# hl7.fhir.us.core 3.1.1 → 6.1.0 — version-difference evidence pack

Three major releases apart, and the profile set nearly doubles: 29 profiles exist in both versions, 30 only in 6.1.0, and 1 only in 3.1.1.

This pack is the downloadable form of the public report at `/ig-gap/core-3-1-1-to-6-1-0`. It is per-pair and carries public content only; the cross-pair rollup and arbitrary-pair export remain a separate, gated capability (IG-115 / Suite B).

## Inputs

| Side | Package | sha256 |
|---|---|---|
| Baseline | `hl7.fhir.us.core#3.1.1` | `c96f3f8893277bb81791c067a8e87d5cfe8816dcc4c7938ec6a13be9585b37a0` |
| Target | `hl7.fhir.us.core#6.1.0` | `ec096f29bc4ce8f04117dfc4ef82e7289c67a7e2188892e86288c45389d158d9` |

Engines: comparison 1.0.0 · normalization 1.3.0 · schema v2 · generator 1.1.0 · inputs hash `0d152adea100b3b5c8a2c2f0012f5102`

These two archives, identified by SHA-256, are the complete input. Anyone can fetch them and confirm they are looking at the same bytes this analysis read. The analysis itself is ImOnFHIR's.

There is deliberately no generation timestamp: the report is a pure function of the two archives, so the digests date it better than a clock would.

## The shape of the change

162 element-level requirement changes, each graded to exactly one tier — every count in this pack is complete, computed over the full change set.

| Tier | Count |
|---|---|
| Critical | 12 |
| Needs review | 66 |
| Indeterminate | 0 |
| Informational | 84 |
| **Total** | **162** |

### Read the element counts as a floor

30 profiles exist only in 6.1.0, and 1 only in 3.1.1. Those have no counterpart to compare against, so they contribute no element-level rows — the element comparison covers the 29 profiles present in both versions. Neither number is a total on its own.

The 364 mandatory or must-support elements attributed to added profiles are counted from each profile’s effective element list; where a profile ships no snapshot that list is reconstructed by merging its differential onto its base, so treat the figure as indicative rather than audited.

## Where the change concentrates

Most breaking changes (absolute critical count):

- `http://hl7.org/fhir/us/core/StructureDefinition/us-core-smokingstatus` — 3 critical of 13 changes
- `http://hl7.org/fhir/us/core/StructureDefinition/us-core-pulse-oximetry` — 2 critical of 11 changes
- `http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest` — 1 critical of 17 changes

Most sharply changed (critical share; profiles with at least 5 changes — the floor keeps one-change profiles from scoring 100%):

- `http://hl7.org/fhir/us/core/StructureDefinition/us-core-smokingstatus` — 23% of 13 changes critical
- `http://hl7.org/fhir/us/core/StructureDefinition/us-core-pulse-oximetry` — 18% of 11 changes critical
- `http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference` — 17% of 6 changes critical

## The other planes

| Plane | Changes | Highest severity present |
|---|---|---|
| Operations | 5 | needs review |
| Value sets | 40 | needs review |
| Capability statements | 38 | needs review |

