These requirements apply to the actor: US Core Certifying System Legend: Key: An identifier for the requirement. Context: The name and link to the narrative section that pertains to the requirement. There can be more than one narrative section that references the same requirement. Conformance: The conformance verb of the requirement: SHALL, SHOULD, MAY, SHALL-NOT, or SHOULD-NOT. Requirement: The actual requirements statement, which is a direct quote from the IG and may include helpful context in square brackets. Note that statements in the narrative section that contain multiple requirements in a single context are split into individual requirement statements. Key Context Conformance Requirement CONF-0011 •general-requirements.html#profile-support--interaction-support SHALL Certifying Systems SHALL implement all components in the USCDI [USCDI link] CONF-0012 •general-requirements.html#profile-support--interaction-support SHALL Certifying Systems SHALL implement all components in the ... the US Core CapabilityStatement [Definition] . CONF-0124 •scopes.html#smart-scopes SHALL Certifying systems SHALL support all US Core’s required scopes. CONF-0392 •StructureDefinition-us-core-immunization.html#profile-specific-implementation-guidance SHOULD NDC vaccine codes SHOULD be supported as an additional code [of CVX Vaccine Codes] CONF-0411 •StructureDefinition-us-core-medicationrequest.html#profile-specific-implementation-guidance SHALL Although both MedicationRequest.reasonCode and MedicationRequest.reasonReference are marked as Additional USCDI Requirements [which are required for organizations participating in the ONC Health IT Certification program]. The certifying Server system is not required to support both, but SHALL support at least one of these elements CONF-0414 •StructureDefinition-us-core-medicationrequest.html#profile-specific-implementation-guidance SHALL [For organizations participating in the ONC Health IT Certification program and supporting MedicationRequest.reasonReference,] Servers SHALL support at least one target resource in MedicationRequest.reasonReference CONF-0444 •StructureDefinition-us-core-simple-observation.html#profile-specific-implementation-guidance SHALL Although none of the Observation.derivedFrom references are flagged as Must Support, the Certifying System SHALL* support at least one of them CONF-0465 •StructureDefinition-us-core-patient.html#profile-specific-implementation-guidance SHALL Although Patient.deceased[x] is marked as additional USCDI, certifying systems are not required to support both [boolean and dateTime data types], but SHALL support [at] least Patient.deceasedDateTime CONF-0469 •StructureDefinition-us-core-patient.html#profile-specific-implementation-guidance SHALL Certifying systems [, those that are participating in the ONC Health IT certification program,] SHALL... follow the Project US@ Technical Specification for Patient Addresses Final Version 1.0 as the standard style guide for Patient.address.line and Patient.address.city for new and updated records. CONF-0482 •StructureDefinition-us-core-procedure.html#profile-specific-implementation-guidance SHALL [For organizations participating in the ONC Health IT Certification program] Servers … SHALL support ... US Core Procedure Profile for communicating the reason or justification for a referral as Additional USCDI Requirements CONF-0484 •StructureDefinition-us-core-procedure.html#profile-specific-implementation-guidance SHALL [For organizations participating in the ONC Health IT Certification program,] although both Procedure.reasonCode and Procedure.reasonReference are marked as Additional USCDI Requirements, the certifying Server system is not required to support both, but SHALL support at least one of these elements. CONF-0516 •StructureDefinition-us-core-servicerequest.html#profile-specific-implementation-guidance SHALL [For organizations participating in the ONC Health IT Certification program] Servers … SHALL support ... US Core Service Request Profile for communicating the reason or justification for a referral as Additional USCDI Requirements CONF-0518 •StructureDefinition-us-core-servicerequest.html#profile-specific-implementation-guidance SHALL [For organizations participating in the ONC Health IT Certification program,] although both ServiceRequest.reasonCode and ServiceRequest.reasonReference are marked as Additional USCDI Requirements, the certifying Server system is not required to support both, but SHALL support at least one of these elements. CONF-0520 •StructureDefinition-us-core-servicerequest.html#profile-specific-implementation-guidance SHALL [For organizations participating in the ONC Health IT Certification program,] when using ServiceRequest.reasonReference Servers SHALL support at least one target resource in ServiceRequest.reasonReference CONF-0522 •StructureDefinition-us-core-servicerequest.html#profile-specific-implementation-guidance SHOULD [For organizations participating in the ONC Health IT Certification program,] when using ServiceRequest.reasonReference …The referenced resources SHOULD be a US Core Profile as documented in Referencing US Core Profiles CONF-0801 •must-support.html#defined-pattern-elements SHALL If an element is marked as Additional USCDI and defined by a pattern [as described by ElementDefinition.pattern], then the pattern defines the elements and element values that the Certifying System SHALL be capable of providing. CONF-0802 •must-support.html#must-support---primitive-elements SHALL Primitive elements are single elements with