# Requirements Tables - US Core Implementation Guide v9.0.0

* [**Table of Contents**](toc.md)
* [**Conformance**](conformance.md)
* **Requirements Tables**

## Requirements Tables

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| *Page standards status:*[Trial-use](http://hl7.org/fhir/R4/versions.html#std-process) |

The Server and Client Requirements tables below list the requirements defined in the US Core Implementation Guide’s narrative sections. They represent the regulatory, business, functional, and technical specifications that design artifacts must meet to ensure interoperability. They are documented here to provide a clear, consolidated reference for implementers working with this guide. This table is based on the [US Core Server v8.0.0 Specification Requirements](https://inferno.healthit.gov/suites/us_core_v800/), created by [Inferno](https://inferno.healthit.gov/) and its open-source testing framework to support the ONC Health IT Certification Program. The table data is also available as a [CSV](tables/us_core_reqs.csv) and [Excel](tables/us_core_reqs.xlsx) file, as well as in [US Core Requirements Resources](capability-statements.md) .

**Legend:**

* **Key:** An identifier for the requirement.
* **Context:** The name and link to the narrative section that pertains to the requirement. There can be more than one narrative section that references the same requirement.
* **Conformance:** The conformance verb of the requirement: **SHALL**, **SHOULD**, **MAY**, **SHALL-NOT**, or **SHOULD-NOT**.
* **Certifying Systems Only**: A Flag for server requirements to indicate whether the requirement is an additional USCDI certification requirement.
* **Requirement:** The actual requirements statement, which is a direct quote from the IG and may include helpful context in square brackets. Note that statements in the narrative section that contain multiple requirements in a single context are split into individual requirement statements.

### Server Requirements

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| :--- | :--- | :--- | :--- | :--- |
| CONF-0001 | • [General-Requirements: Profile-Only-Support](general-requirements.md#CONF-0001) |  | **SHALL** | To support a US Core Profile, a Server: **SHALL** Be able to populate all profile data elements that are mandatory and/or flagged as Must Support as defined by that profile’s StructureDefinition. |
| CONF-0002 | • [General-Requirements: Profile-Only-Support](general-requirements.md#CONF-0002) |  | **SHOULD** | To support a US Core Profile, a Server: **SHOULD** declare support for a US Core Profile by including its official URL in the Server’s `CapabilityStatement.rest.resource.supportedProfile` element. |
| CONF-0003 | • [General-Requirements: Profile-Support--Interaction-Support](general-requirements.md#CONF-0003) |  | **MAY** | Servers **MAY** deploy and support one or more US Core Profiles to represent clinical information |
| CONF-0004 | • [General-Requirements: Profile-Support--Interaction-Support](general-requirements.md#CONF-0004) |  | **MAY** | Server **MAY** deploy and support … the following US Core interaction: “Quick Start” defined for each Profile |
| CONF-0005 | • [General-Requirements: Profile-Support--Interaction-Support](general-requirements.md#CONF-0005) |  | **MAY** | Server **MAY** deploy and support … the following US Core interaction: [Clinical Notes](https://hl7.org/fhir/us/core/clinical-notes.html) |
| CONF-0006 | • [General-Requirements: Profile-Support--Interaction-Support](general-requirements.md#CONF-0006) |  | **MAY** | Server **MAY** deploy and support … the following US Core interaction: [Medication List](https://hl7.org/fhir/us/core/medication-list.html) |
| CONF-0007 | • [General-Requirements: Profile-Support--Interaction-Support](general-requirements.md#CONF-0007) |  | **MAY** | Server **MAY** deploy and support … the following US Core interaction: [Basic Provenance](https://hl7.org/fhir/us/core/basic-provenance.html) |
| CONF-0008 | • [General-Requirements: Profile-Support--Interaction-Support](general-requirements.md#CONF-0008) |  | **MAY** | Server **MAY** deploy and support … the following US Core interaction: [Screening and Assessments](https://hl7.org/fhir/us/core/screening-and-assessments.html) |
| CONF-0009 | • [General-Requirements: Profile-Support--Interaction-Support](general-requirements.md#CONF-0009) |  | **MAY** | Servers implementing … [clinical information representation] can claim conformance to the US Core Profile content structure … by implementing all or parts of the US Core CapabilityStatement into their capabilities. |
| CONF-0010 | • [General-Requirements: Profile-Support--Interaction-Support](general-requirements.md#CONF-0010) |  | **MAY** | Servers implementing … [interactions] can claim conformance to the … RESTful interactions defined by implementing all or parts of the US Core CapabilityStatement into their capabilities |
| CONF-0011 | • [General-Requirements: Profile-Support--Interaction-Support](general-requirements.md#CONF-0011) | **X** | **SHALL** | Certifying Systems **SHALL** implement all components in the USCDI [[USCDI link](https://www.healthit.gov/isp/united-states-core-data-interoperability-uscdi)] |
| CONF-0012 | • [General-Requirements: Profile-Support--Interaction-Support](general-requirements.md#CONF-0012) | **X** | **SHALL** | Certifying Systems **SHALL** implement all components in the … the US Core CapabilityStatement [[Definition](https://hl7.org/fhir/us/core/CapabilityStatement-us-core-Server.html)] . |
| CONF-0013 | • [General-Requirements: Claiming-Conformance-To-A-Us-Core-Profile](general-requirements.md#CONF-0013) |  | **SHALL** | [To claim conformance to a US Core Profile] a conformant Server:**SHALL** Be able to populate all profile data elements that are mandatory and/or flagged as Must Support as defined by that profile’s StructureDefinition. |
| CONF-0014 | • [General-Requirements: Claiming-Conformance-To-A-Us-Core-Profile](general-requirements.md#CONF-0014) |  | **SHOULD** | [To claim conformance to a US Core Profile] a conformant Server:**SHOULD** declare conformance with the US [Core Server Capability Statement](https://hl7.org/fhir/us/core/CapabilityStatement-us-core-Server.html) by including its official URL in the Server’s `CapabilityStatement.instantiates` element: `http://hl7.org/fhir/us/core/CapabilityStatement/us-core-Server` |
| CONF-0015 | • [General-Requirements: Claiming-Conformance-To-A-Us-Core-Profile](general-requirements.md#CONF-0015) |  | **SHALL** | [To claim conformance to a US Core Profile] a conformant Server:**SHALL** specify the full capability details from the US Core CapabilityStatement it claims to implement. |
| CONF-0016 | • [General-Requirements: Claiming-Conformance-To-A-Us-Core-Profile](general-requirements.md#CONF-0016) |  | **SHALL** | [To claim conformance to a US Core Profile] a conformant Server:**SHALL**… Declare support for the US Core Profile by including its official URL in the Server’s CapabilityStatement.rest.resource.supportedProfile element. |
| CONF-0017 | • [General-Requirements: Claiming-Conformance-To-A-Us-Core-Profile](general-requirements.md#CONF-0017) |  | **SHALL** | [To claim conformance to a US Core Profile] a conformant Server:**SHALL**… Declare support for the US Core Profile’s FHIR RESTful transactions. |
| CONF-0018 | • [General-Requirements: Required-Bindings-For-Coded-Elements](general-requirements.md#CONF-0018) |  | **SHALL** | [Required binding](http://hl7.org/fhir/R4/terminologies.html#required) to a ValueSet definition means that one of the codes from the specified ValueSet **SHALL** be used. |
| CONF-0019 | • [General-Requirements: Required-Bindings-For-Coded-Elements](general-requirements.md#CONF-0019) |  | **SHALL** | For `CodeableConcept`, which permits multiple codings and a text element, this [[Required binding](http://hl7.org/fhir/R4/terminologies.html#required) to a ValueSet definition] rule applies to at least one of the codings |
| CONF-0020 | • [General-Requirements: Required-Bindings-For-Coded-Elements](general-requirements.md#CONF-0020) |  | **SHALL-NOT** | For a [[required binding](http://hl7.org/fhir/R4/terminologies.html#required) to a ValueSet definition], a `CodeableConcept`which permits multiple codings and a text element … [using] only text is not valid. |
| CONF-0021 | • [General-Requirements: Required-Bindings-For-Coded-Elements](general-requirements.md#CONF-0021) |  | **SHALL** | [When populating a coded element with a [required binding](http://hl7.org/fhir/R4/terminologies.html#required] to a ValueSet definition] US Core Responders **SHALL** provide a code exclusively from [the required binding] ValueSet |
| CONF-0023 | • [General-Requirements: Extensible-Binding-For-Coded-Elements](general-requirements.md#CONF-0023) |  | **SHALL** | [Extensible binding] (http://hl7.org/fhir/R4/terminologies.html#extensible) means that one of the codes from the specified value set **SHALL** be used when an appropriate concept exists;… |
| CONF-0024 | • [General-Requirements: Extensible-Binding-For-Coded-Elements](general-requirements.md#CONF-0024) |  | **MAY** | [When using an [extensible Binding] (http://hl7.org/fhir/R4/terminologies.html#extensible)] If no suitable code exists in the [extensible] ValueSet, alternate code(s) **MAY** be used.. |
| CONF-0026 | • [General-Requirements: Extensible-Binding-For-Coded-Elements](general-requirements.md#CONF-0026) |  | **SHOULD-NOT** | For `CodeableConcept` [with an [extensible binding] (http://hl7.org/fhir/R4/terminologies.html#extensible) … Text-only representation **SHOULD NOT** be used - coded values are expected whenever possible to support interoperability. |
| CONF-0027 | • [General-Requirements: Extensible-Binding-For-Coded-Elements](general-requirements.md#CONF-0027) |  | **SHALL** | When claiming conformance to … [to a US Core profile extensible binding rule, a] US Core Responders **SHALL** provide: A code from … [the] valueset 'DataElement.code.code' if the concept exists in the valueset [for a DataElement.code that has an extensible binding] Or an alternative code if the concept does not exist in the valueset [for a DataElement.code that has an extensible binding] Or text in … `[DataElement.code.text]’ if only text is available [for a DataElement.code that has an extensible binding] |
| CONF-0029 | • [General-Requirements: Translations](general-requirements.md#CONF-0029) |  | **MAY** | Alternate codes **MAY** be provided in addition to the standard codes defined in required or extensible ValueSets. These alternate codes are called "additional codings". |
| CONF-0030 | • [General-Requirements: Translations](general-requirements.md#CONF-0030) |  | **MAY** | [The additional codings] **MAY** be equivalent to or narrower in meaning than the standard concept code. |
| CONF-0033 | • [General-Requirements: Modifier-Elements](general-requirements.md#CONF-0033) |  | **MAY** | Not all modifier elements are Mandatory or Must Support, and there is no requirement for supporting them |
| CONF-0034 | • [General-Requirements: Modifier-Elements](general-requirements.md#CONF-0034) |  | **MAY** | Servers **MAY** communicate a system-wide profile in their CapabilityStatement to identify which additional elements, including modifier elements, they support |
| CONF-0039 | • [General-Requirements: Missing-Data](general-requirements.md#CONF-0039) |  | **SHALL** | If the source system does not have data for an element with a minimum cardinality = 0 (including elements labeled Must Support), the data element **SHALL** be omitted from the resource. |
| CONF-0040 | • [General-Requirements: Missing-Data](general-requirements.md#CONF-0040) |  | **SHALL** | If the data element is a Mandatory element (in other words, where the minimum cardinality is > 0), it **SHALL** be present even if the source system does not have data. |
| CONF-0041 | • [General-Requirements: Missing-Data](general-requirements.md#CONF-0041) |  | **SHALL** | For [mandatory] non-coded data elements [where data is not available], use the [DataAbsentReason Extension](http://hl7.org/fhir/R4/extension-data-absent-reason.html) in the data type … [with] the code `unknown` - The value is expected to exist but is not known. |
| CONF-0042 | • [General-Requirements: Missing-Data](general-requirements.md#CONF-0042) |  | **SHALL** | [In situations where data is not available] for [mandatory] coded data elements … [with] **example**, **preferred**, or **extensible** binding strengths (CodeableConcept or Coding datatypes) If the source system has text but no coded data, only the text element is used. |
| CONF-0043 | • [General-Requirements: Missing-Data](general-requirements.md#CONF-0043) |  | **SHALL** | [In situations where data is not available] for [mandatory] coded data elements… [with] **example**, **preferred**, or **extensible** binding strengths (CodeableConcept or Coding datatypes): For Coding datatypes, the text-only data is represented as a display element |
| CONF-0044 | • [General-Requirements: Missing-Data](general-requirements.md#CONF-0044) |  | **SHALL** | [In situations where data is not available] for [mandatory] coded data elements… [with] **example**, **preferred**, or **extensible** binding strengths (CodeableConcept or Coding datatypes): … If there is neither text nor coded data … [then] use the appropriate “unknown” concept code from the ValueSet if available. |
| CONF-0045 | • [General-Requirements: Missing-Data](general-requirements.md#CONF-0045) |  | **SHALL** | [In situations where data is not available] for [mandatory] coded data elements… [with] **example**, **preferred**, or **extensible** binding strengths (CodeableConcept or Coding datatypes): … If there is neither text nor coded data … [then] if the ValueSet does not have the appropriate “unknown” concept code, use unknown from the [DataAbsentReason Code System](http://hl7.org/fhir/R4/codesystem-data-absent-reason.html). |
| CONF-0046 | • [General-Requirements: Missing-Data](general-requirements.md#CONF-0046) |  | **SHALL** | [In situations where data is not available] for [mandatory] coded data elements… [with] **required** binding strength (CodeableConcept or code datatypes): use the appropriate “unknown” concept code from the ValueSet if available |
| CONF-0047 | • [General-Requirements: Missing-Data](general-requirements.md#CONF-0047) |  | **SHALL** | [In situations where data is not available] for [mandatory] coded data elements… [with] **required** binding strength (CodeableConcept or code datatypes): If the ValueSet does not have the appropriate “unknown” concept code, you must use a concept from the ValueSet. Otherwise, the instance will not be conformant |
| CONF-0048 | • [General-Requirements: Missing-Data](general-requirements.md#CONF-0048) |  | **SHALL** | [If the source system does not have data for a Mandatory element for a coded data element with **required** binding strength] If any of these status codes is missing [meaning it lacks an "unknown" or otherwise appropriate concept code from the ValueSet, a] 404 HTTP error code and an OperationOutcome **SHALL** be returned in response to a read transaction on the resource. |
| CONF-0049 | • [General-Requirements: Missing-Data](general-requirements.md#CONF-0049) |  | **SHALL** | [If the source system does not have data for a Mandatory element for a coded data element with **required** binding strength, and the ValueSet does not have the appropriate "unknown" concept code, then] if returning a response to a search, the problematic resource **SHALL** be excluded from the search set |
| CONF-0050 | • [General-Requirements: Missing-Data](general-requirements.md#CONF-0050) |  | **SHOULD** | [If the source system does not have data for a Mandatory element for a coded data element with **required** binding strength, and the ValueSet does not have the appropriate "unknown" concept code, then] if returning a response to a search, … a **warning** OperationOutcome **SHOULD** be included indicating that other search results were found but could not be compliantly expressed and have been suppressed. |
| CONF-0051 | • [General-Requirements: Fhir-Restful-Search-Api-Requirements](general-requirements.md#CONF-0051) |  | **SHALL** | The [FHIR RESTful Search API](http://hl7.org/fhir/R4/http.html#search) requires that Servers that support search **SHALL** support the HTTP `POST`-based search. |
| CONF-0052 | • [General-Requirements: Fhir-Restful-Search-Api-Requirements](general-requirements.md#CONF-0052) |  | **SHALL** | For all the supported search interactions in this guide, Servers **SHALL** also support the `GET`-based search. |
| CONF-0055 | • [General-Requirements: Fhir-Restful-Search-Api-Requirements](general-requirements.md#CONF-0055) |  | **SHALL** | When searching using the `token` type searchparameter [(how to search by token)](http://hl7.org/fhir/R4/search.html#token) The Server **SHALL** support both [system and code values] |
| CONF-0058 | • [General-Requirements: Fhir-Restful-Search-Api-Requirements](general-requirements.md#CONF-0058) |  | **SHALL** | When searching using the `reference` type searchparameter [(how to search by reference)](http://hl7.org/fhir/R4/search.html#reference) The Server **SHALL** support both [id and Type values] |
| CONF-0061 | • [General-Requirements: Fhir-Restful-Search-Api-Requirements](general-requirements.md#CONF-0061) |  | **SHALL** | When searching using the `date` type searchparameter [(how to search by date)](http://hl7.org/fhir/R4/search.html#date) The Server **SHALL** support values precise to the day for elements of datatype `date` |
| CONF-0062 | • [General-Requirements: Fhir-Restful-Search-Api-Requirements](general-requirements.md#CONF-0062) |  | **SHALL** | When searching using the `date` type searchparameter [(how to search by date)](http://hl7.org/fhir/R4/search.html#date) The Server **SHALL** support values precise … to the second + time offset for elements of `datatype` dateTime |
| CONF-0063 | • [General-Requirements: Search-For-Servers-Requiring-Status](general-requirements.md#CONF-0063) |  | **SHOULD** | Servers **SHOULD** support a query for resources without requiring a status parameter. |
| CONF-0064 | • [General-Requirements: Search-For-Servers-Requiring-Status](general-requirements.md#CONF-0064) |  | **SHALL** | If business requirements prohibit [querying a resource without a status parameter], they **SHALL** follow the guidelines here. |
| CONF-0065 | • [General-Requirements: Search-For-Servers-Requiring-Status](general-requirements.md#CONF-0065) |  | **MAY** | For searches where the Client does not supply a status parameter, an implementation’s business rules **MAY** override the FHIR RESTful search expectations and require a status parameter to be provided |
| CONF-0066 | • [General-Requirements: Search-For-Servers-Requiring-Status](general-requirements.md#CONF-0066) |  | **SHALL** | For searches where the Client does not supply a status parameter, … systems [that require a status parameter to be provided] are allowed to reject such requests as follows:**SHALL** return an HTTP 400 status |
| CONF-0067 | • [General-Requirements: Search-For-Servers-Requiring-Status](general-requirements.md#CONF-0067) |  | **SHALL** | For searches where the Client does not supply a status parameter, … systems [that require a status parameter to be provided] are allowed to reject such requests as follows:**SHALL** return an [OperationOutcome](http://hl7.org/fhir/R4/operationoutcome.html) specifying that status(es) must be present. |
| CONF-0068 | • [General-Requirements: Search-For-Servers-Requiring-Status](general-requirements.md#CONF-0068) |  | **SHALL** | For searches where the Client does not supply a status parameter, … systems [that require a status parameter to be provided] are allowed to reject such requests as follows:**SHALL** support search with status if status required |
| CONF-0069 | • [General-Requirements: Search-For-Servers-Requiring-Status](general-requirements.md#CONF-0069) |  | **SHALL-NOT** | **SHALL NOT** restrict search results ( i.e., apply ‘hidden’ filters) when a Client includes status parameters in the query. |
| CONF-0070 | • [General-Requirements: Search-For-Servers-Requiring-Status](general-requirements.md#CONF-0070) |  | **SHOULD** | [For systems that require a status parameter to be provided,] if a system doesn’t support a specific status code value that is queried, it **SHOULD** return an HTTP 200 status with a search bundle. |
| CONF-0071 | • [General-Requirements: Search-For-Servers-Requiring-Status](general-requirements.md#CONF-0071) |  | **SHOULD** | [For systems that require a status parameter to be provided,] if a system doesn’t support a specific status code value that is queried [and returns a search bundle],… [t]he search bundle **SHOULD** contain resources matching the search criteria |
| CONF-0072 | • [General-Requirements: Search-For-Servers-Requiring-Status](general-requirements.md#CONF-0072) |  | **SHOULD** | [For systems that require a status parameter to be provided,] if a system doesn’t support a specific status code value that is queried [and returns a search bundle],… [t]he search bundle **SHOULD** contain … an OperationOutcome warning the Client which status code value is not supported. |
| CONF-0073 | • [General-Requirements: Search-For-Servers-Requiring-Status](general-requirements.md#CONF-0073) |  | **SHALL** | For searches where the Client does not supply a status parameter, … systems [that require a status parameter to be provided] are allowed to reject such requests as follows:…**SHALL** document this behavior in its CapabilityStatement for the “search-type” interaction in `CapabilityStatement.rest.resource.interaction.documentation.` |
| CONF-0075 | • [Must-Support: Must-Support-Elements](must-support.md#CONF-0075) |  | **SHALL** | For querying and reading US Core Profiles, Must Support on any profile data element **SHALL** be interpreted as follows…:US Core Responders **SHALL** be capable of populating all data elements as part of the query results specified by the [US Core Server Capability Statement](https://hl7.org/fhir/us/core/STU8/CapabilityStatement-us-core-Server.html). |
| CONF-0078 | • [Must-Support: Must-Support-Elements](must-support.md#CONF-0078) |  | **SHALL-NOT** | **SHALL NOT** include the data elements in the resource instance returned as part of the query results. |
| CONF-0080 | • [Must-Support: Must-Support-El+D647Ements](must-support.md#CONF-0080) |  | **SHOULD** | For querying and reading US Core Profiles, Must Support on any profile data element **SHALL** be interpreted as follows…: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. |
| CONF-0081 | • [Must-Support: Must-Support-Elements](must-support.md#CONF-0081) |  | **SHOULD** | [When sending reason for missing information, follow] the same methdology outlined in the [Missing Data](https://hl7.org/fhir/us/core/STU8/general-requirements.html#missing-data) section but using the appropriate reason code instead of unknown [reason code]. |
| CONF-0084 | • [Must-Support: Additional-USCDI-Requirements](must-support.md#CONF-0084) |  | **SHALL** | Implementors [US Core Responders] seeking ONC certification [in the ONC IT Health Certification program] **SHALL** interpret Additional USCDI Requirements as Must Support elements as documented above and below; |
| CONF-0086 | • [Must-Support: Additional-USCDI-Requirements](must-support.md#CONF-0086) |  | **SHALL** | Implementors [US Core Responders] [not] seeking ONC certification [in the ONC IT Health Certification program] **SHALL** interpret Additional USCDI Requirements as … optional. |
| CONF-0087 | • [Must-Support: Defined-Pattern-Elements](must-support.md#CONF-0087) |  | **SHALL** | If an element is marked as Must Support and defined by a pattern [as described by [ElementDefinition.pattern](http://hl7.org/fhir/R4/elementdefinition-definitions.html#ElementDefinition.pattern_x_)], then the pattern defines the elements and element values that the Server **SHALL** be capable of providing. |
| CONF-0090 | • [Must-Support: Must-Support---Primitive-Elements](must-support.md#CONF-0090) |  | **SHALL** | 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. |
| CONF-0091 | • [Must-Support: Must-Support---Primitive-Elements](must-support.md#CONF-0091) |  | **SHALL** | [W]hen claiming conformance [to a profile with a must support primitive element] … US Core responders **SHALL** be capable of providing the value [of the primitive element] |
| CONF-0093 | • [Must-Support: Must-Support---Complex-Elements](must-support.md#CONF-0093) |  | **SHALL** | For any complex element marked as Must Support, the Server **SHALL** be capable of providing at least one of the sub-element values. |
| CONF-0094 | • [Must-Support: Must-Support---Complex-Elements](must-support.md#CONF-0094) |  | **SHALL** | If any sub-element is marked as Must Support [for a complex element], it **SHALL** also meet the Must Support requirements and satisfy the Must Support requirements for the parent element. |
| CONF-0095 | • [Must-Support: Must-Support---Complex-Elements](must-support.md#CONF-0095) |  | **MAY** | [I]f any sub-element is marked as Must Support or Additional USCDI [for a complex element] and the parent element is not, there is no expectation that you must support the parent. |
| CONF-0096 | • [Must-Support: Must-Support---Complex-Elements](must-support.md#CONF-0096) |  | **SHALL** | [I]f any sub-element is marked as Must Support [for a complex element] and the parent element is not… [and] the parent element is present in an instance, Servers **SHALL** support the sub-element(s) marked as Must Support. |
| CONF-0097 | • [Must-Support: Must-Support---Complex-Elements](must-support.md#CONF-0097) |  | **SHALL** | When claiming conformance [to a must support complex element with no must support sub-elements] … US Core Responders **SHALL** be capable of providing a value in [the] sub-element |
| CONF-0099 | • [Must-Support: Must-Support---Complex-Elements](must-support.md#CONF-0099) |  | **SHALL** | When claiming conformance [to a must support complex element with one or more must support sub-elements] … US Core Responders **SHALL** be capable of providing a value in [each must support sub-element] |
| CONF-0101 | • [Must-Support: Must-Support---Complex-Elements](must-support.md#CONF-0101) |  | **MAY** | Systems [US Core Responders] can support the other elements [of a complex element, not labeled as a Must Support], but this is not a requirement of US Core |
| CONF-0105 | • [Must-Support: Must-Support---Resource-References](must-support.md#CONF-0105) |  | **SHALL** | When a Reference type element is labeled as **Must Support**, has multiple target profiles referenced, and specific targets are labeled as **Must Support**," …* US Core Responders **SHALL** be capable of providing [such an element] with a valid reference to [all listed Must Support profile(s).]
