2026 US Quality Core Implementation Guide
0.5.0 - release

2026 US Quality Core Implementation Guide - Downloaded Version 0.5.0 See the Directory of published versions

## Resource Profile: US Quality Core Communication Not Done

Official URL: http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-communicationnotdone | Version: 0.5.0 | Highlight text changes?
Active as of 2026-06-05 | Computable Name: USQualityCoreCommunicationNotDone

Profile of CommunicationNotDone for decision support/quality metrics. Defines the core set of elements and extensions for quality rule and measure authors.

### USCDI+ Quality Element Support Expectations

This profile does not include USCDI+ Quality flagged elements and is not in scope for USCDI+ Quality V1 conformance requirements in this guide. See the USCDI+ Quality page for the list of profiles and elements that are in scope for USCDI+ Quality V1.

This profile is inherited from QI-Core v6.0.0 and is included to ease adoption for systems that currently support QI-Core. Refer to the Formal Views section for the formal summary, definitions, terminology requirements, and mandatory element requirements.

### Profile Specific Implementation Guidance

This profile represents a communication event that intentionally did not occur for a medical, patient, or system reason. To represent communication events that did occur, use the US Quality Core Communication profile.

Additional informational guidance for authoring CQL using this profile is provided in the CQL Authoring Usage (Informational) section of this page.

Usages:

- Examples for this Profile: Communication/negation-example

You can also check for usages in the FHIR IG Statistics

### Formal Views of Profile Content

Description Differentials, Snapshots, and other representations.

- Key Elements Table
- Differential Table
- Snapshot Table
- Statistics/References
- All

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Communication | C | 0..* | Communication | A record of information transmitted from a sender to a receiver Constraints: cnd-1
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:recorded |  | 1..1 | dateTime | Extension URL: http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-recorded
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
status | ?!Σ | 1..1 | code | preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown Binding: EventStatus (required): The status of the communication. Fixed Value: not-done
statusReason | Σ | 1..1 | CodeableConcept | Reason for current status Binding: USQualityCore Negation Reason Codes (extensible)
subject | Σ | 0..1 | Reference(US Quality Core Patient | Group) | Focus of message
topic |  | 1..1 | CodeableConcept | Description of the purpose/content Binding: CommunicationTopic (preferred): Codes describing the purpose or content of the communication.
Slices for extension |  |  |  | Content/Rules for all slices
extension:notDoneValueSet |  | 0..1 | canonical(ValueSet) | Url of a value set of activities not requested or performed URL: http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-notDoneValueSet
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Communication.status | Base | required | EventStatus | 📍4.0.1 | FHIR Std.
Communication.statusReason | Base | extensible | USQualityCore Negation Reason Codes | 📦0.5.0 | This IG
Communication.topic | Base | preferred | CommunicationTopic | 📦4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
cnd-1 | error | Communication | to indicate what communication was not carried out, either at least one coding in the topic or a notDoneValueSet extension shall be provided | `topic.extension('http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-notDoneValueSet').exists() xor topic.coding.exists()`
dom-2 | error | Communication | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Communication | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource | `contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`
dom-4 | error | Communication | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5 | error | Communication | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Communication | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Communication | C | 0..* | Communication | A record of information transmitted from a sender to a receiver Constraints: cnd-1
Slices for extension |  |  |  | Content/Rules for all slices
extension:recorded |  | 1..1 | dateTime | Extension URL: http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-recorded
status |  | 1..1 | code | preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown Fixed Value: not-done
statusReason |  | 1..1 | CodeableConcept | Reason for current status Binding: USQualityCore Negation Reason Codes (extensible)
subject |  | 0..1 | Reference(US Quality Core Patient | Group) | Focus of message
topic |  | 1..1 | CodeableConcept | Description of the purpose/content Binding: CommunicationTopic (preferred): Codes describing the purpose or content of the communication.
Slices for extension |  |  |  | Content/Rules for all slices
extension:notDoneValueSet |  | 0..1 | canonical(ValueSet) | Url of a value set of activities not requested or performed URL: http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-notDoneValueSet
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
Communication.statusReason | Base | extensible | USQualityCore Negation Reason Codes | 📦0.5.0 | This IG
Communication.topic | Base | preferred | CommunicationTopic | 📦4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
cnd-1 | error | Communication | to indicate what communication was not carried out, either at least one coding in the topic or a notDoneValueSet extension shall be provided | `topic.extension('http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-notDoneValueSet').exists() xor topic.coding.exists()`

