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Packagehl7.fhir.us.core
Resource TypeBasic
IdBasic-us-core-certifying-system.json
FHIR VersionR4
Sourcehttps://build.fhir.org/ig/HL7/US-Core/Requirements-us-core-certifying-system.html
URLhttp://hl7.org/fhir/us/core/Requirements/us-core-certifying-system
Version9.0.0
Statusdraft
Date2026-03-30T06:37:42+00:00
NameUSCoreCertifyingSystemRequirements
TitleUS Core Certifying System Requirements
Realmus
Authorityhl7
CopyrightUsed by permission of HL7 International, all rights reserved Creative Commons License

Resources that use this resource

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Narrative

Note: links and images are rebased to the (stated) source

These requirements apply to the actor: US Core Certifying System

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.
  • 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.
Key Context Conformance Requirement
CONF-0011 •general-requirements.html#profile-support--interaction-support
 SHALL

A Server that certifies to the 21st Century Cures Act for accessing patient data SHALL implement all components in the USCDI [USCDI link]
CONF-0012 •general-requirements.html#profile-support--interaction-support
 SHALL

A Server that certifies to the 21st Century Cures Act for accessing patient data SHALL implement all components in the ... the US Core CapabilityStatement [Definition] .
CONF-0124 •scopes.html#smart-scopes
 SHALL

Implementations meeting US EHR certification [of the ONC IT Health Certification program] requirements must support all US Core’s required scopes.
CONF-0391 •StructureDefinition-us-core-immunization.html#profile-specific-implementation-guidance
 SHALL

[For organization participating in the ONC Health IT Certification program] CVX vaccine codes are required
CONF-0392 •StructureDefinition-us-core-immunization.html#profile-specific-implementation-guidance
 SHOULD

NDC vaccine codes SHOULD be supported as an additional code [of CVX Vaccine Codes]
CONF-0405 •StructureDefinition-us-core-medicationrequest.html#profile-specific-implementation-guidance
 SHALL

[For organization participating in the ONC Health IT Certification program Servers SHALL support the additional USCDI requirement:], The reason or indication for the prescription
CONF-0406 •StructureDefinition-us-core-medicationrequest.html#profile-specific-implementation-guidance
 SHALL

[For organization participating in the ONC Health IT Certification program Servers SHALL support the additional USCDI requirement:] reported adherence to prescribed medication instructions
CONF-0411 •StructureDefinition-us-core-medicationrequest.html#profile-specific-implementation-guidance
 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.html#profile-specific-implementation-guidance
 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-0444 •StructureDefinition-us-core-simple-observation.html#profile-specific-implementation-guidance
 SHALL

Although none of the Observation.derivedFrom references are flagged as Must Support, the Certifying System SHALL* support at least one of them
CONF-0465 •StructureDefinition-us-core-patient.html#profile-specific-implementation-guidance
 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-0469 •StructureDefinition-us-core-patient.html#profile-specific-implementation-guidance
 SHALL

Certifying systems [, 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 as the standard style guide for Patient.address.line and Patient.address.city for new and updated records.
CONF-0482 •StructureDefinition-us-core-procedure.html#profile-specific-implementation-guidance
 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.html#profile-specific-implementation-guidance
 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-0516 •StructureDefinition-us-core-servicerequest.html#profile-specific-implementation-guidance
 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.html#profile-specific-implementation-guidance
 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.html#profile-specific-implementation-guidance
 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.html#profile-specific-implementation-guidance
 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
CONF-0801 •must-support.html#defined-pattern-elements
 SHALL

If an element is marked as Additional USCDI and defined by a pattern [as described by ElementDefinition.pattern], then the pattern defines the elements and element values that the Certifying System SHALL be capable of providing.
CONF-0802 •must-support.html#must-support---primitive-elements
 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.html#must-support---complex-elements
 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-0805 •must-support.html#must-support---complex-elements
 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 represented in the structure, Certifying System SHALL support the sub-elements labeled as Additional USCDI.
CONF-0809 •must-support.html#must-support-targets-for-us-core-profiles
 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-0811 •must-support.html#must-support-targets-for-us-core-profiles
 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.html#must-support---slices
 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-0814 •must-support.html#must-support---slices
 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-0833 •StructureDefinition-us-core-condition-problems-health-concerns.html#profile-specific-implementation-guidance
 SHALL