 |
| CONF-0107 | • [Must-Support: Must-Support---Resource-References](must-support.md#CONF-0107) |  | **MAY** | Systems [US Core Responders] can support other [resource] references [other than those labeled as Must Support], but this is not a requirement of US Core |
| CONF-0109 | • [Must-Support: Must-Support---Resource-References](must-support.md#CONF-0109) |  | **SHALL** | When a Reference type element is labeled as **Must Support** and has a single target profile referenced …* US Core Responders **SHALL** be capable of providing [such an element] with a valid reference to [the Must Support Profile.]
 |
| CONF-0111 | • [Must-Support: Must-Support---Choice-Of-Data-Types](must-support.md#CONF-0111) |  | **SHALL** | [If a profile has] a Must Support element [with] a choice of datatypes for its content [and some of] the datatypes … are labeled as Must Support … When claiming conformance to [such a] profile:* US Core Responders **SHALL** be capable of populating [the Must Support data type choice]
 |
| CONF-0114 | • [Must-Support: Must-Support---Choice-Of-Data-Types](must-support.md#CONF-0114) |  | **MAY** | [If a profile has] a Must Support element [with] a choice of datatypes for its content [and some of] the datatypes … are labeled as Must Support[, or a profile has] an Additional USCDI element [with] a choice of datatypes for its content [and some of] the datatypes … are labeled as Additional USCDI…[US Core Responders] **MAY** support populating … other [data type] choice elements (such as Observation.effectivePeriod), but this is not a requirement of US Core. |
| CONF-0115 | • [Must-Support: Must-Support---Choice-Of-Profile-Elements](must-support.md#CONF-0115) |  | **SHALL** | 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 requirement. In such cases, the Server or Certifying System **SHALL** support at least one element. |
| CONF-0117 | • [Scopes: Capability-Sets](scopes.md#CONF-0117) |  | **MAY** | An individual SMART Server will publish a granular list of its capabilities, and a set of these capabilities is combined to support a specific use, a Capability Set. See SMART App Launch’s [FHIR OAuth authorization Endpoints and Capabilities](https://hl7.org/fhir/smart-app-launch/STU2/conformance.html#smart-on-fhir-oauth-authorization-endpoints-and-capabilities) for more details. Servers **MAY** support … [any] SMART on FHIR Capability Sets and capabilities [(see [FHIR OAuth authorization Endpoints and Capabilities](https://hl7.org/fhir/smart-app-launch/STU2/conformance.html#smart-on-fhir-oauth-authorization-endpoints-and-capabilities))] |
| CONF-0118 | • [Scopes: Capabilities-For-Implementations-Supporting-User-Facing-Applications](scopes.md#CONF-0118) |  | **SHOULD** | At least one of the following SMART on FHIR Capability Sets **SHOULD** be supported for US Core Servers that support User-Facing Applications … [Patient Access Standalone Apps](https://hl7.org/fhir/smart-app-launch/STU2/conformance.html#patient-access-for-standalone-apps) [Clinician Access for EHR Launch](https://hl7.org/fhir/smart-app-launch/STU2/conformance.html#clinician-access-for-standalone) |
| CONF-0119 | • [Scopes: Capabilities-For-Implementations-Supporting-User-Facing-Applications](scopes.md#CONF-0119) |  | **SHALL** | For certified systems[, those participating in the ONC IT Health Certification program], both **SHALL** be supported: [Patient Access Standalone Apps](https://hl7.org/fhir/smart-app-launch/STU2/conformance.html#patient-access-for-standalone-apps) [Clinician Access for EHR Launch](https://hl7.org/fhir/smart-app-launch/STU2/conformance.html#clinician-access-for-standalone) |
| CONF-0120 | • [Scopes: Capabilities-For-Implementations-Supporting-Backend-Services](scopes.md#CONF-0120) |  | **SHALL** | Implementations [US Core Responders] supporting Backend Services … **SHALL** include support for the Client-confidential-asymmetric capability. |
| CONF-0121 | • [Scopes: Capabilities-For-Implementations-Supporting-Backend-Services](scopes.md#CONF-0121) |  | **SHALL** | Implementations [US Core Responders] supporting Backend Services … **SHALL** include support for the … system/scopes. |
| CONF-0123 | • [Scopes: Us-Core-Servers-Shall-Support-Token-Introspection](scopes.md#CONF-0123) |  | **SHALL** | US Core Server[s] **SHALL** support token introspection defined by the SMART App Launch Guide. For more details and additional consideration, see SMART App Launch’s [Token Introspection](https://hl7.org/fhir/smart-app-launch/STU2/token-introspection.html#token-introspection). |
| CONF-0124 | • [Scopes: Smart-Scopes](scopes.md#CONF-0124) | **X** | **SHALL** | Certifying systems **SHALL** support all US Core’s required scopes. |
| CONF-0125 | • [Scopes: Smart-Scopes](scopes.md#CONF-0125) |  | **MAY** | Other systems **MAY** support scopes for the US Core APIs they support [instead of all US Core's required scopes] |
| CONF-0126 | • [Scopes: Smart-Scopes](scopes.md#CONF-0126) |  | **MAY** | Servers **MAY** support other scopes in addition to those listed below and in the Quick Start sections. |
| CONF-0128 | • [Scopes: Us-Core-Scopes](scopes.md#CONF-0128) |  | **SHALL** | For “User-Facing Applications”, a system’s support for patient-level (patient) or user-level (user) scopes depends on its published list of SMART on FHIR capabilities (see the [capability sets](https://hl7.org/fhir/us/core/STU8/scopes.html#capability-sets) above). For example, if a Server lists permission-patient and permission-user in its capabilities, it **SHALL** support both patient-level and user-level required scopes |
| CONF-0129 | • [Scopes: Us-Core-Scopes](scopes.md#CONF-0129) |  | **SHOULD** | For “User-Facing Applications”, a system’s support for patient-level (patient) or user-level (user) scopes depends on its published list of SMART on FHIR capabilities (see the [capability sets](https://hl7.org/fhir/us/core/STU8/scopes.html#capability-sets) above). For example, if a Server lists permission-patient and permission-user in its capabilities, it … **SHOULD** support both patient-level and user-level recommended best-practice scopes |
| CONF-0130 | • [Scopes: Us-Core-Scopes](scopes.md#CONF-0130) |  | **SHALL** | For “Backend-Services”, System-level scopes (system) describe data that a Client system is directly authorized to access. Systems that support system-level (system) scopes **SHALL** support the required US Core scopes |
| CONF-0131 | • [Scopes: Us-Core-Scopes](scopes.md#CONF-0131) |  | **SHOULD** | For “Backend-Services”, System-level scopes (system) describe data that a Client system is directly authorized to access. Systems that support system-level (system) scopes **SHOULD** support the recommended US Core scopes |
| CONF-0132 | • [Scopes: Scopes-For-Requesting-Fhir-Resources-By-Type](scopes.md#CONF-0132)• [Structuredefinition-Us-Core-Allergyintolerance: Us-Core-Scopes](StructureDefinition-us-core-allergyintolerance.md#CONF-0132) |  | **SHALL** | The following scopes that correspond directly to FHIR resource types **SHALL** be supported … [For] AllergyIntolerance [the] <patient|user|system>/AllergyIntolerance.rs [see [SMART Clinical Scope Syntax](https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax) for details on clinical data scopes] |
| CONF-0133 | • [Scopes: Scopes-For-Requesting-Fhir-Resources-By-Type](scopes.md#CONF-0133) |  | **SHALL** | The following scopes that correspond directly to FHIR resource types **SHALL** be supported … [For] CarePlan [the] <patient|user|system>/CarePlan.rs [see [SMART Clinical Scope Syntax](https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax) for details on clinical data scopes] |
| CONF-0134 | • [Scopes: Scopes-For-Requesting-Fhir-Resources-By-Type](scopes.md#CONF-0134) |  | **SHALL** | The following scopes that correspond directly to FHIR resource types **SHALL** be supported … [For] CareTeam [the] <patient|user|system>/CareTeam.rs [see [SMART Clinical Scope Syntax](https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax) for details on clinical data scopes] |
| CONF-0135 | • [Scopes: Scopes-For-Requesting-Fhir-Resources-By-Type](scopes.md#CONF-0135) |  | **SHALL** | The following scopes that correspond directly to FHIR resource types **SHALL** be supported … [For] Condition [the] <patient|user|system>/Condition.rs [see [SMART Clinical Scope Syntax](https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax) for details on clinical data scopes] |
| CONF-0136 | • [Scopes: Scopes-For-Requesting-Fhir-Resources-By-Type](scopes.md#CONF-0136) |  | **SHALL** | The following scopes that correspond directly to FHIR resource types **SHALL** be supported … [For] Coverage [the] <patient|user|system>/Coverage.rs [see [SMART Clinical Scope Syntax](https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax) for details on clinical data scopes] |
| CONF-0137 | • [Scopes: Scopes-For-Requesting-Fhir-Resources-By-Type](scopes.md#CONF-0137) |  | **SHALL** | The following scopes that correspond directly to FHIR resource types **SHALL** be supported … [For] Device [the] <patient|user|system>/Device.rs [see [SMART Clinical Scope Syntax](https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax) for details on clinical data scopes] |
| CONF-0138 | • [Scopes: Scopes-For-Requesting-Fhir-Resources-By-Type](scopes.md#CONF-0138) |  | **SHALL** | The following scopes that correspond directly to FHIR resource types **SHALL** be supported … [For] DiagnosticReport [the] <patient|user|system>/DiagnosticReport.rs [see [SMART Clinical Scope Syntax](https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax) for details on clinical data scopes] |
| CONF-0139 | • [Scopes: Scopes-For-Requesting-Fhir-Resources-By-Type](scopes.md#CONF-0139) |  | **SHALL** | The following scopes that correspond directly to FHIR resource types **SHALL** be supported … [For] DocumentReference [the] <patient|user|system>/DocumentReference.rs [see [SMART Clinical Scope Syntax](https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax) for details on clinical data scopes] |
| CONF-0140 | • [Scopes: Scopes-For-Requesting-Fhir-Resources-By-Type](scopes.md#CONF-0140) |  | **SHALL** | The following scopes that correspond directly to FHIR resource types **SHALL** be supported … [For] Encounter [the] <patient|user|system>/Encounter.rs [see [SMART Clinical Scope Syntax](https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax) for details on clinical data scopes] |
| CONF-0141 | • [Scopes: Scopes-For-Requesting-Fhir-Resources-By-Type](scopes.md#CONF-0141) |  | **SHALL** | The following scopes that correspond directly to FHIR resource types **SHALL** be supported … [For] Goal [the] <patient|user|system>/Goal.rs [see [SMART Clinical Scope Syntax](https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax) for details on clinical data scopes] |
| CONF-0142 | • [Scopes: Scopes-For-Requesting-Fhir-Resources-By-Type](scopes.md#CONF-0142) |  | **SHALL** | The following scopes that correspond directly to FHIR resource types **SHALL** be supported … [For] Immunization [the] <patient|user|system>/Immunization.rs [see [SMART Clinical Scope Syntax](https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax) for details on clinical data scopes] |
| CONF-0143 | • [Scopes: Scopes-For-Requesting-Fhir-Resources-By-Type](scopes.md#CONF-0143) |  | **SHALL** | The following scopes that correspond directly to FHIR resource types **SHALL** be supported … [For] MedicationDispense [the] <patient|user|system>/MedicationDispense.rs [see [SMART Clinical Scope Syntax](https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax) for details on clinical data scopes] |
| CONF-0144 | • [Scopes: Scopes-For-Requesting-Fhir-Resources-By-Type](scopes.md#CONF-0144) |  | **SHALL** | The following scopes that correspond directly to FHIR resource types **SHALL** be supported … [For] MedicationRequest [the] <patient|user|system>/MedicationRequest.rs [see [SMART Clinical Scope Syntax](https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax) for details on clinical data scopes] |
| CONF-0145 | • [Scopes: Scopes-For-Requesting-Fhir-Resources-By-Type](scopes.md#CONF-0145) |  | **SHALL** | The following scopes that correspond directly to FHIR resource types **SHALL** be supported … [For] Observation [the] <patient|user|system>/Observation.rs [see [SMART Clinical Scope Syntax](https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax) for details on clinical data scopes] |
| CONF-0146 | • [Scopes: Scopes-For-Requesting-Fhir-Resources-By-Type](scopes.md#CONF-0146) |  | **SHALL** | The following scopes that correspond directly to FHIR resource types **SHALL** be supported … [For] Organization [the] <patient|user|system>/Organization.rs [see [SMART Clinical Scope Syntax](https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax) for details on clinical data scopes] |
| CONF-0147 | • [Scopes: Scopes-For-Requesting-Fhir-Resources-By-Type](scopes.md#CONF-0147) |  | **SHALL** | The following scopes that correspond directly to FHIR resource types **SHALL** be supported … [For] Patient [the] <patient|user|system>/Patient.rs [see [SMART Clinical Scope Syntax](https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax) for details on clinical data scopes] |
| CONF-0148 | • [Scopes: Scopes-For-Requesting-Fhir-Resources-By-Type](scopes.md#CONF-0148) |  | **SHALL** | The following scopes that correspond directly to FHIR resource types **SHALL** be supported … [For] Practitioner [the] <patient|user|system>/Practitioner.rs [see [SMART Clinical Scope Syntax](https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax) for details on clinical data scopes] |
| CONF-0149 | • [Scopes: Scopes-For-Requesting-Fhir-Resources-By-Type](scopes.md#CONF-0149) |  | **SHALL** | The following scopes that correspond directly to FHIR resource types **SHALL** be supported … [For] PractitionerRole [the] <patient|user|system>/PractitionerRole.rs [see [SMART Clinical Scope Syntax](https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax) for details on clinical data scopes] |
| CONF-0150 | • [Scopes: Scopes-For-Requesting-Fhir-Resources-By-Type](scopes.md#CONF-0150) |  | **SHALL** | The following scopes that correspond directly to FHIR resource types **SHALL** be supported … [For] Procedure [the] <patient|user|system>/Procedure.rs [see [SMART Clinical Scope Syntax](https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax) for details on clinical data scopes] |
| CONF-0151 | • [Scopes: Scopes-For-Requesting-Fhir-Resources-By-Type](scopes.md#CONF-0151) |  | **SHALL** | The following scopes that correspond directly to FHIR resource types **SHALL** be supported … [For] Provenance [the] <patient|user|system>/Provenance.rs [see [SMART Clinical Scope Syntax](https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax) for details on clinical data scopes] |
| CONF-0152 | • [Scopes: Scopes-For-Requesting-Fhir-Resources-By-Type](scopes.md#CONF-0152) |  | **SHALL** | The following scopes that correspond directly to FHIR resource types **SHALL** be supported … [For] QuestionnaireResponse [the] <patient|user|system>/QuestionnaireResponse.rs [see [SMART Clinical Scope Syntax](https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax) for details on clinical data scopes] |
| CONF-0153 | • [Scopes: Scopes-For-Requesting-Fhir-Resources-By-Type](scopes.md#CONF-0153) |  | **SHALL** | The following scopes that correspond directly to FHIR resource types **SHALL** be supported … [For] RelatedPerson [the] <patient|user|system>/RelatedPerson.rs [see [SMART Clinical Scope Syntax](https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax) for details on clinical data scopes] |
| CONF-0154 | • [Scopes: Scopes-For-Requesting-Fhir-Resources-By-Type](scopes.md#CONF-0154) |  | **SHALL** | The following scopes that correspond directly to FHIR resource types **SHALL** be supported … [For] ServiceRequest [the] <patient|user|system>/ServiceRequest.rs [see [SMART Clinical Scope Syntax](https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax) for details on clinical data scopes] |
| CONF-0155 | • [Scopes: Scopes-For-Requesting-Fhir-Resources-By-Type](scopes.md#CONF-0155) |  | **SHALL** | The following scopes that correspond directly to FHIR resource types **SHALL** be supported … [For] Specimen [the] <patient|user|system>/Specimen.rs [see [SMART Clinical Scope Syntax](https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax) for details on clinical data scopes] |
| CONF-0156 | • [Scopes: Scopes-For-Requesting-Fhir-Resources-By-Type](scopes.md#CONF-0156) |  | **MAY** | The following scopes that correspond directly to FHIR resource types **MAY** be supported … [For] Location [the] <patient|user|system>/Location.rs [see [SMART Clinical Scope Syntax](https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax) for details on clinical data scopes] |
| CONF-0157 | • [Scopes: Scopes-For-Requesting-Fhir-Resources-By-Type](scopes.md#CONF-0157) |  | **MAY** | The following scopes that correspond directly to FHIR resource types **MAY** be supported … [For] Medication [the] <patient|user|system>/Medication.rs [see [SMART Clinical Scope Syntax](https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax) for details on clinical data scopes] |
| CONF-0158 | • [Scopes: Granular-Scopes-For-Requesting-Fhir-Resources](scopes.md#CONF-0158) |  | **SHALL** | The following granular scopes **SHALL** be supported … [For] Condition [the] <patient|user|system>/Condition.rs?category=http://hl7.org/fhir/us/core/CodeSystem/condition-category|health-concern [see [SMART Clinical Scope Syntax](https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax) for details on clinical data scopes] |
| CONF-0159 | • [Scopes: Granular-Scopes-For-Requesting-Fhir-Resources](scopes.md#CONF-0159) |  | **SHALL** | The following granular scopes **SHALL** be supported … [For] Condition [the] <patient|user|system>/Condition.rs?category=http://terminology.hl7.org/CodeSystem/condition-category|encounter-diagnosis [see [SMART Clinical Scope Syntax](https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax) for details on clinical data scopes] |
| CONF-0160 | • [Scopes: Granular-Scopes-For-Requesting-Fhir-Resources](scopes.md#CONF-0160) |  | **SHALL** | The following granular scopes **SHALL** be supported … [For] Condition [the] <patient|user|system>/Condition.rs?category=http://terminology.hl7.org/CodeSystem/condition-category|problem-list-item [see [SMART Clinical Scope Syntax](https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax) for details on clinical data scopes] |
| CONF-0161 | • [Scopes: Granular-Scopes-For-Requesting-Fhir-Resources](scopes.md#CONF-0161) |  | **SHALL** | The following granular scopes **SHALL** be supported … [For] Observation [the] <patient|user|system>/Observation.rs?category=http://hl7.org/fhir/us/core/CodeSystem/us-core-category|sdoh [see [SMART Clinical Scope Syntax](https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax) for details on clinical data scopes] |
| CONF-0162 | • [Scopes: Granular-Scopes-For-Requesting-Fhir-Resources](scopes.md#CONF-0162) |  | **SHALL** | The following granular scopes **SHALL** be supported … [For] Observation [the] <patient|user|system>/Observation.rs?category=http://terminology.hl7.org//CodeSystem-observation-category|social-history [see [SMART Clinical Scope Syntax](https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax) for details on clinical data scopes] |
| CONF-0163 | • [Scopes: Granular-Scopes-For-Requesting-Fhir-Resources](scopes.md#CONF-0163) |  | **SHALL** | The following granular scopes **SHALL** be supported … [For] Observation [the] <patient|user|system>/Observation.rs?category=http://terminology.hl7.org/CodeSystem/observation-category|laboratory [see [SMART Clinical Scope Syntax](https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax) for details on clinical data scopes] |
| CONF-0164 | • [Scopes: Granular-Scopes-For-Requesting-Fhir-Resources](scopes.md#CONF-0164) |  | **SHALL** | The following granular scopes **SHALL** be supported … [For] Observation [the] <patient|user|system>/Observation.rs?category=http://terminology.hl7.org/CodeSystem/observation-category|survey [see [SMART Clinical Scope Syntax](https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax) for details on clinical data scopes] |
| CONF-0165 | • [Scopes: Granular-Scopes-For-Requesting-Fhir-Resources](scopes.md#CONF-0165) |  | **SHALL** | The following granular scopes **SHALL** be supported … [For] Observation [the] <patient|user|system>/Observation.rs?category=http://terminology.hl7.org/CodeSystem/observation-category|vital-signs [see [SMART Clinical Scope Syntax](https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax) for details on clinical data scopes] |
| CONF-0166 | • [Scopes: Granular-Scopes-For-Requesting-Fhir-Resources](scopes.md#CONF-0166) |  | **SHOULD** | The following granular scopes **SHOULD** be supported … [For] DocumentReference [the] <patient|user|system>/DocumentReference.rs?category=http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category|clinical-note [see [SMART Clinical Scope Syntax](https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax) for details on clinical data scopes] |
| CONF-0167 | • [Scopes: Servers-Shall-Support-The-Following-Metadata-In-Their-Well-Knownsmart-Configuration](scopes.md#CONF-0167) |  | **SHALL** | In addition to the capabilities defined in the Server’s CapabilityStatement, Servers **SHALL** document their SMART capabilities in their [Well-Known Uniform Resource Identifiers (URIs)](https://hl7.org/fhir/smart-app-launch/STU2/conformance.html#using-well-known) JSON file. |
| CONF-0168 | • [Scopes: Additional-Us-Core-Requirements](scopes.md#CONF-0168) |  | **SHALL** | US Core requires … additional metadata [to be available through the Server's [Well-Known Uniform Resource Identifier (URI)](https://hl7.org/fhir/smart-app-launch/STU2/conformance.html#using-well-known)]: … [in] `scopes_supported` [the] array of scopes a Client **MAY** request…. The Server **SHALL** list all the required US Core Scopes for the US Core Profiles they support in the scopes_supported array |
| CONF-0169 | • [Scopes: Additional-Us-Core-Requirements](scopes.md#CONF-0169) |  | **MAY** | US Core requires … additional metadata [to be available through the Server's [Well-Known Uniform Resource Identifier (URI)](https://hl7.org/fhir/smart-app-launch/STU2/conformance.html#using-well-known)]: … [in] `scopes_supported` [the] array of scopes a Client **MAY** request. The Server [MAY support] additional scopes (so Clients **SHOULD**not consider … [the required scopes] an exhaustive list). |
| CONF-0170 | • [Scopes: Additional-Us-Core-Requirements](scopes.md#CONF-0170) |  | **MAY** | US Core requires … additional metadata [to be available through the Server's [Well-Known Uniform Resource Identifier (URI)](https://hl7.org/fhir/smart-app-launch/STU2/conformance.html#using-well-known)]: … [in] `scopes_supported` [the] array of scopes a Client **MAY** request. Servers **MAY** limit Clients’ scopes to those configured at registration time. |
| CONF-0171 | • [Scopes: Additional-Us-Core-Requirements](scopes.md#CONF-0171) |  | **SHALL** | US Core requires … additional metadata [to be available through the Server's [Well-Known Uniform Resource Identifier (URI)](https://hl7.org/fhir/smart-app-launch/STU2/conformance.html#using-well-known)]: … [in] `scopes_supported` [the] array of scopes a Client **MAY** request. … Servers **SHALL** allow users to select a subset of the requested scopes at the approval time. |
| CONF-0173 | • [Scopes: Additional-Us-Core-Requirements](scopes.md#CONF-0173) |  | **SHALL** | US Core requires … additional metadata [to be available through the Server's [Well-Known Uniform Resource Identifier (URI)](https://hl7.org/fhir/smart-app-launch/STU2/conformance.html#using-well-known)]: … [in] `introspection_endpoint` the URL to a Server’s introspection endpoint. … Servers **SHALL** document this endpoint in the file |
| CONF-0174 | • [General-Guidance: Referencing-Us-Core-Profiles](general-guidance.md#CONF-0174) |  | **SHOULD** | Therefore, a [reference](http://hl7.org/fhir/R4/references.html) to a US Core resource **SHOULD** include a logical id (Reference.reference), not an identifier (Reference.identifier). |
| CONF-0175 | • [General-Guidance: Referencing-Us-Core-Profiles](general-guidance.md#CONF-0175) |  | **SHOULD** | For all references, US Core Responders **SHOULD** return resources that conform to a US Core profile if a US Core profile exists for the resource type. |
| CONF-0176 | • [General-Guidance: Contained-Resources](general-guidance.md#CONF-0176) |  | **SHOULD-NOT** | When responding to a query, Servers **SHOULD** not use inline [contained](http://hl7.org/fhir/R4/references.html#contained) resources to represent the returned data. |
| CONF-0177 | • [General-Guidance: Contained-Resources](general-guidance.md#CONF-0177) |  | **SHOULD** | [I]f referencing a contained resource in a US Core Profile, the contained resource **SHOULD** be a US Core Profile if a US Core Profile exists for the resource type. |
| CONF-0178 | • [General-Guidance: Contained-Resources](general-guidance.md#CONF-0178) |  | **SHOULD** | [M]asking data [where a specific piece of data is hidden for security and privacy reasons] **SHOULD** be handled based on implemented policies. |
| CONF-0179 | • [General-Guidance: Contained-Resources](general-guidance.md#CONF-0179) |  | **SHOULD** | [When masking data] elements with a minimum cardinality = 0 (including elements labeled Must Support) [for security and privacy reasons], the element **SHOULD** be omitted from the resource. |