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Communication | C | 0..* | Communication | A record of information transmitted from a sender to a receiver Constraints: cnd-1
id | Σ | 0..1 | id | Logical id of this artifact
meta | Σ | 0..1 | Meta | Metadata about the resource
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
language |  | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained |  | 0..* | Resource | Contained, inline Resources
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:recorded |  | 1..1 | dateTime | Extension URL: http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-recorded
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier | Σ | 0..* | Identifier | Unique identifier
instantiatesCanonical | Σ | 0..* | canonical(PlanDefinition | ActivityDefinition | Measure | OperationDefinition | Questionnaire) | Instantiates FHIR protocol or definition
instantiatesUri | Σ | 0..* | uri | Instantiates external protocol or definition
basedOn | Σ | 0..* | Reference(Resource) | Request fulfilled by this communication
partOf | Σ | 0..* | Reference(Resource) | Part of this action
inResponseTo |  | 0..* | Reference(Communication) | Reply to
status | ?!Σ | 1..1 | code | preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown Binding: EventStatus (required): The status of the communication. Fixed Value: not-done
statusReason | Σ | 1..1 | CodeableConcept | Reason for current status Binding: USQualityCore Negation Reason Codes (extensible)
category |  | 0..* | CodeableConcept | Message category Binding: CommunicationCategory (example): Codes for general categories of communications such as alerts, instructions, etc.
priority | Σ | 0..1 | code | routine | urgent | asap | stat Binding: RequestPriority (required): Codes indicating the relative importance of a communication.
medium |  | 0..* | CodeableConcept | A channel of communication Binding: v3 Code System ParticipationMode (example): Codes for communication mediums such as phone, fax, email, in person, etc.
subject | Σ | 0..1 | Reference(US Quality Core Patient | Group) | Focus of message
topic |  | 1..1 | CodeableConcept | Description of the purpose/content Binding: CommunicationTopic (preferred): Codes describing the purpose or content of the communication.
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
extension:notDoneValueSet |  | 0..1 | canonical(ValueSet) | Url of a value set of activities not requested or performed URL: http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-notDoneValueSet
coding | Σ | 0..* | Coding | Code defined by a terminology system
text | Σ | 0..1 | string | Plain text representation of the concept
about |  | 0..* | Reference(Resource) | Resources that pertain to this communication
encounter | Σ | 0..1 | Reference(Encounter) | Encounter created as part of
sent |  | 0..1 | dateTime | When sent
received |  | 0..1 | dateTime | When received
recipient |  | 0..* | Reference(Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson | Group | CareTeam | HealthcareService) | Message recipient
sender |  | 0..1 | Reference(Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson | HealthcareService) | Message sender
reasonCode | Σ | 0..* | CodeableConcept | Indication for message Binding: SNOMEDCTClinicalFindings (example): Codes for describing reasons for the occurrence of a communication.
reasonReference | Σ | 0..* | Reference(Condition | Observation | DiagnosticReport | DocumentReference) | Why was communication done?
payload |  | 0..* | BackboneElement | Message payload
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
content[x] |  | 1..1 |  | Message part content
contentString |  |  | string |
contentAttachment |  |  | Attachment |
contentReference |  |  | Reference(Resource) |
note |  | 0..* | Annotation | Comments made about the communication
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Communication.language | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std.
Communication.status | Base | required | EventStatus | 📍4.0.1 | FHIR Std.
Communication.statusReason | Base | extensible | USQualityCore Negation Reason Codes | 📦0.5.0 | This IG
Communication.category | Base | example | CommunicationCategory | 📍4.0.1 | FHIR Std.
Communication.priority | Base | required | Request priority | 📍4.0.1 | FHIR Std.
Communication.medium | Base | example | v3 Code System ParticipationMode | 📦2018-08-12 | FHIR Std.
Communication.topic | Base | preferred | CommunicationTopic | 📦4.0.1 | FHIR Std.
Communication.reasonCode | Base | example | SNOMED CT Clinical Findings | 📍4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
cnd-1 | error | Communication | to indicate what communication was not carried out, either at least one coding in the topic or a notDoneValueSet extension shall be provided | `topic.extension('http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-notDoneValueSet').exists() xor topic.coding.exists()`
dom-2 | error | Communication | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Communication | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource | `contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`
dom-4 | error | Communication | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5 | error | Communication | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Communication | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`