Certifying Systems SHALL support, a category of "sdoh"
CONF-0834 •StructureDefinition-us-core-condition-problems-health-concerns.html#profile-specific-implementation-guidance
 SHOULD

Certifying Systems ... SHOULD support the ... US Core Simple Observation Category codes
CONF-0835 •StructureDefinition-us-core-condition-problems-health-concerns.html#profile-specific-implementation-guidance
 MAY

Certifying Systems ... MAY support other categories
CONF-0846 •StructureDefinition-us-core-observation-screening-assessment.html#profile-specific-implementation-guidance
 SHALL

[For the US Core Observation Screening Assessment Profile,] Certifying Systems SHALL support, the US Core Screening Assessment Observation Category codes
CONF-0847 •StructureDefinition-us-core-observation-screening-assessment.html#profile-specific-implementation-guidance
 SHOULD

[For the US Core Observation Screening Assessment Profile,] Certifying Systems SHOULD support, the US Core Screening Assessment Observation Maximum Category codes
CONF-0848 •StructureDefinition-us-core-observation-screening-assessment.html#profile-specific-implementation-guidance
 MAY

[For the US Core Observation Screening Assessment Profile,] Certifying Systems MAY support other codes.
CONF-0852 •StructureDefinition-us-core-patient.html#profile-specific-implementation-guidance
 SHALL

Although the [US Core Interpreter Needed Extension] 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-0861 •StructureDefinition-us-core-simple-observation.html#profile-specific-implementation-guidance
 SHOULD
CONF-0862 •StructureDefinition-us-core-simple-observation.html#profile-specific-implementation-guidance
 SHALL
CONF-0863 •StructureDefinition-us-core-simple-observation.html#profile-specific-implementation-guidance
 MAY
CONF-0872 •must-support.html#must-support---slices
 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-0883 •must-support.html#must-support---resource-references
 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.html#must-support---choice-of-data-types
 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-0902 •StructureDefinition-us-core-location.html#profile-specific-implementation-guidance
 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.