| CONF-0180 | • [General-Guidance: Contained-Resources](general-guidance.md#CONF-0180) |  | **SHOULD** | [When masking] Mandatory elements (in other words, where the minimum cardinality is > 0) [for security and privacy reasons, use the code “unknown” following the guidance on Missing Data in the Conformance Sections. |
| CONF-0181 | • [General-Guidance: Snomed-Ct-United-States-Edition](general-guidance.md#CONF-0181) |  | **MAY** | [When using SNOMED codes in US Core Profiles I]mplementers **MAY** use the default system URI [of [SNOMED CT](http://snomed.info/sct)], which refers to an unspecified edition/version [of SNOMED] |
| CONF-0182 | • [General-Guidance: Snomed-Ct-United-States-Edition](general-guidance.md#CONF-0182) |  | **SHOULD** | [To enable] terminology Servers to be able to validate US Edition-only codes [of [SNOMED CT](http://snomed.info/sct)], implementers **SHOULD** provide the accompanying system URI to describe the edition [see example 2 on [US Core general guidance](https://hl7.org/fhir/us/core/STU8/general-guidance.html#snomed-ct-united-states-edition)] |
| CONF-0183 | • [General-Guidance: Using-Ucum-Codes-In-The-Quantity-Datatype](general-guidance.md#CONF-0183) |  | **SHOULD** | [If a] US Core Profiles binds the Quantity.code element in the Quantity datatype to the [UCUM](http://unitsofmeasure.org/) code system, [then] systems **SHOULD**also use UCUM for the optional valueRange and valueRatio datatypes (which are complex datatypes with Quantity elements) |
| CONF-0184 | • [General-Guidance: Using-Ucum-Codes-In-The-Quantity-Datatype](general-guidance.md#CONF-0184) |  | **SHOULD** | [If a] US Core Profiles binds the Quantity.code element in the Quantity datatype to the [UCUM](http://unitsofmeasure.org/) code system, [when] UCUM code [is] provided [it **SHOULD** be indicated in the Quantity.unit and Quantity.code elements with Quantity.system = "http://unitsofmeasure.org"] |
| CONF-0185 | • [General-Guidance: Using-Ucum-Codes-In-The-Quantity-Datatype](general-guidance.md#CONF-0185) |  | **SHOULD** | [If a] US Core Profiles binds the Quantity.code element in the Quantity datatype to the [UCUM](http://unitsofmeasure.org/) code system, [then] if UCUM units are unavailable, represent units in the unit element |
| CONF-0186 | • [General-Guidance: Using-Ucum-Codes-In-The-Quantity-Datatype](general-guidance.md#CONF-0186) |  | **SHOULD-NOT** | **SHOULD NOT** supply the unit field] |
| CONF-0187 | • [General-Guidance: Representing-Deleted-And-Entered-In-Error-Information](general-guidance.md#CONF-0187) |  | **SHOULD-NOT** | A FHIR Server **SHOULD** not delete records. |
| CONF-0188 | • [General-Guidance: Representing-Deleted-And-Entered-In-Error-Information](general-guidance.md#CONF-0188) |  | **SHOULD** | A FHIR Server **SHOULD** update the appropriate resource status to entered-in-error or inactive [when requested to delete records] |
| CONF-0189 | • [General-Guidance: Representing-Deleted-And-Entered-In-Error-Information](general-guidance.md#CONF-0189) |  | **SHOULD** | If a system supports the deletion of records, they **SHOULD** refer to the [Deletion Safety Checks](http://hl7.org/fhir/R4/safety.html#conformance) in the FHIR specification. |
| CONF-0190 | • [General-Guidance: Representing-Deleted-And-Entered-In-Error-Information](general-guidance.md#CONF-0190) |  | **SHOULD** | A FHIR Server **SHOULD** allow these resources [those entered in error] to be searchable by Client applications. |
| CONF-0191 | • [General-Guidance: Representing-Deleted-And-Entered-In-Error-Information](general-guidance.md#CONF-0191) |  | **SHOULD** | If the FHIR Server has updated the resource status to entered-in-error: For patient facing applications, A FHIR Server **SHOULD** remove the resource’s contents, leaving only an id and status. Note that this typically will not conform to the US Core or FHIR StructureDefinitions. |
| CONF-0192 | • [General-Guidance: Representing-Deleted-And-Entered-In-Error-Information](general-guidance.md#CONF-0192) |  | **MAY** | If the FHIR Server has updated the resource status to entered-in-error: … For provider-facing applications, the content **MAY** be supplied with content and additional detail (such as the reason for the status change) that the patient viewing system would typically not have access to. |
| CONF-0193 | • [General-Guidance: Language-Support](general-guidance.md#CONF-0193) |  | **SHOULD** | the data provider **SHOULD** do their best to translate (safely) to the requested language [when accessing records in a native or requested language] |
| CONF-0195 | • [General-Guidance: Language-Support](general-guidance.md#CONF-0195) |  | **SHOULD** | [When Clients request a resource in a specific language] Servers **SHOULD** make reasonable efforts to translate what can be safely translated. |
| CONF-0196 | • [General-Guidance: Language-Support](general-guidance.md#CONF-0196) |  | **SHOULD** | [When Clients request a resource in a specific language] Servers **SHOULD** populate the Resource’s language element with a code based on the underlying language of record, not the requested language. |
| CONF-0197 | • [General-Guidance: Language-Support](general-guidance.md#CONF-0197) |  | **SHOULD** | [When Clients request a resource in a specific language] Servers **SHOULD** … [use] the [Human Language](http://hl7.org/fhir/R4/extension-language.html) Extension when the language of a display, etc, is known to differ from the stated (or inferred) language. |
| CONF-0198 | • [General-Guidance: Language-Support](general-guidance.md#CONF-0198) |  | **SHOULD** | [When Clients request a resource in a specific language] [Servers **SHOULD** use] the [Translation](http://hl7.org/fhir/R4/extension-translation.html) Extension when the Server provides additional translations by its own choice or in response to a different Accept-Language than what the resource is stored in. |
| CONF-0199 | • [General-Guidance: Language-Support](general-guidance.md#CONF-0199) |  | **SHOULD** | [When Clients request a resource in a specific language] Servers **SHOULD** make it known what languages are supported in their CapabilityStatement(s) using this extension: http://hl7.org/fhir/5.0/StructureDefinition/extension-CapablilityStatement.acceptLanguage [[definition](https://hl7.org/fhir/R5/capabilitystatement-definitions.html#CapabilityStatement.acceptLanguage)] |
| CONF-0200 | • [General-Guidance: Searching-Using-Lastupdated](general-guidance.md#CONF-0200) |  | **SHOULD** | Servers **SHOULD** support the [_lastUpdated](http://hl7.org/fhir/R4/search.html#lastUpdated) search parameter for US Core Profiles |
| CONF-0201 | • [General-Guidance: Searching-Using-Lastupdated](general-guidance.md#CONF-0201) |  | **SHOULD** | Servers … **SHOULD** populate [Resource.meta.lastUpdated](http://hl7.org/fhir/R4/resource.html#Meta) for US Core Profiles as accurately as possible. |
| CONF-0202 | • [General-Guidance: Searching-Using-Lastupdated](general-guidance.md#CONF-0202) |  | **SHALL** | Servers **SHALL** document in CapabilityStatement.rest.resource.searchParam.documentation the types of changes that can be detected using the _lastUpdated search parameter |
| CONF-0203 | • [General-Guidance: Compartment-Based-Search](general-guidance.md#CONF-0203) |  | **MAY** | US Core Servers [MAY support compartment based searchs, but] are not required to support patient [compartment](http://hl7.org/fhir/R4/compartmentdefinition.html) based searches. |
| CONF-0204 | • [General-Guidance: Across-Platform-Searches](general-guidance.md#CONF-0204) |  | **MAY** | US Core Servers [MAY resolve absolute URLs, but] are not required to resolve absolute URLs external to their environment. |
| CONF-0205 | • [General-Guidance: Limiting-The-Number-Of-Search-Results](general-guidance.md#CONF-0205) |  | **MAY** | Servers can [MAY] choose to return the results in a series of pages to manage the number of search results returned. |
| CONF-0206 | • [Clinical-Notes: Clinical-Notes](clinical-notes.md#CONF-0206)• [Clinical-Notes: Support-Requirements](clinical-notes.md#CONF-0206) |  | **SHALL** | Servers **SHALL** support, at minimum, these … "Common Clinical Notes": [Consultation Note (11488-4)](https://loinc.org/11488-4.html) |
| CONF-0207 | • [Clinical-Notes: Clinical-Notes](clinical-notes.md#CONF-0207)• [Clinical-Notes: Support-Requirements](clinical-notes.md#CONF-0207) |  | **SHALL** | Servers **SHALL** support, at minimum, these … "Common Clinical Notes": [Discharge Summary (18842-5)](https://loinc.org/18842-5.html) |
| CONF-0208 | • [Clinical-Notes: Clinical-Notes](clinical-notes.md#CONF-0208)• [Clinical-Notes: Support-Requirements](clinical-notes.md#CONF-0208) |  | **SHALL** | Servers **SHALL** support, at minimum, these … "Common Clinical Notes": [History & Physical Note (34117-2)](https://loinc.org/34117-2.html) |
| CONF-0209 | • [Clinical-Notes: Clinical-Notes](clinical-notes.md#CONF-0209)• [Clinical-Notes: Support-Requirements](clinical-notes.md#CONF-0209) |  | **SHALL** | Servers **SHALL** support, at minimum, these … "Common Clinical Notes": [Procedures Note (28570-0)](https://loinc.org/28570-0.html) |
| CONF-0210 | • [Clinical-Notes: Clinical-Notes](clinical-notes.md#CONF-0210)• [Clinical-Notes: Support-Requirements](clinical-notes.md#CONF-0210) |  | **SHALL** | Servers **SHALL** support, at minimum, these … "Common Clinical Notes": [Progress Note (11506-3)](https://loinc.org/11506-3.html) |
| CONF-0211 | • [Clinical-Notes: Clinical-Notes](clinical-notes.md#CONF-0211)• [Clinical-Notes: Support-Requirements](clinical-notes.md#CONF-0211) |  | **SHALL** | Servers **SHALL** support, at minimum, these … "Common Clinical Notes": [Imaging Narrative (18748-4)](https://loinc.org/18748-4.html) |
| CONF-0212 | • [Clinical-Notes: Clinical-Notes](clinical-notes.md#CONF-0212)• [Clinical-Notes: Support-Requirements](clinical-notes.md#CONF-0212) |  | **SHALL** | Servers **SHALL** support, at minimum, these … "Common Clinical Notes": [Laboratory Report Narrative (11502-2)](https://loinc.org/11502-2.html) |
| CONF-0213 | • [Clinical-Notes: Clinical-Notes](clinical-notes.md#CONF-0213)• [Clinical-Notes: Support-Requirements](clinical-notes.md#CONF-0213) |  | **SHALL** | Servers **SHALL** support, at minimum, these … "Common Clinical Notes": [Pathology Report Narrative (11526-1)](https://loinc.org/11526-1.html) |
| CONF-0214 | • [Clinical-Notes: Clinical-Notes](clinical-notes.md#CONF-0214)• [Clinical-Notes: Support-Requirements](clinical-notes.md#CONF-0214) |  | **SHALL** | Servers **SHALL** support, at minimum, these … DiagnosticReport categories: [Cardiology (LP29708-2)](https://loinc.org/LP29708-2) |
| CONF-0215 | • [Clinical-Notes: Clinical-Notes](clinical-notes.md#CONF-0215)• [Clinical-Notes: Support-Requirements](clinical-notes.md#CONF-0215) |  | **SHALL** | Servers **SHALL** support, at minimum, these … DiagnosticReport categories: [Pathology (LP7839-6)](https://loinc.org/LP7839-6) |
| CONF-0216 | • [Clinical-Notes: Clinical-Notes](clinical-notes.md#CONF-0216)• [Clinical-Notes: Support-Requirements](clinical-notes.md#CONF-0216) |  | **SHALL** | Servers **SHALL** support, at minimum, these … DiagnosticReport categories: [Radiology (LP29684-5)](https://loinc.org/LP29684-5) |
| CONF-0217 | • [Clinical-Notes: Clinical-Notes](clinical-notes.md#CONF-0217) |  | **SHOULD** | systems are encouraged to support other common notes types, such as: [Referral Note (57133-1)](https://loinc.org/57133-1.html) |
| CONF-0219 | • [Clinical-Notes: Clinical-Notes](clinical-notes.md#CONF-0219) |  | **SHOULD** | systems are encouraged to support other common notes types, such as: [Nurse Note (34746-8)](https://loinc.org/34746-8.html) |
| CONF-0220 | • [Clinical-Notes: Fhir-Resources-To-Exchange-Clinical-Notes](clinical-notes.md#CONF-0220) |  | **SHALL** | To enable consistent access to scanned DiagnosticReport clinical reports, the FHIR Server **SHALL** expose these overlapping scanned or narrative-only reports through both DiagnosticReport and DocumentReference by representing the same attachment URL [as] DocumentReference.content.attachment.url [and] DiagnosticReport.presentedForm.url |
| CONF-0221 | • [Clinical-Notes: Fhir-Resources-To-Exchange-Clinical-Notes](clinical-notes.md#CONF-0221) |  | **SHALL** | when DiagnosticReport.presentedForm.url references a Scan (PDF), that Attachment **SHALL** also be accessible through DocumentReference.content.attachment.url |
| CONF-0222 | • [Clinical-Notes: Support-Requirements](clinical-notes.md#CONF-0222) |  | **MAY** | Systems [Servers] **MAY** extend their capabilities [around types of clinical notes] to the complete US Core DocumentReference Type Value Set. |
| CONF-0223 | • [Clinical-Notes: Support-Requirements](clinical-notes.md#CONF-0223) |  | **SHALL** | Systems **SHALL** implement the [US Core DocumentReference Profile](https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-documentreference.html) |
| CONF-0224 | • [Clinical-Notes: Support-Requirements](clinical-notes.md#CONF-0224) |  | **SHALL** | Systems **SHALL** implement the [US Core DiagnosticReport Profile for Report and Note exchange](https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-diagnosticreport-note.html) |
| CONF-0225 | • [Clinical-Notes: Support-Requirements](clinical-notes.md#CONF-0225) |  | **MAY** | Systems [Servers] **MAY** support other [DiagnosticReport] categories as well. |
| CONF-0227 | • [Clinical-Notes: Support-Requirements](clinical-notes.md#CONF-0227) |  | **SHOULD** | The following **SHOULD** be exposed via DiagnosticReport: Imaging Narrative |
| CONF-0228 | • [Clinical-Notes: Support-Requirements](clinical-notes.md#CONF-0228) |  | **SHOULD** | The following **SHOULD** be exposed via DiagnosticReport: Laboratory Report Narrative |
| CONF-0229 | • [Clinical-Notes: Support-Requirements](clinical-notes.md#CONF-0229) |  | **SHOULD** | The following **SHOULD** be exposed via DiagnosticReport: Pathology Report Narrative |
| CONF-0230 | • [Clinical-Notes: Support-Requirements](clinical-notes.md#CONF-0230) |  | **SHOULD** | The following **SHOULD** be exposed via DiagnosticReport: Procedure Note |
| CONF-0231 | • [Clinical-Notes: Support-Requirements](clinical-notes.md#CONF-0231) |  | **SHALL** | Servers that support DiagnosticReport **SHALL** include the clinical note narrative content in `DiagnosticReport.presentedForm` |
| CONF-0233 | • [Clinical-Notes: Using-Expand](clinical-notes.md#CONF-0233) |  | **SHOULD** | FHIR Server claiming support to this guide **SHOULD** support the $expand operation [[operation link](http://hl7.org/fhir/R4/valueset-operation-expand.html) to provide information to Clients requesting information on the note and report types the Server supports] |
| CONF-0234 | • [Clinical-Notes: Using-Expand](clinical-notes.md#CONF-0234) |  | **SHOULD** | [If Servers support the [$expand](http://hl7.org/fhir/R4/valueset-operation-expand.html) operation for discovering note and report types, then Servers **SHALL** support] the #expand operation as follows: GET [base]/ValueSet/$expand?context=http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note#DiagnosticReport.category&contextDirection=outgoing for DiagnosticReport report category discovery [for read operations] |
| CONF-0235 | • [Clinical-Notes: Using-Expand](clinical-notes.md#CONF-0235) |  | **SHOULD** | [If Servers support the [$expand](http://hl7.org/fhir/R4/valueset-operation-expand.html) operation for discovering note and report types, then Servers **SHALL** support] the #expand operation as follows: GET [base]/ValueSet/$expand?context=http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note#DiagnosticReport.category&contextDirection=incoming for DiagnosticReport report category discovery [for write operations] |
| CONF-0236 | • [Clinical-Notes: Using-Expand](clinical-notes.md#CONF-0236) |  | **SHOULD** | [If Servers support the [$expand](http://hl7.org/fhir/R4/valueset-operation-expand.html) operation for discovering note and report types, then Servers **SHALL** support] the #expand operation as follows: GET [base]/ValueSet/$expand?context=http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note#DiagnosticReport.code&contextDirection=outgoing for DiagnosticReport report type discovery [for read operations] |
| CONF-0237 | • [Clinical-Notes: Using-Expand](clinical-notes.md#CONF-0237) |  | **SHOULD** | [If Servers support the [$expand](http://hl7.org/fhir/R4/valueset-operation-expand.html) operation for discovering note and report types, then Servers **SHALL** support] the #expand operation as follows: GET [base]/ValueSet/$expand?context=http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note#DiagnosticReport.code&contextDirection=incoming for DiagnosticReport report type discovery [for write operations] |
| CONF-0238 | • [Clinical-Notes: Using-Expand](clinical-notes.md#CONF-0238) |  | **SHOULD** | [If Servers support the [$expand](http://hl7.org/fhir/R4/valueset-operation-expand.html) operation for discovering note and report types, then Servers **SHALL** support] the #expand operation as follows: GET [base]/ValueSet/$expand?context=http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference#DocumentReference.category&contextDirection=outgoing for DocumentReference note category discovery [for read operations] |
| CONF-0239 | • [Clinical-Notes: Using-Expand](clinical-notes.md#CONF-0239) |  | **SHOULD** | [If Servers support the [$expand](http://hl7.org/fhir/R4/valueset-operation-expand.html) operation for discovering note and report types, then Servers **SHALL** support] the #expand operation as follows: GET [base]/ValueSet/$expand?context=http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference#DocumentReference.category&contextDirection=incoming for DocumentReference note category discovery [for write operations] |
| CONF-0240 | • [Clinical-Notes: Using-Expand](clinical-notes.md#CONF-0240) |  | **SHOULD** | [If Servers support the [$expand](http://hl7.org/fhir/R4/valueset-operation-expand.html) operation for discovering note and report types, then Servers **SHALL** support] the #expand operation as follows: GET [base]/ValueSet/$expand?context=http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference#DocumentReference.type&contextDirection=outgoing for DocumentReference note type discovery [for read operations] |
| CONF-0241 | • [Clinical-Notes: Using-Expand](clinical-notes.md#CONF-0241) |  | **SHOULD** | [If Servers support the [$expand](http://hl7.org/fhir/R4/valueset-operation-expand.html) operation for discovering note and report types, then Servers **SHALL** support] the #expand operation as follows: GET [base]/ValueSet/$expand?context=http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference#DocumentReference.type&contextDirection=incoming for DocumentReference note type discovery [for write operations] |
| CONF-0242 | • [Clinical-Notes: Discovering-Server-Read-And-Write-Formats](clinical-notes.md#CONF-0242) |  | **SHOULD** | [If Servers support the [$expand](http://hl7.org/fhir/R4/valueset-operation-expand.html) operation then] the note and report types for a particular Server [SHOULD be] discovered by invoking the #expand operation as follows: GET [base]/ValueSet/$expand?context=http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note#DiagnosticReport.presentedForm.contentType&contextDirection=outgoing for DiagnosticReport report content type discovery [for read operations] |
| CONF-0243 | • [Clinical-Notes: Discovering-Server-Read-And-Write-Formats](clinical-notes.md#CONF-0243) |  | **SHOULD** | [If Servers support the [$expand](http://hl7.org/fhir/R4/valueset-operation-expand.html) operation then] the note and report types for a particular Server [SHOULD be] discovered by invoking the #expand operation as follows: GET [base]/ValueSet/$expand?context=http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note#DiagnosticReport.presentedForm.contentType&contextDirection=incoming for DiagnosticReport report content type discovery [for write operations] |
| CONF-0244 | • [Clinical-Notes: Discovering-Server-Read-And-Write-Formats](clinical-notes.md#CONF-0244) |  | **SHOULD** | [If Servers support the [$expand](http://hl7.org/fhir/R4/valueset-operation-expand.html) operation then] the note and report types for a particular Server [SHOULD be] discovered by invoking the #expand operation as follows: GET [base]/ValueSet/$expand?context=http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference#DocumentReference.content.attachment.contentType&contextDirection=outgoing for DocumentReference note content type discovery [for read operations] |
| CONF-0245 | • [Clinical-Notes: Discovering-Server-Read-And-Write-Formats](clinical-notes.md#CONF-0245) |  | **SHOULD** | [If Servers support the [$expand](http://hl7.org/fhir/R4/valueset-operation-expand.html) operation then] the note and report types for a particular Server [SHOULD be] discovered by invoking the #expand operation as follows: GET [base]/ValueSet/$expand?context=http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference#DocumentReference.content.attachment.contentType&contextDirection=incoming for DocumentReference note content type discovery [for write operations] |
| CONF-0247 | • [Medication-List: Options-For-Representing-Medication](medication-list.md#CONF-0247) |  | **SHALL** | When using a code [to represent a medication][, the code **SHALL** follow the [extensible](http://hl7.org/fhir/R4/terminologies.html#extensible) binding rules to [Medication Clinical Drug (RxNorm)](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1010.4/expansion) - i.e., unless RxNorm does not cover the concept, the RxNorm code **SHALL** be used. |
| CONF-0248 | • [Medication-List: Options-For-Representing-Medication](medication-list.md#CONF-0248)• [Structuredefinition-Us-Core-Medicationdispense: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-medicationdispense.md#CONF-0248)• [Structuredefinition-Us-Core-Medicationrequest: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-medicationrequest.md#CONF-0248)• [Structuredefinition-Us-Core-Medication: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-medication.md#CONF-0248) |  | **MAY** | USCDI recommends the [National Drug Codes (NDC)](https://www.fda.gov/drugs/drug-approvals-and-databases/national-drug-code-directory) as an optional medication terminology. They **MAY** be supplied as an additional coding element [when representing a medication] |
| CONF-0249 | • [Medication-List: Options-For-Representing-Medication](medication-list.md#CONF-0249) |  | **MAY** | When referencing the Medication resource, the resource **MAY** be included in the returned bundle, as an external resource, or as a [contained](http://hl7.org/fhir/R4/references.html#contained) resource if it can’t stand alone. … The Server application **MAY** choose any combination of these methods |
| CONF-0250 | • [Medication-List: Options-For-Representing-Medication](medication-list.md#CONF-0250) |  | **SHALL** | if an external reference to Medication is used, the Server **SHALL** support the [_include](http://hl7.org/fhir/R4/search.html#include) parameter for searching this element |
| CONF-0252 | • [Medication-List: Fetching-All-Medications-Active-Medications-And-All-Medications-For-An-Encounter](medication-list.md#CONF-0252) |  | **SHALL** | Requirements to access “all medications” [all historical, active, and future prescribed medications and medications entered in error and whose status is unknown.] and “all active medications” [all medications with an active status. Active medications do not include past, future, unknown status, and entered-in-error medications.] for a patient: A MedicationRequest resource query **SHALL** be all that is required to access "all medications" or "all active medications" for a patient. (In other words, no other medication resource type needs to be fetched) |
| CONF-0253 | • [Medication-List: Fetching-All-Medications-Active-Medications-And-All-Medications-For-An-Encounter](medication-list.md#CONF-0253) |  | **SHALL** | Requirements to access “all medications” [all historical, active, and future prescribed medications and medications entered in error and whose status is unknown.] and “all active medications” [all medications with an active status. Active medications do not include past, future, unknown status, and entered-in-error medications.] for a patient: The [MedicationRequest resource] query result **SHALL** include all MedicationRequest resources with a `MedicationRequest.intent` = "order" representing authorized medication orders directly derived from the system's orders. |
| CONF-0254 | • [Medication-List: Fetching-All-Medications-Active-Medications-And-All-Medications-For-An-Encounter](medication-list.md#CONF-0254) |  | **SHALL** | Requirements to access “all medications” [all historical, active, and future prescribed medications and medications entered in error and whose status is unknown.] and “all active medications” [all medications with an active status. Active medications do not include past, future, unknown status, and entered-in-error medications.] for a patient: The [MedicationRequest resource] query result **SHALL** include all prescribed and "self-prescribed" MedicationRequest resources with a `MedicationRequest.intent` = "plan" representing reported medications. |
| CONF-0256 | • [Medication-List: Fetching-All-Medications-Active-Medications-And-All-Medications-For-An-Encounter](medication-list.md#CONF-0256) |  | **SHALL** | Requirements to access “all medications” [all historical, active, and future prescribed medications and medications entered in error and whose status is unknown.] and “all active medications” [all medications with an active status. Active medications do not include past, future, unknown status, and entered-in-error medications.] for a patient: Servers **SHALL** use the `MedicationRequest.reported[x]` element to indicate that the MedicationRequest record was captured as a secondary "reported" record rather than an original primary source-of-truth record. |
