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 Procedure

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

Profile of Procedure 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:

- extension:recorded: (USCDI+ Quality) When the procedure was first captured in the subject's record
- partOf: (USCDI+ Quality) Part of referenced event
- status: (USCDI+ Quality) (USCDI) preparation | in-progress | ​on-hold​ | stopped​ | completed | entered-in-error​ | unknown​
- statusReason: (USCDI+ Quality) Reason for current status
- code: (USCDI+ Quality) (USCDI) Identification of the procedure
- performed[x]: (USCDI+ Quality) (USCDI) When the procedure was performed
- reasonCode: (USCDI+ Quality) Coded reason procedure performed
- reasonReference: (USCDI+ Quality) The justification that the procedure was performed

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

To represent that a procedure intentionally did not occur for a medical, patient, or system reason, use the US Quality Core Procedure Not Done profile.

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 Claim, US Quality Core Encounter and US Quality Core ImagingStudy
- Examples for this Profile: Procedure/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
--- | --- | --- | --- | ---
Procedure | C | 0..* | USCoreProcedureProfile(6.1.0) | An action that is being or was performed on a patient Constraints: us-core-7
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
Slices for extension |  |  |  | Content/Rules for all slices
extension:recorded |  | 0..1 | dateTime | (USCDI+ Quality) When the procedure was first captured in the subject's record URL: http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-recorded
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
basedOn | Σ | 0..* | Reference(US Quality Core CarePlan | US Quality Core ServiceRequest) | (USCDI) A request for this procedure
partOf | Σ | 0..* | Reference(Procedure | Observation | MedicationAdministration) | (USCDI+ Quality) Part of referenced event
status | ?!S Σ C | 1..1 | code | (USCDI+ Quality) (USCDI) preparation | in-progress | ​on-hold​ | stopped​ | completed | entered-in-error​ | unknown​ Binding: Non-Negative Event Status (required)
statusReason | Σ | 0..1 | CodeableConcept | (USCDI+ Quality) Reason for current status Binding: ProcedureNotPerformedReason(SNOMED-CT) (example): A code that identifies the reason a procedure was not performed.
category | Σ | 0..1 | CodeableConcept | Classification of the procedure Binding: ProcedureCategoryCodes(SNOMEDCT) (example): A code that classifies a procedure for searching, sorting and display purposes.
code | S Σ | 1..1 | CodeableConcept | (USCDI+ Quality) (USCDI) Identification of the procedure Binding: US Core Procedure Codes (extensible): Codes describing the type of Procedure
subject | S Σ | 1..1 | Reference(US Quality Core Patient) | (USCDI) Who the procedure was performed on
performed[x] | S Σ C | 0..1 |  | (USCDI+ Quality) (USCDI) When the procedure was performed
performedDateTime |  |  | dateTime S |
performedPeriod |  |  | Period |
performedString |  |  | string |
performedAge |  |  | Age |
performedRange |  |  | Range |
reasonCode | Σ | 0..* | CodeableConcept | (USCDI+ Quality) Coded reason procedure performed Binding: ProcedureReasonCodes (preferred): A code that identifies the reason a procedure is required.
reasonReference | Σ | 0..* | Reference(US Quality Core Condition Encounter Diagnosis | US Quality Core Condition Problems Health Concerns | US Quality Core DiagnosticReport Profile for Report and Note Exchange | US Core DocumentReference Profile(6.1.0)) | (USCDI+ Quality) The justification that the procedure was performed
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Procedure.status | Base | required | Non-Negative Event Status | 📦0.5.0 | This IG
Procedure.statusReason | Base | example | Procedure Not Performed Reason (SNOMED-CT) | 📦4.0.1 | FHIR Std.
Procedure.category | Base | example | Procedure Category Codes (SNOMED CT) | 📦4.0.1 | FHIR Std.
Procedure.code | Base | extensible | US Core Procedure Codes | 📦7.0.0 | US Core v7.0
Procedure.reasonCode | Base | preferred | Procedure Reason Codes | 📦4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | Procedure | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Procedure | 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 | Procedure | 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 | Procedure | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Procedure | 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()`
us-core-7 | error | Procedure | Performed SHALL be present if the status is 'completed' or 'in-progress' | `(status='completed' or status='in-progress') implies performed.exists()`