Source1

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  "id": "us-core-certifying-system",
  "text": {
    "status": "extensions",
    "div": "<!-- snip (see above) -->"
  },
  "extension": [
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      "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
      "valueCode": "cgp"
    },
    {
      "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
      "valueInteger": 3,
      "_valueInteger": {
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
            "valueCanonical": "http://hl7.org/fhir/us/core/ImplementationGuide/hl7.fhir.us.core"
          }
        ]
      }
    },
    {
      "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
      "valueCode": "trial-use",
      "_valueCode": {
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
            "valueCanonical": "http://hl7.org/fhir/us/core/ImplementationGuide/hl7.fhir.us.core"
          }
        ]
      }
    },
    {
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      "valueUri": "http://hl7.org/fhir/us/core/Requirements/us-core-certifying-system"
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      "valueString": "9.0.0"
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      "valueString": "USCoreCertifyingSystemRequirements"
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    {
      "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.title",
      "valueString": "US Core Certifying System Requirements"
    },
    {
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      "valueString": "HL7 International / Cross-Group Projects"
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      "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.description",
      "valueMarkdown": "This [Requirements](https://hl7.org/fhir/R5/requirements.html) resource lists the *additional requirements* for systems certifying for ASTP Health IT Certification (g(10) certification. These requirements represent the regulatory and technical specifications that design artifacts must meet to ensure interoperability.  See the [US Core Server Requirements](Requirements-us-core-server.html) for the US Core Responder (Server) requirements defined in the US Core Implementation Guide narrative sections."
    },
    {
      "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.jurisdiction",
      "valueCodeableConcept": {
        "coding": [
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    {
      "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.copyright",
      "valueMarkdown": "Used by permission of HL7 International, all rights reserved Creative Commons License"
    },
    {
      "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.actor",
      "_valueCanonical": {
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/display",
            "valueString": "US Core Certifying System"
          }
        ]
      }
    },
    {
      "extension": [
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key",
          "valueId": "CONF-0011"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance",
          "valueCode": "SHALL"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement",
          "valueMarkdown": "A Server that certifies to the [21st Century Cures Act for accessing patient data](https://www.federalregister.gov/d/2020-07419/p-1177) **SHALL** implement all components in the USCDI [[USCDI link](https://www.healthit.gov/isp/united-states-core-data-interoperability-uscdi)]"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.reference",
          "valueUrl": "general-requirements.html#profile-support--interaction-support",
          "_valueUrl": {
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/narrativeLink",
                "valueUrl": "general-requirements.html#CONF-0011"
              }
            ]
          }
        }
      ],
      "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement"
    },
    {
      "extension": [
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key",
          "valueId": "CONF-0012"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance",
          "valueCode": "SHALL"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement",
          "valueMarkdown": "A Server that certifies to the [21st Century Cures Act for accessing patient data](https://www.federalregister.gov/d/2020-07419/p-1177) **SHALL** implement all components in the ... the US Core CapabilityStatement [[Definition](https://hl7.org/fhir/us/core/CapabilityStatement-us-core-Server.html)] ."
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.reference",
          "valueUrl": "general-requirements.html#profile-support--interaction-support",
          "_valueUrl": {
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/narrativeLink",
                "valueUrl": "general-requirements.html#CONF-0012"
              }
            ]
          }
        }
      ],
      "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement"
    },
    {
      "extension": [
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key",
          "valueId": "CONF-0124"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance",
          "valueCode": "SHALL"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement",
          "valueMarkdown": "Implementations meeting US EHR certification [of the ONC IT Health Certification program] requirements must support all US Core’s required scopes."
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.reference",
          "valueUrl": "scopes.html#smart-scopes",
          "_valueUrl": {
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/narrativeLink",
                "valueUrl": "scopes.html#CONF-0124"
              }
            ]
          }
        }
      ],
      "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement"
    },
    {
      "extension": [
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key",
          "valueId": "CONF-0391"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance",
          "valueCode": "SHALL"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement",
          "valueMarkdown": "[For organization participating in the ONC Health IT Certification program] [CVX vaccine codes](https://www2a.cdc.gov/vaccines/iis/iisstandards/ndc_crosswalk.asp) are required"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.reference",
          "valueUrl": "StructureDefinition-us-core-immunization.html#profile-specific-implementation-guidance",
          "_valueUrl": {
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/narrativeLink",
                "valueUrl": "StructureDefinition-us-core-immunization.html#CONF-0391"
              }
            ]
          }
        }
      ],
      "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement"
    },
    {
      "extension": [
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key",
          "valueId": "CONF-0392"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance",
          "valueCode": "SHOULD"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement",
          "valueMarkdown": "[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)]"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.reference",
          "valueUrl": "StructureDefinition-us-core-immunization.html#profile-specific-implementation-guidance",
          "_valueUrl": {
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/narrativeLink",
                "valueUrl": "StructureDefinition-us-core-immunization.html#CONF-0392"
              }
            ]
          }
        }
      ],
