DocumentReference Profile | `DocumentReference.category:uscore`
References To An Associated Survey, Assessment, Or Screening Tool | US Core Simple Observation Profile | `Observation.derivedFrom`
Specimen Source Site | US Core Specimen Profile | `Specimen.collection`
Specimen Source Site | US Core Specimen Profile | `Specimen.collection.bodySite`
Specimen Condition Acceptability | US Core Specimen Profile | `Specimen.condition`
Health Status Assessments | US Core Simple Observation Profile | `Observation.category:us-core`
Health Status Assessments | US Core Observation Screening Assessment Profile | `Observation.category:screening-assessment`
Health Status Assessments | US Core Condition Problems and Health Concerns Profile | `Condition.category:screening-assessment`
Pregnancy Status | US Core Observation Pregnancy Intent Profile | `Observation.performer`
Pregnancy Status | US Core Observation Pregnancy Status Profile | `Observation.performer`
Provenance Author | US Core AllergyIntolerance Profile | `AllergyIntolerance.recorder`
Provenance Author | US Core Care Experience Preference Profile | `Observation.performer`
Provenance Author | US Core CarePlan Profile | `CarePlan.contributor`
Provenance Author | US Core Condition Encounter Diagnosis Profile | `Condition.recorder`
Provenance Author | US Core Condition Problems and Health Concerns Profile | `Condition.recorder`
Provenance Author | US Core Observation Occupation Profile | `Observation.performer`
Provenance Author | US Core Treatment Intervention Preference Profile | `Observation.performer`
Orders | US Core ServiceRequest Profile | `ServiceRequest.code.text`
Laboratory Tests | US Core Laboratory Result Observation Profile | `Observation.code.text`
Care Plan | US Core CarePlan Profile | `CarePlan.addresses`
Family Health History | US Core FamilyMemberHistory Profile | `FamilyMemberHistory.extension:recorder`
Unique Device Identifier | US Core Device Profile | `Device.udiCarrier`
Unique Device Identifier | US Core Device Profile | `Device.distinctIdentifier`
Unique Device Identifier | US Core Device Profile | `Device.manufactureDate`
Unique Device Identifier | US Core Device Profile | `Device.expirationDate`
Unique Device Identifier | US Core Device Profile | `Device.lotNumber`
Unique Device Identifier | US Core Device Profile | `Device.serialNumber`

#### Communicating Additional USCDI Requirements for Certifying Systems

Throughout the rest of the specification, the term "Certifying System" will be used consistently to refer to such systems seeking ONC certification, distinguishing them from other implementers (e.g., non-certifying systems) that may treat Additional USCDI Requirements as optional. To communicate when Additional USCDI Requirements elements are in a US Core profile:

1. The profiles page includes an "Additional USCDI Requirements" listing the elements under the "Mandatory and Must Support Data Elements" section.
2. The computable US Core USCDI Requirement Extension is added to each element in the profile's StructureDefinition.
3. The formal view of the profile content displays "ADDITIONAL USCDI:" in the element's short description (see below for examples).

### Presentation of Must Support, Mandatory, and USCDI Requirement Elements in the Formal Profile Views

On each profile page, several different formal views of the US Core Profile contents are displayed in a tree format under tabs labeled "Differential Table", "Snapshot Table", and "Key Elements Table". Several examples below illustrate the presentation of Must Support elements and their rules. Except where noted, the same rules apply for the Additional USCDI Requirements for Certifying Systems.

#### Differential Table View

Elements with a cardinality starting with "1" under the column header, "Card." (e.g., 1..1) are Mandatory elements. Elements labeled Must Support in the "Differential Table" view are flagged with an S. Elements with the label "ADDITIONAL USCDI:" under the header "Description and Constraints" are Additional USCDI Requirements. Figure 1 illustrates an example of this:

Figure 1: Differential Table View

#### Key Elements Table View

The "Key Elements Table" view consists of:

1. All the Mandatory, Must Support, and Additional USCDI Requirements elements in the differential view
2. Any Mandatory, Must Support, and Additional USCDI Requirements elements inherited from a US Core Profile or other profile from which it is derived. (e.g., the US Core Body Height Profile is based on the US Core Vital Signs Profile, and the US Core QuestionnaireResponse Profile is based on the Structured Data Capture (SDC) Questionnaire Response Profile)
3. any Mandatory or modifier elements not in 1. or 2.