| CONF-0258 | • [Medication-List: Fetching-All-Medications-Active-Medications-And-All-Medications-For-An-Encounter](medication-list.md#CONF-0258) |  | **SHOULD** | Requirements to access “all medications” [all historical, active, and future prescribed medications and medications entered in error and whose status is unknown.] and “all active medications” [all medications with an active status. Active medications do not include past, future, unknown status, and entered-in-error medications.] for a patient: When recording "self-prescribed" medication, Servers **SHOULD** use the `MedicationRequest.requester` element to indicate the Patient or RelatedPerson is the prescriber. |
| CONF-0259 | • [Medication-List: Fetching-All-Medications-Active-Medications-And-All-Medications-For-An-Encounter](medication-list.md#CONF-0259) |  | **SHOULD** | Requirements to access “all medications” [all historical, active, and future prescribed medications and medications entered in error and whose status is unknown.] and “all active medications” [all medications with an active status. Active medications do not include past, future, unknown status, and entered-in-error medications.] for a patient: Servers **SHOULD** support the encounter search parameter. |
| CONF-0260 | • [Medication-List: Fetching-All-Medications-Active-Medications-And-All-Medications-For-An-Encounter](medication-list.md#CONF-0260) |  | **SHOULD** | Requirements to access “all medications” [all historical, active, and future prescribed medications and medications entered in error and whose status is unknown.] and “all active medications” [all medications with an active status. Active medications do not include past, future, unknown status, and entered-in-error medications.] for a patient: [If Servers support the encounter search parameter, s]earching by encounter will return all medications ordered during that encounter, including medications administered in the hospital and prescribed or discharge medications intended to be taken at home. |
| CONF-0262 | • [Medication-List: Fetching-All-Medications-Active-Medications-And-All-Medications-For-An-Encounter](medication-list.md#CONF-0262) |  | **MAY** | Requirements to access “all medications” [all historical, active, and future prescribed medications and medications entered in error and whose status is unknown.] and “all active medications” [all medications with an active status. Active medications do not include past, future, unknown status, and entered-in-error medications.] for a patient: Servers **MAY** support the search parameters `category`and `encounter`. This search will return all medications ordered during an encounter for a given MedicationRequest.category such as "inpatient". |
| CONF-0263 | • [Medication-List: De-Duplication-Of-Data](medication-list.md#CONF-0263) |  | **MAY** | To provide a list of a patient’s medications, it **MAY** be necessary to “de-duplicate” them. The de-duplication activity **MAY** be supplied by the Server |
| CONF-0267 | • [Basic-Provenance: Hie-Transformation](basic-provenance.md#CONF-0267) |  | **MAY** | An agent.type=”assembler”, agent.type=”transmitter”, or other agents from [Provenance Agent Type](https://hl7.org/fhir/us/core/STU8/ValueSet-us-core-provenance-participant-type.html) value set **MAY** also be included. |
| CONF-0268 | • [Screening-And-Assessments: Introduction](screening-and-assessments.md#CONF-0268) |  | **SHOULD** | implementers [of US Core's framework of Screening and Assessments] **SHOULD** consider more constrained, domain-specific profiles derived from the US Core Profiles to meet the needs of their respective use cases. |
| CONF-0269 | • [Screening-And-Assessments: Clinical-Judgments](screening-and-assessments.md#CONF-0269) |  | **SHALL** | Every Server that supports the USDCI Data Class “Health Status/Assessments”:**SHALL** support representing clinical judgments using [US Core Condition Problems and Health Concerns Profile](https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-condition-problems-health-concerns.html) or [US Core Simple Observation Profile](https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-simple-observation.html). |
| CONF-0270 | • [Screening-And-Assessments: Clinical-Judgments](screening-and-assessments.md#CONF-0270) |  | **SHOULD** | Every Server that supports the USDCI Data Class “Health Status/Assessments”: … The US Core Simple Observation Profile's Observation.derivedFrom element **SHOULD** reference the [Structured Screening and Assessment](https://hl7.org/fhir/us/core/STU8/screening-and-assessments.html#structured-screening-and-assessments) upon which clinical judgment observations are made |
| CONF-0271 | • [Screening-And-Assessments: Clinical-Judgments](screening-and-assessments.md#CONF-0271) |  | **SHOULD** | Every Server that supports the USDCI Data Class “Health Status/Assessments”: … the US Core Condition Profile's Condition.evidence.detail element **SHOULD** reference the [Structured Screening and Assessment](https://hl7.org/fhir/us/core/STU8/screening-and-assessments.html#structured-screening-and-assessments) which assist in diagnosing problems or health concerns. |
| CONF-0272 | • [Screening-And-Assessments: Choosing-Between-Questionnaireresponse-And-Observation](screening-and-assessments.md#CONF-0272) |  | **SHOULD** | For API developers using US Core, it’s important to understand when to use the QuestionnaireResponse versus Observation to represent structured assessments and surveys. Here are some guidelines to help choose the appropriate profile: Observations represent specific point-in-time facts that need to be searched, trended, the subject of statistical analysis, and directly referenced in support of other actions … anything that meets one of the preceding criteria **SHOULD** be surfaced as an Observation. |
| CONF-0280 | • [Screening-And-Assessments: USCDI-Health-Assessments-Data-Element-Value-Sets](screening-and-assessments.md#CONF-0280) |  | **SHOULD** | Implementers **SHOULD** treat these [USCDI Health Status Assessments Data Element] value sets as having an [extensible](http://hl7.org/fhir/R4/terminologies.html#extensible) binding. |
| CONF-0281 | • [Screening-And-Assessments: USCDI-Health-Assessments-Data-Element-Value-Sets](screening-and-assessments.md#CONF-0281) |  | **SHOULD** | when recording SDOH data [with] US Core Profiles, Servers **SHOULD** use … [Social Determinants of Health Conditions Value Set](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1196.788/expansion), [Social Determinants of Health Procedures Value Set](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1196.789/expansion), [Social Determinants of Health Goals Value Set](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1247.71/expansion), [and] [Social Determinants of Health Service Requests Value Set](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1196.790/expansion) |
| CONF-0287 | • [Changes-Between-Versions: No-Guarantee-That-Resource-Ids-Are-Preserved](changes-between-versions.md#CONF-0287) |  | **SHOULD** | Servers **SHOULD** maintain a stable common identifier for a resource across [FHIR] versions. |
| CONF-0288 | • [Changes-Between-Versions: Expectation-That-Data-Is-Preserved-Between-Versions](changes-between-versions.md#CONF-0288) |  | **SHOULD** | In an upgraded R4 endpoint, any data in FHIR DSTU2 **SHOULD** be in FHIR R4. |
| CONF-0289 | • [Changes-Between-Versions: Expectation-That-Data-Is-Preserved-Between-Versions](changes-between-versions.md#CONF-0289) |  | **SHOULD** | The FHIR RESTful resource types supported in a DSTU2 implementation **SHOULD** be supported in a R4 implementation |
| CONF-0290 | • [Changes-Between-Versions: Expectation-That-Data-Is-Preserved-Between-Versions](changes-between-versions.md#CONF-0290) |  | **SHOULD** | The FHIR RESTful resource types supported in a DSTU2 implementation **SHOULD** be supported in a R4 implementation [with the] exception [of] MedicationStatement **MAY** be deprecated, and the data **SHOULD** be mapped to MedicationRequest. |
| CONF-0291 | • [Changes-Between-Versions: Expectation-That-Data-Is-Preserved-Between-Versions](changes-between-versions.md#CONF-0291) |  | **SHOULD** | The FHIR RESTful resource types supported in a DSTU2 implementation **SHOULD** be supported in a R4 implementation [with the] exception [of] Care teams as represented by CarePlan in DSTU2 **SHOULD** be replaced by and the data mapped to CareTeam in R4 |
| CONF-0295 | • [Changes-Between-Versions: Expectation-That-Data-Is-Preserved-Between-Versions](changes-between-versions.md#CONF-0295) |  | **SHOULD** | Servers **SHOULD** make available the same information in DSTU2 and R4 where the more recent standard allows. |
| CONF-0296 | • [Changes-Between-Versions: Expectation-That-Data-Is-Preserved-Between-Versions](changes-between-versions.md#CONF-0296) |  | **SHOULD** | Servers **SHOULD** make available the same information in DSTU2 and R4 where the more recent standard allows … [with the] exception [of] MedicationStatement data [should be] mapped to MedicationRequest |
| CONF-0297 | • [Changes-Between-Versions: Expectation-That-Data-Is-Preserved-Between-Versions](changes-between-versions.md#CONF-0297) |  | **SHOULD** | Servers **SHOULD** make available the same information in DSTU2 and R4 where the more recent standard allows … [with the] exception [of] care teams, as represented by CarePlan, **SHOULD** be mapped to CareTeam in R4 |
| CONF-0298 | • [Changes-Between-Versions: Expectation-That-Data-Is-Preserved-Between-Versions](changes-between-versions.md#CONF-0298) |  | **SHOULD** | Data **SHOULD** be maintained between [FHIR] versions (i.e., not be degraded). |
| CONF-0300 | • [Changes-Between-Versions: Authorization-Across-Versions](changes-between-versions.md#CONF-0300) |  | **SHOULD** | To allow Clients to use a single authorization token when accessing resources from multiple version-specific endpoints, Servers **SHOULD** use the same base authorization endpoint across versions. |
| CONF-0302 | • [Structuredefinition-Us-Core-Allergyintolerance: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-allergyintolerance.md#CONF-0302) |  | **SHALL** | [The clinical status of the allergy] **SHALL** be present if verification status is not “entered-in-error” |
| CONF-0303 | • [Structuredefinition-Us-Core-Allergyintolerance: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-allergyintolerance.md#CONF-0303) |  | **SHALL-NOT** | [The clinical status of the allergy] **SHALL NOT** be present if verification Status is “entered-in-error” |
| CONF-0305 | • [Structuredefinition-Us-Core-Allergyintolerance: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-allergyintolerance.md#CONF-0305) |  | **MAY** | No Known Allergies **MAY** be represented using the US Core-AllergyIntolerance profile |
| CONF-0306 | • [Structuredefinition-Us-Core-Allergyintolerance: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-allergyintolerance.md#CONF-0306) |  | **SHALL** | [When No Known Allergies is documented the system **SHALL** use an] appropriate negation code in AllergyIntolerance.code |
| CONF-0307 | • [Structuredefinition-Us-Core-Allergyintolerance: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-allergyintolerance.md#CONF-0307) |  | **SHALL** | [When No Known Allergies is documented the system **SHALL** use an] verification status in AllergyIntolerance.verificationStatus |
| CONF-0308 | • [Structuredefinition-Us-Core-Allergyintolerance: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-allergyintolerance.md#CONF-0308) |  | **SHOULD** | If a patient has not been asked about their allergies, this would be represented as: AllergyIntolerance.code = “1631000175102” (Patient not asked (contextual qualifier) (qualifier value)) AllergyIntolerance.verificationStatus = “unconfirmed” or empty (in other words, the element omitted) |
| CONF-0309 | • [Structuredefinition-Us-Core-Allergyintolerance: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-allergyintolerance.md#CONF-0309) |  | **SHOULD** | If a patient has been asked, but has indicated they have no known allergies, this would be represented as: AllergyIntolerance.code = “716186003” (No known allergy (situation)) AllergyIntolerance.verificationStatus = “confirmed” |
| CONF-0310 | • [Structuredefinition-Us-Core-Careplan: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-careplan.md#CONF-0310) |  | **SHOULD** | Considerations for systems aligning with [HL7 Consolidated (C-CDA)](http://www.hl7.org/implement/standards/product_brief.cfm?product_id=492) Care Plan requirements: US Core Goal **SHOULD** be present in CarePlan.goal |
| CONF-0311 | • [Structuredefinition-Us-Core-Careplan: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-careplan.md#CONF-0311) |  | **SHOULD** | Considerations for systems aligning with [HL7 Consolidated (C-CDA)] (http://www.hl7.org/implement/standards/product_brief.cfm?product_id=492) Care Plan requirements: … US Core Condition **SHOULD** be present in CarePlan.addresses |
| CONF-0312 | • [Structuredefinition-Us-Core-Careplan: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-careplan.md#CONF-0312) |  | **MAY** | Considerations for systems aligning with [HL7 Consolidated (C-CDA)] (http://www.hl7.org/implement/standards/product_brief.cfm?product_id=492) Care Plan requirements: Assessment and Plan **MAY** be included as narrative in CarePlan.text |
| CONF-0313 | • [Structuredefinition-Us-Core-Careteam: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-careteam.md#CONF-0313) |  | **SHALL** | Although both US Core Practitioner Profile and US Core PractitionerRole are Must Support, … Server system[s conforming to the US Core CareTeam profile are] … not required to support references to both, but **SHALL** support at least one of them |
| CONF-0317 | • [Structuredefinition-Us-Core-Careteam: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-careteam.md#CONF-0317) |  | **SHOULD** | [When conforming to the US Core CareTeam profile] Because the US Core PractitionerRole Profile supplies the provider’s location and contact information and a reference to the Practitioner, Server systems [conforming to the US Core CareTeam profile] **SHOULD** reference it instead of the US Core Practitioner Profile [when conforming to the US Core CareTeam profile] . |
| CONF-0318 | • [Structuredefinition-Us-Core-Careteam: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-careteam.md#CONF-0318) |  | **SHALL** | Servers [conforming to the US Core CareTeam profile] that support only US Core Practitioner Profile and do not support the US Core PractitionerRole Profile **SHALL** provide implementation-specific guidance on how to access a provider’s location … information using only the Practitioner resource. |
| CONF-0319 | • [Structuredefinition-Us-Core-Careteam: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-careteam.md#CONF-0319) |  | **SHALL** | Servers [conforming to the US Core CareTeam profile] that support only US Core Practitioner Profile and do not support the US Core PractitionerRole Profile **SHALL** provide implementation-specific guidance on how to access a provider’s … contact information using only the Practitioner resource. |
| CONF-0323 | • [Structuredefinition-Us-Core-Condition-Encounter-Diagnosis: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-condition-encounter-diagnosis.md#CONF-0323)• [Structuredefinition-Us-Core-Condition-Problems-Health-Concerns: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-condition-problems-health-concerns.md#CONF-0323) |  | **SHOULD** | USCDI’s applicable vocabulary standards for Encounter Diagnosis are SNOMED CT and ICD-10-CM. The US Core Condition Codes only supports ICD-9-CM for historical purposes. When using ICD codes, only non-header ICD-10-CM codes **SHOULD** be used as the primary code for current encounter diagnoses. |
| CONF-0324 | • [Structuredefinition-Us-Core-Condition-Encounter-Diagnosis: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-condition-encounter-diagnosis.md#CONF-0324) |  | **SHOULD** | [A US Core Condition Encounter Diagnosis] encounter **SHOULD** always be referenced in Condition.encounter. |
| CONF-0331 | • [Structuredefinition-Us-Core-Condition-Problems-Health-Concerns: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-condition-problems-health-concerns.md#CONF-0331) |  | **SHOULD** | If the category is "problem-list-item", Condition.clinicalStatus **SHOULD** be present. |
| CONF-0332 | • [Structuredefinition-Us-Core-Condition-Problems-Health-Concerns: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-condition-problems-health-concerns.md#CONF-0332) |  | **SHOULD** | Updates to .meta.lastUpdated **SHOULD** reflect: New problems and health concerns |
| CONF-0333 | • [Structuredefinition-Us-Core-Condition-Problems-Health-Concerns: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-condition-problems-health-concerns.md#CONF-0333) |  | **SHOULD** | Updates to .meta.lastUpdated **SHOULD** reflect: Changes in the clinical status or verification status of problems or health concerns. |
| CONF-0334 | • [Structuredefinition-Us-Core-Coverage: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-coverage.md#CONF-0334) |  | **MAY** | A coverage.type of “81” (Self-pay) **MAY** be used to imply that the patient has no coverage or that an individual or organization other than an insurer is taking responsibility for payment for a portion of the health care costs. |
| CONF-0336 | • [Structuredefinition-Us-Core-Coverage: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-coverage.md#CONF-0336) |  | **SHOULD** | To differentiate Medicare Parts A, B, C, and D systems **SHOULD** use the following codes [when sending Coverage.type]: [For] Part A and B [use] 121 (Medicare Fee For Service) |
| CONF-0337 | • [Structuredefinition-Us-Core-Coverage: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-coverage.md#CONF-0337) |  | **SHOULD** | To differentiate Medicare Parts A, B, C, and D systems **SHOULD** use the following codes: [For] Part C (Medicare Advantage Plan) [use] 111 (Medicare HMO), 112 (Medicare PPO), 113 (Medicare POS) |
| CONF-0338 | • [Structuredefinition-Us-Core-Coverage: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-coverage.md#CONF-0338) |  | **SHOULD** | To differentiate Medicare Parts A, B, C, and D systems **SHOULD** use the following codes: [For] Part D [use] 122 (Medicare Drug Benefit) |
| CONF-0339 | • [Structuredefinition-Us-Core-Coverage: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-coverage.md#CONF-0339) |  | **SHOULD** | If Insurers issue unique member IDs for dependents, then the memberId Coverage.identifier **SHOULD**be used [with the unique dependent ID] instead of Coverage.dependent to uniquely refer to the dependent with respect to their insurance. |
| CONF-0341 | • [Structuredefinition-Us-Core-Device: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-device.md#CONF-0341) |  | **SHOULD** | Implementers **SHOULD** use the FDA Global UDI Database (GUDID) and associated APIs to parse and validate the [unique device ID] UDI |
| CONF-0342 | • [Structuredefinition-Us-Core-Device: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-device.md#CONF-0342) |  | **SHALL** | Medical devices with UDI information **SHALL** represent the UDI code in Device.udiCarrier.carrierHRF |
| CONF-0343 | • [Structuredefinition-Us-Core-Device: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-device.md#CONF-0343) |  | **SHALL** | UDI-PI elements present [in Device.udiCarrier.carrierHRF] **SHALL** be represented in the corresponding US Core Device Profile elements |
| CONF-0344 | • [Structuredefinition-Us-Core-Device: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-device.md#CONF-0344) |  | **SHOULD** | If UDI is not present and the manufacturer … is available, … [it] **SHOULD** be included to support historical reports of implantable medical devices [where] manufacturer [is sent in] Device.manufacturer |
| CONF-0345 | • [Structuredefinition-Us-Core-Device: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-device.md#CONF-0345) |  | **SHOULD** | If UDI is not present and the … model number information is available, … [it] **SHOULD** be included to support historical reports of implantable medical devices [where] model [is sent in] Device.model |
| CONF-0347 | • [Structuredefinition-Us-Core-Device: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-device.md#CONF-0347) |  | **MAY** | Records of implanted devices **MAY** be queried against UDI data, including: UDI HRF string (udi-carrier) |
| CONF-0348 | • [Structuredefinition-Us-Core-Device: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-device.md#CONF-0348) |  | **MAY** | Records of implanted devices **MAY** be queried against UDI data, including:UDI Device Identifier (udi-di) |
| CONF-0349 | • [Structuredefinition-Us-Core-Device: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-device.md#CONF-0349) |  | **MAY** | Records of implanted devices **MAY** be queried against UDI data, including: Manufacturer (manufacturer) |
| CONF-0350 | • [Structuredefinition-Us-Core-Device: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-device.md#CONF-0350) |  | **MAY** | Records of implanted devices **MAY** be queried against UDI data, including: Model number (model) |
| CONF-0351 | • [Structuredefinition-Us-Core-Device: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-device.md#CONF-0351) |  | **MAY** | Implementers **MAY** also adopt custom SearchParameters for searching by lot numbers |
| CONF-0352 | • [Structuredefinition-Us-Core-Device: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-device.md#CONF-0352) |  | **MAY** | Implementers **MAY** also adopt custom SearchParameters for searching by serial number |
| CONF-0353 | • [Structuredefinition-Us-Core-Device: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-device.md#CONF-0353) |  | **MAY** | Implementers **MAY** also adopt custom SearchParameters for searching by expiration date |
| CONF-0354 | • [Structuredefinition-Us-Core-Device: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-device.md#CONF-0354) |  | **MAY** | Implementers **MAY** also adopt custom SearchParameters for searching by manufacture date |
| CONF-0355 | • [Structuredefinition-Us-Core-Device: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-device.md#CONF-0355) |  | **MAY** | Implementers **MAY** also adopt custom SearchParameters for searching by distinct identifier |
| CONF-0356 | • [Structuredefinition-Us-Core-Diagnosticreport-Lab: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-diagnosticreport-lab.md#CONF-0356)• [Structuredefinition-Us-Core-Diagnosticreport-Note: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-diagnosticreport-note.md#CONF-0356) |  | **SHALL** | The diagnostically relevant time (known as the “effective time” and typically the time of specimen collection) … **SHALL** be present if status [of the diagnostic report] is ‘partial’, ‘preliminary’, ‘final’, ‘amended’, ‘corrected’, or ‘appended’. |
| CONF-0357 | • [Structuredefinition-Us-Core-Diagnosticreport-Lab: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-diagnosticreport-lab.md#CONF-0357) |  | **SHALL** | When the report was released … **SHALL** be present if status [of the diagnostic report] is ‘partial’, ‘preliminary’, ‘final’, ‘amended’, ‘corrected’, or ‘appended’. |
| CONF-0358 | • [Structuredefinition-Us-Core-Diagnosticreport-Lab: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-diagnosticreport-lab.md#CONF-0358) |  | **SHOULD** | Updates to .meta.lastUpdated **SHOULD** reflect New laboratory reports. |
| CONF-0359 | • [Structuredefinition-Us-Core-Diagnosticreport-Lab: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-diagnosticreport-lab.md#CONF-0359) |  | **SHOULD** | Updates to .meta.lastUpdated **SHOULD** reflect changes in the status of laboratory reports, including events that trigger the same status (e.g., amended → amended). |
| CONF-0361 | • [Structuredefinition-Us-Core-Diagnosticreport-Note: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-diagnosticreport-note.md#CONF-0361) |  | **MAY** | Other [diagnostic report] categories **MAY** be supported [when using US Core DiagnosticReport Profile for Report and Note Exchange] |
| CONF-0364 | • [Structuredefinition-Us-Core-Diagnosticreport-Note: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-diagnosticreport-note.md#CONF-0364) |  | **SHOULD** | For Diagnostic Imaging Reports systems **SHOULD** support using the subset of LOINC codes listed in Table 4: LOINC® Document Type Codes in **HL7 Standard for CDA® Release 2: Imaging Integration; Basic Imaging Reports in CDA and DICOM, Release 1** |
| CONF-0366 | • [Structuredefinition-Us-Core-Documentreference: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-documentreference.md#CONF-0366) |  | **MAY** | The DocumentReference.type binding **MAY** extend to the whole [US Core DocumentReference Type Value Set](https://hl7.org/fhir/us/core/STU8/ValueSet-us-core-documentreference-type.html) |
| CONF-0367 | • [Structuredefinition-Us-Core-Documentreference: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-documentreference.md#CONF-0367) |  | **MAY** | [DocumentReference.type **MAY** also use] other category schemes such as the LOINC-based [Document Class Value Set](http://hl7.org/fhir/R4/valueset-document-classcodes.html) and [IHE XDSclassCode](https://wiki.ihe.net/index.php/XDS_classCode_Metadata_Coding_System) |