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Procedure |  | 0..* | USCoreProcedureProfile(6.1.0) | An action that is being or was performed on a patient
implicitRules |  | 0..1 | uri | A set of rules under which this content was created
Slices for extension |  |  |  | Content/Rules for all slices
extension:recorded |  | 0..1 | dateTime | (USCDI+ Quality) When the procedure was first captured in the subject's record URL: http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-recorded
basedOn | Σ | 0..* | Reference(US Quality Core CarePlan | US Quality Core ServiceRequest) | (USCDI) A request for this procedure
partOf |  | 0..* | Reference(Procedure | Observation | MedicationAdministration) | (USCDI+ Quality) Part of referenced event
status |  | 1..1 | code | (USCDI+ Quality) (USCDI) preparation | in-progress | ​on-hold​ | stopped​ | completed | entered-in-error​ | unknown​ Binding: Non-Negative Event Status (required)
statusReason |  | 0..1 | CodeableConcept | (USCDI+ Quality) Reason for current status
category |  | 0..1 | CodeableConcept | Classification of the procedure
code |  | 1..1 | CodeableConcept | (USCDI+ Quality) (USCDI) Identification of the procedure
subject |  | 1..1 | Reference(US Quality Core Patient) | (USCDI) Who the procedure was performed on
performed[x] |  | 0..1 | dateTime, Period, string, Age, Range | (USCDI+ Quality) (USCDI) When the procedure was performed
performer |  |  |  |
actor |  | 1..1 | Reference(US Quality Core Practitioner | US Quality Core Organization | US Quality Core Patient | US Quality Core RelatedPerson) | The reference to the practitioner
reasonCode |  | 0..* | CodeableConcept | (USCDI+ Quality) Coded reason procedure performed Binding: ProcedureReasonCodes (preferred): A code that identifies the reason a procedure is required.
reasonReference |  | 0..* | Reference(US Quality Core Condition Encounter Diagnosis | US Quality Core Condition Problems Health Concerns | US Quality Core DiagnosticReport Profile for Report and Note Exchange | US Core DocumentReference Profile(6.1.0)) | (USCDI+ Quality) The justification that the procedure was performed
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
Procedure.status | Base | required | Non-Negative Event Status | 📦0.5.0 | This IG
Procedure.reasonCode | Base | preferred | Procedure Reason Codes | 📦4.0.1 | FHIR Std.