This view includes the same flags and labels described in Differential Table View:

Figure 2: Key Elements Table View

#### Snapshot Table View

The "Snapshot Table" view in Figure 3 view consists of:

1. all the Mandatory, Must Support, and Additional USCDI Requirements elements in the differential view
2. any inherited Mandatory, Must Support, and Additional USCDI Requirements elements from a US Core or other profile upon which it is based. (e.g., US Core Body Height Profile based on Vital Signs Profile or US Core QuestionnaireResponse Profile based on Structured Data Capture (SDC) Questionnaire Response Profile)
3. any base FHIR elements not in 1. or 2.

This view includes the same flags and labels as described in Differential Table View:

Figure 3: Snapshot Table View

#### Defined Pattern Elements

The StructureDefinitions define the US Core Profiles and the ElementDefinition.pattern, used almost exclusively for the CodeableConcept and Coding datatypes. If an element is marked as Must Support and defined by a pattern, then the pattern defines the elements and element values that the Server SHALL be capable of providing.§ If an element is marked as Additional USCDI and defined by a pattern, then the pattern defines the elements and element values that the Certifying System SHALL be capable of providing.§

For example, the US Core DiagnosticReport Profile for Laboratory Results Reporting category element is defined with a pattern requiring fixed values in `DiagnosticReport.category.coding.system` and `DiagnosticReport.category.coding.code` for a Coding element. When claiming conformance to this profile:

- US Core Responders SHALL provide these values in a `DiagnosticReport.category`
- US Core Requestors SHALL be capable of processing these values in `DiagnosticReport.category`

Figure 4: US Core DiagnosticReport.category

#### Must Support - Primitive Elements

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.§ If they are marked as Additional USCDI, then the Certifying System SHALL be capable of providing the element value to meet the Additional USCDI requirement.§

For example, the US Core DiagnosticReport Profile for Laboratory Results Reporting issued element is a primitive `instant` datatype. Therefore, when claiming conformance to this profile:

- US Core Responders SHALL be capable of providing a value in a `DiagnosticReport.issued`§
- US Core Requestors SHALL be capable of processing the value in `DiagnosticReport.issued`§

Figure 5: US Core DiagnosticReport.issued

#### Must Support - Complex Elements

Complex elements are composed of primitive and other complex elements. Note that coded elements (`CodeableConcept`, `Coding`, and `code` datatypes) also have additional binding rules documented in the Coded Elements section.

For any complex element marked as Must Support, the Server SHALL be capable of providing at least one of the sub-element values.§ If any sub-element is marked as Must Support, it SHALL also meet the Must Support requirements and satisfy the Must Support requirements for the parent element.§

For any complex element marked as Additional USCDI, the Certifying System SHALL be capable of providing at least one of the sub-element values.§ If any sub-element is marked as Additional USCDI, it must also meet the Additional USCDI requirements and satisfy the Additional USCDI requirements for the parent element.§

For example, the US Core DiagnosticReport Profile for Report and Note exchange `presentedForm` element is labeled Must Support and has no Must Support sub-elements. When claiming conformance to this profile:

- US Core Responders SHALL be capable of providing a value in `DiagnosticReport.presentedForm` sub-element.§
- US Core Requestors SHALL be capable of processing the value in `DiagnosticReport.presentedForm`.§

Figure 6: US Core DiagnosticReport.presentedForm

For example, the US Core Patient Profile `name` element is labeled Must Support and has Must Support sub-elements "family" and "given". When claiming conformance to this profile:

- US Core Responders SHALL be capable of providing a value in `Patient.name.family` and `Patient.name.given`.§
- US Core Requestors SHALL be capable of processing the value in `Patient.name.family` and `Patient.name.given`.§

Figure 7: US Core Patient.name

On the other hand, if any sub-element is marked as Must Support or Additional USCDI and the parent element is not, there is no expectation that you must support the parent.§ However, if the parent element is present in an instance, Servers SHALL support the sub-element(s) marked as Must Support and Certifying System SHALL support the sub-elements labeled as Additional USCDI.§,§

For example, the US Core Patient Profile `telecom` element is not labeled Must Support, but `telecom.system`, `telecom.value`, `telecom.use` are. When claiming conformance to this profile:

- If US Core Responders support `Patient.telecom`, they SHALL be capable of providing values in `Patient.telecom.system` , `Patient.telecom.value`, and `Patient.telecom.use`.
- US Core Requestors SHALL be capable of processing the values in `Patient.telecom`.