| CONF-0368 | • [Structuredefinition-Us-Core-Documentreference: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-documentreference.md#CONF-0368)• [Structuredefinition-Us-Core-Adi-Documentreference: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-adi-documentreference.md#CONF-0368) |  | **SHALL** | Although both [DocumentReference.attachment.url and DocumentReference.attachment.data] are marked as Must Support, the Server system is not required to support an address and inline base64 encoded data, but **SHALL** support at least one of these elements. |
| CONF-0372 | • [Structuredefinition-Us-Core-Documentreference: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-documentreference.md#CONF-0372)• [Structuredefinition-Us-Core-Adi-Documentreference: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-adi-documentreference.md#CONF-0372) |  | **SHALL** | If there are multiple DocumentReference.content element repetitions, these **SHALL** all represent the same document in different formats or attachment metadata |
| CONF-0373 | • [Structuredefinition-Us-Core-Documentreference: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-documentreference.md#CONF-0373)• [Structuredefinition-Us-Core-Adi-Documentreference: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-adi-documentreference.md#CONF-0373) |  | **SHALL-NOT** | The [documentReference.content] element **SHALL NOT** contain different versions of the same content. |
| CONF-0374 | • [Structuredefinition-Us-Core-Documentreference: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-documentreference.md#CONF-0374)• [Structuredefinition-Us-Core-Adi-Documentreference: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-adi-documentreference.md#CONF-0374) |  | **SHALL** | The organization responsible for the DocumentReference **SHALL** be present either in DocumentReference.custodian or accessible in the Provenance resource targeting the DocumentReference using Provenance.agent.who or Provenance.agent.onBehalfOf |
| CONF-0375 | • [Structuredefinition-Us-Core-Encounter: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-encounter.md#CONF-0375) |  | **SHALL** | Although … marked as Must Support, Servers are not required to support both [an Encounter.reasonCode or a reference with Encounter.reasonReference], but they **SHALL** support at least one of these elements. |
| CONF-0378 | • [Structuredefinition-Us-Core-Encounter: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-encounter.md#CONF-0378) |  | **SHOULD** | If Encounter.reasonReference references an Observation, it **SHOULD** conform to a US Core Observation [profile applicable to the observation being made] |
| CONF-0379 | • [Structuredefinition-Us-Core-Encounter: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-encounter.md#CONF-0379) |  | **SHALL** | Although … marked as Must Support, Servers are not required to support both Encounter.location.location and Encounter.serviceProvider, but they **SHALL** support at least one of these elements. |
| CONF-0382 | • [Structuredefinition-Us-Core-Encounter: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-encounter.md#CONF-0382)• [Structuredefinition-Us-Core-Location: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-location.md#CONF-0382) |  | **SHOULD** | If the event facility/location differs from the Encounter.location, systems **SHOULD** reference it directly |
| CONF-0383 | • [Structuredefinition-Us-Core-Encounter: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-encounter.md#CONF-0383)• [Structuredefinition-Us-Core-Location: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-location.md#CONF-0383) |  | **SHALL** | If the event facility/location differs from the Encounter.location, … systems **SHALL** use the location element for all resources where the element is available. |
| CONF-0384 | • [Structuredefinition-Us-Core-Encounter: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-encounter.md#CONF-0384)• [Structuredefinition-Us-Core-Location: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-location.md#CONF-0384) |  | **MAY** | If the event facility/location differs from the Encounter.location … systems **MAY** use the standard [Event Location Extension](http://hl7.org/fhir/StructureDefinition/event-location) for US Core DiagnosticReport Profile for Laboratory Results Reporting and US Core Observation Clinical Result Profile. |
| CONF-0385 | • [Structuredefinition-Us-Core-Encounter: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-encounter.md#CONF-0385) |  | **SHOULD** | Updates to .meta.lastUpdated **SHOULD** reflect New encounters/visits |
| CONF-0386 | • [Structuredefinition-Us-Core-Encounter: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-encounter.md#CONF-0386) |  | **SHOULD** | Updates to .meta.lastUpdated **SHOULD** reflect changes in the status of encounters, including events that trigger the same status (e.g., in-progress → in-progress). |
| CONF-0387 | • [Structuredefinition-Us-Core-Goal: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-goal.md#CONF-0387) |  | **SHALL** | Although both Goal.startDate and Goal.target.dueDate are marked as Must Support, the Server system is not required to support both, but **SHALL** support at least one of these elements. |
| CONF-0390 | • [Structuredefinition-Us-Core-Immunization: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-immunization.md#CONF-0390) |  | **SHALL** | Servers **SHALL** use the status code: not-done to represent that an immunization was not given. |
| CONF-0392 | • [Structuredefinition-Us-Core-Immunization: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-immunization.md#CONF-0392) | **X** | **SHOULD** | [NDC vaccine codes](http://www2a.cdc.gov/vaccines/iis/iisstandards/ndc_crosswalk.asp) **SHOULD** be supported as an additional code [of [CVX Vaccine Codes](https://www2a.cdc.gov/vaccines/iis/iisstandards/ndc_crosswalk.asp)] |
| CONF-0399 | • [Structuredefinition-Us-Core-Medicationdispense: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-medicationdispense.md#CONF-0399)• [Structuredefinition-Us-Core-Medicationrequest: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-medicationrequest.md#CONF-0399) |  | **MAY** | When referencing a Medication resource in .medicationReference, the resource **MAY** be [contained](http://hl7.org/fhir/R4/references.html#contained) |
| CONF-0400 | • [Structuredefinition-Us-Core-Medicationdispense: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-medicationdispense.md#CONF-0400)• [Structuredefinition-Us-Core-Medicationrequest: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-medicationrequest.md#CONF-0400) |  | **MAY** | When referencing a Medication resource in .medicationReference, the resource **MAY** be an external resource |
| CONF-0401 | • [Structuredefinition-Us-Core-Medicationdispense: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-medicationdispense.md#CONF-0401)• [Structuredefinition-Us-Core-Medicationrequest: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-medicationrequest.md#CONF-0401) |  | **SHALL** | The Server systems are not required to support both a [medication] code and a reference [when sending medicationDispense], but **SHALL** support at least one of these methods |
| CONF-0402 | • [Structuredefinition-Us-Core-Medicationdispense: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-medicationdispense.md#CONF-0402)• [Structuredefinition-Us-Core-Medicationrequest: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-medicationrequest.md#CONF-0402) |  | **SHALL** | If an external reference to a Medication resource is used, the Server **SHALL** support the [_include](http://hl7.org/fhir/R4/search.html#include) parameter for searching this element. |
| CONF-0407 | • [Structuredefinition-Us-Core-Medicationrequest: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-medicationrequest.md#CONF-0407) |  | **SHOULD** | When recording “self-prescribed” medication, requester **SHOULD** be used to indicate the Patient or RelatedPerson as the prescriber |
| CONF-0408 | • [Structuredefinition-Us-Core-Medicationrequest: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-medicationrequest.md#CONF-0408) |  | **SHALL** | Although [medicationRequest.reportedBoolean and MedicationRequest.reportedReference] are both marked as Must Support, the Server system is not required to support both, but **SHALL** support at least one of these elements |
| CONF-0411 | • [Structuredefinition-Us-Core-Medicationrequest: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-medicationrequest.md#CONF-0411) | **X** | **SHALL** | Although both MedicationRequest.reasonCode and MedicationRequest.reasonReference are marked as Additional USCDI Requirements [which are required for organizations participating in the ONC Health IT Certification program]. The certifying Server system is not required to support both, but **SHALL** support at least one of these elements |
| CONF-0414 | • [Structuredefinition-Us-Core-Medicationrequest: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-medicationrequest.md#CONF-0414) | **X** | **SHALL** | [For organizations participating in the ONC Health IT Certification program and supporting MedicationRequest.reasonReference,] Servers **SHALL** support at least one target resource in MedicationRequest.reasonReference |
| CONF-0416 | • [Structuredefinition-Us-Core-Medicationrequest: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-medicationrequest.md#CONF-0416) |  | **SHOULD** | [For organizations participating in the ONC Health IT Certification program,] the referenced resources **SHOULD** be a US Core Profile as documented in [Referencing US Core Profiles](https://hl7.org/fhir/us/core/STU8/general-guidance.html#referencing-us-core-profiles). |
| CONF-0417 | • [Structuredefinition-Us-Core-Medicationrequest: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-medicationrequest.md#CONF-0417) |  | **SHOULD** | Source EHR identifiers **SHOULD** be included to support deduplication across MedicationRequest resources. |
| CONF-0419 | • [Structuredefinition-Us-Core-Average-Blood-Pressure: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-average-blood-pressure.md#CONF-0419)• [Structuredefinition-Us-Core-Vital-Signs: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-vital-signs.md#CONF-0419)• [Structuredefinition-Us-Core-Treatment-Intervention-Preference: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-treatment-intervention-preference.md#CONF-0419) |  | **MAY** | The observations **MAY** have additional codes that translate or map to the Observation code or category codes [such as] … local system-specific codes [and] …more specific codes |
| CONF-0420 | • [Structuredefinition-Us-Core-Average-Blood-Pressure: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-average-blood-pressure.md#CONF-0420)• [Structuredefinition-Us-Core-Vital-Signs: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-vital-signs.md#CONF-0420)• [Structuredefinition-Us-Core-Treatment-Intervention-Preference: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-treatment-intervention-preference.md#CONF-0420) |  | **SHOULD** | [For an Observation a] code system value **SHOULD** be supplied for each additional code |
| CONF-0421 | • [Structuredefinition-Us-Core-Average-Blood-Pressure: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-average-blood-pressure.md#CONF-0421) |  | **SHALL** | Because the blood pressure values are communicated in the mandatory systolic and diastolic components [when using the US Core Average Blood Pressure Profile,] the Observation.value[x] element **SHALL** be omitted |
| CONF-0422 | • [Structuredefinition-Us-Core-Care-Experience-Preference: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-care-experience-preference.md#CONF-0422)• [Structuredefinition-Us-Core-Treatment-Intervention-Preference: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-treatment-intervention-preference.md#CONF-0422) |  | **SHOULD** | The context or precondition of a patient’s [care experience] preference **SHOULD** be supplied in the Observation.valueString or in an extension |
| CONF-0423 | • [Structuredefinition-Us-Core-Observation-Clinical-Result: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-observation-clinical-result.md#CONF-0423) |  | **SHOULD** | Servers **SHOULD** use the base FHIR [Observation Category Codes] (http://hl7.org/fhir/R4/valueset-observation-category.html) [in Observation.category] |
| CONF-0424 | • [Structuredefinition-Us-Core-Observation-Clinical-Result: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-observation-clinical-result.md#CONF-0424)• [Structuredefinition-Us-Core-Observation-Lab: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-observation-lab.md#CONF-0424) |  | **SHOULD** | Systems **SHOULD** support Observation.effectivePeriod to accurately represent measurements over time |
| CONF-0425 | • [Structuredefinition-Us-Core-Observation-Clinical-Result: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-observation-clinical-result.md#CONF-0425)• [Structuredefinition-Us-Core-Observation-Lab: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-observation-lab.md#CONF-0425)• [Structuredefinition-Us-Core-Observation-Screening-Assessment: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-observation-screening-assessment.md#CONF-0425)• [Structuredefinition-Us-Core-Observation-Lab: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-observation-lab.md#CONF-0425) |  | **SHALL** | An Observation.component without a value, **SHALL** include a reason why the data is absent |
| CONF-0426 | • [Structuredefinition-Us-Core-Observation-Clinical-Result: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-observation-clinical-result.md#CONF-0426)• [Structuredefinition-Us-Core-Observation-Lab: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-observation-lab.md#CONF-0426)• [Structuredefinition-Us-Core-Observation-Screening-Assessment: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-observation-screening-assessment.md#CONF-0426)• [Structuredefinition-Us-Core-Vital-Signs: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-vital-signs.md#CONF-0426) |  | **MAY** | Systems that never provide a component observation without a component value **MAY** choose not to support Observation.component.dataAbsentReason |
| CONF-0427 | • [Structuredefinition-Us-Core-Observation-Clinical-Result: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-observation-clinical-result.md#CONF-0427)• [Structuredefinition-Us-Core-Observation-Lab: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-observation-lab.md#CONF-0427)• [Structuredefinition-Us-Core-Observation-Screening-Assessment: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-observation-screening-assessment.md#CONF-0427)• [Structuredefinition-Us-Core-Vital-Signs: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-vital-signs.md#CONF-0427) |  | **SHALL** | An Observation without a value, **SHALL** include a reason why the data is absent |
| CONF-0428 | • [Structuredefinition-Us-Core-Observation-Clinical-Result: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-observation-clinical-result.md#CONF-0428)• [Structuredefinition-Us-Core-Observation-Lab: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-observation-lab.md#CONF-0428)• [Structuredefinition-Us-Core-Observation-Screening-Assessment: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-observation-screening-assessment.md#CONF-0428)• [Structuredefinition-Us-Core-Vital-Signs: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-vital-signs.md#CONF-0428) |  | **MAY** | [For] an Observation without a value … [Systems **MAY** choose not to] include a reason why the data is absent … [if] there are component observations or … reporting panel observations using Observation.hasMember |
| CONF-0429 | • [Structuredefinition-Us-Core-Observation-Clinical-Result: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-observation-clinical-result.md#CONF-0429)• [Structuredefinition-Us-Core-Observation-Lab: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-observation-lab.md#CONF-0429)• [Structuredefinition-Us-Core-Observation-Screening-Assessment: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-observation-screening-assessment.md#CONF-0429)• [Structuredefinition-Us-Core-Vital-Signs: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-vital-signs.md#CONF-0429) |  | **MAY** | Systems that never provide an observation without a value **MAY** choose not to support Observation.dataAbsentReason |
| CONF-0430 | • [Structuredefinition-Us-Core-Observation-Lab: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-observation-lab.md#CONF-0430) |  | **SHOULD** | [When sending US Core Laboratory Results Observation Profile] updates to .meta.lastUpdated **SHOULD** reflect new laboratory observations |
| CONF-0431 | • [Structuredefinition-Us-Core-Observation-Lab: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-observation-lab.md#CONF-0431) |  | **SHOULD** | [When sending US Core Laboratory Results Observation Profile] updates to .meta.lastUpdated **SHOULD** reflect changes in the status of laboratory observations, including events that trigger the same status (e.g., amended → amended) |
| CONF-0432 | • [Structuredefinition-Us-Core-Observation-Occupation: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-observation-occupation.md#CONF-0432) |  | **SHALL** | [When sending US Core Observation Occupation Profile] for … [a] current job ,systems **SHALL** omit observation.effectivePeriod.end to indicate it is ongoing. |
| CONF-0433 | • [Structuredefinition-Us-Core-Observation-Occupation: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-observation-occupation.md#CONF-0433) |  | **SHALL** | When the industry is known, but the occupation is not, systems **SHALL** use the value “unknown” from the [DataAbsentReason Code System](http://hl7.org/fhir/R4/codesystem-data-absent-reason.html) |
| CONF-0434 | • [Structuredefinition-Us-Core-Observation-Occupation: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-observation-occupation.md#CONF-0434) |  | **SHALL** | when the occupation is known but the industry is not, systems **SHALL** omit the industry Observation.component |
| CONF-0437 | • [Structuredefinition-Us-Core-Observation-Screening-Assessment: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-observation-screening-assessment.md#CONF-0437) |  | **SHOULD** | [For] multi-question surveys or assessments Observation.code is an overarching assessment or screening code, and the Observation.value element **SHOULD** be empty |
| CONF-0438 | • [Structuredefinition-Us-Core-Observation-Screening-Assessment: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-observation-screening-assessment.md#CONF-0438) |  | **SHOULD** | A practitioner’s clinical observation or assertion about a patient’s health status, which is not a response to a screening or assessment question, **SHOULD** use the [US Core Simple Observation Profile](https://hl7.org/fhir/us/core/StructureDefinition-us-core-simple-observation.html) instead [of the US Core Observation Screening Assessment Profile] |
| CONF-0439 | • [Structuredefinition-Us-Core-Observation-Screening-Assessment: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-observation-screening-assessment.md#CONF-0439) |  | **SHALL** | the Server system … **SHALL** support [either] Reference(US Core Observation Screening Assessment Profile) or Reference(US Core QuestionnaireResponse Profile) for Observation.derivedFrom |
| CONF-0441 | • [Structuredefinition-Us-Core-Simple-Observation: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-simple-observation.md#CONF-0441) |  | **SHOULD** | Observations formally part of an assessment tool or survey **SHOULD** use the [US Core Observation Screening Assessment Profile](https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-observation-screening-assessment.html). |
| CONF-0442 | • [Structuredefinition-Us-Core-Simple-Observation: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-simple-observation.md#CONF-0442) |  | **SHOULD** | An assertion or determination derived from screening and assessment tools **SHOULD** reference them using Observation.derivedFrom |
| CONF-0443 | • [Structuredefinition-Us-Core-Simple-Observation: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-simple-observation.md#CONF-0443) |  | **SHOULD** | When using `Observation.derivedFrom’ to reference an Observation, the referenced Observation **SHOULD** be a US Core Observation |
| CONF-0444 | • [Structuredefinition-Us-Core-Simple-Observation: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-simple-observation.md#CONF-0444) | **X** | **SHALL** | Although none of the Observation.derivedFrom [references are flagged as Must Support](https://hl7.org/fhir/us/core/STU8/must-support.html#must-support---resource-references), the Certifying System *SHALL** support at least one of them |
| CONF-0447 | • [Structuredefinition-Us-Core-Vital-Signs: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-vital-signs.md#CONF-0447) |  | **MAY** | [US Core Vital Signs] observations **MAY** have [component](http://hl7.org/fhir/R4/observation.html#gr-comp) observations … [see] FHIR core specification [vital signs table](http://hl7.org/fhir/R4/observation-vitalsigns.html#vitals-table) for examples |
| CONF-0448 | • [Structuredefinition-Pediatric-Bmi-For-Age: Profile-Specific-Implementation-Guidance](StructureDefinition-pediatric-bmi-for-age.md#CONF-0448)• [Structuredefinition-Pediatric-Weight-For-Height: Profile-Specific-Implementation-Guidance](StructureDefinition-pediatric-weight-for-height.md#CONF-0448)• [Structuredefinition-Head-Occipital-Frontal-Circumference-Percentile: Profile-Specific-Implementation-Guidance](StructureDefinition-head-occipital-frontal-circumference-percentile.md#CONF-0448) |  | **SHOULD** | Information about the growth chart tables used to determine percentiles **SHOULD** be supplied in Observation.note.text |
| CONF-0449 | • [Structuredefinition-Us-Core-Blood-Pressure: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-blood-pressure.md#CONF-0449) |  | **SHOULD** | [In the US Core Blood Pressure Profile] because the blood pressure values are communicated in the mandatory systolic and diastolic components[,] the Observation.value[x] element **SHOULD** be omitted |
| CONF-0450 | • [Structuredefinition-Us-Core-Blood-Pressure: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-blood-pressure.md#CONF-0450) |  | **SHALL** | [In the US Core Blood Pressure Profile] because the blood pressure values are communicated in the mandatory systolic and diastolic components[,] an Observation without a systolic or diastolic result value, **SHALL** include a reason why the data is absent in Observation.component.dataAbsentReason |
| CONF-0451 | • [Structuredefinition-Us-Core-Blood-Pressure: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-blood-pressure.md#CONF-0451) |  | **SHALL** | [In the US Core Blood Pressure Profile] because the blood pressure values are communicated in the mandatory systolic and diastolic components[,] All Server systems - including those that never provide a component observation without a value - **SHALL** support Observation.component.dataAbsentReason for the components. |
| CONF-0452 | • [Structuredefinition-Us-Core-Pulse-Oximetry: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-pulse-oximetry.md#CONF-0452) |  | **MAY** | Inspired oxygen therapy **MAY** be represented with [component](http://hl7.org/fhir/R4/observation.html#gr-comp) observations when measured at the same time as the pulse oximetry measurements [in the US Core Pulse Oximetry profile] |
| CONF-0453 | • [Structuredefinition-Us-Core-Pulse-Oximetry: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-pulse-oximetry.md#CONF-0453) |  | **SHOULD** | Many pulse oximetry readings are taken while the patient is breathing room air. The concept of “room air” (unmodified, ambient air) **SHOULD** be represented as an inhaled oxygen flow rate of 0 liters/min |
| CONF-0454 | • [Structuredefinition-Us-Core-Pulse-Oximetry: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-pulse-oximetry.md#CONF-0454) |  | **SHOULD** | A pulse oximetry reading without inspired oxygen component observations **MAY** imply that the measurement was performed while the patient was breathing room air or that the inspired oxygen reading was omitted. To remove this uncertainty, the inspired oxygen [component](http://hl7.org/fhir/R4/observation.html#gr-comp) observations **SHOULD** be used [when using the US Core Pulse Oximetry profile.] |
| CONF-0455 | • [Structuredefinition-Us-Core-Organization: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-organization.md#CONF-0455) |  | **SHALL** | Systems **SHALL** support National Provider Identifier (NPI) for organizations |
| CONF-0456 | • [Structuredefinition-Us-Core-Organization: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-organization.md#CONF-0456) |  | **SHOULD** | Systems … **SHOULD** the National Association of Insurance Commissioners NAIC Company code (sometimes called “NAIC Number” or “cocode”) for payers. |
| CONF-0457 | • [Structuredefinition-Us-Core-Organization: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-organization.md#CONF-0457) |  | **SHOULD** | Systems … **SHOULD** support Clinical Laboratory Improvement Amendments (CLIA) for laboratories |
| CONF-0461 | • [Structuredefinition-Us-Core-Patient: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-patient.md#CONF-0461) |  | **MAY** | The Complex [Extension] for Race … allow[s] for one or more codes of which **MAY** include additional codes from the detailed ethnicity … value sets drawn from the [Race & Ethnicity - CDC (CDCREC)](https://phinvads.cdc.gov/vads/ViewCodeSystem.action?id=2.16.840.1.113883.6.238) code system [when using the [US Core Race Extension] (https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-race.html)] |