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Procedure | C | 0..* | USCoreProcedureProfile(6.1.0) | An action that is being or was performed on a patient Constraints: us-core-7
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 |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:recorded |  | 0..1 | dateTime | (USCDI+ Quality) When the procedure was first captured in the subject's record 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 | External Identifiers for this procedure
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(US Quality Core CarePlan | US Quality Core ServiceRequest) | (USCDI) A request for this procedure
partOf | Σ | 0..* | Reference(Procedure | Observation | MedicationAdministration) | (USCDI+ Quality) Part of referenced event
status | ?!S Σ C | 1..1 | code | (USCDI+ Quality) (USCDI) preparation | in-progress | ​on-hold​ | stopped​ | completed | entered-in-error​ | unknown​ Binding: Non-Negative Event Status (required)
statusReason | Σ | 0..1 | CodeableConcept | (USCDI+ Quality) Reason for current status Binding: ProcedureNotPerformedReason(SNOMED-CT) (example): A code that identifies the reason a procedure was not performed.
category | Σ | 0..1 | CodeableConcept | Classification of the procedure Binding: ProcedureCategoryCodes(SNOMEDCT) (example): A code that classifies a procedure for searching, sorting and display purposes.
code | S Σ | 1..1 | CodeableConcept | (USCDI+ Quality) (USCDI) Identification of the procedure Binding: US Core Procedure Codes (extensible): Codes describing the type of Procedure
subject | S Σ | 1..1 | Reference(US Quality Core Patient) | (USCDI) Who the procedure was performed on
encounter | Σ | 0..1 | Reference(Encounter) | Encounter created as part of
performed[x] | S Σ C | 0..1 |  | (USCDI+ Quality) (USCDI) When the procedure was performed
performedDateTime |  |  | dateTime S |
performedPeriod |  |  | Period |
performedString |  |  | string |
performedAge |  |  | Age |
performedRange |  |  | Range |
recorder | Σ | 0..1 | Reference(Patient | RelatedPerson | Practitioner | PractitionerRole) | Who recorded the procedure
asserter | Σ | 0..1 | Reference(Patient | RelatedPerson | Practitioner | PractitionerRole) | Person who asserts this procedure
performer | Σ | 0..* | BackboneElement | The people who performed the procedure
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
function | Σ | 0..1 | CodeableConcept | Type of performance Binding: ProcedurePerformerRoleCodes (example): A code that identifies the role of a performer of the procedure.
actor | Σ | 1..1 | Reference(US Quality Core Practitioner | US Quality Core Organization | US Quality Core Patient | US Quality Core RelatedPerson) | The reference to the practitioner
onBehalfOf |  | 0..1 | Reference(Organization) | Organization the device or practitioner was acting for
location | Σ | 0..1 | Reference(Location) | Where the procedure happened
reasonCode | Σ | 0..* | CodeableConcept | (USCDI+ Quality) Coded reason procedure performed Binding: ProcedureReasonCodes (preferred): A code that identifies the reason a procedure is required.
reasonReference | Σ | 0..* | Reference(US Quality Core Condition Encounter Diagnosis | US Quality Core Condition Problems Health Concerns | US Quality Core DiagnosticReport Profile for Report and Note Exchange | US Core DocumentReference Profile(6.1.0)) | (USCDI+ Quality) The justification that the procedure was performed
bodySite | Σ | 0..* | CodeableConcept | Target body sites Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.
outcome | Σ | 0..1 | CodeableConcept | The result of procedure Binding: ProcedureOutcomeCodes(SNOMEDCT) (example): An outcome of a procedure - whether it was resolved or otherwise.
report |  | 0..* | Reference(DiagnosticReport | DocumentReference | Composition) | Any report resulting from the procedure
complication |  | 0..* | CodeableConcept | Complication following the procedure Binding: Condition/Problem/DiagnosisCodes (example): Codes describing complications that resulted from a procedure.
complicationDetail |  | 0..* | Reference(Condition) | A condition that is a result of the procedure
followUp |  | 0..* | CodeableConcept | Instructions for follow up Binding: ProcedureFollowUpCodes(SNOMEDCT) (example): Specific follow up required for a procedure e.g. removal of sutures.
note |  | 0..* | Annotation | Additional information about the procedure
focalDevice |  | 0..* | BackboneElement | Manipulated, implanted, or removed device
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
action |  | 0..1 | CodeableConcept | Kind of change to device Binding: ProcedureDeviceActionCodes (preferred): A kind of change that happened to the device during the procedure.
manipulated |  | 1..1 | Reference(Device) | Device that was changed
usedReference |  | 0..* | Reference(Device | Medication | Substance) | Items used during procedure
usedCode |  | 0..* | CodeableConcept | Coded items used during the procedure Binding: FHIRDeviceTypes (example): Codes describing items used during a procedure.
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Procedure.language | Base | preferred | Common Languages | 📦4.0.1 | FHIR Std.
Procedure.status | Base | required | Non-Negative Event Status | 📦0.5.0 | This IG
Procedure.statusReason | Base | example | Procedure Not Performed Reason (SNOMED-CT) | 📦4.0.1 | FHIR Std.
Procedure.category | Base | example | Procedure Category Codes (SNOMED CT) | 📦4.0.1 | FHIR Std.
Procedure.code | Base | extensible | US Core Procedure Codes | 📦7.0.0 | US Core v7.0
Procedure.performer.​function | Base | example | Procedure Performer Role Codes | 📦4.0.1 | FHIR Std.
Procedure.reasonCode | Base | preferred | Procedure Reason Codes | 📦4.0.1 | FHIR Std.
Procedure.bodySite | Base | example | SNOMED CT Body Structures | 📦4.0.1 | FHIR Std.
Procedure.outcome | Base | example | Procedure Outcome Codes (SNOMED CT) | 📦4.0.1 | FHIR Std.
Procedure.complication | Base | example | Condition/Problem/Diagnosis Codes | 📦4.0.1 | FHIR Std.
Procedure.followUp | Base | example | Procedure Follow up Codes (SNOMED CT) | 📦4.0.1 | FHIR Std.
Procedure.focalDevice.​action | Base | preferred | Procedure Device Action Codes | 📦4.0.1 | FHIR Std.
Procedure.usedCode | Base | example | FHIR Device Types | 📦4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | Procedure | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Procedure | 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 | Procedure | 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 | Procedure | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Procedure | 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()`
us-core-7 | error | Procedure | Performed SHALL be present if the status is 'completed' or 'in-progress' | `(status='completed' or status='in-progress') implies performed.exists()`

