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

## US Quality Core Downloads

### Full Implementation Guide

The following file contains the complete, downloadable implementation guide:

- Full IG

### IG Package

The following file is the FHIR IG Package NPM Subset

- package.tgz

### Definitions

In addition to the above, we have provided format-specific definitions:

- XML
- JSON
- TTL

These files should be the first choice whenever generating any implementation artifacts since they contain all of the rules about what makes these US Quality Core profiles valid. Implementers will still need to be familiar with the content of the specification and profiles that apply in order to make a conformant implementation. See the overview on validating FHIR profiles and resources for more information about validating profiles and how to use these artifacts.

### Examples

All examples used in this Implementation Guide:

- XML
- JSON
- TTL

### Dependencies

IG | Package | FHIR | Comment
--- | --- | --- | ---
2026 US Quality Core Implementation Guide | fhir.onc.us-quality-core#0.5.0 | R4 |
FHIR Extensions Pack | hl7.fhir.uv.extensions.r4#5.3.0 | R4 | Automatically added as a dependency - all IGs depend on the HL7 Extension Pack
HL7 Terminology (THO) | hl7.terminology.r4#7.1.0 | R4 |
FHIR Extensions Pack | hl7.fhir.uv.extensions.r4#5.2.0 | R4 |
US Core Implementation Guide | hl7.fhir.us.core#6.1.0 | R4 |
HL7 Terminology (THO) | hl7.terminology.r4#5.0.0 | R4 |
FHIR Extensions Pack | hl7.fhir.uv.extensions.r4#1.0.0 | R4 |
Bulk Data Access IG | hl7.fhir.uv.bulkdata#2.0.0 | R4 |
SMART App Launch | hl7.fhir.uv.smart-app-launch#2.1.0 | R4 |
VSAC | us.nlm.vsac#0.11.0 | R4 |
Structured Data Capture | hl7.fhir.uv.sdc#3.0.0 | R4 |
PHINVads | us.cdc.phinvads#0.12.0 | R4 |
IHE FormatCode Vocabulary | ihe.formatcode.fhir#1.1.0 | R4 |
fhir.dicom | fhir.dicom#2024.1.20240120 | R4 |
Using CQL With FHIR | hl7.fhir.uv.cql#2.0.0 | R4 |
HL7 Terminology (THO) | hl7.terminology.r4#6.5.0 | R4 |
Common CQL Artifacts for FHIR (US-Based) | hl7.fhir.us.cql#2.0.0-ballot | R4 |
Canonical Resource Management Infrastructure Implementation Guide | hl7.fhir.uv.crmi#1.0.0 | R4 |
HL7 Terminology (THO) | hl7.terminology#5.5.0 | R4 |
FHIR Extensions Pack | hl7.fhir.uv.extensions.r4#5.1.0 | R4 |
US Core Implementation Guide | hl7.fhir.us.core#7.0.0 | R4 |
HL7 Terminology (THO) | hl7.terminology.r4#5.5.0 | R4 |
SMART App Launch | hl7.fhir.uv.smart-app-launch#2.0.0 | R4 |
VSAC | us.nlm.vsac#0.18.0 | R4 |
FHIR Tooling Extensions IG | hl7.fhir.uv.tools.r4#1.1.2 | R4 | for example references

Package hl7.fhir.uv.extensions.r4#5.2.0 This IG defines the global extensions - the ones defined for everyone. These extensions are always in scope wherever FHIR is being used (built Mon, Feb 10, 2025 21:45+1100+11:00)

Package hl7.fhir.uv.extensions.r4#5.3.0 This IG defines the global extensions - the ones defined for everyone. These extensions are always in scope wherever FHIR is being used (built Sat, May 16, 2026 18:32+1000+10:00)

Package hl7.fhir.uv.extensions.r4#1.0.0 This IG defines the global extensions - the ones defined for everyone. These extensions are always in scope wherever FHIR is being used (built Sun, Mar 26, 2023 08:46+1100+11:00)

Package hl7.fhir.uv.bulkdata#2.0.0 FHIR based approach for exporting large data sets from a FHIR server to a client application (built Fri, Nov 26, 2021 05:56+1100+11:00)