| CONF-0462 | • [Structuredefinition-Us-Core-Patient: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-patient.md#CONF-0462) |  | **SHALL** | The Complex [Extension] for Race … allow[s] for one or more codes of which **SHALL** include a text description [of category codes when using the [US Core Race Extension] (https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-race.html)] |
| CONF-0463 | • [Structuredefinition-Us-Core-Patient: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-patient.md#CONF-0463) |  | **MAY** | The Complex [Extension] for … Ethnicity allow[s] for one or more codes of which **MAY** include additional codes from the detailed … race value sets drawn from the [Race & Ethnicity - CDC (CDCREC)](https://phinvads.cdc.gov/vads/ViewCodeSystem.action?id=2.16.840.1.113883.6.238) code system [when using the [US Core Race Extension] (https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-race.html)] |
| CONF-0464 | • [Structuredefinition-Us-Core-Patient: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-patient.md#CONF-0464) |  | **SHALL** | The Complex [Extension] for … Ethnicity allow[s] for one or more codes of which **SHALL** include a text description [of category codes when using the [US Core Ethnicity Extension] (https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-ethnicity.html)] |
| CONF-0465 | • [Structuredefinition-Us-Core-Patient: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-patient.md#CONF-0465) | **X** | **SHALL** | Although Patient.deceased[x] is marked as additional USCDI, certifying systems are not required to support both [boolean and dateTime data types], but **SHALL** support [at] least Patient.deceasedDateTime |
| CONF-0466 | • [Structuredefinition-Us-Core-Patient: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-patient.md#CONF-0466) |  | **SHALL** | Systems **SHALL** represent **Previous name** by setting `Patient.name.use` to "old" or providing an end date in `Patient.name.period` or doing both. |
| CONF-0467 | • [Structuredefinition-Us-Core-Patient: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-patient.md#CONF-0467) |  | **SHALL** | Systems **SHALL** represent **Previous Address** by setting `Patient.address.use` to "old" or providing an end date in `Patient.address.period` or doing both. |
| CONF-0469 | • [Structuredefinition-Us-Core-Patient: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-patient.md#CONF-0469) | **X** | **SHALL** | [Certifying systems](https://www.healthit.gov/topic/certification-ehrs/about-onc-health-it-certification-program) [, those that are participating in the ONC Health IT certification program,] **SHALL**… follow the [Project US@ Technical Specification for Patient Addresses Final Version 1.0](https://asapnet.org/wp-content/uploads/2022/03/Project_US_FINAL_Technical_Specification_Version_1.0.pdf) as the standard style guide for Patient.address.line and Patient.address.city for new and updated records. |
| CONF-0470 | • [Structuredefinition-Us-Core-Patient: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-patient.md#CONF-0470) |  | **SHOULD** | Non-certifying systems[, systems that are not participating in the ONC Health IT certification program,] **SHOULD** follow the [Project US@ Technical Specification for Patient Addresses Final Version 1.0](https://asapnet.org/wp-content/uploads/2022/03/Project_US_FINAL_Technical_Specification_Version_1.0.pdf) as the standard style guide for Patient.address.line and Patient.address.city for new and updated records. |
| CONF-0471 | • [Structuredefinition-Us-Core-Patient: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-patient.md#CONF-0471) |  | **MAY** | [For systems participating in the ONC Health IT certification program,] this requirement [to follow the [Project US@ Technical Specification for Patient Addresses Final Version 1.0](https://asapnet.org/wp-content/uploads/2022/03/Project_US_FINAL_Technical_Specification_Version_1.0.pdf) for Patient.address.line and Patient.address.city]. Both certifying and non-certifying systems **MAY** choose not to use Project US@ for historical records or documents that are not exposed through FHIR-based APIs. |
| CONF-0472 | • [Structuredefinition-Us-Core-Patient: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-patient.md#CONF-0472) |  | **SHOULD-NOT** | **SHOULD NOT** be used as a patient identifier in Patient.identifier.value |
| CONF-0473 | • [Structuredefinition-Us-Core-Practitioner: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-practitioner.md#CONF-0473) |  | **SHALL** | Servers that support only the US Core Practitioner Profile and do not support the [US Core PractitionerRole Profile](https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-practitionerrole.html) **SHALL** provide implementation-specific guidance on how to access a provider’s location and contact information using only the Practitioner resource. |
| CONF-0474 | • [Structuredefinition-Us-Core-Practitioner: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-practitioner.md#CONF-0474) |  | **MAY** | Although Practitioner.address is marked as Must Support, the Server system **MAY** choose not to support it if they support the US Core PractitionerRole Profile |
| CONF-0475 | • [Structuredefinition-Us-Core-Practitioner: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-practitioner.md#CONF-0475) |  | **SHALL** | [When using the US Core Practitioner Profile] Practitioner.address … **SHALL**[be supported] if … [the Server does] not support the US Core PractitionerRole Profile |
| CONF-0477 | • [Structuredefinition-Us-Core-Practitioner: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-practitioner.md#CONF-0477) |  | **SHOULD** | Only professional/work contact information about the practitioner **SHOULD** be available to the patient |
| CONF-0480 | • [Structuredefinition-Us-Core-Procedure: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-procedure.md#CONF-0480) |  | **SHOULD** | [If using LOINC codes in procedure.code] only LOINC concepts that reflect actual procedures **SHOULD** be used |
| CONF-0482 | • [Structuredefinition-Us-Core-Procedure: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-procedure.md#CONF-0482) | **X** | **SHALL** | [For organizations participating in the ONC Health IT Certification program] Servers … **SHALL** support … US Core Procedure Profile for communicating the reason or justification for a referral as Additional USCDI Requirements |
| CONF-0484 | • [Structuredefinition-Us-Core-Procedure: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-procedure.md#CONF-0484) | **X** | **SHALL** | [For organizations participating in the ONC Health IT Certification program,] although both Procedure.reasonCode and Procedure.reasonReference are marked as Additional USCDI Requirements, the certifying Server system is not required to support both, but **SHALL** support at least one of these elements. |
| CONF-0486 | • [Structuredefinition-Us-Core-Procedure: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-procedure.md#CONF-0486) |  | **SHALL** | [For organizations participating in the ONC Health IT Certification program,] when using Procedure.reasonReference Servers **SHALL** support at least one target resource in Procedure.reasonReference |
| CONF-0488 | • [Structuredefinition-Us-Core-Procedure: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-procedure.md#CONF-0488) |  | **SHOULD** | [For organizations participating in the ONC Health IT Certification program,] when using Procedure.reasonReference …The referenced resources **SHOULD** be a US Core Profile as documented in [Referencing US Core Profiles](https://hl7.org/fhir/us/core/STU8/general-guidance.html#referencing-us-core-profiles) |
| CONF-0489 | • [Structuredefinition-Us-Core-Provenance: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-provenance.md#CONF-0489) |  | **SHALL** | The US Core Provenance resource **SHALL** be supported for these US Core resource types: AllergyIntolerance, CarePlan, CareTeam, Condition, Coverage, Device, DiagnosticReport, DocumentReference, Encounter, Goal, Immunization, MedicationDispense, MedicationRequest, Observation, Patient, Procedure, QuestionnaireResponse, RelatedPerson, ServiceRequest |
| CONF-0508 | • [Structuredefinition-Us-Core-Provenance: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-provenance.md#CONF-0508) |  | **SHALL** | If a system receives a provider in Provenance.agent.who as free text, they must capture [the organization] who sent them the information [and upon] request … **SHALL** provide this organization as the source |
| CONF-0509 | • [Structuredefinition-Us-Core-Provenance: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-provenance.md#CONF-0509) |  | **MAY** | If a system receives a provider in Provenance.agent.who as free text, … [upon request they] **MAY** include the free text provider. |
| CONF-0514 | • [Structuredefinition-Us-Core-Servicerequest: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-servicerequest.md#CONF-0514) |  | **MAY** | The Must Support `ServiceRequest.category` is bound, at a minimum, to the [US Core ServiceRequest Category Codes](https://hl7.org/fhir/us/core/STU8/ValueSet-us-core-servicerequest-category.html), and other category codes **MAY** be used. |
| CONF-0515 | • [Structuredefinition-Us-Core-Servicerequest: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-servicerequest.md#CONF-0515) |  | **SHOULD** | The ServiceRequest.code value … **SHOULD** be constrained to a subset for a particular use case or domain |
| CONF-0516 | • [Structuredefinition-Us-Core-Servicerequest: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-servicerequest.md#CONF-0516) | **X** | **SHALL** | [For organizations participating in the ONC Health IT Certification program] Servers … **SHALL** support … US Core Service Request Profile for communicating the reason or justification for a referral as Additional USCDI Requirements |
| CONF-0518 | • [Structuredefinition-Us-Core-Servicerequest: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-servicerequest.md#CONF-0518) | **X** | **SHALL** | [For organizations participating in the ONC Health IT Certification program,] although both ServiceRequest.reasonCode and ServiceRequest.reasonReference are marked as Additional USCDI Requirements, the certifying Server system is not required to support both, but **SHALL** support at least one of these elements. |
| CONF-0520 | • [Structuredefinition-Us-Core-Servicerequest: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-servicerequest.md#CONF-0520) | **X** | **SHALL** | [For organizations participating in the ONC Health IT Certification program,] when using ServiceRequest.reasonReference Servers **SHALL** support at least one target resource in ServiceRequest.reasonReference |
| CONF-0522 | • [Structuredefinition-Us-Core-Servicerequest: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-servicerequest.md#CONF-0522) | **X** | **SHOULD** | [For organizations participating in the ONC Health IT Certification program,] when using ServiceRequest.reasonReference …The referenced resources **SHOULD** be a US Core Profile as documented in [Referencing US Core Profiles](https://hl7.org/fhir/us/core/STU8/general-guidance.html#referencing-us-core-profiles) |
| CONF-0523 | • [Structuredefinition-Us-Core-Specimen: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-specimen.md#CONF-0523)• [Structuredefinition-Us-Core-Medication: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-medication.md#CONF-0523) |  | **MAY** | Since the binding [for Specimen.type and additional USCDI elements] is [extensible](http://hl7.org/fhir/R4/terminologies.html#extensible) when a code is unavailable, servers **MAY** use text. |
| CONF-0524 | • [Structuredefinition-Us-Core-Specimen: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-specimen.md#CONF-0524) |  | **SHALL** | Although both Specimen.identifier and Specimen.accessionIdentifier are marked as Must Support, the Server system is not required to support both, but **SHALL** support at least one of these elements. |
| CONF-0550 | • [Security: Patient-Privacy-And-Security](security.md#CONF-0550) |  | **SHALL** | Systems **SHALL** establish a risk analysis and management regime that conforms with HIPAA security regulatory requirements |
| CONF-0552 | • [Security: Patient-Privacy-And-Security](security.md#CONF-0552) |  | **SHOULD** | US Federal systems **SHOULD** conform with the risk management and mitigation requirements defined in NIST 800 series documents. |
| CONF-0554 | • [Security: Patient-Privacy-And-Security](security.md#CONF-0554) |  | **SHOULD** | US Federal systems … **SHOULD** include security category assignment following NIST 800-60 vol. 2 Appendix D.14. |
| CONF-0556 | • [Security: Patient-Privacy-And-Security](security.md#CONF-0556) |  | **SHOULD** | The coordination of risk management and the related security and privacy controls … **SHOULD** be defined in the Business Associate Agreement when available. |
| CONF-0558 | • [Security: Patient-Privacy-And-Security](security.md#CONF-0558) |  | **SHALL** | Systems **SHALL** reference a single time source to establish a common time base for security auditing and clinical data records among computing systems. |
| CONF-0560 | • [Security: Patient-Privacy-And-Security](security.md#CONF-0560) |  | **SHOULD** | The selected time service **SHOULD** be documented in the Business Associate Agreement when available. |
| CONF-0562 | • [Security: Patient-Privacy-And-Security](security.md#CONF-0562) |  | **SHALL** | Systems **SHALL** keep audit logs of the various transactions. |
| CONF-0564 | • [Security: Patient-Privacy-And-Security](security.md#CONF-0564) |  | **SHALL** | Systems **SHALL** use TLS version 1.2 or higher for all transmissions not taking place over a secure network connection. |
| CONF-0566 | • [Security: Patient-Privacy-And-Security](security.md#CONF-0566) |  | **SHOULD** | US Federal systems **SHOULD** conform with FIPS PUB 140-2. |
| CONF-0568 | • [Security: Patient-Privacy-And-Security](security.md#CONF-0568) |  | **SHALL** | Systems **SHALL** conform to [FHIR Communications Security](http://hl7.org/fhir/R4/security.html#http) requirements. |
| CONF-0570 | • [Security: Patient-Privacy-And-Security](security.md#CONF-0570) |  | **SHALL** | For Authentication and Authorization, Systems **SHALL** support any [SMART App Launch Version 2.0.0](http://hl7.org/fhir/smart-app-launch/history.html) and later for Client <-> Server interactions. |
| CONF-0572 | • [Security: Patient-Privacy-And-Security](security.md#CONF-0572) |  | **SHALL** | Systems **SHALL** implement consent requirements per their state, local, and institutional policies. |
| CONF-0574 | • [Security: Patient-Privacy-And-Security](security.md#CONF-0574) |  | **SHOULD** | The Business Associate Agreements **SHOULD** document systems’ mutual consent requirements. |
| CONF-0576 | • [Security: Patient-Privacy-And-Security](security.md#CONF-0576) |  | **SHOULD** | Systems **SHOULD** provide Provenance statements using the [US Core Provenance Profile](https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-provenance.html) resource and associated requirements. |
| CONF-0578 | • [Security: Patient-Privacy-And-Security](security.md#CONF-0578) |  | **MAY** | Systems **MAY** implement the [FHIR Digital Signatures](http://hl7.org/fhir/R4/security.html#digital%20signatures) |
| CONF-0580 | • [Security: Patient-Privacy-And-Security](security.md#CONF-0580) |  | **MAY** | Systems **MAY** protect the confidentiality of data at rest via encryption and associated access controls. |
| CONF-0801 | • [Must-Support: Defined-Pattern-Elements](must-support.md#CONF-0801) | **X** | **SHALL** | If an element is marked as **Additional USCDI** and defined by a pattern [as described by [ElementDefinition.pattern](http://hl7.org/fhir/R4/elementdefinition-definitions.html#ElementDefinition.pattern_x_)], then the pattern defines the elements **and** element values that the Certifying System **SHALL** be capable of providing. |
| CONF-0802 | • [Must-Support: Must-Support---Primitive-Elements](must-support.md#CONF-0802) | **X** | **SHALL** | Primitive elements are single elements with a primitive value…. 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. |
| CONF-0803 | • [Must-Support: Must-Support---Complex-Elements](must-support.md#CONF-0803) | **X** | **SHALL** | For any complex element marked as **Additional USCDI**, the Certifying System **SHALL** be capable of providing at least one of the sub-element values. |
| CONF-0804 | • [Must-Support: Must-Support---Complex-Elements](must-support.md#CONF-0804) |  | **SHALL** | If any sub-element is marked as **Additional USCDI** [for a complex element], it must also meet the **Additional USCDI** requirements and satisfy the **Additional USCDI** requirements for the parent element. |
| CONF-0805 | • [Must-Support: Must-Support---Complex-Elements](must-support.md#CONF-0805) | **X** | **SHALL** | [I]f any sub-element is marked as **Additional USCDI** [for a complex element] and the parent element is not… [and] the parent element is present in an instance, Certifying System **SHALL** support the sub-elements labeled as **Additional USCDI**. |
| CONF-0808 | • [Must-Support: Must-Support-Targets-For-Us-Core-Profiles](must-support.md#CONF-0808) |  | **SHALL** | When a Reference type element is labeled as Must Support and has a single target profile referenced, the target profile **SHALL** be supported. |
| CONF-0809 | • [Must-Support: Must-Support-Targets-For-Us-Core-Profiles](must-support.md#CONF-0809) | **X** | **SHALL** | 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. |
| CONF-0810 | • [Must-Support: Must-Support-Targets-For-Us-Core-Profiles](must-support.md#CONF-0810) |  | **SHALL** | 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. |
| CONF-0811 | • [Must-Support: Must-Support-Targets-For-Us-Core-Profiles](must-support.md#CONF-0811) | **X** | **SHALL** | 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. |
| CONF-0812 | • [Must-Support: Must-Support---Slices](must-support.md#CONF-0812) | **X** | **SHALL** | [I]f a slice is labeled as … Must Support/Additional USCDI and the slicer element is not labeled as … Additional USCDI, then if the … certifying system supports the element, it must support the slice's definition. There are no examples of this structure in US Core. |
| CONF-0813 | • [Must-Support: Must-Support---Slices](must-support.md#CONF-0813) |  | **MAY** | [If a] slicer's Must Support property only defines the element level Must Support…[, i.e.,] no Must Support… property is defined for the slice, then support for that slice's definition is optional. |
| CONF-0814 | • [Must-Support: Must-Support---Slices](must-support.md#CONF-0814) | **X** | **SHALL** | [I]f a slice is labeled as … Must Support and the slicer element is … labeled as … Must Support/Additional USCDI, then … certifying system [**SHALL** support] the element[ and] the slice's definition. |
| CONF-0818 | • [Clinical-Notes: Clinical-Notes](clinical-notes.md#CONF-0818) |  | **SHALL** | Servers **SHALL** support, at minimum, these … "Common Clinical Notes": [Surgical Operation Note (11504-8)](https://loinc.org/11504-8.html) |
| CONF-0819 | • [Clinical-Notes: Clinical-Notes](clinical-notes.md#CONF-0819) |  | **SHALL** | Servers **SHALL** support, at minimum, these … "Common Clinical Notes": [Emergency Department Note (34111-5)](https://loinc.org/34111-5.html) |
| CONF-0821 | • [Screening-And-Assessments: Structured-Screening-And-Assessments](screening-and-assessments.md#CONF-0821) |  | **SHOULD** | Servers that support the USCDI Health Status/Assessments Data Class … **SHOULD** support the SDC Base Questionnaire and the US Core QuestionnaireResponse Profile." |
| CONF-0822 | • [Screening-And-Assessments: Category-Codes](screening-and-assessments.md#CONF-0822) |  | **SHALL** | For the US Core Simple Observation Profile, Servers **SHALL** support all the category codes [listed](https://hl7.org/fhir/us/core/STU8/screening-and-assessments.html#category-codes). |
| CONF-0823 | • [Screening-And-Assessments: Category-Codes](screening-and-assessments.md#CONF-0823) |  | **SHALL** | For the … US Core Observation Screening Assessment Profiles, Servers **SHALL** support all the category codes [listed](https://hl7.org/fhir/us/core/STU8/screening-and-assessments.html#category-codes). |
| CONF-0824 | • [Screening-And-Assessments: Category-Codes](screening-and-assessments.md#CONF-0824) |  | **SHALL** | For the US Core Condition Problems and Health Concerns Profile, Servers **SHALL** support the code ,"sdoh" |
| CONF-0825 | • [Screening-And-Assessments: Category-Codes](screening-and-assessments.md#CONF-0825) |  | **SHOULD** | For the US Core Condition Problems and Health Concerns Profile, Servers **SHOULD** support the other category codes [listed](https://hl7.org/fhir/us/core/STU8/screening-and-assessments.html#category-codes). |
| CONF-0826 | • [Screening-And-Assessments: Category-Codes](screening-and-assessments.md#CONF-0826) |  | **SHOULD** | For the US Core ServiceRequest Profile, Servers **SHOULD** support all the [[listed](https://hl7.org/fhir/us/core/STU8/screening-and-assessments.html#category-codes)] category codes. |
| CONF-0834 | • [Structuredefinition-Us-Core-Condition-Problems-Health-Concerns: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-condition-problems-health-concerns.md#CONF-0834) | **X** | **SHOULD** | Certifying Systems … **SHOULD** support the … [US Core Simple Observation Category](https://hl7.org/fhir/us/core/STU8/ValueSet-us-core-simple-observation-category.html) codes |
| CONF-0836 | • [Structuredefinition-Us-Core-Diagnosticreport-Note: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-diagnosticreport-note.md#CONF-0836) |  | **SHOULD** | The `DiagnosticReport.basedOn` element connects the DiagnosticReport to the originating order in the EHR. Systems that initiate the order **SHOULD** use this element when reporting the results. |
| CONF-0837 | • [Structuredefinition-Us-Core-Diagnosticreport-Note: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-diagnosticreport-note.md#CONF-0837) |  | **SHOULD** | The `DiagnosticReport.media.link` element **SHOULD** be used to support links to various patient-friendly content, such as jpg images of x-rays (see the DiagnosticReport Chest X-ray Report Example). |
| CONF-0838 | • [Structuredefinition-Us-Core-Diagnosticreport-Note: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-diagnosticreport-note.md#CONF-0838) |  | **SHOULD** | The `DiagnosticReport.imagingStudy` element **SHOULD** be used to support exchange with systems that can view DICOM (Digital Imaging and Communications in Medicine) studies, series, and SOP (Service-Object Pair) instances referenced in the -[ImagingStudy](http://hl7.org/fhir/R4/imagingstudy.html) resource. |
| CONF-0839 | • [Structuredefinition-Us-Core-Documentreference: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-documentreference.md#CONF-0839)• [Structuredefinition-Us-Core-Adi-Documentreference: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-adi-documentreference.md#CONF-0839) |  | **SHOULD** | If the referenced document or file [referenced by `DocumentReference.content.attachment.url`] is hosted on a Server outside the FHIR Server, it **SHOULD**be securely accessible using the same authorization credentials that were used to access the FHIR Server. This reduces complexity for the Client and improves the user experience. |
| CONF-0840 | • [Structuredefinition-Us-Core-Encounter: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-encounter.md#CONF-0840) |  | **SHALL** | Although the [US Core Interpreter Needed] extension is marked as an Additional USCDI Requirements on both US Core Patient and US Core Encounter Profiles, the certifying Server system is not required to support the extension on both profiles, but **SHALL** support the extension on at least one. |
| CONF-0841 | • [Structuredefinition-Us-Core-Immunization: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-immunization.md#CONF-0841) |  | **MAY** | There is no guarantee that vaccine lot numbers are globally unique, and they are not recommended for matching or de-duplication across systems unless used with other data elements such as a vaccine product code, manufacturer code, or date of administration. Implementers **MAY** communicate the `Immunization.manufacturer` to ensure global uniqueness to lot numbers. |
| CONF-0842 | • [Structuredefinition-Us-Core-Medicationrequest: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-medicationrequest.md#CONF-0842) |  | **SHALL** | Servers **SHALL** return all active medications following the [Get All Active Medications](https://hl7.org/fhir/us/core/STU8/medication-list.html#get-all-active-medications) guidance. |
| CONF-0843 | • [Structuredefinition-Us-Core-Observation-Lab: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-observation-lab.md#CONF-0843) |  | **SHOULD** | [For US Core Laboratory Result Observation Profile, even] when the specimen type is already implied by the LOINC code used in `Observation.code` (e.g., a LOINC code for Blood Glucose), the `Observation.specimen` element **SHOULD** also be populated with the referenced Specimen resource to explicitly communicate the collected specimen type. |
| CONF-0844 | • [Structuredefinition-Us-Core-Observation-Lab: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-observation-lab.md#CONF-0844) |  | **SHOULD** | [For US Core Laboratory Result Observation Profile, the] type of specimen [in `Observation.specimen`] **SHOULD** not conflict with the LOINC code [in `Observation.code`]. |