Figure 8: US Core Patient.telecom

Systems MAY support the other elements, but this is not a requirement of US Core.§,§

#### Must Support - Resource References

This section documents additional Must Support requirements for the Reference type element.

##### Must Support Targets for US Core Profiles

When a Reference type element is labeled as Must Support and has a single target profile referenced, the target profile SHALL be supported.§ When a Reference type element is labeled as Additional USCDI and has a single target profile referenced, the target profile SHALL be supported for Certifying Systems.§

For example, the US Core AllergyIntolerance Profile patient is labeled Must Support. When claiming conformance to this profile:

- US Core Responders SHALL be capable of providing an `AllergyIntolerance.patient` with a valid reference to a US Core Patient Profile.§
- US Core Requestors SHALL be capable of processing an `AllergyIntolerance.patient` with a valid reference to a US Core Patient Profile.§

Figure 9: US Core AllergyIntolerance.patient

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.§ When a Reference type element labeled as Additional USCDI, has multiple target profiles referenced, and specific targets are labeled as Must Support, the Must Support target profile(s) SHALL be supported by Certifying Systems.§

For example, the US Core DocumentReference Profile `DocumentReference.author` is a Must Support element, and six target profiles are displayed with only the US Core Practitioner Profile labeled Must Support. When claiming conformance to this profile:

- US Core Responders SHALL be capable of providing a DocumentReference.author with a valid reference to a US Core Practitioner Profile.§
- US Core Requestors SHALL be capable of processing a DocumentReference.author with a valid reference to a US Core Practitioner Profile.§

Systems can support other references, but this is not a requirement of US Core.§,§

Figure 10: US Core DocumentReference.author

The tables below list the Must Support target US Core Profiles and FHIR Resources for each US Core Profile.