Summary

Structures

This structure refers to these other structures:

- US Quality Core CarePlan (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-careplan)
- US Quality Core ServiceRequest (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-servicerequest)
- US Quality Core Patient (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-patient)
- US Quality Core Practitioner (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-practitioner)
- US Quality Core Organization (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-organization)
- US Quality Core RelatedPerson (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-relatedperson)
- US Quality Core Condition Encounter Diagnosis (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-condition-encounter-diagnosis)
- US Quality Core Condition Problems Health Concerns (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-condition-problems-health-concerns)
- US Quality Core DiagnosticReport Profile for Report and Note Exchange (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-diagnosticreport-note)
- US Core DocumentReference Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference|6.1.0)

Extensions

This structure refers to these extensions:

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

Key Elements View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Procedure | C | 0..* | USCoreProcedureProfile(6.1.0) | An action that is being or was performed on a patient Constraints: us-core-7
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
Slices for extension |  |  |  | Content/Rules for all slices
extension:recorded |  | 0..1 | dateTime | (USCDI+ Quality) When the procedure was first captured in the subject's record URL: http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-recorded
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
basedOn | Σ | 0..* | Reference(US Quality Core CarePlan | US Quality Core ServiceRequest) | (USCDI) A request for this procedure
partOf | Σ | 0..* | Reference(Procedure | Observation | MedicationAdministration) | (USCDI+ Quality) Part of referenced event
status | ?!S Σ C | 1..1 | code | (USCDI+ Quality) (USCDI) preparation | in-progress | ​on-hold​ | stopped​ | completed | entered-in-error​ | unknown​ Binding: Non-Negative Event Status (required)
statusReason | Σ | 0..1 | CodeableConcept | (USCDI+ Quality) Reason for current status Binding: ProcedureNotPerformedReason(SNOMED-CT) (example): A code that identifies the reason a procedure was not performed.
category | Σ | 0..1 | CodeableConcept | Classification of the procedure Binding: ProcedureCategoryCodes(SNOMEDCT) (example): A code that classifies a procedure for searching, sorting and display purposes.
code | S Σ | 1..1 | CodeableConcept | (USCDI+ Quality) (USCDI) Identification of the procedure Binding: US Core Procedure Codes (extensible): Codes describing the type of Procedure
subject | S Σ | 1..1 | Reference(US Quality Core Patient) | (USCDI) Who the procedure was performed on
performed[x] | S Σ C | 0..1 |  | (USCDI+ Quality) (USCDI) When the procedure was performed
performedDateTime |  |  | dateTime S |
performedPeriod |  |  | Period |
performedString |  |  | string |
performedAge |  |  | Age |
performedRange |  |  | Range |
reasonCode | Σ | 0..* | CodeableConcept | (USCDI+ Quality) Coded reason procedure performed Binding: ProcedureReasonCodes (preferred): A code that identifies the reason a procedure is required.
reasonReference | Σ | 0..* | Reference(US Quality Core Condition Encounter Diagnosis | US Quality Core Condition Problems Health Concerns | US Quality Core DiagnosticReport Profile for Report and Note Exchange | US Core DocumentReference Profile(6.1.0)) | (USCDI+ Quality) The justification that the procedure was performed
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Procedure.status | Base | required | Non-Negative Event Status | 📦0.5.0 | This IG
Procedure.statusReason | Base | example | Procedure Not Performed Reason (SNOMED-CT) | 📦4.0.1 | FHIR Std.
Procedure.category | Base | example | Procedure Category Codes (SNOMED CT) | 📦4.0.1 | FHIR Std.
Procedure.code | Base | extensible | US Core Procedure Codes | 📦7.0.0 | US Core v7.0
Procedure.reasonCode | Base | preferred | Procedure Reason Codes | 📦4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | Procedure | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Procedure | 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 | Procedure | 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 | Procedure | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Procedure | 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()`
us-core-7 | error | Procedure | Performed SHALL be present if the status is 'completed' or 'in-progress' | `(status='completed' or status='in-progress') implies performed.exists()`

