FHIR Extensions Pack
5.3.0-ballot - (September 2025 Ballot) International flag

This page is part of the FHIR Core Extensions Registry (v5.3.0-ballot: Release 5.3) based on FHIR (HL7® FHIR® Standard) v5.0.0. This version is a pre-release. The current official version is 5.2.0. For a full list of available versions, see the Directory of published versions

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Official URL: http://hl7.org/fhir/extensions/ImplementationGuide/hl7.fhir.uv.extensions Version: 5.3.0-ballot
IG Standards status: Trial-use Maturity Level: 1 Computable Name: FHIRExtensionPack

Contents:

Introduction

The Extension Pack defines the FHIR extensions that are globally defined and available in all implementation contexts. Prior to R5 these extensions were defined in the core specification, but starting from R5 they have been moved out of the specification into a separate extensions pack so that the extensions can be updated more often than the base specification. This extension pack also defines some search parameters for the extensions.

The FHIR Extension Pack is intended for use with all supported versions of FHIR. While the Extension Pack definitions are based on R5, most of the extensions can be used as-is or with a little modification with earlier versions of the specification:

  • There is information on each extension description describing the use of the extension with other FHIR Versions
  • A very few extensions can't be used in earlier versions
  • There are packages for use with older versions with tooling based packages: hl7.fhir.uv.extensions.r4 and hl7.fhir.uv.extensions.r3
  • The version of the Extensions Pack (5.3.0-ballot) is not the same as the FHIR version, since it applies equally to FHIR versions R5, R4, R4B, and R3

Note to Balloters

This is the ballot for release 5.3.0 of the Extension Pack. While comment is welcome on all extensions, please pay particular consideration to the following matters:

The FHIR Management Group recognizes the difficulty of balloting the extensions pack for the community. The Extensions Pack ballot serves as a checkpoint for the continuous development of the Extension pack content prior to publishing the normal formal milestone, and is an opportunity for the community to review and comment on Extensions of interest. Given that there are 680 extensions that span the entire span of the FHIR implementation space, there is no expectation that ballot reviewers will be able to review all the resources. For this reason, ballot cycles of the extensions pack do not contribute towards extension maturity after the first ballot. There are, however, several structural enhancements aimed at addressing extension use tracking and useability:

Content Registries

Update Policy

Extensions

References to the extensions defined in this extension pack are found in Extension.url or in profile references to defined extensions in ElementDefinition.type.profile. While the profile references may be versioned using canonical versioned references, the most important references are in Extension.url and these are version-less.

For this reason, the extensions defined in this extension pack are managed very conservatively with regard to breaking changes:

  • Extensions that are active are not subject to breaking changes. New extensions will be introduced if necessary
  • Extensions labelled 'draft' may have breaking changes if the FHIR Management Group is satisfied that they are not in use in production, or if all the existing users are agree to making the change. The exact rules and processes still being discussed, but not all 'draft' extensions are subject to change
  • In this regard, the definitions for breaking change to Normative artifacts apply. Note that the focus of these rules is preserving the validity and meaning of existing extensions, not preventing applications processing extensions from having to change
  • The extensions all have the status of 'trial-use' but once they are active they are treated as normative. The FHIR Management Group has not yet decided how these extensions will be balloted in the future
  • If a breaking change needs to be introduced to an extension, the original extension will be marked as deprecated and a new one will be created. If the scope of the extension has significantly changed, it may be given a completely new URL. If the scope is largely the same, the url will remain the same, except that a version will be appended. E.g. "[original url]-v2". The deprecated extension will have a note added that points to the replacing extension.

For more information, see FHIR Extension Pack Policy.

Intellectual Property Considerations

This implementation guide and the underlying FHIR specification are licensed as public domain under the FHIR license. The license page also describes rules for the use of the FHIR name and logo.

This guide includes extensions making use of terminologies such as LOINC and SNOMED CT that have more restrictive licensing requirements. Implementers should make themselves familiar with licensing and any other constraints of terminologies used as part of their implementation process. Licencing requirements may limit the systems to which data recorded using certain codes may be shared.

This publication includes IP covered under the following statements.

Dependencies

This IG depends on the following additional IGs:

IGPackageFHIRComment
.. FHIR Extensions Packhl7.fhir.uv.extensions#5.3.0-ballotR5
... HL7 Terminology (THO)hl7.terminology.r5#6.5.0R5Automatically added as a dependency - all IGs depend on HL7 Terminology

There are no Global profiles defined