Must Support Targets for Must Support US Core Elements

US Core Profile | Must Support Target Profiles
--- | ---
US Core Pediatric Head Occipital Frontal Circumference Percentile Profile | US Core Patient Profile
US Core Pediatric BMI for Age Observation Profile | US Core Patient Profile
US Core Pediatric Weight for Height Observation Profile | US Core Patient Profile
US Core ADI DocumentReference Profile | US Core Patient Profile US Core Practitioner Profile
US Core AllergyIntolerance Profile | US Core Patient Profile
US Core Average Blood Pressure Profile | US Core Patient Profile
US Core Blood Pressure Profile | US Core Patient Profile
US Core BMI Profile | US Core Patient Profile
US Core Body Height Profile | US Core Patient Profile
US Core Body Temperature Profile | US Core Patient Profile
US Core Body Weight Profile | US Core Patient Profile
US Core Care Experience Preference Profile | US Core Patient Profile
US Core CarePlan Profile | US Core Patient Profile
US Core CareTeam Profile | US Core Patient Profile US Core Practitioner Profile US Core PractitionerRole Profile US Core RelatedPerson Profile
US Core Condition Encounter Diagnosis Profile | US Core Encounter Profile US Core Patient Profile
US Core Condition Problems and Health Concerns Profile | US Core Patient Profile
US Core Coverage Profile | US Core Organization Profile US Core Patient Profile
US Core Device Profile | US Core Patient Profile
US Core DiagnosticReport Profile for Laboratory Results Reporting | US Core Encounter Profile US Core Laboratory Result Observation Profile US Core Patient Profile US Core Practitioner Profile
US Core DiagnosticReport Profile for Report and Note Exchange | US Core Encounter Profile US Core Observation Clinical Result Profile US Core Organization Profile US Core Patient Profile US Core Practitioner Profile
US Core DocumentReference Profile | US Core Encounter Profile US Core Patient Profile US Core Practitioner Profile
US Core Encounter Profile | US Core Condition Encounter Diagnosis Profile US Core Condition Problems and Health Concerns Profile US Core Location Profile US Core Organization Profile US Core Patient Profile US Core Practitioner Profile
US Core FamilyMemberHistory Profile | US Core Patient Profile
US Core Goal Profile | US Core Patient Profile US Core Practitioner Profile
US Core Head Circumference Profile | US Core Patient Profile
US Core Heart Rate Profile | US Core Patient Profile
US Core Immunization Profile | US Core Encounter Profile US Core Location Profile US Core Patient Profile US Core Practitioner Profile
US Core Location Profile | US Core Organization Profile
US Core MedicationDispense Profile | US Core Encounter Profile US Core Medication Profile US Core MedicationRequest Profile US Core Patient Profile
US Core MedicationRequest Profile | US Core Encounter Profile US Core Medication Profile US Core Patient Profile US Core Practitioner Profile
US Core Observation ADI Documentation Profile | US Core ADI DocumentReference Profile US Core Patient Profile US Core Practitioner Profile
US Core Observation Clinical Result Profile | US Core Encounter Profile US Core Patient Profile US Core Practitioner Profile
US Core Laboratory Result Observation Profile | US Core Encounter Profile US Core Patient Profile US Core Practitioner Profile US Core Specimen Profile
US Core Observation Occupation Profile | US Core Patient Profile
US Core Observation Pregnancy Intent Profile | US Core Patient Profile
US Core Observation Pregnancy Status Profile | US Core Patient Profile
US Core Observation Screening Assessment Profile | US Core Observation Screening Assessment Profile US Core Patient Profile US Core Practitioner Profile US Core QuestionnaireResponse Profile
US Core Observation Sexual Orientation Profile | US Core Patient Profile
US Core PractitionerRole Profile | Endpoint US Core Location Profile US Core Organization Profile US Core Practitioner Profile
US Core Procedure Profile | US Core Encounter Profile US Core Patient Profile
US Core Provenance Profile | [Resource] US Core Organization Profile
US Core Pulse Oximetry Profile | US Core Patient Profile
US Core QuestionnaireResponse Profile | US Core Patient Profile US Core Practitioner Profile
US Core RelatedPerson Profile | US Core Patient Profile
US Core Respiratory Rate Profile | US Core Patient Profile
US Core ServiceRequest Profile | US Core Encounter Profile US Core Patient Profile US Core Practitioner Profile
US Core Simple Observation Profile | US Core Patient Profile US Core Practitioner Profile
US Core Smoking Status Observation Profile | US Core Patient Profile US Core Practitioner Profile
US Core Specimen Profile | US Core Patient Profile
US Core Treatment Intervention Preference Profile | US Core Patient Profile
US Core Vital Signs Profile | US Core Patient Profile

Additional Must Support Targets for Certifying Systems supporting Additional USCDI US Core Elements as Must Support (see Additional USCDI Requirements above).

US Core Profile | Choice of Target Profiles
--- | ---
US Core CarePlan Profile | US Core Condition Problems and Health Concerns Profile
US Core Procedure Profile | US Core Practitioner Profile

##### Choice of At Least One Target for US Core Profiles

When a Reference element is labeled as Must Support has multiple target profiles referenced, but none are labeled as Must Support, at least one target profile SHALL be supported. When a Reference element is labeled as Additional USCDI has multiple target profiles referenced, but none are labeled as Must Support, at least one target profile SHALL be supported by Certifying Systems.§

For example, the US Core Vital Signs Profile `Observation.performer` is a Must Support element, and there are six target profiles displayed with none labeled as Must Support. When claiming conformance to this profile:

- US Core Responders SHALL be capable of supporting `Observation.performer` with a valid reference to at least one target profile.§
- US Core Requestors SHALL be capable of processing `Observation.performer` with a valid reference to any target profile.§

Figure 11: US Core Vital Signs Profile `Observation.performer`

The tables below list the at least one candidate target US Core Profiles and FHIR Resources for each US Core Profile. Note that these targets may overlap with the Must Support Targets listed above.