Package hl7.fhir.uv.sdc#3.0.0 The SDC specification provides an infrastructure to standardize the capture and expanded use of patient-level data collected within an EHR. This includes two components: * Support more sophisticated questionnaire/form use-cases such as those needed for research, oncology, pathology and other clinical domains. *Support pre-population and auto-population of EHR data into forms/questionnaires for uses outside direct clinical care (patient safety, adverse event reporting, public health reporting, etc.). (built Tue, Mar 8, 2022 18:32+0000+00:00)

Package ihe.formatcode.fhir#1.1.0 Implementation Guide for IHE defined FormatCode vocabulary. (built Thu, Feb 24, 2022 16:55-0600-06:00)

Package hl7.fhir.us.core#6.1.0 The US Core Implementation Guide is based on FHIR Version R4 and defines the minimum conformance requirements for accessing patient data. The Argonaut pilot implementations, ONC 2015 Edition Common Clinical Data Set (CCDS), and ONC U.S. Core Data for Interoperability (USCDI) v1 provided the requirements for this guide. The prior Argonaut search and vocabulary requirements, based on FHIR DSTU2, are updated in this guide to support FHIR Version R4. This guide was used as the basis for further testing and guidance by the Argonaut Project Team to provide additional content and guidance specific to Data Query Access for purpose of ONC Certification testing. These profiles are the foundation for future US Realm FHIR implementation guides. In addition to Argonaut, they are used by DAF-Research, QI-Core, and CIMI. Under the guidance of HL7 and the HL7 US Realm Steering Committee, the content will expand in future versions to meet the needs specific to the US Realm. These requirements were originally developed, balloted, and published in FHIR DSTU2 as part of the Office of the National Coordinator for Health Information Technology (ONC) sponsored Data Access Framework (DAF) project. For more information on how DAF became US Core see the US Core change notes. (built Fri, Jun 30, 2023 14:02+0000+00:00)

Package hl7.fhir.uv.cql#2.0.0 This implementation guide defines profiles, operations and guidance for the use of CQL with FHIR, both as a mechanism for querying, as well as inline and integrated usage as part of knowledge artifacts. (built Tue, Jul 8, 2025 14:47+0000+00:00)

Package hl7.fhir.uv.extensions.r4#5.1.0 This IG defines the global extensions - the ones defined for everyone. These extensions are always in scope wherever FHIR is being used (built Sat, Apr 27, 2024 18:39+1000+10:00)

Package hl7.fhir.uv.crmi#1.0.0 This implementation guide defines profiles, operations, capability statements and guidance to facilitate the content management lifecycle for authoring, publishing, distribution, and implementation of FHIR knowledge artifacts such as value sets, profiles, libraries, rules, and measures. The guide is intended to be used by specification and content implementation guide authors as both a dependency for validation of published artifacts, and a guide for construction and publication of content. (built Fri, May 31, 2024 16:38+0000+00:00)

Package hl7.fhir.us.core#7.0.0 The US Core Implementation Guide is based on FHIR Version R4 and defines the minimum conformance requirements for accessing patient data. The Argonaut pilot implementations, ONC 2015 Edition Common Clinical Data Set (CCDS), and ONC U.S. Core Data for Interoperability (USCDI) v1 provided the requirements for this guide. The prior Argonaut search and vocabulary requirements, based on FHIR DSTU2, are updated in this guide to support FHIR Version R4. This guide was used as the basis for further testing and guidance by the Argonaut Project Team to provide additional content and guidance specific to Data Query Access for purpose of ONC Certification testing. These profiles are the foundation for future US Realm FHIR implementation guides. In addition to Argonaut, they are used by DAF-Research, QI-Core, and CIMI. Under the guidance of HL7 and the HL7 US Realm Steering Committee, the content will expand in future versions to meet the needs specific to the US Realm. These requirements were originally developed, balloted, and published in FHIR DSTU2 as part of the Office of the National Coordinator for Health Information Technology (ONC) sponsored Data Access Framework (DAF) project. For more information on how DAF became US Core see the US Core change notes. (built Wed, May 8, 2024 15:33+0000+00:00)