a primitive value…. If they are marked as Additional USCDI, then the Certifying System SHALL be capable of providing the element value to meet the Additional USCDI requirement. CONF-0803 •must-support.html#must-support---complex-elements SHALL For any complex element marked as Additional USCDI, the Certifying System SHALL be capable of providing at least one of the sub-element values. CONF-0805 •must-support.html#must-support---complex-elements SHALL [I]f any sub-element is marked as Additional USCDI [for a complex element] and the parent element is not… [and] the parent element is present in an instance, Certifying System SHALL support the sub-elements labeled as Additional USCDI. CONF-0809 •must-support.html#must-support-targets-for-us-core-profiles SHALL When a Reference type element is labeled as Additional USCDI and has a single target profile referenced, the target profile SHALL be supported for Certifying Systems. CONF-0811 •must-support.html#must-support-targets-for-us-core-profiles SHALL When a Reference type element labeled as Additional USCDI, has multiple target profiles referenced, and specific targets are labeled as Must Support, the Must Support target profile(s) SHALL be supported by Certifying Systems. CONF-0812 •must-support.html#must-support---slices SHALL [I]f a slice is labeled as ... Must Support/Additional USCDI and the slicer element is not labeled as ... Additional USCDI, then if the ... certifying system supports the element, it must support the slice's definition. There are no examples of this structure in US Core. CONF-0814 •must-support.html#must-support---slices SHALL [I]f a slice is labeled as … Must Support and the slicer element is ... labeled as … Must Support/Additional USCDI, then … certifying system [SHALL support] the element[ and] the slice's definition. CONF-0834 •StructureDefinition-us-core-condition-problems-health-concerns.html#profile-specific-implementation-guidance SHOULD Certifying Systems ... SHOULD support the ... US Core Simple Observation Category codes CONF-0846 •StructureDefinition-us-core-observation-screening-assessment.html#profile-specific-implementation-guidance SHALL [For the US Core Observation Screening Assessment Profile,] Certifying Systems SHALL support, the US Core Screening Assessment Observation Category codes CONF-0847 •StructureDefinition-us-core-observation-screening-assessment.html#profile-specific-implementation-guidance SHOULD [For the US Core Observation Screening Assessment Profile,] Certifying Systems SHOULD support, the US Core Screening Assessment Observation Maximum Category codes CONF-0848 •StructureDefinition-us-core-observation-screening-assessment.html#profile-specific-implementation-guidance MAY [For the US Core Observation Screening Assessment Profile,] Certifying Systems MAY support other codes. CONF-0852 •StructureDefinition-us-core-patient.html#profile-specific-implementation-guidance SHALL Although the [US Core Interpreter Needed Extension] is marked as an Additional USCDI Requirement on both US Core Patient and US Core Encounter Profiles, the certifying Server system is not required to support the extension on both profiles but SHALL support the extension on at least one. CONF-0861 •StructureDefinition-us-core-simple-observation.html#profile-specific-implementation-guidance SHOULD [For US Core Simple Observation Profile, ]Certifying Systems ... SHOULD support the other US Core Simple Observation Category codes [in addition to the US Core Screening Assessment Observation Category codes] CONF-0862 •StructureDefinition-us-core-simple-observation.html#profile-specific-implementation-guidance SHALL [For US Core Simple Observation Profile, ]Certifying Systems SHALL support, the US Core Screening Assessment Observation Category codes CONF-0863 •StructureDefinition-us-core-simple-observation.html#profile-specific-implementation-guidance MAY [For US Core Simple Observation Profile, ]Certifying Systems ... MAY support other categories [in addition to US Core Screening Assessment Observation Category codes and US Core Simple Observation Category codes]. CONF-0872 •must-support.html#must-support---slices SHALL [I]f a slice is labeled as Additional USCDI... and the slicer element is ... labeled as Must Support/Additional USCDI..., then ... the Certifying System... [SHALL support] the element[ and] the slice's definition. CONF-0883 •must-support.html#must-support---resource-references SHALL When a Reference element is labeled as Additional USCDI has multiple target profiles referenced, but none are labeled as Must Support, at least one target profile SHALL be supported by Certifying Systems. CONF-0884 •must-support.html#must-support---choice-of-data-types SHALL If an Additional USCDI element has a choice of datatypes for its content, the datatypes the Certifying System SHALL support are labeled as Must Support. CONF-0902 •StructureDefinition-us-core-location.html#profile-specific-implementation-guidance MAY Healthcare Service Location Codes (HSLOC) and SNOMED-CT Healthcare Facility Type value sets meet the USCDI applicable vocabulary standard for the Encounter Location Data Element. Certifying Systems MAY use a code from either vocabulary. CONF-0910 •StructureDefinition-us-core-patient.html#profile-specific-implementation-guidance •StructureDefinition-us-core-encounter.html#profile-specific-implementation-guidance SHALL Servers SHALL use the US Core Interpreter Needed Extension on [the US Core Patient Profile] or the US Core Encounter Profile to communicate whether a patient needs an interpreter.