## Profile coverage

Compared in both versions: 29 · added in target: 30 · removed from baseline: 1

- PROFILE_ADDED `http://hl7.org/fhir/us/core/StructureDefinition/us-core-coverage`
- PROFILE_ADDED `http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis`
- PROFILE_ADDED `http://hl7.org/fhir/us/core/StructureDefinition/us-core-body-temperature`
- PROFILE_REMOVED `http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition`
- PROFILE_ADDED `http://hl7.org/fhir/us/core/StructureDefinition/us-core-simple-observation`
- PROFILE_ADDED `http://hl7.org/fhir/us/core/StructureDefinition/us-core-vital-signs`
- PROFILE_ADDED `http://hl7.org/fhir/us/core/StructureDefinition/us-core-heart-rate`
- PROFILE_ADDED `http://hl7.org/fhir/us/core/StructureDefinition/us-core-respiratory-rate`
- PROFILE_ADDED `http://hl7.org/fhir/us/core/StructureDefinition/us-core-relatedperson`
- PROFILE_ADDED `http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-sexual-orientation`
- PROFILE_ADDED `http://hl7.org/fhir/us/core/StructureDefinition/us-core-bmi`
- PROFILE_ADDED `http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement`
- PROFILE_ADDED `http://hl7.org/fhir/us/core/StructureDefinition/us-core-sex`
- PROFILE_ADDED `http://hl7.org/fhir/us/core/StructureDefinition/us-core-jurisdiction`
- PROFILE_ADDED `http://hl7.org/fhir/us/core/StructureDefinition/us-core-servicerequest`
- PROFILE_ADDED `http://hl7.org/fhir/us/core/StructureDefinition/us-core-tribal-affiliation`
- PROFILE_ADDED `http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-screening-assessment`
- PROFILE_ADDED `http://hl7.org/fhir/us/core/StructureDefinition/us-core-genderIdentity`
- PROFILE_ADDED `http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-problems-health-concerns`
- PROFILE_ADDED `http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-occupation`
- PROFILE_ADDED `http://hl7.org/fhir/us/core/StructureDefinition/us-core-extension-questionnaire-uri`
- PROFILE_ADDED `http://hl7.org/fhir/us/core/StructureDefinition/us-core-body-height`
- PROFILE_ADDED `http://hl7.org/fhir/us/core/StructureDefinition/us-core-blood-pressure`
- PROFILE_ADDED `http://hl7.org/fhir/us/core/StructureDefinition/us-core-body-weight`
- PROFILE_ADDED `http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-pregnancyintent`
- PROFILE_ADDED `http://hl7.org/fhir/us/core/StructureDefinition/us-core-head-circumference`
- PROFILE_ADDED `http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationdispense`
- PROFILE_ADDED `http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-pregnancystatus`
- PROFILE_ADDED `http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-clinical-result`
- PROFILE_ADDED `http://hl7.org/fhir/us/core/StructureDefinition/us-core-specimen`
- PROFILE_ADDED `http://hl7.org/fhir/us/core/StructureDefinition/us-core-questionnaireresponse`

## Changes by effect

| Effect | Count |
|---|---|
| binding added | 11 |
| binding strength changed | 4 |
| informational change | 4 |
| invariant added | 15 |
| invariant changed | 3 |
| invariant removed | 4 |
| newly required | 5 |
| new support expectation | 20 |
| no longer required | 12 |
| profile inheritance changed | 5 |
| slice added | 11 |
| slice cardinality changed | 4 |
| slice removed | 8 |
| support expectation removed | 9 |
| target profile expanded | 9 |
| target profile narrowed | 6 |
| type expanded | 8 |
| type narrowed | 1 |
| valueset reference changed | 23 |

## Sampled evidence rows

Every count above is complete. The rows below are a bounded, deterministic sample of 40 (122 further changes are counted above but not sampled here), chosen so every kind of change and the most-affected profiles are each represented. Each row carries its stable change id — cite the id, not the prose; the id survives regeneration, the prose may not.

