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 Flag

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

Profile of Flag 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.

Usages:

- Examples for this Profile: Flag/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
--- | --- | --- | --- | ---
Flag |  | 0..* | Flag | Key information to flag to healthcare providers
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
status | ?!Σ | 1..1 | code | active | inactive | entered-in-error Binding: FlagStatus (required): Indicates whether this flag is active and needs to be displayed to a user, or whether it is no longer needed or was entered in error.
category | Σ | 0..* | CodeableConcept | Clinical, administrative, etc. Binding: FlagCategory (preferred)
code | Σ | 1..1 | CodeableConcept | Coded or textual message to display to user Binding: FlagCode (preferred)
subject | Σ | 1..1 | Reference(US Quality Core Patient | US Quality Core Location | Group | US Quality Core Organization | US Quality Core Practitioner) | Who/What is flag about?
period | Σ | 0..1 | Period | Time period when flag is active
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Flag.status | Base | required | FlagStatus | 📍4.0.1 | FHIR Std.
Flag.category | Base | preferred | Flag Category | 📦4.0.1 | FHIR Std.
Flag.code | Base | preferred | Flag Code | 📦4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | Flag | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Flag | 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 | Flag | 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 | Flag | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Flag | 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
--- | --- | --- | --- | ---
Flag |  | 0..* | Flag | Key information to flag to healthcare providers
status |  | 1..1 | code | active | inactive | entered-in-error
category |  | 0..* | CodeableConcept | Clinical, administrative, etc. Binding: FlagCategory (preferred)
code |  | 1..1 | CodeableConcept | Coded or textual message to display to user Binding: FlagCode (preferred)
subject |  | 1..1 | Reference(US Quality Core Patient | US Quality Core Location | Group | US Quality Core Organization | US Quality Core Practitioner) | Who/What is flag about?
period |  | 0..1 | Period | Time period when flag is active
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
Flag.category | Base | preferred | Flag Category | 📦4.0.1 | FHIR Std.
Flag.code | Base | preferred | Flag Code | 📦4.0.1 | FHIR Std.

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Flag |  | 0..* | Flag | Key information to flag to healthcare providers
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
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier | Σ | 0..* | Identifier | Business identifier
status | ?!Σ | 1..1 | code | active | inactive | entered-in-error Binding: FlagStatus (required): Indicates whether this flag is active and needs to be displayed to a user, or whether it is no longer needed or was entered in error.
category | Σ | 0..* | CodeableConcept | Clinical, administrative, etc. Binding: FlagCategory (preferred)
code | Σ | 1..1 | CodeableConcept | Coded or textual message to display to user Binding: FlagCode (preferred)
subject | Σ | 1..1 | Reference(US Quality Core Patient | US Quality Core Location | Group | US Quality Core Organization | US Quality Core Practitioner) | Who/What is flag about?
period | Σ | 0..1 | Period | Time period when flag is active
encounter | Σ | 0..1 | Reference(Encounter) | Alert relevant during encounter
author | Σ | 0..1 | Reference(Device | Organization | Patient | Practitioner | PractitionerRole) | Flag creator
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Flag.language | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std.
Flag.status | Base | required | FlagStatus | 📍4.0.1 | FHIR Std.
Flag.category | Base | preferred | Flag Category | 📦4.0.1 | FHIR Std.
Flag.code | Base | preferred | Flag Code | 📦4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | Flag | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Flag | 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 | Flag | 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 | Flag | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Flag | 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

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)
- US Quality Core Location (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-location)
- US Quality Core Organization (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-organization)
- US Quality Core Practitioner (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-practitioner)

Key Elements View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Flag |  | 0..* | Flag | Key information to flag to healthcare providers
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
status | ?!Σ | 1..1 | code | active | inactive | entered-in-error Binding: FlagStatus (required): Indicates whether this flag is active and needs to be displayed to a user, or whether it is no longer needed or was entered in error.
category | Σ | 0..* | CodeableConcept | Clinical, administrative, etc. Binding: FlagCategory (preferred)
code | Σ | 1..1 | CodeableConcept | Coded or textual message to display to user Binding: FlagCode (preferred)
subject | Σ | 1..1 | Reference(US Quality Core Patient | US Quality Core Location | Group | US Quality Core Organization | US Quality Core Practitioner) | Who/What is flag about?
period | Σ | 0..1 | Period | Time period when flag is active
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Flag.status | Base | required | FlagStatus | 📍4.0.1 | FHIR Std.
Flag.category | Base | preferred | Flag Category | 📦4.0.1 | FHIR Std.
Flag.code | Base | preferred | Flag Code | 📦4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | Flag | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Flag | 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 | Flag | 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 | Flag | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Flag | 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
--- | --- | --- | --- | ---
Flag |  | 0..* | Flag | Key information to flag to healthcare providers
status |  | 1..1 | code | active | inactive | entered-in-error
category |  | 0..* | CodeableConcept | Clinical, administrative, etc. Binding: FlagCategory (preferred)
code |  | 1..1 | CodeableConcept | Coded or textual message to display to user Binding: FlagCode (preferred)
subject |  | 1..1 | Reference(US Quality Core Patient | US Quality Core Location | Group | US Quality Core Organization | US Quality Core Practitioner) | Who/What is flag about?
period |  | 0..1 | Period | Time period when flag is active
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
Flag.category | Base | preferred | Flag Category | 📦4.0.1 | FHIR Std.
Flag.code | Base | preferred | Flag Code | 📦4.0.1 | FHIR Std.

Snapshot ViewView

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Flag |  | 0..* | Flag | Key information to flag to healthcare providers
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
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier | Σ | 0..* | Identifier | Business identifier
status | ?!Σ | 1..1 | code | active | inactive | entered-in-error Binding: FlagStatus (required): Indicates whether this flag is active and needs to be displayed to a user, or whether it is no longer needed or was entered in error.
category | Σ | 0..* | CodeableConcept | Clinical, administrative, etc. Binding: FlagCategory (preferred)
code | Σ | 1..1 | CodeableConcept | Coded or textual message to display to user Binding: FlagCode (preferred)
subject | Σ | 1..1 | Reference(US Quality Core Patient | US Quality Core Location | Group | US Quality Core Organization | US Quality Core Practitioner) | Who/What is flag about?
period | Σ | 0..1 | Period | Time period when flag is active
encounter | Σ | 0..1 | Reference(Encounter) | Alert relevant during encounter
author | Σ | 0..1 | Reference(Device | Organization | Patient | Practitioner | PractitionerRole) | Flag creator
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Flag.language | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std.
Flag.status | Base | required | FlagStatus | 📍4.0.1 | FHIR Std.
Flag.category | Base | preferred | Flag Category | 📦4.0.1 | FHIR Std.
Flag.code | Base | preferred | Flag Code | 📦4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | Flag | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Flag | 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 | Flag | 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 | Flag | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Flag | 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

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)
- US Quality Core Location (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-location)
- US Quality Core Organization (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-organization)
- US Quality Core Practitioner (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-practitioner)

Other representations of profile: CSV, Excel, Schematron