# hl7.fhir.us.core 6.1.0 → 9.0.0 — version-difference evidence pack

The second leg of the US Core walk: 924 requirement changes across the 58 profiles present in both versions, with only 12 profiles added and 1 removed.

This pack is the downloadable form of the public report at `/ig-gap/core-6-1-0-to-9-0-0`. 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#6.1.0` | `ec096f29bc4ce8f04117dfc4ef82e7289c67a7e2188892e86288c45389d158d9` |
| Target | `hl7.fhir.us.core#9.0.0` | `d7b54d2ec2a48cea94ffea5d939ad67a681f80b94d69594a08cebac36da9e059` |

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

924 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 | 46 |
| Needs review | 395 |
| Indeterminate | 0 |
| Informational | 483 |
| **Total** | **924** |

### Read the element counts as a floor

12 profiles exist only in 9.0.0, and 1 only in 6.1.0. Those have no counterpart to compare against, so they contribute no element-level rows — the element comparison covers the 58 profiles present in both versions. Neither number is a total on its own.

The 107 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-immunization` — 3 critical of 23 changes
- `http://hl7.org/fhir/us/core/StructureDefinition/us-core-careplan` — 2 critical of 28 changes
- `http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab` — 2 critical of 28 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-provenance` — 17% of 12 changes critical
- `http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-lab` — 14% of 14 changes critical
- `http://hl7.org/fhir/us/core/StructureDefinition/us-core-allergyintolerance` — 14% of 7 changes critical

## The other planes

| Plane | Changes | Highest severity present |
|---|---|---|
| Operations | 0 | — |
| Value sets | 32 | needs review |
| Capability statements | 20 | needs review |

## Profile coverage

Compared in both versions: 58 · added in target: 12 · removed from baseline: 1

- PROFILE_ADDED `http://hl7.org/fhir/us/core/StructureDefinition/us-core-authentication-time`
- PROFILE_ADDED `http://hl7.org/fhir/us/core/StructureDefinition/us-core-adi-documentreference`
- PROFILE_ADDED `http://hl7.org/fhir/us/core/StructureDefinition/us-core-average-blood-pressure`
- PROFILE_ADDED `http://hl7.org/fhir/us/core/StructureDefinition/us-core-treatment-intervention-preference`
- PROFILE_ADDED `http://hl7.org/fhir/us/core/StructureDefinition/us-core-familymemberhistory`
- PROFILE_ADDED `http://hl7.org/fhir/us/core/StructureDefinition/us-core-interpreter-needed`
- PROFILE_ADDED `http://hl7.org/fhir/us/core/StructureDefinition/us-core-familymemberhistory-recorder`
- PROFILE_ADDED `http://hl7.org/fhir/us/core/StructureDefinition/us-core-device`
- PROFILE_ADDED `http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-adi-documentation`
- PROFILE_REMOVED `http://hl7.org/fhir/us/core/StructureDefinition/us-core-implantable-device`
- PROFILE_ADDED `http://hl7.org/fhir/us/core/StructureDefinition/us-core-care-experience-preference`
- PROFILE_ADDED `http://hl7.org/fhir/us/core/StructureDefinition/us-core-individual-sex`
- PROFILE_ADDED `http://hl7.org/fhir/us/core/StructureDefinition/us-core-medication-adherence`

## Changes by effect

| Effect | Count |
|---|---|
| binding removed | 1 |
| binding strength changed | 4 |
| informational change | 1 |
| invariant added | 8 |
| invariant changed | 22 |
| invariant removed | 2 |
| new support expectation | 45 |
| no longer required | 2 |
| reference requirement changed | 304 |
| slice added | 10 |
| slice cardinality changed | 1 |
| slice removed | 6 |
| support expectation removed | 10 |
| target profile expanded | 19 |
| target profile narrowed | 46 |
| type expanded | 1 |
| valueset reference changed | 442 |