- `req:http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference|DocumentReference.custodian||TARGET_PROFILE||:TARGET_PROFILE_NARROWED`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference`
  - element: `DocumentReference.custodian` · target profile narrowed · critical
  - ["http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization"] → ["http://hl7.org/fhir/StructureDefinition/Organization"]
- `req:http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter|Encounter.serviceProvider||TARGET_PROFILE||:TARGET_PROFILE_NARROWED`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter`
  - element: `Encounter.serviceProvider` · target profile narrowed · critical
  - ["http://hl7.org/fhir/StructureDefinition/Organization"] → ["http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization"]
- `req:http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity|Extension.extension||MIN_CARDINALITY||:NEWLY_REQUIRED`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity`
  - element: `Extension.extension` · newly required · critical
  - 0 → 1
- `req:http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest|MedicationRequest.encounter||TARGET_PROFILE||:TARGET_PROFILE_NARROWED`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest`
  - element: `MedicationRequest.encounter` · target profile narrowed · critical
  - ["http://hl7.org/fhir/StructureDefinition/Encounter"] → ["http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter"]
- `req:http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab|Observation.specimen||TARGET_PROFILE||:TARGET_PROFILE_NARROWED`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab`
  - element: `Observation.specimen` · target profile narrowed · critical
  - ["http://hl7.org/fhir/StructureDefinition/Specimen"] → ["http://hl7.org/fhir/us/core/StructureDefinition/us-core-specimen"]
- `req:http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure|Procedure.basedOn||TARGET_PROFILE||:TARGET_PROFILE_NARROWED`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure`
  - element: `Procedure.basedOn` · target profile narrowed · critical
  - ["http://hl7.org/fhir/StructureDefinition/CarePlan","http://hl7.org/fhir/StructureDefinition/ServiceRequest"] → ["http://hl7.org/fhir/us/core/StructureDefinition/us-core-careplan","http://hl7.org/fhir/us/core/StructureDefinition/us-core-servicerequest"]
- `req:http://hl7.org/fhir/us/core/StructureDefinition/us-core-pulse-oximetry|Observation.code.coding||MIN_CARDINALITY||:NEWLY_REQUIRED`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/us-core-pulse-oximetry`
  - element: `Observation.code.coding` · newly required · critical
  - 0 → 2
- `req:http://hl7.org/fhir/us/core/StructureDefinition/us-core-pulse-oximetry|Observation.subject||TARGET_PROFILE||:TARGET_PROFILE_NARROWED`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/us-core-pulse-oximetry`
  - element: `Observation.subject` · target profile narrowed · critical
  - ["http://hl7.org/fhir/StructureDefinition/Patient"] → ["http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient"]
- `req:http://hl7.org/fhir/us/core/StructureDefinition/us-core-race|Extension.extension||MIN_CARDINALITY||:NEWLY_REQUIRED`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/us-core-race`
  - element: `Extension.extension` · newly required · critical
  - 0 → 1
- `req:http://hl7.org/fhir/us/core/StructureDefinition/us-core-smokingstatus|Observation.category||MIN_CARDINALITY||:NEWLY_REQUIRED`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/us-core-smokingstatus`
  - element: `Observation.category` · newly required · critical
  - 0 → 1
- `req:http://hl7.org/fhir/us/core/StructureDefinition/us-core-smokingstatus|Observation.effective[x]||MIN_CARDINALITY||:NEWLY_REQUIRED`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/us-core-smokingstatus`
  - element: `Observation.effective[x]` · newly required · critical
  - 0 → 1
- `req:http://hl7.org/fhir/us/core/StructureDefinition/us-core-smokingstatus|Observation.effective[x]||TYPE||:TYPE_NARROWED`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/us-core-smokingstatus`
  - element: `Observation.effective[x]` · type narrowed · critical
  - ["Period","Timing","dateTime","instant"] → ["dateTime"]
- `req:http://hl7.org/fhir/us/core/StructureDefinition/head-occipital-frontal-circumference-percentile|Observation.value[x]|valueQuantity|BINDING||valueQuantity:BINDING_ADDED`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/head-occipital-frontal-circumference-percentile`
  - element: `Observation.value[x]` · binding added · needs review
  - — → {"strength":"extensible","description":"Common UCUM units for recording Vital Signs.","valueSet":"http://hl7.org/fhir/ValueSet/ucum-vitals-common|4.0.1"}
- `req:http://hl7.org/fhir/us/core/StructureDefinition/head-occipital-frontal-circumference-percentile|Observation.value[x]||BINDING||:BINDING_ADDED`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/head-occipital-frontal-circumference-percentile`
  - element: `Observation.value[x]` · binding added · needs review
  - — → {"strength":"extensible","description":"Common UCUM units for recording Vital Signs.","valueSet":"http://hl7.org/fhir/ValueSet/ucum-vitals-common|4.0.1"}
- `req:http://hl7.org/fhir/us/core/StructureDefinition/head-occipital-frontal-circumference-percentile|Observation||PROFILE_INHERITANCE||:PROFILE_INHERITANCE_CHANGED`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/head-occipital-frontal-circumference-percentile`