HL7 International / Cross-Group Projects
This [Requirements](https://hl7.org/fhir/R5/requirements.html) resource lists the *additional requirements* for systems certifying for Office of the National Coordinator for Health Information Technology (ONC) Health IT Certification (g(10) certification. These requirements represent the regulatory and technical specifications that design artifacts must meet to ensure interoperability. See the [US Core Server Requirements](Requirements-us-core-server.html) for the US Core Responder (Server) requirements defined in the US Core Implementation Guide narrative sections.
Certifying Systems **SHALL** implement all components in the USCDI [[USCDI link](https://www.healthit.gov/isp/united-states-core-data-interoperability-uscdi)]
Certifying Systems **SHALL** implement all components in the ... the US Core CapabilityStatement [[Definition](https://hl7.org/fhir/us/core/CapabilityStatement-us-core-Server.html)] .
Certifying systems **SHALL** support all US Core’s required scopes.
[NDC vaccine codes](http://www2a.cdc.gov/vaccines/iis/iisstandards/ndc_crosswalk.asp) **SHOULD** be supported as an additional code [of [CVX Vaccine Codes](https://www2a.cdc.gov/vaccines/iis/iisstandards/ndc_crosswalk.asp)]
Although both MedicationRequest.reasonCode and MedicationRequest.reasonReference are marked as Additional USCDI Requirements [which are required for organizations participating in the ONC Health IT Certification program]. The certifying Server system is not required to support both, but **SHALL** support at least one of these elements
[For organizations participating in the ONC Health IT Certification program and supporting MedicationRequest.reasonReference,] Servers **SHALL** support at least one target resource in MedicationRequest.reasonReference
Although none of the Observation.derivedFrom [references are flagged as Must Support](https://hl7.org/fhir/us/core/STU8/must-support.html#must-support---resource-references), the Certifying System *SHALL** support at least one of them
Although Patient.deceased[x] is marked as additional USCDI, certifying systems are not required to support both [boolean and dateTime data types], but **SHALL** support [at] least Patient.deceasedDateTime
[Certifying systems](https://www.healthit.gov/topic/certification-ehrs/about-onc-health-it-certification-program) [, those that are participating in the ONC Health IT certification program,] **SHALL**... follow the [Project US@ Technical Specification for Patient Addresses Final Version 1.0](https://asapnet.org/wp-content/uploads/2022/03/Project_US_FINAL_Technical_Specification_Version_1.0.pdf) as the standard style guide for Patient.address.line and Patient.address.city for new and updated records.
[For organizations participating in the ONC Health IT Certification program] Servers … **SHALL** support ... US Core Procedure Profile for communicating the reason or justification for a referral as Additional USCDI Requirements
[For organizations participating in the ONC Health IT Certification program,] although both Procedure.reasonCode and Procedure.reasonReference are marked as Additional USCDI Requirements, the certifying Server system is not required to support both, but **SHALL** support at least one of these elements.
[For organizations participating in the ONC Health IT Certification program] Servers … **SHALL** support ... US Core Service Request Profile for communicating the reason or justification for a referral as Additional USCDI Requirements
[For organizations participating in the ONC Health IT Certification program,] although both ServiceRequest.reasonCode and ServiceRequest.reasonReference are marked as Additional USCDI Requirements, the certifying Server system is not required to support both, but **SHALL** support at least one of these elements.
[For organizations participating in the ONC Health IT Certification program,] when using ServiceRequest.reasonReference Servers **SHALL** support at least one target resource in ServiceRequest.reasonReference
[For organizations participating in the ONC Health IT Certification program,] when using ServiceRequest.reasonReference …The referenced resources **SHOULD** be a US Core Profile as documented in [Referencing US Core Profiles](https://hl7.org/fhir/us/core/STU8/general-guidance.html#referencing-us-core-profiles)
If an element is marked as *Additional USCDI* and defined by a pattern [as described by [ElementDefinition.pattern](http://hl7.org/fhir/R4/elementdefinition-definitions.html#ElementDefinition.pattern_x_)], then the pattern defines the elements *and* element values that the Certifying System **SHALL** be capable of providing.