Summary

Mandatory: 4 elements
Fixed: 1 element

Structures

This structure refers to these other structures:

- US Quality Core Patient (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-patient)

Extensions

This structure refers to these extensions:

- http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-recorded
- http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-notDoneValueSet

Key Elements View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Communication | C | 0..* | Communication | A record of information transmitted from a sender to a receiver Constraints: cnd-1
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:recorded |  | 1..1 | dateTime | Extension URL: http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-recorded
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
status | ?!Σ | 1..1 | code | preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown Binding: EventStatus (required): The status of the communication. Fixed Value: not-done
statusReason | Σ | 1..1 | CodeableConcept | Reason for current status Binding: USQualityCore Negation Reason Codes (extensible)
subject | Σ | 0..1 | Reference(US Quality Core Patient | Group) | Focus of message
topic |  | 1..1 | CodeableConcept | Description of the purpose/content Binding: CommunicationTopic (preferred): Codes describing the purpose or content of the communication.
Slices for extension |  |  |  | Content/Rules for all slices
extension:notDoneValueSet |  | 0..1 | canonical(ValueSet) | Url of a value set of activities not requested or performed URL: http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-notDoneValueSet
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Communication.status | Base | required | EventStatus | 📍4.0.1 | FHIR Std.
Communication.statusReason | Base | extensible | USQualityCore Negation Reason Codes | 📦0.5.0 | This IG
Communication.topic | Base | preferred | CommunicationTopic | 📦4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
cnd-1 | error | Communication | to indicate what communication was not carried out, either at least one coding in the topic or a notDoneValueSet extension shall be provided | `topic.extension('http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-notDoneValueSet').exists() xor topic.coding.exists()`
dom-2 | error | Communication | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Communication | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource | `contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`
dom-4 | error | Communication | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5 | error | Communication | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Communication | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`

Differential View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Communication | C | 0..* | Communication | A record of information transmitted from a sender to a receiver Constraints: cnd-1
Slices for extension |  |  |  | Content/Rules for all slices
extension:recorded |  | 1..1 | dateTime | Extension URL: http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-recorded
status |  | 1..1 | code | preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown Fixed Value: not-done
statusReason |  | 1..1 | CodeableConcept | Reason for current status Binding: USQualityCore Negation Reason Codes (extensible)
subject |  | 0..1 | Reference(US Quality Core Patient | Group) | Focus of message
topic |  | 1..1 | CodeableConcept | Description of the purpose/content Binding: CommunicationTopic (preferred): Codes describing the purpose or content of the communication.
Slices for extension |  |  |  | Content/Rules for all slices
extension:notDoneValueSet |  | 0..1 | canonical(ValueSet) | Url of a value set of activities not requested or performed URL: http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-notDoneValueSet
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
Communication.statusReason | Base | extensible | USQualityCore Negation Reason Codes | 📦0.5.0 | This IG
Communication.topic | Base | preferred | CommunicationTopic | 📦4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
cnd-1 | error | Communication | to indicate what communication was not carried out, either at least one coding in the topic or a notDoneValueSet extension shall be provided | `topic.extension('http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-notDoneValueSet').exists() xor topic.coding.exists()`