  - element: `Observation` · profile inheritance changed · needs review
  - http://hl7.org/fhir/StructureDefinition/vitalsigns → http://hl7.org/fhir/us/core/StructureDefinition/us-core-vital-signs
- `req:http://hl7.org/fhir/us/core/StructureDefinition/pediatric-bmi-for-age|Observation.value[x]|valueQuantity|BINDING||valueQuantity:BINDING_ADDED`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/pediatric-bmi-for-age`
  - element: `Observation.value[x]` · binding added · needs review
  - — → {"strength":"extensible","description":"Common UCUM units for recording Vital Signs.","valueSet":"http://hl7.org/fhir/ValueSet/ucum-vitals-common|4.0.1"}
- `req:http://hl7.org/fhir/us/core/StructureDefinition/pediatric-weight-for-height|Observation.value[x]|valueQuantity|BINDING||valueQuantity:BINDING_ADDED`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/pediatric-weight-for-height`
  - element: `Observation.value[x]` · binding added · needs review
  - — → {"strength":"extensible","description":"Common UCUM units for recording Vital Signs.","valueSet":"http://hl7.org/fhir/ValueSet/ucum-vitals-common|4.0.1"}
- `req:http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex|Extension.value[x]||BINDING||:BINDING_ADDED`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex`
  - element: `Extension.value[x]` · binding added · needs review
  - — → {"strength":"required","description":"Code for sex assigned at birth","valueSet":"http://hl7.org/fhir/us/core/ValueSet/birthsex"}
- `req:http://hl7.org/fhir/us/core/StructureDefinition/us-core-careplan|CarePlan.text.div||MUST_SUPPORT||:NEW_SUPPORT_EXPECTATION`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/us-core-careplan`
  - element: `CarePlan.text.div` · new support expectation · needs review
  - false → true
- `req:http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-lab|DiagnosticReport||INVARIANT|us-core-8|:INVARIANT_ADDED`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-lab`
  - element: `DiagnosticReport` · invariant added · needs review
  - — → {"key":"us-core-8","severity":"error","human":"effective[x] SHALL be present if the status is 'partial', 'preliminary', 'final', 'amended', 'corrected' or 'appended'","expression":"(status='partial' or status='preliminary' or status='final' or status='amended' or status='corrected' or status='appended' ) implies effective.exists()"}
- `req:http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-lab|DiagnosticReport||INVARIANT|us-core-9|:INVARIANT_ADDED`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-lab`
  - element: `DiagnosticReport` · invariant added · needs review
  - — → {"key":"us-core-9","severity":"error","human":"issued SHALL be present if the status is 'partial', 'preliminary', 'final', 'amended', 'corrected' or 'appended'","expression":"(status='partial' or status='preliminary' or status='final' or status='amended' or status='corrected' or status='appended' ) implies issued.exists()"}
- `req:http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note|DiagnosticReport.category|us-core|SLICING|us-core|:SLICE_ADDED`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note`
  - element: `DiagnosticReport.category` · slice added · needs review
  - — → {"sliceName":"us-core","min":0,"max":"*"}
- `req:http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note|DiagnosticReport.media.link||MUST_SUPPORT||:NEW_SUPPORT_EXPECTATION`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note`
  - element: `DiagnosticReport.media.link` · new support expectation · needs review
  - false → true
- `req:http://hl7.org/fhir/us/core/StructureDefinition/us-core-goal|Goal.start[x]||MUST_SUPPORT||:NEW_SUPPORT_EXPECTATION`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/us-core-goal`
  - element: `Goal.start[x]` · new support expectation · needs review
  - false → true
- `req:http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization|Immunization||INVARIANT|us-core-5|:INVARIANT_ADDED`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization`
  - element: `Immunization` · invariant added · needs review
  - — → {"extension":[{"url":"http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice","valueBoolean":true}],"key":"us-core-5","severity":"warning","human":"SHOULD have a translation to the NDC value set","expression":"vaccineCode.coding.where(system='http://hl7.org/fhir/sid/ndc').empty()","xpath":"not(exists(f:vaccineCode/f:coding/f:system[@value='http://hl7.org/fhir/sid/ndc']))"}
- `req:http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization|Organization.identifier|CLIA|INVARIANT|us-core-18|:INVARIANT_ADDED`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization`
  - element: `Organization.identifier` · invariant added · needs review
  - — → {"key":"us-core-18","severity":"error","human":"CLIA number must be 10 digits with a letter \"D\" in third position","expression":"value.matches('^[0-9]{2}D[0-9]{7}$')","xpath":"f:value/f:matches(value,/^[0-9]{2}D[0-9]{7}$/)"}
- `req:http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient|Patient.extension|genderIdentity|SLICING|genderIdentity|:SLICE_ADDED`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient`
  - element: `Patient.extension` · slice added · needs review
  - — → {"sliceName":"genderIdentity","min":0,"max":"*"}
- `req:http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitionerrole|PractitionerRole||INVARIANT|us-core-13|:INVARIANT_ADDED`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitionerrole`
  - element: `PractitionerRole` · invariant added · needs review