Primitive elements are single elements with a primitive value…. If they are marked as *Additional USCDI*, then the Certifying System **SHALL** be capable of providing the element value to meet the *Additional USCDI* requirement.
For any complex element marked as *Additional USCDI*, the Certifying System **SHALL** be capable of providing at least one of the sub-element values.
[I]f any sub-element is marked as *Additional USCDI* [for a complex element] and the parent element is not… [and] the parent element is present in an instance, Certifying System **SHALL** support the sub-elements labeled as *Additional USCDI*.
When a Reference type element is labeled as Additional USCDI and has a single target profile referenced, the target profile **SHALL** be supported for Certifying Systems.
When a Reference type element labeled as Additional USCDI, has multiple target profiles referenced, and specific targets are labeled as Must Support, the Must Support target profile(s) **SHALL** be supported by Certifying Systems.
[I]f a slice is labeled as ... Must Support/Additional USCDI and the slicer element is not labeled as ... Additional USCDI, then if the ... certifying system supports the element, it must support the slice's definition. There are no examples of this structure in US Core.
[I]f a slice is labeled as … Must Support and the slicer element is ... labeled as … Must Support/Additional USCDI, then … certifying system [**SHALL** support] the element[ and] the slice's definition.
Certifying Systems ... **SHOULD** support the ... [US Core Simple Observation Category](https://hl7.org/fhir/us/core/STU8/ValueSet-us-core-simple-observation-category.html) codes
[For the US Core Observation Screening Assessment Profile,] Certifying Systems **SHALL** support, the [US Core Screening Assessment Observation Category](https://hl7.org/fhir/us/core/STU8/ValueSet-us-core-screening-assessment-observation-category.html) codes
[For the US Core Observation Screening Assessment Profile,] Certifying Systems **SHOULD** support, the [US Core Screening Assessment Observation Maximum Category](https://hl7.org/fhir/us/core/STU8/ValueSet-us-core-screening-assessment-observation-maximum-category.html) codes
[For the US Core Observation Screening Assessment Profile,] Certifying Systems **MAY** support other codes.
Although the [[US Core Interpreter Needed Extension](https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-interpreter-needed.html)] is marked as an Additional USCDI Requirement on both US Core Patient and US Core Encounter Profiles, the certifying Server system is not required to support the extension on both profiles but **SHALL** support the extension on at least one.
[For [US Core Simple Observation Profile](https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-simple-observation.html), ]Certifying Systems ... **SHOULD** support the other [US Core Simple Observation Category codes](https://hl7.org/fhir/us/core/STU8/ValueSet-us-core-simple-observation-category.html) [in addition to the [US Core Screening Assessment Observation Category codes](https://hl7.org/fhir/us/core/STU8/ValueSet-us-core-screening-assessment-observation-category.html)]
[For [US Core Simple Observation Profile](https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-simple-observation.html), ]Certifying Systems **SHALL** support, the [US Core Screening Assessment Observation Category codes](https://hl7.org/fhir/us/core/STU8/ValueSet-us-core-screening-assessment-observation-category.html)
[For [US Core Simple Observation Profile](https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-simple-observation.html), ]Certifying Systems ... **MAY** support other categories [in addition to [US Core Screening Assessment Observation Category codes](https://hl7.org/fhir/us/core/STU8/ValueSet-us-core-screening-assessment-observation-category.html) and [US Core Simple Observation Category codes](https://hl7.org/fhir/us/core/STU8/ValueSet-us-core-simple-observation-category.html)].
[I]f a slice is labeled as Additional USCDI... and the slicer element is ... labeled as Must Support/Additional USCDI..., then ... the Certifying System... [**SHALL** support] the element[ and] the slice's definition.
When a Reference element is labeled as *Additional USCDI* has multiple target profiles referenced, but none are labeled as *Must Support*, *at least one* target profile **SHALL** be supported by Certifying Systems.
If an *Additional USCDI* element has a choice of datatypes for its content, the datatypes the Certifying System **SHALL** support are labeled as *Must Support*.
Healthcare Service Location Codes (HSLOC) and SNOMED-CT Healthcare Facility Type value sets meet the USCDI applicable vocabulary standard for the Encounter Location Data Element. Certifying Systems **MAY** use a code from either vocabulary.
Servers **SHALL** use the [US Core Interpreter Needed Extension](https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-interpreter-needed.html) on [the [US Core Patient Profile](https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-patient.html)] or the [US Core Encounter Profile](https://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-encounter.html) to communicate whether a patient needs an interpreter.