Differential View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Procedure |  | 0..* | USCoreProcedureProfile(6.1.0) | An action that is being or was performed on a patient
implicitRules |  | 0..1 | uri | A set of rules under which this content was created
Slices for extension |  |  |  | Content/Rules for all slices
extension:recorded |  | 0..1 | dateTime | (USCDI+ Quality) When the procedure was first captured in the subject's record URL: http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-recorded
basedOn | Σ | 0..* | Reference(US Quality Core CarePlan | US Quality Core ServiceRequest) | (USCDI) A request for this procedure
partOf |  | 0..* | Reference(Procedure | Observation | MedicationAdministration) | (USCDI+ Quality) Part of referenced event
status |  | 1..1 | code | (USCDI+ Quality) (USCDI) preparation | in-progress | ​on-hold​ | stopped​ | completed | entered-in-error​ | unknown​ Binding: Non-Negative Event Status (required)
statusReason |  | 0..1 | CodeableConcept | (USCDI+ Quality) Reason for current status
category |  | 0..1 | CodeableConcept | Classification of the procedure
code |  | 1..1 | CodeableConcept | (USCDI+ Quality) (USCDI) Identification of the procedure
subject |  | 1..1 | Reference(US Quality Core Patient) | (USCDI) Who the procedure was performed on
performed[x] |  | 0..1 | dateTime, Period, string, Age, Range | (USCDI+ Quality) (USCDI) When the procedure was performed
performer |  |  |  |
actor |  | 1..1 | Reference(US Quality Core Practitioner | US Quality Core Organization | US Quality Core Patient | US Quality Core RelatedPerson) | The reference to the practitioner
reasonCode |  | 0..* | CodeableConcept | (USCDI+ Quality) Coded reason procedure performed Binding: ProcedureReasonCodes (preferred): A code that identifies the reason a procedure is required.
reasonReference |  | 0..* | Reference(US Quality Core Condition Encounter Diagnosis | US Quality Core Condition Problems Health Concerns | US Quality Core DiagnosticReport Profile for Report and Note Exchange | US Core DocumentReference Profile(6.1.0)) | (USCDI+ Quality) The justification that the procedure was performed
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
Procedure.status | Base | required | Non-Negative Event Status | 📦0.5.0 | This IG
Procedure.reasonCode | Base | preferred | Procedure Reason Codes | 📦4.0.1 | FHIR Std.