Snapshot ViewView

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Communication | C | 0..* | Communication | A record of information transmitted from a sender to a receiver Constraints: cnd-1
id | Σ | 0..1 | id | Logical id of this artifact
meta | Σ | 0..1 | Meta | Metadata about the resource
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
language |  | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained |  | 0..* | Resource | Contained, inline Resources
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:recorded |  | 1..1 | dateTime | Extension URL: http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-recorded
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier | Σ | 0..* | Identifier | Unique identifier
instantiatesCanonical | Σ | 0..* | canonical(PlanDefinition | ActivityDefinition | Measure | OperationDefinition | Questionnaire) | Instantiates FHIR protocol or definition
instantiatesUri | Σ | 0..* | uri | Instantiates external protocol or definition
basedOn | Σ | 0..* | Reference(Resource) | Request fulfilled by this communication
partOf | Σ | 0..* | Reference(Resource) | Part of this action
inResponseTo |  | 0..* | Reference(Communication) | Reply to
status | ?!Σ | 1..1 | code | preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown Binding: EventStatus (required): The status of the communication. Fixed Value: not-done
statusReason | Σ | 1..1 | CodeableConcept | Reason for current status Binding: USQualityCore Negation Reason Codes (extensible)
category |  | 0..* | CodeableConcept | Message category Binding: CommunicationCategory (example): Codes for general categories of communications such as alerts, instructions, etc.
priority | Σ | 0..1 | code | routine | urgent | asap | stat Binding: RequestPriority (required): Codes indicating the relative importance of a communication.
medium |  | 0..* | CodeableConcept | A channel of communication Binding: v3 Code System ParticipationMode (example): Codes for communication mediums such as phone, fax, email, in person, etc.
subject | Σ | 0..1 | Reference(US Quality Core Patient | Group) | Focus of message
topic |  | 1..1 | CodeableConcept | Description of the purpose/content Binding: CommunicationTopic (preferred): Codes describing the purpose or content of the communication.
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
extension:notDoneValueSet |  | 0..1 | canonical(ValueSet) | Url of a value set of activities not requested or performed URL: http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-notDoneValueSet
coding | Σ | 0..* | Coding | Code defined by a terminology system
text | Σ | 0..1 | string | Plain text representation of the concept
about |  | 0..* | Reference(Resource) | Resources that pertain to this communication
encounter | Σ | 0..1 | Reference(Encounter) | Encounter created as part of
sent |  | 0..1 | dateTime | When sent
received |  | 0..1 | dateTime | When received
recipient |  | 0..* | Reference(Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson | Group | CareTeam | HealthcareService) | Message recipient
sender |  | 0..1 | Reference(Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson | HealthcareService) | Message sender
reasonCode | Σ | 0..* | CodeableConcept | Indication for message Binding: SNOMEDCTClinicalFindings (example): Codes for describing reasons for the occurrence of a communication.
reasonReference | Σ | 0..* | Reference(Condition | Observation | DiagnosticReport | DocumentReference) | Why was communication done?
payload |  | 0..* | BackboneElement | Message payload
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
content[x] |  | 1..1 |  | Message part content
contentString |  |  | string |
contentAttachment |  |  | Attachment |
contentReference |  |  | Reference(Resource) |
note |  | 0..* | Annotation | Comments made about the communication
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Communication.language | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std.
Communication.status | Base | required | EventStatus | 📍4.0.1 | FHIR Std.
Communication.statusReason | Base | extensible | USQualityCore Negation Reason Codes | 📦0.5.0 | This IG
Communication.category | Base | example | CommunicationCategory | 📍4.0.1 | FHIR Std.
Communication.priority | Base | required | Request priority | 📍4.0.1 | FHIR Std.
Communication.medium | Base | example | v3 Code System ParticipationMode | 📦2018-08-12 | FHIR Std.
Communication.topic | Base | preferred | CommunicationTopic | 📦4.0.1 | FHIR Std.
Communication.reasonCode | Base | example | SNOMED CT Clinical Findings | 📍4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
cnd-1 | error | Communication | to indicate what communication was not carried out, either at least one coding in the topic or a notDoneValueSet extension shall be provided | `topic.extension('http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-notDoneValueSet').exists() xor topic.coding.exists()`
dom-2 | error | Communication | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Communication | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource | `contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`
dom-4 | error | Communication | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5 | error | Communication | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Communication | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`

Summary

Mandatory: 4 elements
Fixed: 1 element

Structures

This structure refers to these other structures:

- US Quality Core Patient (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-patient)

Extensions

This structure refers to these extensions:

- http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-recorded
- http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-notDoneValueSet

Other representations of profile: CSV, Excel, Schematron

### Notes:

#### CQL Authoring Usage (Informational)

The Communication and CommunicationNotDone profiles represent the positive and negative statements for a communication event.

This example meets measure intent for exclusion as defined in the following illustrative CQL (informational; not part of conformance requirements):

    [CommunicationNotDone: "Macular edema absent (finding)"] MacularEdemaAbsentNotCommunicated
      with "Diabetic Retinopathy Encounter" EncounterDiabeticRetinopathy
        such that MacularEdemaAbsentNotCommunicated.sent during EncounterDiabeticRetinopathy.period
          and ( MacularEdemaAbsentNotCommunicated.statusReason in "Medical Reason"
            or MacularEdemaAbsentNotCommunicated.statusReason in "Patient Reason"
          )

For a more complete discussion of representation of negation within US Quality Core and quality improvement artifacts, see the Negation in US Quality Core topic.