      "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement"
    },
    {
      "extension": [
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key",
          "valueId": "CONF-0405"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance",
          "valueCode": "SHALL"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement",
          "valueMarkdown": "[For organization participating in the ONC Health IT Certification program Servers **SHALL** support the [additional USCDI requirement](https://hl7.org/fhir/us/core/STU8/must-support.html#additional-uscdi-requirements):], The reason or indication for the prescription"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.reference",
          "valueUrl": "StructureDefinition-us-core-medicationrequest.html#profile-specific-implementation-guidance",
          "_valueUrl": {
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/narrativeLink",
                "valueUrl": "StructureDefinition-us-core-medicationrequest.html#CONF-0405"
              }
            ]
          }
        }
      ],
      "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement"
    },
    {
      "extension": [
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key",
          "valueId": "CONF-0406"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance",
          "valueCode": "SHALL"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement",
          "valueMarkdown": "[For organization participating in the ONC Health IT Certification program Servers **SHALL** support the [additional USCDI requirement](https://hl7.org/fhir/us/core/STU8/must-support.html#additional-uscdi-requirements):] reported adherence to prescribed medication instructions"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.reference",
          "valueUrl": "StructureDefinition-us-core-medicationrequest.html#profile-specific-implementation-guidance",
          "_valueUrl": {
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/narrativeLink",
                "valueUrl": "StructureDefinition-us-core-medicationrequest.html#CONF-0406"
              }
            ]
          }
        }
      ],
      "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement"
    },
    {
      "extension": [
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key",
          "valueId": "CONF-0411"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance",
          "valueCode": "SHALL"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement",
          "valueMarkdown": "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"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.reference",
          "valueUrl": "StructureDefinition-us-core-medicationrequest.html#profile-specific-implementation-guidance",
          "_valueUrl": {
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/narrativeLink",
                "valueUrl": "StructureDefinition-us-core-medicationrequest.html#CONF-0411"
              }
            ]
          }
        }
      ],
      "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement"
    },
    {
      "extension": [
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key",
          "valueId": "CONF-0414"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance",
          "valueCode": "SHALL"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement",
          "valueMarkdown": "[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"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.reference",
          "valueUrl": "StructureDefinition-us-core-medicationrequest.html#profile-specific-implementation-guidance",
          "_valueUrl": {
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/narrativeLink",
                "valueUrl": "StructureDefinition-us-core-medicationrequest.html#CONF-0414"
              }
            ]
          }
        }
      ],
      "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement"
    },
    {
      "extension": [
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key",
          "valueId": "CONF-0444"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance",
          "valueCode": "SHALL"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement",
          "valueMarkdown": "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"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.reference",
          "valueUrl": "StructureDefinition-us-core-simple-observation.html#profile-specific-implementation-guidance",
          "_valueUrl": {
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/narrativeLink",
                "valueUrl": "StructureDefinition-us-core-simple-observation.html#CONF-0444"
              }
            ]
          }
        }
      ],
      "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement"
    },
    {
      "extension": [
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key",
          "valueId": "CONF-0465"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance",
          "valueCode": "SHALL"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement",
          "valueMarkdown": "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"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.reference",
          "valueUrl": "StructureDefinition-us-core-patient.html#profile-specific-implementation-guidance",
          "_valueUrl": {
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/narrativeLink",
                "valueUrl": "StructureDefinition-us-core-patient.html#CONF-0465"
              }
            ]
          }
        }
      ],
      "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement"
    },
    {
      "extension": [
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key",
          "valueId": "CONF-0469"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance",
          "valueCode": "SHALL"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement",
          "valueMarkdown": "[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."
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.reference",
          "valueUrl": "StructureDefinition-us-core-patient.html#profile-specific-implementation-guidance",
          "_valueUrl": {
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/narrativeLink",
                "valueUrl": "StructureDefinition-us-core-patient.html#CONF-0469"
              }
            ]
          }
        }
      ],
      "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement"
    },
    {
      "extension": [
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key",
          "valueId": "CONF-0482"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance",
          "valueCode": "SHALL"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement",
          "valueMarkdown": "[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"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.reference",
          "valueUrl": "StructureDefinition-us-core-procedure.html#profile-specific-implementation-guidance",
          "_valueUrl": {
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/narrativeLink",
                "valueUrl": "StructureDefinition-us-core-procedure.html#CONF-0482"
              }
            ]
          }
        }
      ],
      "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement"
    },
    {
      "extension": [
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key",
          "valueId": "CONF-0484"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance",
          "valueCode": "SHALL"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement",