Choice of Targets for Must Support US Core Elements

US Core Profile | Must Support Target Profiles
--- | ---
US Core Pediatric Head Occipital Frontal Circumference Percentile Profile | PractitionerRole US Core CareTeam Profile US Core Organization Profile US Core Patient Profile US Core Practitioner Profile US Core RelatedPerson Profile
US Core Pediatric BMI for Age Observation Profile | PractitionerRole US Core CareTeam Profile US Core Organization Profile US Core Patient Profile US Core Practitioner Profile US Core RelatedPerson Profile
US Core Pediatric Weight for Height Observation Profile | PractitionerRole US Core CareTeam Profile US Core Organization Profile US Core Patient Profile US Core Practitioner Profile US Core RelatedPerson Profile
US Core Average Blood Pressure Profile | PractitionerRole US Core CareTeam Profile US Core Organization Profile US Core Patient Profile US Core Practitioner Profile US Core RelatedPerson Profile
US Core Blood Pressure Profile | PractitionerRole US Core CareTeam Profile US Core Organization Profile US Core Patient Profile US Core Practitioner Profile US Core RelatedPerson Profile
US Core BMI Profile | PractitionerRole US Core CareTeam Profile US Core Organization Profile US Core Patient Profile US Core Practitioner Profile US Core RelatedPerson Profile
US Core Body Height Profile | PractitionerRole US Core CareTeam Profile US Core Organization Profile US Core Patient Profile US Core Practitioner Profile US Core RelatedPerson Profile
US Core Body Temperature Profile | PractitionerRole US Core CareTeam Profile US Core Organization Profile US Core Patient Profile US Core Practitioner Profile US Core RelatedPerson Profile
US Core Body Weight Profile | PractitionerRole US Core CareTeam Profile US Core Organization Profile US Core Patient Profile US Core Practitioner Profile US Core RelatedPerson Profile
US Core Head Circumference Profile | PractitionerRole US Core CareTeam Profile US Core Organization Profile US Core Patient Profile US Core Practitioner Profile US Core RelatedPerson Profile
US Core Heart Rate Profile | PractitionerRole US Core CareTeam Profile US Core Organization Profile US Core Patient Profile US Core Practitioner Profile US Core RelatedPerson Profile
US Core Pulse Oximetry Profile | PractitionerRole US Core CareTeam Profile US Core Organization Profile US Core Patient Profile US Core Practitioner Profile US Core RelatedPerson Profile
US Core Respiratory Rate Profile | PractitionerRole US Core CareTeam Profile US Core Organization Profile US Core Patient Profile US Core Practitioner Profile US Core RelatedPerson Profile
US Core Vital Signs Profile | PractitionerRole US Core CareTeam Profile US Core Organization Profile US Core Patient Profile US Core Practitioner Profile US Core RelatedPerson Profile

Choice of Targets for Additional USCDI US Core Elements

US Core Profile | Choice of Target Profiles
--- | ---
US Core AllergyIntolerance Profile | PractitionerRole US Core Patient Profile US Core Practitioner Profile US Core RelatedPerson Profile
US Core Care Experience Preference Profile | PractitionerRole US Core CareTeam Profile US Core Organization Profile US Core Patient Profile US Core Practitioner Profile US Core RelatedPerson Profile
US Core CarePlan Profile | PractitionerRole US Core CareTeam Profile US Core Device Profile US Core Organization Profile US Core Patient Profile US Core Practitioner Profile US Core RelatedPerson Profile
US Core Condition Encounter Diagnosis Profile | PractitionerRole US Core Patient Profile US Core Practitioner Profile US Core RelatedPerson Profile
US Core Condition Problems and Health Concerns Profile | PractitionerRole US Core Patient Profile US Core Practitioner Profile US Core RelatedPerson Profile
US Core MedicationRequest Profile | Condition Observation
US Core Observation Occupation Profile | PractitionerRole US Core CareTeam Profile US Core Organization Profile US Core Patient Profile US Core Practitioner Profile US Core RelatedPerson Profile
US Core Observation Pregnancy Intent Profile | PractitionerRole US Core CareTeam Profile US Core Organization Profile US Core Patient Profile US Core Practitioner Profile US Core RelatedPerson Profile
US Core Observation Pregnancy Status Profile | PractitionerRole US Core CareTeam Profile US Core Organization Profile US Core Patient Profile US Core Practitioner Profile US Core RelatedPerson Profile
US Core Procedure Profile | Condition DiagnosticReport DocumentReference Observation Procedure US Core CarePlan Profile US Core ServiceRequest Profile
US Core ServiceRequest Profile | Condition DiagnosticReport DocumentReference Observation
US Core Simple Observation Profile | ImagingStudy Media MolecularSequence Observation US Core DocumentReference Profile US Core QuestionnaireResponse Profile
US Core Treatment Intervention Preference Profile | PractitionerRole US Core CareTeam Profile US Core Organization Profile US Core Patient Profile US Core Practitioner Profile US Core RelatedPerson Profile