| CONF-0845 | • [Structuredefinition-Us-Core-Observation-Screening-Assessment: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-observation-screening-assessment.md#CONF-0845) |  | **SHALL** | [For the US Core Observation Screening Assessment Profile, the] category type "survey" is required. |
| CONF-0846 | • [Structuredefinition-Us-Core-Observation-Screening-Assessment: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-observation-screening-assessment.md#CONF-0846) | **X** | **SHALL** | [For the US Core Observation Screening Assessment Profile,] Certifying Systems **SHALL** support, the [US Core Screening Assessment Observation Category](https://hl7.org/fhir/us/core/STU8/ValueSet-us-core-screening-assessment-observation-category.html) codes |
| CONF-0847 | • [Structuredefinition-Us-Core-Observation-Screening-Assessment: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-observation-screening-assessment.md#CONF-0847) | **X** | **SHOULD** | [For the US Core Observation Screening Assessment Profile,] Certifying Systems **SHOULD** support, the [US Core Screening Assessment Observation Maximum Category](https://hl7.org/fhir/us/core/STU8/ValueSet-us-core-screening-assessment-observation-maximum-category.html) codes |
| CONF-0848 | • [Structuredefinition-Us-Core-Observation-Screening-Assessment: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-observation-screening-assessment.md#CONF-0848) | **X** | **MAY** | [For the US Core Observation Screening Assessment Profile,] Certifying Systems **MAY** support other codes. |
| CONF-0850 | • [Structuredefinition-Us-Core-Observation-Screening-Assessment: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-observation-screening-assessment.md#CONF-0850) |  | **SHOULD** | [For the US Core Observation Screening Assessment Profile,] when using Observation.derivedFrom to reference an Observation, the referenced Observation **SHOULD** be a US Core Observation. |
| CONF-0851 | • [Structuredefinition-Us-Core-Patient: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-patient.md#CONF-0851)• [Structuredefinition-Us-Core-Encounter: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-encounter.md#CONF-0851) |  | **SHOULD** | Servers **SHOULD** use the [US Core Interpreter Needed Extension](https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-interpreter-needed.html) on [the [US Core Patient Profile](https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-patient.html)] or the [US Core Encounter Profile](https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-encounter.html) to communicate whether a patient needs an interpreter. |
| CONF-0852 | • [Structuredefinition-Us-Core-Patient: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-patient.md#CONF-0852) | **X** | **SHALL** | Although the [[US Core Interpreter Needed Extension](https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-interpreter-needed.html)] is marked as an Additional USCDI Requirement on both US Core Patient and US Core Encounter Profiles, the certifying Server system is not required to support the extension on both profiles but **SHALL** support the extension on at least one. |
| CONF-0855 | • [Structuredefinition-Us-Core-Patient: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-patient.md#CONF-0855)• [Structuredefinition-Us-Core-Encounter: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-encounter.md#CONF-0855) |  | **SHOULD** | Systems **SHOULD** designate the patient's preferred language in the Patient.communication.preferred element. |
| CONF-0857 | • [Structuredefinition-Us-Core-Servicerequest: Root](StructureDefinition-us-core-servicerequest.md#CONF-0857) |  | **SHOULD** | For the USCDI **Laboratory Order**, **Imaging Order**, **Clinical Test Order**, and **Procedure Order** Data Elements, implementers **SHOULD** use the corresponding category codes listed in the table |
| CONF-0861 | • [Structuredefinition-Us-Core-Simple-Observation: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-simple-observation.md#CONF-0861) | **X** | **SHOULD** | [For [US Core Simple Observation Profile](https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-simple-observation.html), ]Certifying Systems … **SHOULD** support the other [US Core Simple Observation Category codes](https://hl7.org/fhir/us/core/STU8/ValueSet-us-core-simple-observation-category.html) [in addition to the [US Core Screening Assessment Observation Category codes](https://hl7.org/fhir/us/core/STU8/ValueSet-us-core-screening-assessment-observation-category.html)] |
| CONF-0862 | • [Structuredefinition-Us-Core-Simple-Observation: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-simple-observation.md#CONF-0862) | **X** | **SHALL** | [For [US Core Simple Observation Profile](https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-simple-observation.html), ]Certifying Systems **SHALL** support, the [US Core Screening Assessment Observation Category codes](https://hl7.org/fhir/us/core/STU8/ValueSet-us-core-screening-assessment-observation-category.html) |
| CONF-0863 | • [Structuredefinition-Us-Core-Simple-Observation: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-simple-observation.md#CONF-0863) | **X** | **MAY** | [For [US Core Simple Observation Profile](https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-simple-observation.html), ]Certifying Systems … **MAY** support other categories [in addition to [US Core Screening Assessment Observation Category codes](https://hl7.org/fhir/us/core/STU8/ValueSet-us-core-screening-assessment-observation-category.html) and [US Core Simple Observation Category codes](https://hl7.org/fhir/us/core/STU8/ValueSet-us-core-simple-observation-category.html)]. |
| CONF-0868 | • [Structuredefinition-Us-Core-Simple-Observation: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-simple-observation.md#CONF-0868) |  | **SHALL** | Although 'Observation.performer' target profiles [US Core Practitioner Profile](https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-practitioner.html) and [US Core Patient Profile](https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-patient.html) are labeled Must Support. Servers are not required to support both, but **SHALL** support at least one. |
| CONF-0871 | • [Must-Support: Must-Support---Slices](must-support.md#CONF-0871) |  | **MAY** | [If a] slicer's Additional USCDI property only defines the element level Additional USCDI…[, i.e.,] no Additional USCDI… property is defined for the slice, then support for that slice's definition is optional. |
| CONF-0872 | • [Must-Support: Must-Support---Slices](must-support.md#CONF-0872) | **X** | **SHALL** | [I]f a slice is labeled as Additional USCDI… and the slicer element is … labeled as Must Support/Additional USCDI…, then … the Certifying System… [**SHALL** support] the element[ and] the slice's definition. |
| CONF-0881 | • [Must-Support: Must-Support---Resource-References](must-support.md#CONF-0881) |  | **SHALL** | When a Reference element is labeled as **Must Support** has multiple target profiles referenced, but none are labeled as **Must Support**…* US Core Responders **SHALL** be capable of providing [such an element] with a valid reference to **at least one** target profile.
 |
| CONF-0883 | • [Must-Support: Must-Support---Resource-References](must-support.md#CONF-0883) | **X** | **SHALL** | 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. |
| CONF-0884 | • [Must-Support: Must-Support---Choice-Of-Data-Types](must-support.md#CONF-0884) | **X** | **SHALL** | 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**. |
| CONF-0885 | • [Basic-Provenance: Individual-Level-Provenance](basic-provenance.md#CONF-0885) |  | **SHOULD** | The author is communicated by the elements and the author's role by the referenced target resource (for example, Patient, Practitioner/PractitionerRole, RelatedPerson, Device). Details about the author's role are contained in the target resource's contents. Many of these elements are labeled Must Support or Additional USCDI Requirements. However,[even if they are not labeled Must Support or Additional USCDI Requirements] all of these elements and target resources **SHOULD** be supported in the profiles if the system captures the data. |
| CONF-0887 | • [Structuredefinition-Us-Core-Observation-Screening-Assessment: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-observation-screening-assessment.md#CONF-0887) |  | **SHALL** | Although 'Observation.performer' target profiles [US Core Practitioner Profile](https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-practitioner.html) and [US Core Patient Profile](https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-patient.html) are labeled Must Support. Servers are not required to support both, but **SHALL** support at least one. |
| CONF-0889 | • [Structuredefinition-Us-Core-Practitioner: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-practitioner.md#CONF-0889)• [Structuredefinition-Us-Core-Organization: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-organization.md#CONF-0889)• [Structuredefinition-Us-Core-Patient: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-patient.md#CONF-0889)• [Structuredefinition-Us-Core-Relatedperson: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-relatedperson.md#CONF-0889) |  | **SHOULD** | … this profile uses USPS Two Letter Alphabetic Codes for US states. When encoding addresses outside the US, systems **SHOULD** use the [ISO 3166 subdivision codes](https://www.iso.org/iso-3166-country-codes.html). |
| CONF-0890 | • [Structuredefinition-Us-Core-Practitionerrole: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-practitionerrole.md#CONF-0890) |  | **SHOULD** | Due to implementer feedback, some US Core Profiles reference the base FHIR PractitionerRole resource instead of the US Core PractitionerRole Profile. However, the US Core PractitionerRole Profile **SHOULD** be used as the default profile if referenced by another US Core profile. |
| CONF-0891 | • [Structuredefinition-Us-Core-Practitionerrole: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-practitionerrole.md#CONF-0891) |  | **SHOULD** | When selecting role codes…implementers **SHOULD** choose the code that reflects the specific duties performed within that role rather than the specialty unless the individual's professional specialization characterizes the role. |
| CONF-0892 | • [Structuredefinition-Us-Core-Procedure: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-procedure.md#CONF-0892) |  | **SHOULD** | A procedure including an implantable device **SHOULD** use `Procedure.focalDevice` referencing the US Core Device Profile |
| CONF-0894 | • [Structuredefinition-Us-Core-Practitionerrole: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-practitionerrole.md#CONF-0894) |  | **SHOULD** | Unless exchanging legacy or text-only data, medical specialty codes **SHOULD** be taken from NUCC or SNOMED CT. |
| CONF-0895 | • [Structuredefinition-Us-Core-Procedure: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-procedure.md#CONF-0895) |  | **SHOULD** | Unless exchanging legacy or text-only data, procedure codes **SHOULD** be taken from SNOMED-CT, CPT, HCPCS II, ICD-10-PCS, CDT, or LOINC*. |
| CONF-0896 | • [General-Requirements: Extensible-Binding-For-Coded-Elements](general-requirements.md#CONF-0896) |  | **SHOULD** | US Core guidance provides more flexibility for situations where implementers cannot fully comply with the FHIR guidance. This flexibility is sometimes necessary and expected for legacy and text-only data. However, for newly recorded, non-legacy data, a system **SHOULD** adhere to the extensible binding rules. |
| CONF-0897 | • [General-Requirements: Extensible-Binding-For-Coded-Elements](general-requirements.md#CONF-0897) |  | **SHOULD** | For data not captured by the system transmitting the information, the coded data **SHOULD** be automatically converted to fine-grained codes from the specified ValueSet. |
| CONF-0898 | • [General-Requirements: Extensible-Binding-For-Coded-Elements](general-requirements.md#CONF-0898) |  | **MAY** | For data not captured by the system transmitting the information, ….the system **MAY** provide the existing code or the free text, and a high-level abstract code, such as the SNOMED CT code "71388002"(Procedure), to remain conformant with the extensible binding. |
| CONF-0899 | • [Structuredefinition-Us-Core-Adi-Documentreference: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-adi-documentreference.md#CONF-0899) |  | **SHOULD** | To represent the patient and provider attestation metadata, the optional DocumentReference Attestor R5 Extension defined in the US Core DocumentReference Profile **SHOULD** be used |
| CONF-0900 | • [Structuredefinition-Us-Core-Condition-Problems-Health-Concerns: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-condition-problems-health-concerns.md#CONF-0900)• [Structuredefinition-Us-Core-Condition-Encounter-Diagnosis: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-condition-encounter-diagnosis.md#CONF-0900) |  | **SHOULD** | Unless exchanging legacy or text-only data, condition codes **SHOULD** be taken from SNOMED CT and ICD-10-CM, USCDI's applicable vocabulary standards for the Problem Data Element. |
| CONF-0901 | • [Structuredefinition-Us-Core-Location: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-location.md#CONF-0901) |  | **MAY** | The Service Delivery Location Role Type value set is inherited from the base resource, and, although its binding strength is [extensible](http://hl7.org/fhir/R4/terminologies.html#extensible) in the base resource, US Core implementers **MAY** treat it as [preferred](http://hl7.org/fhir/R4/terminologies.html#preferred). |
| CONF-0902 | • [Structuredefinition-Us-Core-Location: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-location.md#CONF-0902) | **X** | **MAY** | Healthcare Service Location Codes (HSLOC) and SNOMED-CT Healthcare Facility Type value sets meet the USCDI applicable vocabulary standard for the Encounter Location Data Element. Certifying Systems **MAY** use a code from either vocabulary. |
| CONF-0903 | • [Structuredefinition-Us-Core-Goal: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-goal.md#CONF-0903) |  | **SHOULD** | When exchanging Social Determinants of Health (SDOH) data, implementers **SHOULD** use the [Social Determinants of Health Goals](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1247.71/expansion) set which is curated by the Gravity Project to represent goals for all SDOH Domains. |
| CONF-0904 | • [Structuredefinition-Us-Core-Servicerequest: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-servicerequest.md#CONF-0904) |  | **SHOULD** | 
| | | | | | | |
| :--- | :--- | :--- | :--- | :--- | :--- | :--- |
| Implementers**SHOULD**conform to the binding strengths listed for each USCDI Order context…Laboratory Order | [LOINC Common Laboratory Orders Value Set] | extensible, Imaging Order | [LOINC Radiology Codes] | preferred, Clinical Test Order | [LOINC Clinical Test Codes] | preferred |
 |
| CONF-0905 | • [Structuredefinition-Us-Core-Servicerequest: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-servicerequest.md#CONF-0905) |  | **MAY** | the US Core ServiceRequest Profile **MAY** be used to represent a derived "actionable" order based on a portable Medical Order(PMO). |
| CONF-0906 | • [Structuredefinition-Us-Core-Servicerequest: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-servicerequest.md#CONF-0906) |  | **SHOULD** | [When] used to represent a derived "actionable" order based on a PMO…The `ServiceRequest.category` **SHOULD** be bound to [Portable Medical Order Categories](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1267.34/Expansion) |
| CONF-0907 | • [Structuredefinition-Us-Core-Servicerequest: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-servicerequest.md#CONF-0907) |  | **SHOULD** | [When] used to represent a derived "actionable" order based on a PMO…ServiceRequest.code` **SHOULD** be aligned with the appropriate Category |
| CONF-0908 | • [Structuredefinition-Us-Core-Servicerequest: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-servicerequest.md#CONF-0908) |  | **SHOULD** | The `ServiceReqest.reasonReference` **SHOULD** be used to reference the US Core ADI DocumentReference Profile that indexes the PMO. |
| CONF-0909 | • [Scopes: Scopes-For-Requesting-Fhir-Resources-By-Type](scopes.md#CONF-0909) |  | **SHALL** | The following scopes that correspond directly to FHIR resource types **SHALL** be supported … [For] RelatedPerson [the] <patient|user|system>/FamilyMemberHistory.rs [see [SMART Clinical Scope Syntax](https://hl7.org/fhir/smart-app-launch/STU2/scopes-and-launch-context.html#clinical-scope-syntax) for details on clinical data scopes] |
| CONF-0910 | • [Structuredefinition-Us-Core-Patient: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-patient.md#CONF-0910)• [Structuredefinition-Us-Core-Encounter: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-encounter.md#CONF-0910) | **X** | **SHALL** | Servers **SHALL** use the [US Core Interpreter Needed Extension](https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-interpreter-needed.html) on [the [US Core Patient Profile](https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-patient.html)] or the [US Core Encounter Profile](https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-encounter.html) to communicate whether a patient needs an interpreter. |
| CONF-0912 | • [Terminology: Us-Core-Valueset-And-Codesystem-Versions](terminology.md#CONF-0912) |  | **SHOULD** | When implementing US Core, implementers **SHOULD** use the published versions or later versions of the value sets and code systems. |
| CONF-0913 | • [Terminology: Us-Core-Valueset-And-Codesystem-Versions](terminology.md#CONF-0913) |  | **MAY** | In some cases, [when implementing US Core] implementers **MAY**  need to use terminology from earlier versions to preserve legacy data. |
| CONF-0914 | • [Structuredefinition-Us-Core-Patient: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-patient.md#CONF-0914) |  | **SHALL** | Systems **SHALL** represent **Suffix** using the `Patient.name.suffix` element. |
| CONF-0915 | • [General-Requirements: Conforming-To-Us-Core](general-requirements.md#CONF-0915) |  | **MAY** | Profile Only Support: Systems **MAY** support **only** the US Core Profiles to represent clinical information. |
| CONF-0916 | • [General-Requirements: Conforming-To-Us-Core](general-requirements.md#CONF-0916) |  | **MAY** | Profile Support + Interaction Support: Systems **MAY** support **both** the US Core Profile content structure **and** the RESTful interactions defined for a resource. |

### Client Requirements

| | | | |
| :--- | :--- | :--- | :--- |
| CONF-0022 | • [General-Requirements: Required-Bindings-For-Coded-Elements](general-requirements.md#CONF-0022) | **SHALL** | [When populating a coded element with a [required binding](http://hl7.org/fhir/R4/terminologies.html#required) to a ValueSet definition] US Core Requestors **SHALL** be capable of processing the code [from the required binding ValueSet] |
| CONF-0028 | • [General-Requirements: Extensible-Binding-For-Coded-Elements](general-requirements.md#CONF-0028) | **SHALL** | US Core Requestors **SHALL** be capable of processing the code in ['DataElement.code.code' or text in 'DataElement.code.text' for a DataElement.code that has an extensible binding] |
| CONF-0032 | • [General-Requirements: Modifier-Elements](general-requirements.md#CONF-0032) | **SHALL** | Clients **SHALL** be able to process [elements that are] [Mandatory](https://hl7.org/fhir/us/core/must-support.html) or [Must Support elements](https://hl7.org/fhir/us/core/must-support.html) |
| CONF-0035 | • [General-Requirements: Modifier-Elements](general-requirements.md#CONF-0035) | **SHOULD** | receivers **SHOULD** accept instances that … contain unexpected data elements  [[definition](http://hl7.org/fhir/R4/conformance-rules.html#isModifier)] |
| CONF-0036 | • [General-Requirements: Modifier-Elements](general-requirements.md#CONF-0036) | **SHOULD-NOT** | receivers **SHOULD NOT** accept instances that … contain unexpected data elements … when those elements are modifier elements [[definition](http://hl7.org/fhir/R4/conformance-rules.html#isModifier)] |
| CONF-0037 | • [General-Requirements: Modifier-Elements](general-requirements.md#CONF-0037) | **SHOULD** | Unless a Client determines they can process [a resource with a modifier] safely, rejection is typically the only safe action if unexpected modifier elements are present. |
| CONF-0053 | • [General-Requirements: Fhir-Restful-Search-Api-Requirements](general-requirements.md#CONF-0053) | **SHALL** | When searching using the `token` type searchparameter [(how to search by token)](http://hl7.org/fhir/R4/search.html#token) The Client **SHALL** provide at least a code value |
| CONF-0054 | • [General-Requirements: Fhir-Restful-Search-Api-Requirements](general-requirements.md#CONF-0054) | **MAY** | When searching using the `token` type searchparameter [(how to search by token)](http://hl7.org/fhir/R4/search.html#token) The Client … **MAY** provide both the system and code values. |
| CONF-0056 | • [General-Requirements: Fhir-Restful-Search-Api-Requirements](general-requirements.md#CONF-0056) | **SHALL** | When searching using the `reference` type searchparameter [(how to search by reference)](http://hl7.org/fhir/R4/search.html#reference) The Client **SHALL** provide at least an id value |
| CONF-0057 | • [General-Requirements: Fhir-Restful-Search-Api-Requirements](general-requirements.md#CONF-0057) | **MAY** | When searching using the `reference` type searchparameter [(how to search by reference)](http://hl7.org/fhir/R4/search.html#reference) The Client … **MAY** provide both the Type and id values. |
| CONF-0059 | • [General-Requirements: Fhir-Restful-Search-Api-Requirements](general-requirements.md#CONF-0059) | **SHALL** | When searching using the `date` type searchparameter [(how to search by date)](http://hl7.org/fhir/R4/search.html#date) The Client **SHALL** provide values precise to the day for elements of datatype `date` |
| CONF-0060 | • [General-Requirements: Fhir-Restful-Search-Api-Requirements](general-requirements.md#CONF-0060) | **SHALL** | When searching using the `date` type searchparameter [(how to search by date)](http://hl7.org/fhir/R4/search.html#date) The Client **SHALL** provide values precise … to the second + time offset for elements of datatype `dateTime`. |
| CONF-0076 | • [Must-Support: Must-Support-Elements](must-support.md#CONF-0076) | **SHALL** | For querying and reading US Core Profiles, Must Support on any profile data element **SHALL** be interpreted as follows…:US Core Requestors **SHALL** be capable of processing resource instances containing the data elements without generating an error or causing the application to fail. |
| CONF-0079 | • [Must-Support: Must-Support-Elements](must-support.md#CONF-0079) | **SHALL** | For querying and reading US Core Profiles, Must Support on any profile data element **SHALL** be interpreted as follows…: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. |
| CONF-0082 | • [Must-Support: Must-Support-Elements](must-support.md#CONF-0082) | **SHALL** | For querying and reading US Core Profiles, Must Support on any profile data element **SHALL** be interpreted as follows…:US Core Requestors **SHALL** be able to process resource instances containing data elements asserting missing information. |
| CONF-0083 | • [Must-Support: Additional-USCDI-Requirements](must-support.md#CONF-0083) | **SHALL** | Implementors [US Core Requestors] seeking ONC certification [in the ONC IT Health Certification program] **SHALL** interpret Additional USCDI Requirements as Must Support elements as documented above and below; |
| CONF-0085 | • [Must-Support: Additional-USCDI-Requirements](must-support.md#CONF-0085) | **SHALL** | Implementors [US Core Requestors] [not] seeking ONC certification [in the ONC IT Health Certification program] **SHALL** interpret Additional USCDI Requirements as … optional. |
| CONF-0092 | • [Must-Support: Must-Support---Primitive-Elements](must-support.md#CONF-0092) | **SHALL** | [W]hen claiming conformance [to a profile with a must support primitive element] … US Core requestors **SHALL** be capable of processing the value [of the primitive element] |
| CONF-0098 | • [Must-Support: Must-Support---Complex-Elements](must-support.md#CONF-0098) | **SHALL** | When claiming conformance [to a must support complex element with no must support sub-elements] … US Core Requestors **SHALL** be capable of processing a value in [the complex element] |
| CONF-0100 | • [Must-Support: Must-Support---Complex-Elements](must-support.md#CONF-0100) | **SHALL** | When claiming conformance [to a must support complex element with one or more must support sub-elements] … US Core Requestors **SHALL** be capable of processing a values in [each must support sub-element] |
| CONF-0102 | • [Must-Support: Must-Support---Complex-Elements](must-support.md#CONF-0102) | **MAY** | Systems [US Core Requestors] can support the other elements [of a complex element, not labeled as a Must Support], but this is not a requirement of US Core |
| CONF-0106 | • [Must-Support: Must-Support---Resource-References](must-support.md#CONF-0106) | **SHALL** | When a Reference type element is labeled as **Must Support**, has multiple target profiles referenced, and specific targets are labeled as **Must Support**," …* US Core Responders **SHALL** be capable of providing [such an element] with a valid reference to [all listed Must Support profile(s).]