Snapshot ViewView

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Procedure | C | 0..* | USCoreProcedureProfile(6.1.0) | An action that is being or was performed on a patient Constraints: us-core-7
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 |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:recorded |  | 0..1 | dateTime | (USCDI+ Quality) When the procedure was first captured in the subject's record 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 | External Identifiers for this procedure
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(US Quality Core CarePlan | US Quality Core ServiceRequest) | (USCDI) A request for this procedure
partOf | Σ | 0..* | Reference(Procedure | Observation | MedicationAdministration) | (USCDI+ Quality) Part of referenced event
status | ?!S Σ C | 1..1 | code | (USCDI+ Quality) (USCDI) preparation | in-progress | ​on-hold​ | stopped​ | completed | entered-in-error​ | unknown​ Binding: Non-Negative Event Status (required)
statusReason | Σ | 0..1 | CodeableConcept | (USCDI+ Quality) Reason for current status Binding: ProcedureNotPerformedReason(SNOMED-CT) (example): A code that identifies the reason a procedure was not performed.
category | Σ | 0..1 | CodeableConcept | Classification of the procedure Binding: ProcedureCategoryCodes(SNOMEDCT) (example): A code that classifies a procedure for searching, sorting and display purposes.
code | S Σ | 1..1 | CodeableConcept | (USCDI+ Quality) (USCDI) Identification of the procedure Binding: US Core Procedure Codes (extensible): Codes describing the type of Procedure
subject | S Σ | 1..1 | Reference(US Quality Core Patient) | (USCDI) Who the procedure was performed on
encounter | Σ | 0..1 | Reference(Encounter) | Encounter created as part of
performed[x] | S Σ C | 0..1 |  | (USCDI+ Quality) (USCDI) When the procedure was performed
performedDateTime |  |  | dateTime S |
performedPeriod |  |  | Period |
performedString |  |  | string |
performedAge |  |  | Age |
performedRange |  |  | Range |
recorder | Σ | 0..1 | Reference(Patient | RelatedPerson | Practitioner | PractitionerRole) | Who recorded the procedure
asserter | Σ | 0..1 | Reference(Patient | RelatedPerson | Practitioner | PractitionerRole) | Person who asserts this procedure
performer | Σ | 0..* | BackboneElement | The people who performed the procedure
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
function | Σ | 0..1 | CodeableConcept | Type of performance Binding: ProcedurePerformerRoleCodes (example): A code that identifies the role of a performer of the procedure.
actor | Σ | 1..1 | Reference(US Quality Core Practitioner | US Quality Core Organization | US Quality Core Patient | US Quality Core RelatedPerson) | The reference to the practitioner
onBehalfOf |  | 0..1 | Reference(Organization) | Organization the device or practitioner was acting for
location | Σ | 0..1 | Reference(Location) | Where the procedure happened
reasonCode | Σ | 0..* | CodeableConcept | (USCDI+ Quality) Coded reason procedure performed Binding: ProcedureReasonCodes (preferred): A code that identifies the reason a procedure is required.
reasonReference | Σ | 0..* | Reference(US Quality Core Condition Encounter Diagnosis | US Quality Core Condition Problems Health Concerns | US Quality Core DiagnosticReport Profile for Report and Note Exchange | US Core DocumentReference Profile(6.1.0)) | (USCDI+ Quality) The justification that the procedure was performed
bodySite | Σ | 0..* | CodeableConcept | Target body sites Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.
outcome | Σ | 0..1 | CodeableConcept | The result of procedure Binding: ProcedureOutcomeCodes(SNOMEDCT) (example): An outcome of a procedure - whether it was resolved or otherwise.
report |  | 0..* | Reference(DiagnosticReport | DocumentReference | Composition) | Any report resulting from the procedure
complication |  | 0..* | CodeableConcept | Complication following the procedure Binding: Condition/Problem/DiagnosisCodes (example): Codes describing complications that resulted from a procedure.
complicationDetail |  | 0..* | Reference(Condition) | A condition that is a result of the procedure
followUp |  | 0..* | CodeableConcept | Instructions for follow up Binding: ProcedureFollowUpCodes(SNOMEDCT) (example): Specific follow up required for a procedure e.g. removal of sutures.