#### Must Support - Choice of Data Types

If a Must Support element has a choice of datatypes for its content, the datatypes the Server SHALL support are labeled as Must Support. If an Additional USCDI element has a choice of datatypes for its content, the datatypes the Certifying System SHALL support are labeled as Must Support.§

For example, the US Core Observation Clinical Result Profile effectiveDateTime is labeled Must Support. When claiming conformance to this profile:

- US Core Responders SHALL be capable of populating `Observation.effectiveDateTime`.§
- US Core Requestors SHALL be capable of processing `Observation.effectiveDateTime`.§

Systems MAY support populating and processing other choice elements (such as Observation.effectivePeriod), but this is not a requirement of US Core.§,§

Figure : US Core Observation.effectiveDateTime

For the US Core Observation Clinical Result Profile value element, multiple elements are labeled Must Support. When claiming conformance to this profile:

- US Core Responders SHALL be capable of populating `Observation.valueQuantity`, `Observation.valueCodeableConcept`, and `Observation.valueString`.§
- US Core Requestors SHALL be capable of processing `Observation.valueQuantity`, `Observation.valueCodeableConcept`, and `Observation.valueString`.§

Systems can support the other elements, but this is not a requirement of US Core.§,§

Figure 12: US Core `Observation.value[x]`

#### Must Support - Choice of Profile Elements

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 requirements. In such cases, the Server or Certifying System SHALL support at least one element,§ and the Client application SHALL support all elements.§ Unfortunately, there is no way to define this in a computable way, but these instances are documented in the Profile specific implementation guidance sections.

For example:

- US Core MedicationRequest Profile can represent that information is from a secondary source using a boolean flag in `MedicationRequest.reportedBoolean` or a reference using `MedicationRequest.reportedReference`.
  - Although both are marked as Must Support, the Server system is not required to support both, but SHALL support at least one of these elements.
  - The Client application SHALL support both elements.

Figure 13: US Core `MedicationRequest.reported[x]`

#### Must Support - Slices

FHIR profiles use slicing to define repeating elements (elements that may occur more than once in an instance) by putting constraints on one or more of the repeating elements ("slices"). See Figure 14 below for how that is represented in the guide.

The element that defines the slicing discriminator ("slicer") may define constraints that apply across all slices for the following element properties: max, type (code, profile, targetProfile, aggregation, and versioning), fixed[x], pattern[x], minValue[x], maxValue[x], maxLength, constraints, required and extensible bindings (including additional bindings), mustHaveValue, and valueAlternatives. However, the slicer's Must Support property only defines the element level Must Support/Additional USCDI property. In other words, the slicer's Must Support/Additional USCDI is not inherited by the slices, and each slice must be explicitly tagged with the Must Support/Additional USCDI property to define that slice's conformance strength.§,§ If no Must Support/Additional USCDI property is defined for the slice, then support for that slice's definition is optional.§,§

For example, the US Core Organization Profile `Organization.identifier` element is a Must Support slicer element and defines three slices, "NPI", "CLIA", and "NAIC". Only the "NPI" slice is labeled as a Must Support element. When claiming conformance to this profile:

- US Core Responders SHALL be capable of providing an `Organization.identifier` that conforms to the slicer constraints and the "NPI" slice's constraints. (note that in this case, these conformance requirements are the same - by conforming to the "NPI" slice's constraints, the slicer constraints are met as well).
- US Core Requestors SHALL be capable of processing an `Organization.identifier` that conforms to slicer constraints and the "NPI" slice's constraints.
- Systems MAY support the "CLIA" and "NAIC" slices, but this is not a requirement for US Core.

Figure 14: US Core Organization.identifier

Note that if a slice is labeled as Must Support/Additional USCDI and the slicer element is not labeled as Must Support/Additional USCDI, then if the server/certifying system supports the element, it must support the slice's definition. There are no examples of this structure in US Core.§