Package hl7.fhir.us.cql#2.0.0-ballot This implementation guide contains architectural guidance and re-usable libraries that facilitate the use of Clinical Quality Language (CQL) with FHIR in the US Realm, with an initial use case of Prior Authorization Support Questionnaires as described in the DaVinci Documentation Templates and Rules (DTR) implementation guide. Much of the guidance and content presented here is built on work done in the quality measurement domain, including patterns established by measure developers as part of testing and developing quality measures for use with FHIR. These patterns have been generalized to support US Core as well as harmonized to be usable across use cases. (built Fri, Apr 3, 2026 00:32+1100+11:00)

Package hl7.fhir.uv.tools.r4#1.1.2 This IG defines the extensions that the tools use internally. Some of these extensions are content that are being evaluated for elevation into the main spec, and others are tooling concerns (built Tue, Mar 24, 2026 11:13+1100+11:00)

### Cross Version Analysis

This is an R4 IG. None of the features it uses are changed in R4B, so it can be used as is with R4B systems. Packages for both R4 (fhir.onc.us-quality-core.r4) and R4B (fhir.onc.us-quality-core.r4b) are available.

### Global Profiles

Global Profiles:

Type | Source | Profile
Encounter |  | US Quality Core Encounter
Immunization |  | US Quality Core Immunization
Observation |  | US Quality Core Simple Observation
Organization |  | US Quality Core Organization
Patient |  | US Quality Core Patient
Practitioner |  | US Quality Core Practitioner
PractitionerRole |  | US Quality Core PractitionerRole

All resources of these types must conform to these profiles.

### IP Statements

This publication includes IP covered under the following statements.