note |  | 0..* | Annotation | Additional information about the procedure
focalDevice |  | 0..* | BackboneElement | Manipulated, implanted, or removed device
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
action |  | 0..1 | CodeableConcept | Kind of change to device Binding: ProcedureDeviceActionCodes (preferred): A kind of change that happened to the device during the procedure.
manipulated |  | 1..1 | Reference(Device) | Device that was changed
usedReference |  | 0..* | Reference(Device | Medication | Substance) | Items used during procedure
usedCode |  | 0..* | CodeableConcept | Coded items used during the procedure Binding: FHIRDeviceTypes (example): Codes describing items used during a procedure.
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Procedure.language | Base | preferred | Common Languages | 📦4.0.1 | FHIR Std.
Procedure.status | Base | required | Non-Negative Event Status | 📦0.5.0 | This IG
Procedure.statusReason | Base | example | Procedure Not Performed Reason (SNOMED-CT) | 📦4.0.1 | FHIR Std.
Procedure.category | Base | example | Procedure Category Codes (SNOMED CT) | 📦4.0.1 | FHIR Std.
Procedure.code | Base | extensible | US Core Procedure Codes | 📦7.0.0 | US Core v7.0
Procedure.performer.​function | Base | example | Procedure Performer Role Codes | 📦4.0.1 | FHIR Std.
Procedure.reasonCode | Base | preferred | Procedure Reason Codes | 📦4.0.1 | FHIR Std.
Procedure.bodySite | Base | example | SNOMED CT Body Structures | 📦4.0.1 | FHIR Std.
Procedure.outcome | Base | example | Procedure Outcome Codes (SNOMED CT) | 📦4.0.1 | FHIR Std.
Procedure.complication | Base | example | Condition/Problem/Diagnosis Codes | 📦4.0.1 | FHIR Std.
Procedure.followUp | Base | example | Procedure Follow up Codes (SNOMED CT) | 📦4.0.1 | FHIR Std.
Procedure.focalDevice.​action | Base | preferred | Procedure Device Action Codes | 📦4.0.1 | FHIR Std.
Procedure.usedCode | Base | example | FHIR Device Types | 📦4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | Procedure | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Procedure | 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 | Procedure | 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 | Procedure | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Procedure | 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()`
us-core-7 | error | Procedure | Performed SHALL be present if the status is 'completed' or 'in-progress' | `(status='completed' or status='in-progress') implies performed.exists()`

Summary

Structures

This structure refers to these other structures:

- US Quality Core CarePlan (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-careplan)
- US Quality Core ServiceRequest (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-servicerequest)
- US Quality Core Patient (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-patient)
- US Quality Core Practitioner (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-practitioner)
- US Quality Core Organization (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-organization)
- US Quality Core RelatedPerson (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-relatedperson)
- US Quality Core Condition Encounter Diagnosis (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-condition-encounter-diagnosis)
- US Quality Core Condition Problems Health Concerns (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-condition-problems-health-concerns)
- US Quality Core DiagnosticReport Profile for Report and Note Exchange (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-diagnosticreport-note)
- US Core DocumentReference Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference|6.1.0)

Extensions

This structure refers to these extensions:

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

Other representations of profile: CSV, Excel, Schematron

### Notes:

#### CQL Authoring Usage (Informational)

To create an expression specifically requesting information that a procedure intentionally did not occur for a medical, patient or system reason, use the profile USQualityCore-Procedurenotdone.

The following example illustrates the use of the Procedure profile:

    define "Application of Intermittent Pneumatic Compression Devices":
      ["Procedure": "Application of Intermittent Pneumatic Compression Devices (IPC)"] DeviceApplied
        where DeviceApplied.status = 'completed'