          "valueMarkdown": "[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."
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.reference",
          "valueUrl": "StructureDefinition-us-core-procedure.html#profile-specific-implementation-guidance",
          "_valueUrl": {
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/narrativeLink",
                "valueUrl": "StructureDefinition-us-core-procedure.html#CONF-0484"
              }
            ]
          }
        }
      ],
      "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement"
    },
    {
      "extension": [
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key",
          "valueId": "CONF-0516"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance",
          "valueCode": "SHALL"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement",
          "valueMarkdown": "[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"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.reference",
          "valueUrl": "StructureDefinition-us-core-servicerequest.html#profile-specific-implementation-guidance",
          "_valueUrl": {
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/narrativeLink",
                "valueUrl": "StructureDefinition-us-core-servicerequest.html#CONF-0516"
              }
            ]
          }
        }
      ],
      "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement"
    },
    {
      "extension": [
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key",
          "valueId": "CONF-0518"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance",
          "valueCode": "SHALL"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement",
          "valueMarkdown": "[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."
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.reference",
          "valueUrl": "StructureDefinition-us-core-servicerequest.html#profile-specific-implementation-guidance",
          "_valueUrl": {
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/narrativeLink",
                "valueUrl": "StructureDefinition-us-core-servicerequest.html#CONF-0518"
              }
            ]
          }
        }
      ],
      "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement"
    },
    {
      "extension": [
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key",
          "valueId": "CONF-0520"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance",
          "valueCode": "SHALL"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement",
          "valueMarkdown": "[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"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.reference",
          "valueUrl": "StructureDefinition-us-core-servicerequest.html#profile-specific-implementation-guidance",
          "_valueUrl": {
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/narrativeLink",
                "valueUrl": "StructureDefinition-us-core-servicerequest.html#CONF-0520"
              }
            ]
          }
        }
      ],
      "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement"
    },
    {
      "extension": [
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key",
          "valueId": "CONF-0522"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance",
          "valueCode": "SHOULD"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement",
          "valueMarkdown": "[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)"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.reference",
          "valueUrl": "StructureDefinition-us-core-servicerequest.html#profile-specific-implementation-guidance",
          "_valueUrl": {
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/narrativeLink",
                "valueUrl": "StructureDefinition-us-core-servicerequest.html#CONF-0522"
              }
            ]
          }
        }
      ],
      "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement"
    },
    {
      "extension": [
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key",
          "valueId": "CONF-0801"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance",
          "valueCode": "SHALL"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement",
          "valueMarkdown": "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."
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.reference",
          "valueUrl": "must-support.html#defined-pattern-elements",
          "_valueUrl": {
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/narrativeLink",
                "valueUrl": "must-support.html#CONF-0801"
              }
            ]
          }
        }
      ],
      "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement"
    },
    {
      "extension": [
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key",
          "valueId": "CONF-0802"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance",
          "valueCode": "SHALL"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement",
          "valueMarkdown": "\n\n\nPrimitive 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."
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.reference",
          "valueUrl": "must-support.html#must-support---primitive-elements",
          "_valueUrl": {
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/narrativeLink",
                "valueUrl": "must-support.html#CONF-0802"
              }
            ]
          }
        }
      ],
      "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement"
    },
    {
      "extension": [
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key",
          "valueId": "CONF-0803"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance",
          "valueCode": "SHALL"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement",
          "valueMarkdown": "For any complex element marked as *Additional USCDI*, the Certifying System **SHALL** be capable of providing at least one of the sub-element values. "
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.reference",
          "valueUrl": "must-support.html#must-support---complex-elements",
          "_valueUrl": {
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/narrativeLink",
                "valueUrl": "must-support.html#CONF-0803"
              }
            ]
          }
        }
      ],
      "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement"
    },
    {
      "extension": [
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key",
          "valueId": "CONF-0805"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance",
          "valueCode": "SHALL"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement",
          "valueMarkdown": "[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 represented in the structure, Certifying System **SHALL** support the sub-elements labeled as *Additional USCDI*."
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.reference",
          "valueUrl": "must-support.html#must-support---complex-elements",
          "_valueUrl": {
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/narrativeLink",
                "valueUrl": "must-support.html#CONF-0805"
              }
            ]
          }
        }
      ],
      "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement"
    },
    {
      "extension": [
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key",
          "valueId": "CONF-0809"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance",
          "valueCode": "SHALL"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement",
