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 Medication

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

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

### USCDI+ Quality Element Support Expectations

Systems are expected to support this profile as part of implementing USCDI+ Quality V1 in FHIR and meeting the conformance requirements of this guide.

The following elements are specifically relevant to USCDI+ Quality V1 data classes and elements. Systems are expected to support these elements as applicable to their role in US Quality Core data exchange. See the Must Support section of this guide for more information. These elements are tagged as (USCDI+ Quality) in the formal profile views.

USCDI+ Quality Elements:

- code: (USCDI+ Quality) (USCDI) Codes that identify this medication

Because this profile is derived from US Core, systems are also expected to support Must Support requirements and (USCDI) tagged elements inherited from US Core. The Formal Views section also provides the formal summary, definitions, terminology requirements, and mandatory element requirements.

### Profile Specific Implementation Guidance

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

Usages:

- Refer to this Profile: US Quality Core AdverseEvent, US Quality Core Medication, US Quality Core MedicationAdministration, US Quality Core MedicationDispense and US Quality Core MedicationStatement
- Examples for this Profile: Medication/example
- CapabilityStatements using this Profile: US Quality Core Client CapabilityStatement and US Quality Core Server CapabilityStatement

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
--- | --- | --- | --- | ---
Medication |  | 0..* | USCoreMedicationProfile(6.1.0) | Definition of a Medication
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
code | S Σ | 1..1 | CodeableConcept | (USCDI+ Quality) (USCDI) Codes that identify this medication Binding: Medication Clinical Drug (extensible)
status | ?!Σ | 0..1 | code | active | inactive | entered-in-error Binding: Medication Status Codes (required): A coded concept defining if the medication is in active use.
manufacturer | Σ | 0..1 | Reference(US Quality Core Organization) | Manufacturer of the item
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Medication.code | Base | extensible | Medication Clinical Drug | 📦20170601 | VSAC v0.18
Medication.status | Base | required | Medication status codes | 📍4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | Medication | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Medication | 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 | Medication | 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 | Medication | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Medication | 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
--- | --- | --- | --- | ---
Medication |  | 0..* | USCoreMedicationProfile(6.1.0) | Definition of a Medication
code |  | 1..1 | CodeableConcept | (USCDI+ Quality) (USCDI) Codes that identify this medication
manufacturer |  | 0..1 | Reference(US Quality Core Organization) | Manufacturer of the item
ingredient |  |  |  |
item[x] |  | 1..1 |  | The actual ingredient or content
itemCodeableConcept |  |  | CodeableConcept |
itemReference |  |  | Reference(US Quality Core Substance | US Quality Core Medication) |
isActive |  | 0..1 | boolean | Active ingredient indicator
Documentation for this format

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Medication |  | 0..* | USCoreMedicationProfile(6.1.0) | Definition of a Medication
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 for this medication
code | S Σ | 1..1 | CodeableConcept | (USCDI+ Quality) (USCDI) Codes that identify this medication Binding: Medication Clinical Drug (extensible)
status | ?!Σ | 0..1 | code | active | inactive | entered-in-error Binding: Medication Status Codes (required): A coded concept defining if the medication is in active use.
manufacturer | Σ | 0..1 | Reference(US Quality Core Organization) | Manufacturer of the item
form |  | 0..1 | CodeableConcept | powder | tablets | capsule + Binding: SNOMEDCTFormCodes (example): A coded concept defining the form of a medication.
amount | Σ | 0..1 | Ratio | Amount of drug in package
ingredient |  | 0..* | BackboneElement | Active or inactive ingredient
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
item[x] |  | 1..1 |  | The actual ingredient or content
itemCodeableConcept |  |  | CodeableConcept |
itemReference |  |  | Reference(US Quality Core Substance | US Quality Core Medication) |
isActive |  | 0..1 | boolean | Active ingredient indicator
strength |  | 0..1 | Ratio | Quantity of ingredient present
batch |  | 0..1 | BackboneElement | Details about packaged medications
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
lotNumber |  | 0..1 | string | Identifier assigned to batch
expirationDate |  | 0..1 | dateTime | When batch will expire
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Medication.language | Base | preferred | Common Languages | 📦4.0.1 | FHIR Std.
Medication.code | Base | extensible | Medication Clinical Drug | 📦20170601 | VSAC v0.18
Medication.status | Base | required | Medication status codes | 📍4.0.1 | FHIR Std.
Medication.form | Base | example | SNOMED CT Form Codes | 📦4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | Medication | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Medication | 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 | Medication | 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 | Medication | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Medication | 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 Organization (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-organization)
- US Quality Core Substance (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-substance)
- US Quality Core Medication (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-medication)