- © Copyright 2022 American Medical Association
  Show Usage
  - NUCC Provider Taxonomy: PractitionerRole/example and USQualityCorePractitionerRole
- HL7 Inc.
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  - Claim Type Codes: Claim/example, ClaimResponse/example and USQualityCoreClaimResponse
  - Coverage Class Codes: Coverage/example and USQualityCoreCoverage
- HL7 International.
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  - Financial Resource Status Codes: USQualityCoreClaimResponse
- ISO maintains the copyright on the country codes, and controls its use carefully. For further details see the ISO 3166 web page: https://www.iso.org/iso-3166-country-codes.html
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  - ISO 3166-1 Codes for the representation of names of countries and their subdivisions — Part 1: Country code: NegationReasonCodes, NonNegativeEventStatus... Show 163 more, NonNegativeImmunizationStatus, NonNegativeMedicationAdministrationStatus, NonNegativeMedicationDispenseStatus, NonNegativeObservationStatus, NonNegativeTaskStatus, USQualityCore, USQualityCoreAdverseEvent, USQualityCoreAllergyIntolerance, USQualityCoreBodyStructure, USQualityCoreCarePlan, USQualityCoreCareTeam, USQualityCoreClaim, USQualityCoreClaimResponse, USQualityCoreClientCapabilityStatement, USQualityCoreCommon, USQualityCoreCommonTests, USQualityCoreCommunication, USQualityCoreCommunicationNotDone, USQualityCoreCommunicationRequest, USQualityCoreConditionEncounterDiagnosis, USQualityCoreConditionProblemsHealthConcerns, USQualityCoreCoverage, USQualityCoreDevice, USQualityCoreDeviceNotRequested, USQualityCoreDeviceRequest, USQualityCoreDeviceUseStatement, USQualityCoreDiagnosisPresentOnAdmission, USQualityCoreDiagnosticReportLab, USQualityCoreDiagnosticReportNote, USQualityCoreDoNotPerformReason, USQualityCoreEncounter, USQualityCoreFamilyMemberHistory, USQualityCoreFlag, USQualityCoreGoal, USQualityCoreImagingStudy, USQualityCoreImmunization, USQualityCoreImmunizationEvaluation, USQualityCoreImmunizationNotDone, USQualityCoreImmunizationRecommendation, USQualityCoreIsElective, USQualityCoreLaboratoryResultObservation, USQualityCoreLocation, USQualityCoreMedication, USQualityCoreMedicationAdministration, USQualityCoreMedicationAdministrationNotDone, USQualityCoreMedicationDispense, USQualityCoreMedicationDispenseDeclined, USQualityCoreMedicationDoseType, USQualityCoreMedicationNotRequested, USQualityCoreMedicationRequest, USQualityCoreMedicationStatement, USQualityCoreNonPatientObservation, USQualityCoreNotDoneReason, USQualityCoreNotDoneRecorded, USQualityCoreNotDoneValueSet, USQualityCoreNutritionOrder, USQualityCoreObservationBodyPosition, USQualityCoreObservationCancelled, USQualityCoreObservationClinicalResult, USQualityCoreObservationScreeningAssessment, USQualityCoreOrganization, USQualityCorePatient, USQualityCorePractitioner, USQualityCorePractitionerRole, USQualityCorePresentOnAdmission, USQualityCoreProcedure, USQualityCoreProcedureNotDone, USQualityCoreQuestionnaireResponse, USQualityCoreRelatedPerson, USQualityCoreServerCapabilityStatement, USQualityCoreServiceNotRequested, USQualityCoreServiceRequest, USQualityCoreServiceRequestAppropriatenessScore, USQualityCoreSimpleObservation, USQualityCoreSubstance, USQualityCoreTask, USQualityCoreTaskRejected, USQualityCoreUSCDIQualityExtension, UsQualityCoreAdverseeventEvent, UsQualityCoreAdverseeventRecordedDate, UsQualityCoreAdverseeventSubject, UsQualityCoreAllergyintolerancePatient, UsQualityCoreBodystructurePatient, UsQualityCoreCareplanCategory, UsQualityCoreCareplanPatient, UsQualityCoreCareteamPatient, UsQualityCoreCareteamStatus, UsQualityCoreClaimPatient, UsQualityCoreClaimresponsePatient, UsQualityCoreClaimresponseType, UsQualityCoreCommunicationPatient, UsQualityCoreCommunicationTopic, UsQualityCoreCommunicationrequestCategory, UsQualityCoreCommunicationrequestPatient, UsQualityCoreConditionAbatementDate, UsQualityCoreConditionCategory, UsQualityCoreConditionCode, UsQualityCoreConditionOnsetDate, UsQualityCoreConditionPatient, UsQualityCoreCoveragePatient, UsQualityCoreDevicePatient, UsQualityCoreDeviceType, UsQualityCoreDevicerequestCode, UsQualityCoreDevicerequestDoNotPerform, UsQualityCoreDevicerequestPatient, UsQualityCoreDeviceusestatementDeviceType, UsQualityCoreDeviceusestatementPatient, UsQualityCoreDiagnosticreportCategory, UsQualityCoreDiagnosticreportCode, UsQualityCoreDiagnosticreportDate, UsQualityCoreDiagnosticreportPatient, UsQualityCoreEncounter, UsQualityCoreEncounterDate, UsQualityCoreEncounterPatient, UsQualityCoreEncounterType, UsQualityCoreFamilymemberhistoryPatient, UsQualityCoreFlagCode, UsQualityCoreFlagPatient, UsQualityCoreGoalPatient, UsQualityCoreImmunizationDate, UsQualityCoreImmunizationPatient, UsQualityCoreImmunizationStatus, UsQualityCoreImmunizationevaluationPatient, UsQualityCoreImmunizationevaluationTargetDisease, UsQualityCoreLocation, UsQualityCoreMedicationCode, UsQualityCoreMedicationadministrationCode, UsQualityCoreMedicationadministrationEffectiveTime, UsQualityCoreMedicationadministrationPatient, UsQualityCoreMedicationadministrationStatus, UsQualityCoreMedicationdispensePatient, UsQualityCoreMedicationdispenseStatus, UsQualityCoreMedicationrequestDoNotPerform, UsQualityCoreMedicationrequestIntent, UsQualityCoreMedicationrequestPatient, UsQualityCoreMedicationstatementCode, UsQualityCoreMedicationstatementPatient, UsQualityCoreObservationCategory, UsQualityCoreObservationCode, UsQualityCoreObservationDate, UsQualityCoreObservationPatient, UsQualityCoreObservationStatus, UsQualityCorePatient, UsQualityCorePractitioner, UsQualityCorePractitionerrole, UsQualityCoreProcedureDate, UsQualityCoreProcedurePatient, UsQualityCoreProcedureStatus, UsQualityCoreQuestionnaireresponse, UsQualityCoreQuestionnaireresponsePatient, UsQualityCoreQuestionnaireresponseQuestionnaire, UsQualityCoreRelatedperson, UsQualityCoreRelatedpersonPatient, UsQualityCoreServicerequest, UsQualityCoreServicerequestAuthored, UsQualityCoreServicerequestCategory, UsQualityCoreServicerequestCode, UsQualityCoreServicerequestDoNotPerform, UsQualityCoreServicerequestPatient, UsQualityCoreSubstanceCode, UsQualityCoreTaskCode, UsQualityCoreTaskPatient and UsQualityCoreTaskStatus
- Most of the information on the CDC and ATSDR websites is not subject to copyright, is in the public domain, and may be freely used or reproduced without obtaining copyright permission. For information and exceptions regarding use of CDC material please see https://www.cdc.gov/other/agencymaterials.html
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  - Vaccine Administered Code Set (CVX): Immunization/example, Immunization/negation-example-code, Immunization/statusreason-example, ImmunizationRecommendation/example and USQualityCoreImmunizationRecommendation
- Most of the information on the CDC and ATSDR websites is not subject to copyright, is in the public domain, and may be freely used or reproduced without obtaining copyright permission.For information and exceptions regarding use of CDC material please see https://www.cdc.gov/other/agencymaterials.html.
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  - CDC Race and Ethnicity: Patient/example
- The POA Indicator Codes are in the public domain and are free to use without restriction.
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  - CMS Present on Admission (POA) Indicator: Claim/example, Encounter/example, USQualityCoreClaim, USQualityCoreDiagnosisPresentOnAdmission and USQualityCorePresentOnAdmission
- The UCUM codes, UCUM table (regardless of format), and UCUM Specification are copyright 1999-2009, Regenstrief Institute, Inc. and the Unified Codes for Units of Measures (UCUM) Organization. All rights reserved. https://ucum.org/trac/wiki/TermsOfUse
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  - Unified Code for Units of Measure (UCUM): Goal/example, Immunization/example... Show 19 more, Medication/example, MedicationAdministration/cmd-example, MedicationAdministration/example, MedicationAdministration/negation-example, MedicationAdministration/negation-with-code-example, MedicationDispense/cmd-example, MedicationDispense/example, MedicationDispense/negation-example, MedicationDispense/negation-with-code-example, MedicationRequest/cmd-example, MedicationRequest/example, MedicationRequest/patient-reported-example, MedicationRequest/patient-requester-example, MedicationRequest/practitioner-ordered-example, MedicationStatement/example, NutritionOrder/example, Observation/example, Observation/example-gestation and Observation/laboratory-result-observation-example-blood-glucose
- These codes are excerpted from Digital Imaging and Communications in Medicine (DICOM) Standard, Part 16: Content Mapping Resource, Copyright © 2011 by the National Electrical Manufacturers Association.
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  - DICOM Controlled Terminology Definitions: ImagingStudy/example
- This is an example set.
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  - ICD-10 Procedure Codes: USQualityCoreClaim
  - Adjudication Value Codes: ClaimResponse/example and USQualityCoreClaimResponse
  - Claim Payee Type Codes: Claim/example
  - Process Priority Codes: Claim/example
- This is an extensible set.
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  - SubscriberPolicyholder Relationship Codes: Coverage/example
- This material contains content from LOINC. LOINC is copyright © 1995-2020, Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee and is available at no cost under the license. LOINC® is a registered United States trademark of Regenstrief Institute, Inc.