  - — → {"key":"us-core-13","severity":"error","human":"SHALL have a practitioner, an organization, a healthcare service, or a location.","expression":"practitioner or organization or healthcareService or location","xpath":"exists(f:practitioner) or exists(f:organization) or exists(f:healthcareService) or exists(f:location)"}
- `req:http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner|Practitioner.address||MUST_SUPPORT||:NEW_SUPPORT_EXPECTATION`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner`
  - element: `Practitioner.address` · new support expectation · needs review
  - false → true
- `req:http://hl7.org/fhir/us/core/StructureDefinition/us-core-provenance|Provenance.agent||INVARIANT|provenance-1|:INVARIANT_ADDED`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/us-core-provenance`
  - element: `Provenance.agent` · invariant added · needs review
  - — → {"key":"provenance-1","severity":"error","human":"onBehalfOf SHALL be present when Provenance.agent.who is a Practitioner or Device","expression":"who.exists((resolve() is Practitioner) or (resolve() is Device)) implies onBehalfOf.exists()"}
- `req:http://hl7.org/fhir/us/core/StructureDefinition/head-occipital-frontal-circumference-percentile|Observation.value[x]||TYPE||:TYPE_EXPANDED`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/head-occipital-frontal-circumference-percentile`
  - element: `Observation.value[x]` · type expanded · informational
  - ["Quantity"] → ["CodeableConcept","Period","Quantity","Range","Ratio","SampledData","boolean","dateTime","integer","string","time"]
- `req:http://hl7.org/fhir/us/core/StructureDefinition/pediatric-bmi-for-age|Observation.value[x]||TYPE||:TYPE_EXPANDED`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/pediatric-bmi-for-age`
  - element: `Observation.value[x]` · type expanded · informational
  - ["Quantity"] → ["CodeableConcept","Period","Quantity","Range","Ratio","SampledData","boolean","dateTime","integer","string","time"]
- `req:http://hl7.org/fhir/us/core/StructureDefinition/us-core-careplan|CarePlan.text||MIN_CARDINALITY||:NO_LONGER_REQUIRED`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/us-core-careplan`
  - element: `CarePlan.text` · no longer required · informational
  - 1 → 0
- `req:http://hl7.org/fhir/us/core/StructureDefinition/us-core-careteam|CareTeam.participant.member||TARGET_PROFILE||:TARGET_PROFILE_EXPANDED`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/us-core-careteam`
  - element: `CareTeam.participant.member` · target profile expanded · informational
  - ["http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient","http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner","http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization"] → ["http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner","http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization","http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient","http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitionerrole","http://hl7.org/fhir/us/core/StructureDefinition/us-core-careteam","http://hl7.org/fhir/us/core/StructureDefinition/us-core-relatedperson"]
- `req:http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-lab|DiagnosticReport.effective[x]||MIN_CARDINALITY||:NO_LONGER_REQUIRED`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-lab`
  - element: `DiagnosticReport.effective[x]` · no longer required · informational
  - 1 → 0
- `req:http://hl7.org/fhir/us/core/StructureDefinition/us-core-direct|Extension.value[x]|valueBoolean|SLICING|valueBoolean|valueBoolean:SLICE_REMOVED`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/us-core-direct`
  - element: `Extension.value[x]` · slice removed · informational
  - {"sliceName":"valueBoolean","min":1,"max":"1"} → —
- `req:http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference|DocumentReference.custodian||MUST_SUPPORT||:SUPPORT_EXPECTATION_REMOVED`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference`
  - element: `DocumentReference.custodian` · support expectation removed · informational
  - true → false
- `req:http://hl7.org/fhir/us/core/StructureDefinition/us-core-implantable-device|Device.udiCarrier.carrierAIDC||MUST_SUPPORT||:SUPPORT_EXPECTATION_REMOVED`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/us-core-implantable-device`
  - element: `Device.udiCarrier.carrierAIDC` · support expectation removed · informational
  - true → false
- `req:http://hl7.org/fhir/us/core/StructureDefinition/us-core-allergyintolerance|AllergyIntolerance.code||VALUESET_REFERENCE||:VALUESET_REFERENCE_CHANGED`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/us-core-allergyintolerance`
  - element: `AllergyIntolerance.code` · valueset reference changed · informational
  - {"strength":"extensible","valueSet":"http://hl7.org/fhir/us/core/ValueSet/us-core-allergy-substance"} → {"strength":"extensible","valueSet":"http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1186.8"}
- `req:http://hl7.org/fhir/us/core/StructureDefinition/us-core-medication|Medication.code||VALUESET_REFERENCE||:VALUESET_REFERENCE_CHANGED`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/us-core-medication`
  - element: `Medication.code` · valueset reference changed · informational
  - {"strength":"extensible","description":"Prescribable medications","valueSet":"http://hl7.org/fhir/us/core/ValueSet/us-core-medication-codes"} → {"strength":"extensible","valueSet":"http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1010.4"}