Key Elements View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Medication |  | 0..* | USCoreMedicationProfile(6.1.0) | Definition of a Medication
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
code | S Σ | 1..1 | CodeableConcept | (USCDI+ Quality) (USCDI) Codes that identify this medication Binding: Medication Clinical Drug (extensible)
status | ?!Σ | 0..1 | code | active | inactive | entered-in-error Binding: Medication Status Codes (required): A coded concept defining if the medication is in active use.
manufacturer | Σ | 0..1 | Reference(US Quality Core Organization) | Manufacturer of the item
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Medication.code | Base | extensible | Medication Clinical Drug | 📦20170601 | VSAC v0.18
Medication.status | Base | required | Medication status codes | 📍4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | Medication | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Medication | 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 | Medication | 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 | Medication | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Medication | 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
--- | --- | --- | --- | ---
Medication |  | 0..* | USCoreMedicationProfile(6.1.0) | Definition of a Medication
code |  | 1..1 | CodeableConcept | (USCDI+ Quality) (USCDI) Codes that identify this medication
manufacturer |  | 0..1 | Reference(US Quality Core Organization) | Manufacturer of the item
ingredient |  |  |  |
item[x] |  | 1..1 |  | The actual ingredient or content
itemCodeableConcept |  |  | CodeableConcept |
itemReference |  |  | Reference(US Quality Core Substance | US Quality Core Medication) |
isActive |  | 0..1 | boolean | Active ingredient indicator
Documentation for this format

Snapshot ViewView

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Medication |  | 0..* | USCoreMedicationProfile(6.1.0) | Definition of a Medication
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 for this medication
code | S Σ | 1..1 | CodeableConcept | (USCDI+ Quality) (USCDI) Codes that identify this medication Binding: Medication Clinical Drug (extensible)
status | ?!Σ | 0..1 | code | active | inactive | entered-in-error Binding: Medication Status Codes (required): A coded concept defining if the medication is in active use.
manufacturer | Σ | 0..1 | Reference(US Quality Core Organization) | Manufacturer of the item
form |  | 0..1 | CodeableConcept | powder | tablets | capsule + Binding: SNOMEDCTFormCodes (example): A coded concept defining the form of a medication.
amount | Σ | 0..1 | Ratio | Amount of drug in package
ingredient |  | 0..* | BackboneElement | Active or inactive ingredient
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
item[x] |  | 1..1 |  | The actual ingredient or content
itemCodeableConcept |  |  | CodeableConcept |
itemReference |  |  | Reference(US Quality Core Substance | US Quality Core Medication) |
isActive |  | 0..1 | boolean | Active ingredient indicator
strength |  | 0..1 | Ratio | Quantity of ingredient present
batch |  | 0..1 | BackboneElement | Details about packaged medications
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
lotNumber |  | 0..1 | string | Identifier assigned to batch
expirationDate |  | 0..1 | dateTime | When batch will expire
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Medication.language | Base | preferred | Common Languages | 📦4.0.1 | FHIR Std.
Medication.code | Base | extensible | Medication Clinical Drug | 📦20170601 | VSAC v0.18
Medication.status | Base | required | Medication status codes | 📍4.0.1 | FHIR Std.
Medication.form | Base | example | SNOMED CT Form Codes | 📦4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | Medication | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Medication | 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 | Medication | 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 | Medication | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Medication | 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 Organization (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-organization)
- US Quality Core Substance (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-substance)
- US Quality Core Medication (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-medication)

Other representations of profile: CSV, Excel, Schematron

### Notes:

#### CQL Authoring Usage (Informational)

    define function "GetMedicationCode"(request MedicationRequest):
      if request.medication is CodeableConcept then
        request.medication as CodeableConcept
      else
        (singleton from ([Medication] M where M.id = GetId((request.medication as Reference).reference))).code