          "valueMarkdown": "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."
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.reference",
          "valueUrl": "must-support.html#must-support-targets-for-us-core-profiles",
          "_valueUrl": {
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/narrativeLink",
                "valueUrl": "must-support.html#CONF-0809"
              }
            ]
          }
        }
      ],
      "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement"
    },
    {
      "extension": [
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key",
          "valueId": "CONF-0811"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance",
          "valueCode": "SHALL"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement",
          "valueMarkdown": "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."
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.reference",
          "valueUrl": "must-support.html#must-support-targets-for-us-core-profiles",
          "_valueUrl": {
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/narrativeLink",
                "valueUrl": "must-support.html#CONF-0811"
              }
            ]
          }
        }
      ],
      "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement"
    },
    {
      "extension": [
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key",
          "valueId": "CONF-0812"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance",
          "valueCode": "SHALL"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement",
          "valueMarkdown": "[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."
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.reference",
          "valueUrl": "must-support.html#must-support---slices",
          "_valueUrl": {
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/narrativeLink",
                "valueUrl": "must-support.html#CONF-0812"
              }
            ]
          }
        }
      ],
      "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement"
    },
    {
      "extension": [
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key",
          "valueId": "CONF-0814"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance",
          "valueCode": "SHALL"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement",
          "valueMarkdown": "[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."
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.reference",
          "valueUrl": "must-support.html#must-support---slices",
          "_valueUrl": {
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/narrativeLink",
                "valueUrl": "must-support.html#CONF-0814"
              }
            ]
          }
        }
      ],
      "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement"
    },
    {
      "extension": [
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key",
          "valueId": "CONF-0833"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance",
          "valueCode": "SHALL"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement",
          "valueMarkdown": "Certifying Systems **SHALL** support, a category of \"sdoh\""
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.reference",
          "valueUrl": "StructureDefinition-us-core-condition-problems-health-concerns.html#profile-specific-implementation-guidance",
          "_valueUrl": {
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/narrativeLink",
                "valueUrl": "StructureDefinition-us-core-condition-problems-health-concerns.html#CONF-0833"
              }
            ]
          }
        }
      ],
      "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement"
    },
    {
      "extension": [
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key",
          "valueId": "CONF-0834"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance",
          "valueCode": "SHOULD"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement",
          "valueMarkdown": "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"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.reference",
          "valueUrl": "StructureDefinition-us-core-condition-problems-health-concerns.html#profile-specific-implementation-guidance",
          "_valueUrl": {
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/narrativeLink",
                "valueUrl": "StructureDefinition-us-core-condition-problems-health-concerns.html#CONF-0834"
              }
            ]
          }
        }
      ],
      "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement"
    },
    {
      "extension": [
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key",
          "valueId": "CONF-0835"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance",
          "valueCode": "MAY"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement",
          "valueMarkdown": "Certifying Systems ... **MAY** support other categories"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.reference",
          "valueUrl": "StructureDefinition-us-core-condition-problems-health-concerns.html#profile-specific-implementation-guidance",
          "_valueUrl": {
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/narrativeLink",
                "valueUrl": "StructureDefinition-us-core-condition-problems-health-concerns.html#CONF-0835"
              }
            ]
          }
        }
      ],
      "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement"
    },
    {
      "extension": [
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key",
          "valueId": "CONF-0846"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance",
          "valueCode": "SHALL"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement",
          "valueMarkdown": "[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"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.reference",
          "valueUrl": "StructureDefinition-us-core-observation-screening-assessment.html#profile-specific-implementation-guidance",
          "_valueUrl": {
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/narrativeLink",
                "valueUrl": "StructureDefinition-us-core-observation-screening-assessment.html#CONF-0846"
              }
            ]
          }
        }
      ],
      "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement"
    },
    {
      "extension": [
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key",
          "valueId": "CONF-0847"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance",
          "valueCode": "SHOULD"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement",
          "valueMarkdown": "[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"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.reference",
          "valueUrl": "StructureDefinition-us-core-observation-screening-assessment.html#profile-specific-implementation-guidance",
          "_valueUrl": {
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/narrativeLink",
                "valueUrl": "StructureDefinition-us-core-observation-screening-assessment.html#CONF-0847"
              }
            ]
          }
        }
      ],
      "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement"
    },
    {
      "extension": [
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key",
          "valueId": "CONF-0848"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance",
          "valueCode": "MAY"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement",