## Where rules we track mention this guide

Context only, quoted from our mandate register. None of it changes the comparison above, which depends on the two packages and nothing else.

- CMS-0057-F (by 2027-01-01) — compliance 2027-01-01 — https://www.cms.gov/cms-interoperability-and-prior-authorization-final-rule-cms-0057-f
- CMS-0062-P (proposed — no adopted date) — PROPOSED 2026-04-14, comments closed 2026-06-15 — not final as of 2026-07-26, no adopted compliance date — https://www.federalregister.gov/documents/2026/04/14/2026-07205/medicare-and-medicaid-programs-patient-protection-and-affordable-care-act-interoperability-standards · https://www.cms.gov/priorities/burden-reduction/overview/interoperability/policies-regulations/cms-interoperability-standards-prior-authorization-drugs-proposed-rule-cms-0062-p

## Who maintains this guide, per our register

Where standards work on this guide happens — the room a ballot comment or a question should go to. Quoted from our workgroup register; sourced from the guide's own published footer attribution.

- HL7 International / Cross-Group Projects (owner) — https://www.hl7.org/Special/committees/cgp · https://hl7.org/fhir/us/core/index.html — reviewed 2026-07-26

## What this pack is not

Not a compliance assessment. The comparison carries no deadline and renders no verdict about any organization or implementation. Observed validator differences are not automatic proof of official IG requirement changes.