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  - LOINC: DiagnosticReport/example, DiagnosticReport/note-example... Show 22 more, Goal/example, ImmunizationRecommendation/example, Observation/clinical-result-heart-rate-rhythm, Observation/example, Observation/example-births, Observation/example-delivery-date-estimate, Observation/example-frailty, Observation/example-gestation, Observation/example-obstetric-delivery, Observation/example-odh, Observation/example-parity, Observation/example-pregnancies, Observation/example-preterm-births, Observation/example-screening-assessment-10-minute-apgar-heart-rate, Observation/laboratory-result-observation-example-blood-glucose, Observation/negation-with-code-example, USQualityCoreDiagnosticReportNote, USQualityCoreLaboratoryResultObservation, USQualityCoreNonPatientObservation, USQualityCoreObservationClinicalResult, USQualityCoreObservationScreeningAssessment and USQualityCoreSimpleObservation
- This material contains content that is copyright of SNOMED International. Implementers of these specifications must have the appropriate SNOMED CT Affiliate license - for more information contact https://www.snomed.org/get-snomed or info@snomed.org.
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  - SNOMED Clinical Terms&reg; (SNOMED CT&reg;): AdverseEvent/example, AllergyIntolerance/example... Show 74 more, AllergyIntolerance/example-refuted, BodyStructure/example, CarePlan/example, Condition/appendicitis-example, Condition/example, Condition/health-concern-example, Device/example, DeviceRequest/example, DeviceRequest/negation-example, DeviceRequest/negation-with-code-example, FamilyMemberHistory/example, Flag/example, ImagingStudy/example, Immunization/example, Immunization/negation-example, Immunization/negation-example-code, ImmunizationEvaluation/example, Medication/example, MedicationAdministration/cmd-example, MedicationAdministration/example, MedicationAdministration/negation-example, MedicationAdministration/negation-with-code-example, MedicationDispense/negation-example, MedicationDispense/negation-with-code-example, MedicationRequest/cmd-example, MedicationRequest/example, MedicationRequest/negation-example, MedicationRequest/negation-example-code, MedicationRequest/patient-reported-example, MedicationRequest/patient-requester-example, MedicationRequest/practitioner-ordered-example, NutritionOrder/example, Observation/example, Observation/example-frailty, Observation/example-nonpatient-hemodialysis-machine, Observation/example-nonpatient-hospital-bed, Observation/example-nonpatient-mechanical-ventilator, Observation/negation-example, Observation/negation-with-code-example, Procedure/example, Procedure/negation-example, Procedure/negation-with-code-example, ServiceRequest/appropriateness-example, ServiceRequest/elective-example, ServiceRequest/example, ServiceRequest/myringotomy-example, ServiceRequest/negation-example, ServiceRequest/negation-example-code, Task/negation-example, Task/negation-with-code-example, USQualityCoreAdverseEvent, USQualityCoreBodyStructure, USQualityCoreCarePlan, USQualityCoreDeviceNotRequested, USQualityCoreDeviceRequest, USQualityCoreDeviceUseStatement, USQualityCoreFamilyMemberHistory, USQualityCoreFlag, USQualityCoreGoal, USQualityCoreImmunization, USQualityCoreImmunizationEvaluation, USQualityCoreMedicationAdministration, USQualityCoreMedicationDispenseDeclined, USQualityCoreMedicationDoseType, USQualityCoreMedicationNotRequested, USQualityCoreMedicationStatement, USQualityCoreNonPatientObservation, USQualityCoreObservationBodyPosition, USQualityCoreObservationCancelled, USQualityCorePractitionerRole, USQualityCoreProcedure, USQualityCoreServiceNotRequested, USQualityCoreSimpleObservation and USQualityCoreSubstance
- This material derives from the HL7 Terminology (THO). THO is copyright ©1989+ Health Level Seven International and is made available under the CC0 designation. For more licensing information see: https://terminology.hl7.org/license.html
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  - Appropriateness Score: USQualityCoreServiceRequestAppropriatenessScore
  - degreeLicenseCertificate: Practitioner/example
- Used by permission of HL7 International, all rights reserved Creative Commons License
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  - US Core CarePlan Category Extension Codes: CarePlan/example and USQualityCoreCarePlan
  - US Core Condition Category Extension Codes: Condition/health-concern-example
  - US Core Category: USQualityCoreObservationScreeningAssessment
- Using RxNorm codes of type SAB=RXNORM as this specification describes does not require a UMLS license. Access to the full set of RxNorm definitions, and/or additional use of other RxNorm structures and information requires a UMLS license. The use of RxNorm in this specification is pursuant to HL7's status as a licensee of the NLM UMLS. HL7's license does not convey the right to use RxNorm to any users of this specification; implementers must acquire a license to use RxNorm in their own right.
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  - RxNorm: AllergyIntolerance/example, Medication/example... Show 7 more, MedicationAdministration/negation-with-code-example, MedicationDispense/negation-with-code-example, USQualityCoreMedicationAdministration, USQualityCoreMedicationAdministrationNotDone, USQualityCoreMedicationDispense, USQualityCoreMedicationDispenseDeclined and USQualityCoreMedicationStatement