          "valueMarkdown": "[For the US Core Observation Screening Assessment Profile,] Certifying Systems **MAY** support other codes."
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.reference",
          "valueUrl": "StructureDefinition-us-core-observation-screening-assessment.html#profile-specific-implementation-guidance",
          "_valueUrl": {
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/narrativeLink",
                "valueUrl": "StructureDefinition-us-core-observation-screening-assessment.html#CONF-0848"
              }
            ]
          }
        }
      ],
      "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement"
    },
    {
      "extension": [
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key",
          "valueId": "CONF-0852"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance",
          "valueCode": "SHALL"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement",
          "valueMarkdown": "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."
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.reference",
          "valueUrl": "StructureDefinition-us-core-patient.html#profile-specific-implementation-guidance",
          "_valueUrl": {
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/narrativeLink",
                "valueUrl": "StructureDefinition-us-core-patient.html#CONF-0852"
              }
            ]
          }
        }
      ],
      "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement"
    },
    {
      "extension": [
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key",
          "valueId": "CONF-0861"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance",
          "valueCode": "SHOULD"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement",
          "valueMarkdown": "[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)]"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.reference",
          "valueUrl": "StructureDefinition-us-core-simple-observation.html#profile-specific-implementation-guidance",
          "_valueUrl": {
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/narrativeLink",
                "valueUrl": "StructureDefinition-us-core-simple-observation.html#CONF-0861"
              }
            ]
          }
        }
      ],
      "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement"
    },
    {
      "extension": [
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key",
          "valueId": "CONF-0862"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance",
          "valueCode": "SHALL"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement",
          "valueMarkdown": "[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)"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.reference",
          "valueUrl": "StructureDefinition-us-core-simple-observation.html#profile-specific-implementation-guidance",
          "_valueUrl": {
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/narrativeLink",
                "valueUrl": "StructureDefinition-us-core-simple-observation.html#CONF-0862"
              }
            ]
          }
        }
      ],
      "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement"
    },
    {
      "extension": [
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key",
          "valueId": "CONF-0863"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance",
          "valueCode": "MAY"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement",
          "valueMarkdown": "[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)]."
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.reference",
          "valueUrl": "StructureDefinition-us-core-simple-observation.html#profile-specific-implementation-guidance",
          "_valueUrl": {
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/narrativeLink",
                "valueUrl": "StructureDefinition-us-core-simple-observation.html#CONF-0863"
              }
            ]
          }
        }
      ],
      "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement"
    },
    {
      "extension": [
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key",
          "valueId": "CONF-0872"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance",
          "valueCode": "SHALL"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement",
          "valueMarkdown": "[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."
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.reference",
          "valueUrl": "must-support.html#must-support---slices",
          "_valueUrl": {
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/narrativeLink",
                "valueUrl": "must-support.html#CONF-0872"
              }
            ]
          }
        }
      ],
      "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement"
    },
    {
      "extension": [
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key",
          "valueId": "CONF-0883"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance",
          "valueCode": "SHALL"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement",
          "valueMarkdown": "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."
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.reference",
          "valueUrl": "must-support.html#must-support---resource-references",
          "_valueUrl": {
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/narrativeLink",
                "valueUrl": "must-support.html#CONF-0883"
              }
            ]
          }
        }
      ],
      "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement"
    },
    {
      "extension": [
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key",
          "valueId": "CONF-0884"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance",
          "valueCode": "SHALL"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement",
          "valueMarkdown": "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*."
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.reference",
          "valueUrl": "must-support.html#must-support---choice-of-data-types",
          "_valueUrl": {
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/narrativeLink",
                "valueUrl": "must-support.html#CONF-0884"
              }
            ]
          }
        }
      ],
      "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement"
    },
    {
      "extension": [
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.key",
          "valueId": "CONF-0902"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.conformance",
          "valueCode": "MAY"
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.requirement",
          "valueMarkdown": "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."
        },
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement.reference",
          "valueUrl": "StructureDefinition-us-core-location.html#profile-specific-implementation-guidance",
          "_valueUrl": {
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/narrativeLink",
                "valueUrl": "StructureDefinition-us-core-location.html#CONF-0902"
              }
            ]
          }
        }
      ],
      "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Requirements.statement"
    }
  ],
  "identifier": [
    {
      "system": "urn:ietf:rfc:3986",
      "value": "urn:oid:2.16.840.1.113883.4.642.40.2.36.1"
    }
  ],
  "code": {
    "coding": [
      {
        "system": "http://hl7.org/fhir/fhir-types",
        "code": "Requirements"
      }
    ]
  }
}