 |
| CONF-0108 | • [Must-Support: Must-Support---Resource-References](must-support.md#CONF-0108) | **MAY** | Systems [US Core Requestors] can support other [resource] references [other than those labeled as Must Support], but this is not a requirement of US Core |
| CONF-0110 | • [Must-Support: Must-Support---Resource-References](must-support.md#CONF-0110) | **SHALL** | When a Reference type element is labeled as **Must Support** and has a single target profile referenced …* US Core Responders **SHALL** be capable of providing [such an element] with a valid reference to [the Must Support Profile.]
 |
| CONF-0112 | • [Must-Support: Must-Support---Choice-Of-Data-Types](must-support.md#CONF-0112) | **SHALL** | [If a profile has] a Must Support element [with] a choice of datatypes for its content [and some of] the datatypes … are labeled as Must Support … When claiming conformance to [such a] profile:* US Core Requestors **SHALL** be capable of processing [the Must Support data type choice]
 |
| CONF-0113 | • [Must-Support: Must-Support---Choice-Of-Data-Types](must-support.md#CONF-0113) | **MAY** | [If a profile has] a Must Support element [with] a choice of datatypes for its content [and some of] the datatypes … are labeled as Must Support[, or a profile has] an Additional USCDI element [with] a choice of datatypes for its content [and some of] the datatypes … are labeled as Additional USCDI…[US Core Requestors] **MAY** support … processing other [data type] choice elements (such as Observation.effectivePeriod), but this is not a requirement of US Core. |
| CONF-0116 | • [Must-Support: Must-Support---Choice-Of-Profile-Elements](must-support.md#CONF-0116) | **SHALL** | 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 requirement. In such cases, … the Client application **SHALL** support all elements. |
| CONF-0122 | • [Scopes: Capabilities-For-Implementations-Supporting-Backend-Services](scopes.md#CONF-0122) | **SHALL** | Implementations [US Core Requestors] supporting Backend Services – for example, to meet US EHR certification requirements [of the ONC IT Health Certification program]- **SHALL** include support for the Client-confidential-asymmetric capability and system/scopes. |
| CONF-0127 | • [Scopes: Smart-Scopes](scopes.md#CONF-0127) | **SHOULD** | US Core Clients **SHOULD**follow the [principle of least privilege](https://en.wikipedia.org/wiki/Principle_of_least_privilege) and access only the necessary resources. |
| CONF-0172 | • [Scopes: Additional-Us-Core-Requirements](scopes.md#CONF-0172) | **SHOULD** | US Core requires … additional metadata [to be available through the Server's [Well-Known Uniform Resource Identifier (URI)](https://hl7.org/fhir/smart-app-launch/STU2/conformance.html#using-well-known)]: … [in] `scopes_supported` [the] array of scopes a Client **MAY** request. The app **SHOULD** inspect the returned scopes and accommodate the differences from the scopes it asked for and registered. |
| CONF-0194 | • [General-Guidance: Language-Support](general-guidance.md#CONF-0194) | **MAY** | [When Clients request a resource in a specific language] Clients **MAY** request language/locale using the http [Accept-Language](https://www.ietf.org/rfc/rfc2616.txt) header. |
| CONF-0226 | • [Clinical-Notes: Support-Requirements](clinical-notes.md#CONF-0226) | **MAY** | Systems [Clients] **MAY** support other [DiagnosticReport] categories as well. |
| CONF-0232 | • [Clinical-Notes: Support-Requirements](clinical-notes.md#CONF-0232) | **MAY** | a Client **MAY** determine the note and report types supported by a Server by invoking the standard FHIR Value Set Expansion ([$expand](http://hl7.org/fhir/R4/valueset-operation-expand.html)) operation defined in the FHIR R4 specification. |
| CONF-0251 | • [Medication-List: Options-For-Representing-Medication](medication-list.md#CONF-0251) | **SHALL** | The Client application MUST support all methods [for referencing a medication resource: returned bundle, as an external resource, or as a [contained](http://hl7.org/fhir/R4/references.html#contained) resource] |
| CONF-0264 | • [Medication-List: De-Duplication-Of-Data](medication-list.md#CONF-0264) | **SHOULD** | To provide a list of a patient’s medications, it **MAY** be necessary to “de-duplicate” them. The de-duplication activity … **SHOULD** be provided by the Client. |
| CONF-0275 | • [Screening-And-Assessments: Category-Codes](screening-and-assessments.md#CONF-0275) | **MAY** | API consumers **MAY** query by category when accessing patient information. |
| CONF-0286 | • [Changes-Between-Versions: No-Guarantee-That-Resource-Ids-Are-Preserved](changes-between-versions.md#CONF-0286) | **SHALL** | Therefore, Client applications must plan on deduplication methods that rely on something other than a common identifier across FHIR versions. |
| CONF-0292 | • [Changes-Between-Versions: Expectation-That-Data-Is-Preserved-Between-Versions](changes-between-versions.md#CONF-0292) | **SHOULD** | The FHIR RESTful resource types supported in a DSTU2 implementation **SHOULD** be supported in a R4 implementation |
| CONF-0293 | • [Changes-Between-Versions: Expectation-That-Data-Is-Preserved-Between-Versions](changes-between-versions.md#CONF-0293) | **SHOULD** | The FHIR RESTful resource types supported in a DSTU2 implementation **SHOULD** be supported in a R4 implementation [with the] exception [of] MedicationStatement **MAY** be deprecated, and the data **SHOULD** be mapped to MedicationRequest. |
| CONF-0294 | • [Changes-Between-Versions: Expectation-That-Data-Is-Preserved-Between-Versions](changes-between-versions.md#CONF-0294) | **SHOULD** | The FHIR RESTful resource types supported in a DSTU2 implementation **SHOULD** be supported in a R4 implementation [with the] exception [of] Care teams as represented by CarePlan in DSTU2 **SHOULD** be replaced by and the data mapped to CareTeam in R4 |
| CONF-0299 | • [Changes-Between-Versions: Expectation-That-Data-Is-Preserved-Between-Versions](changes-between-versions.md#CONF-0299) | **SHOULD** | When updating between versions, Clients **SHOULD** consider the impact of any changes to data visualization on the usability for the end user and the maintenance of data integrity. |
| CONF-0314 | • [Structuredefinition-Us-Core-Careteam: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-careteam.md#CONF-0314) | **SHALL** | [C]lient application[s conforming to the US Core CareTeam profile] **SHALL** support [US Core Practitioner Profile] |
| CONF-0315 | • [Structuredefinition-Us-Core-Careteam: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-careteam.md#CONF-0315) | **SHALL** | [C]lient application[s conforming to the US Core CareTeam profile] **SHALL** support [US Core PractitionerRole Profile] |
| CONF-0316 | • [Structuredefinition-Us-Core-Careteam: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-careteam.md#CONF-0316) | **SHALL** | [C]lient application[s conforming to the US Core CareTeam profile] **SHALL** support [US Core RelatedPerson Profile] |
| CONF-0369 | • [Structuredefinition-Us-Core-Documentreference: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-documentreference.md#CONF-0369)• [Structuredefinition-Us-Core-Adi-Documentreference: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-adi-documentreference.md#CONF-0369) | **SHALL** | The Client application **SHALL** support [DocumentReference.attachment.url] |
| CONF-0370 | • [Structuredefinition-Us-Core-Documentreference: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-documentreference.md#CONF-0370)• [Structuredefinition-Us-Core-Adi-Documentreference: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-adi-documentreference.md#CONF-0370) | **SHALL** | The Client application **SHALL** support [DocumentReference.attachment.data] |
| CONF-0376 | • [Structuredefinition-Us-Core-Encounter: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-encounter.md#CONF-0376) | **SHALL** | The Client application **SHALL** support [ Encounter.reasonCode] |
| CONF-0377 | • [Structuredefinition-Us-Core-Encounter: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-encounter.md#CONF-0377) | **SHALL** | The Client application **SHALL** support [Encounter.reasonReference] |
| CONF-0380 | • [Structuredefinition-Us-Core-Encounter: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-encounter.md#CONF-0380) | **SHALL** | The Client application **SHALL** support [Encounter.location.location] |
| CONF-0381 | • [Structuredefinition-Us-Core-Encounter: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-encounter.md#CONF-0381) | **SHALL** | The Client application **SHALL** support [Encounter.serviceProvider] |
| CONF-0388 | • [Structuredefinition-Us-Core-Goal: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-goal.md#CONF-0388) | **SHALL** | The Client application **SHALL** support … Goal.startDate |
| CONF-0389 | • [Structuredefinition-Us-Core-Goal: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-goal.md#CONF-0389) | **SHALL** | The Client application **SHALL** support … Goal.target.dueDate |
| CONF-0403 | • [Structuredefinition-Us-Core-Medicationdispense: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-medicationdispense.md#CONF-0403)• [Structuredefinition-Us-Core-Medicationrequest: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-medicationrequest.md#CONF-0403) | **SHALL** | The Client application **SHALL** support [using a code in .medicationCodeableConcept to represent medications when supporting the US Core MedicationDispense profile] |
| CONF-0404 | • [Structuredefinition-Us-Core-Medicationdispense: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-medicationdispense.md#CONF-0404)• [Structuredefinition-Us-Core-Medicationrequest: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-medicationrequest.md#CONF-0404) | **SHALL** | The Client application **SHALL** support [referencing a Medication resource in .medicationReferencet to represent medications when supporting the US Core MedicationDispense profile] |
| CONF-0409 | • [Structuredefinition-Us-Core-Medicationrequest: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-medicationrequest.md#CONF-0409) | **SHALL** | The Client application **SHALL** support [medicationRequest.reporedtBoolean] |
| CONF-0410 | • [Structuredefinition-Us-Core-Medicationrequest: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-medicationrequest.md#CONF-0410) | **SHALL** | The Client application **SHALL** support [MedicationRequest.reportedReference] |
| CONF-0412 | • [Structuredefinition-Us-Core-Medicationrequest: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-medicationrequest.md#CONF-0412) | **SHALL** | [For organizations participating in the ONC Health IT Certification program,] the certifying Client application **SHALL** support [MedicationRequest.reasonCode.] |
| CONF-0413 | • [Structuredefinition-Us-Core-Medicationrequest: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-medicationrequest.md#CONF-0413) | **SHALL** | [For organizations participating in the ONC Health IT Certification program,] the certifying Client application **SHALL** support [MedicationRequest.reasonReference.] |
| CONF-0415 | • [Structuredefinition-Us-Core-Medicationrequest: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-medicationrequest.md#CONF-0415) | **SHALL** | [For organizations participating in the ONC Health IT Certification program,] Clients **SHALL** support all target resources in MedicationRequest.reasonReference. |
| CONF-0476 | • [Structuredefinition-Us-Core-Practitioner: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-practitioner.md#CONF-0476) | **SHALL** | The Client application **SHALL** support both [the PractitionerRole profile and the Practitioner.address element] |
| CONF-0483 | • [Structuredefinition-Us-Core-Procedure: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-procedure.md#CONF-0483) | **SHALL** | [For organizations participating in the ONC Health IT Certification program] … Clients **SHALL** support … US Core Procedure Profile for communicating the reason or justification for a referral as Additional USCDI Requirements |
| CONF-0485 | • [Structuredefinition-Us-Core-Procedure: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-procedure.md#CONF-0485) | **SHALL** | [For organizations participating in the ONC Health IT Certification program,] The certifying Client application **SHALL** support both [Procedure.reasonCode and Procedure.reasonReference] |
| CONF-0487 | • [Structuredefinition-Us-Core-Procedure: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-procedure.md#CONF-0487) | **SHALL** | [For organizations participating in the ONC Health IT Certification program,] when using Procedure.reasonReference … Clients **SHALL** support all target resources in Procedure.reasonReference |
| CONF-0517 | • [Structuredefinition-Us-Core-Servicerequest: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-servicerequest.md#CONF-0517) | **SHALL** | [For organizations participating in the ONC Health IT Certification program] … Clients **SHALL** support … US Core ServiceRequest Profile for communicating the reason or justification for a referral as Additional USCDI Requirements |
| CONF-0519 | • [Structuredefinition-Us-Core-Servicerequest: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-servicerequest.md#CONF-0519) | **SHALL** | [For organizations participating in the ONC Health IT Certification program,] The certifying Client application **SHALL** support both [ServiceRequest.reasonCode and ServiceRequest.reasonReference] |
| CONF-0521 | • [Structuredefinition-Us-Core-Servicerequest: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-servicerequest.md#CONF-0521) | **SHALL** | [For organizations participating in the ONC Health IT Certification program,] when using ServiceRequest.reasonReference … Clients **SHALL** support all target resources in ServiceRequest.reasonReference |
| CONF-0525 | • [Structuredefinition-Us-Core-Specimen: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-specimen.md#CONF-0525) | **SHALL** | The Client application **SHALL** support both [ Specimen.identifier and Specimen.accessionIdentifier] |
| CONF-0551 | • [Security: Patient-Privacy-And-Security](security.md#CONF-0551) | **SHALL** | Systems **SHALL** establish a risk analysis and management regime that conforms with HIPAA security regulatory requirements |
| CONF-0553 | • [Security: Patient-Privacy-And-Security](security.md#CONF-0553) | **SHOULD** | US Federal systems **SHOULD** conform with the risk management and mitigation requirements defined in NIST 800 series documents. |
| CONF-0555 | • [Security: Patient-Privacy-And-Security](security.md#CONF-0555) | **SHOULD** | US Federal systems … **SHOULD** include security category assignment following NIST 800-60 vol. 2 Appendix D.14. |
| CONF-0557 | • [Security: Patient-Privacy-And-Security](security.md#CONF-0557) | **SHOULD** | The coordination of risk management and the related security and privacy controls … **SHOULD** be defined in the Business Associate Agreement when available. |
| CONF-0559 | • [Security: Patient-Privacy-And-Security](security.md#CONF-0559) | **SHALL** | Systems **SHALL** reference a single time source to establish a common time base for security auditing and clinical data records among computing systems. |
| CONF-0561 | • [Security: Patient-Privacy-And-Security](security.md#CONF-0561) | **SHOULD** | The selected time service **SHOULD** be documented in the Business Associate Agreement when available. |
| CONF-0563 | • [Security: Patient-Privacy-And-Security](security.md#CONF-0563) | **SHALL** | Systems **SHALL** keep audit logs of the various transactions. |
| CONF-0565 | • [Security: Patient-Privacy-And-Security](security.md#CONF-0565) | **SHALL** | Systems **SHALL** use TLS version 1.2 or higher for all transmissions not taking place over a secure network connection. |
| CONF-0567 | • [Security: Patient-Privacy-And-Security](security.md#CONF-0567) | **SHOULD** | US Federal systems **SHOULD** conform with FIPS PUB 140-2. |
| CONF-0569 | • [Security: Patient-Privacy-And-Security](security.md#CONF-0569) | **SHALL** | Systems **SHALL** conform to [FHIR Communications Security](http://hl7.org/fhir/R4/security.html#http) requirements. |
| CONF-0571 | • [Security: Patient-Privacy-And-Security](security.md#CONF-0571) | **SHALL** | For Authentication and Authorization, Systems **SHALL** support any [SMART App Launch version](http://hl7.org/fhir/smart-app-launch/history.html) for Client <-> Server interactions. |
| CONF-0573 | • [Security: Patient-Privacy-And-Security](security.md#CONF-0573) | **SHALL** | Systems **SHALL** implement consent requirements per their state, local, and institutional policies. |
| CONF-0575 | • [Security: Patient-Privacy-And-Security](security.md#CONF-0575) | **SHOULD** | The Business Associate Agreements **SHOULD** document systems’ mutual consent requirements. |
| CONF-0577 | • [Security: Patient-Privacy-And-Security](security.md#CONF-0577) | **SHOULD** | Systems **SHOULD** provide Provenance statements using the [US Core Provenance Profile](https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-provenance.html) resource and associated requirements. |
| CONF-0579 | • [Security: Patient-Privacy-And-Security](security.md#CONF-0579) | **MAY** | Systems **MAY** implement the [FHIR Digital Signatures](http://hl7.org/fhir/R4/security.html#digital%20signatures) |
| CONF-0581 | • [Security: Patient-Privacy-And-Security](security.md#CONF-0581) | **MAY** | Systems **MAY** protect the confidentiality of data at rest via encryption and associated access controls. |
| CONF-0815 | • [General-Guidance: Client-Best-Practices-For-Search](general-guidance.md#CONF-0815) | **SHOULD** | When the Server supports [ the _include search parameter], Clients **SHOULD** use the _include search parameter to retrieve referenced content instead of searching for a resource and then performing a separate search for other references (for example, Patient, Encounter, and Location) in the result set. |
| CONF-0816 | • [General-Guidance: Client-Best-Practices-For-Search](general-guidance.md#CONF-0816) | **SHOULD** | If the Server does not support the _include search parameter, Clients **SHOULD** consolidate duplicate searches before searching for referenced resources in the result set |
| CONF-0817 | • [General-Guidance: Client-Best-Practices-For-Search](general-guidance.md#CONF-0817) | **SHOULD-NOT** | **SHOULD NOT** search the same data within the time stated in the `Cache-Control` header. |
| CONF-0849 | • [Structuredefinition-Us-Core-Observation-Screening-Assessment: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-observation-screening-assessment.md#CONF-0849) | **SHALL** | [For the US Core Observation Screening Assessment Profile,] the Client system … **SHALL** support [both] Reference(US Core Observation Screening Assessment Profile) [and] Reference(US Core QuestionnaireResponse Profile) for Observation.derivedFrom |
| CONF-0853 | • [Structuredefinition-Us-Core-Patient: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-patient.md#CONF-0853) | **SHALL** | The certifying Client application **SHALL** support the [[US Core Interpreter Needed Extension](https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-interpreter-needed.html)] on [the [US Core Patient Profile](https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-patient.html)] . |
| CONF-0854 | • [Structuredefinition-Us-Core-Patient: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-patient.md#CONF-0854) | **SHALL** | The certifying Client application **SHALL** support the [[US Core Interpreter Needed Extension](https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-interpreter-needed.html)] on [the [US Core Encounter Profile](https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-encounter.html)]. |
| CONF-0869 | • [Structuredefinition-Us-Core-Simple-Observation: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-simple-observation.md#CONF-0869) | **SHALL** | 'Observation.performer' target profiles [US Core Practitioner Profile](https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-practitioner.html) and [US Core Patient Profile](https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-patient.html) are labeled Must Support…. Clients **SHALL** support both. |
| CONF-0882 | • [Must-Support: Must-Support---Resource-References](must-support.md#CONF-0882) | **SHALL** | When a Reference element is labeled as **Must Support** has multiple target profiles referenced, but none are labeled as **Must Support**…* US Core Requesters **SHALL** be capable of processing [such an element] with a valid reference to **at least one** target profile.
 |
| CONF-0886 | • [Structuredefinition-Us-Core-Encounter: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-encounter.md#CONF-0886) | **SHALL** | Servers can use the US Core Interpreter Needed Extension on this profile or the [US Core Patient Profile] to communicate whether a patient needs an interpreter…Client application **SHALL** support the extension on both profiles. |
| CONF-0888 | • [Structuredefinition-Us-Core-Observation-Screening-Assessment: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-observation-screening-assessment.md#CONF-0888) | **SHALL** | 'Observation.performer' target profiles [US Core Practitioner Profile](https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-practitioner.html) and [US Core Patient Profile](https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-patient.html) are labeled Must Support…. Clients **SHALL** support both. |
| CONF-0911 | • [Structuredefinition-Us-Core-Servicerequest: Profile-Specific-Implementation-Guidance](StructureDefinition-us-core-servicerequest.md#CONF-0911) | **MAY** | API consumers **MAY** query by category when accessing patient information. |