## Sampled evidence rows

Every count above is complete. The rows below are a bounded, deterministic sample of 40 (884 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/head-occipital-frontal-circumference-percentile|Observation.performer||TARGET_PROFILE||:TARGET_PROFILE_NARROWED`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/head-occipital-frontal-circumference-percentile`
  - element: `Observation.performer` · target profile narrowed · critical
  - ["http://hl7.org/fhir/StructureDefinition/Practitioner","http://hl7.org/fhir/StructureDefinition/PractitionerRole","http://hl7.org/fhir/StructureDefinition/Organization","http://hl7.org/fhir/StructureDefinition/CareTeam","http://hl7.org/fhir/StructureDefinition/Patient","http://hl7.org/fhir/StructureDefinition/RelatedPerson"] → ["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/StructureDefinition/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/pediatric-bmi-for-age|Observation.performer||TARGET_PROFILE||:TARGET_PROFILE_NARROWED`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/pediatric-bmi-for-age`
  - element: `Observation.performer` · target profile narrowed · critical
  - ["http://hl7.org/fhir/StructureDefinition/Practitioner","http://hl7.org/fhir/StructureDefinition/PractitionerRole","http://hl7.org/fhir/StructureDefinition/Organization","http://hl7.org/fhir/StructureDefinition/CareTeam","http://hl7.org/fhir/StructureDefinition/Patient","http://hl7.org/fhir/StructureDefinition/RelatedPerson"] → ["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/StructureDefinition/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/pediatric-weight-for-height|Observation.performer||TARGET_PROFILE||:TARGET_PROFILE_NARROWED`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/pediatric-weight-for-height`
  - element: `Observation.performer` · target profile narrowed · critical
  - ["http://hl7.org/fhir/StructureDefinition/Practitioner","http://hl7.org/fhir/StructureDefinition/PractitionerRole","http://hl7.org/fhir/StructureDefinition/Organization","http://hl7.org/fhir/StructureDefinition/CareTeam","http://hl7.org/fhir/StructureDefinition/Patient","http://hl7.org/fhir/StructureDefinition/RelatedPerson"] → ["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/StructureDefinition/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-blood-pressure|Observation.performer||TARGET_PROFILE||:TARGET_PROFILE_NARROWED`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/us-core-blood-pressure`
  - element: `Observation.performer` · target profile narrowed · critical
  - ["http://hl7.org/fhir/StructureDefinition/Practitioner","http://hl7.org/fhir/StructureDefinition/PractitionerRole","http://hl7.org/fhir/StructureDefinition/Organization","http://hl7.org/fhir/StructureDefinition/CareTeam","http://hl7.org/fhir/StructureDefinition/Patient","http://hl7.org/fhir/StructureDefinition/RelatedPerson"] → ["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/StructureDefinition/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-bmi|Observation.performer||TARGET_PROFILE||:TARGET_PROFILE_NARROWED`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/us-core-bmi`
  - element: `Observation.performer` · target profile narrowed · critical
  - ["http://hl7.org/fhir/StructureDefinition/Practitioner","http://hl7.org/fhir/StructureDefinition/PractitionerRole","http://hl7.org/fhir/StructureDefinition/Organization","http://hl7.org/fhir/StructureDefinition/CareTeam","http://hl7.org/fhir/StructureDefinition/Patient","http://hl7.org/fhir/StructureDefinition/RelatedPerson"] → ["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/StructureDefinition/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-body-height|Observation.performer||TARGET_PROFILE||:TARGET_PROFILE_NARROWED`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/us-core-body-height`
  - element: `Observation.performer` · target profile narrowed · critical
  - ["http://hl7.org/fhir/StructureDefinition/Practitioner","http://hl7.org/fhir/StructureDefinition/PractitionerRole","http://hl7.org/fhir/StructureDefinition/Organization","http://hl7.org/fhir/StructureDefinition/CareTeam","http://hl7.org/fhir/StructureDefinition/Patient","http://hl7.org/fhir/StructureDefinition/RelatedPerson"] → ["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/StructureDefinition/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-body-temperature|Observation.performer||TARGET_PROFILE||:TARGET_PROFILE_NARROWED`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/us-core-body-temperature`
  - element: `Observation.performer` · target profile narrowed · critical
  - ["http://hl7.org/fhir/StructureDefinition/Practitioner","http://hl7.org/fhir/StructureDefinition/PractitionerRole","http://hl7.org/fhir/StructureDefinition/Organization","http://hl7.org/fhir/StructureDefinition/CareTeam","http://hl7.org/fhir/StructureDefinition/Patient","http://hl7.org/fhir/StructureDefinition/RelatedPerson"] → ["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/StructureDefinition/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-body-weight|Observation.performer||TARGET_PROFILE||:TARGET_PROFILE_NARROWED`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/us-core-body-weight`
  - element: `Observation.performer` · target profile narrowed · critical
  - ["http://hl7.org/fhir/StructureDefinition/Practitioner","http://hl7.org/fhir/StructureDefinition/PractitionerRole","http://hl7.org/fhir/StructureDefinition/Organization","http://hl7.org/fhir/StructureDefinition/CareTeam","http://hl7.org/fhir/StructureDefinition/Patient","http://hl7.org/fhir/StructureDefinition/RelatedPerson"] → ["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/StructureDefinition/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-careplan|CarePlan.addresses||TARGET_PROFILE||:TARGET_PROFILE_NARROWED`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/us-core-careplan`
  - element: `CarePlan.addresses` · target profile narrowed · critical
  - ["http://hl7.org/fhir/StructureDefinition/Condition"] → ["http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-problems-health-concerns"]
- `req:http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-lab|DiagnosticReport.encounter||TARGET_PROFILE||:TARGET_PROFILE_NARROWED`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-lab`
  - element: `DiagnosticReport.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-encounter|Encounter.location.location||TARGET_PROFILE||:TARGET_PROFILE_NARROWED`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter`
  - element: `Encounter.location.location` · target profile narrowed · critical
  - ["http://hl7.org/fhir/StructureDefinition/Location"] → ["http://hl7.org/fhir/us/core/StructureDefinition/us-core-location"]
- `req:http://hl7.org/fhir/us/core/StructureDefinition/us-core-head-circumference|Observation.performer||TARGET_PROFILE||:TARGET_PROFILE_NARROWED`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/us-core-head-circumference`
  - element: `Observation.performer` · target profile narrowed · critical
  - ["http://hl7.org/fhir/StructureDefinition/Practitioner","http://hl7.org/fhir/StructureDefinition/PractitionerRole","http://hl7.org/fhir/StructureDefinition/Organization","http://hl7.org/fhir/StructureDefinition/CareTeam","http://hl7.org/fhir/StructureDefinition/Patient","http://hl7.org/fhir/StructureDefinition/RelatedPerson"] → ["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/StructureDefinition/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-heart-rate|Observation.performer||TARGET_PROFILE||:TARGET_PROFILE_NARROWED`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/us-core-heart-rate`
  - element: `Observation.performer` · target profile narrowed · critical
  - ["http://hl7.org/fhir/StructureDefinition/Practitioner","http://hl7.org/fhir/StructureDefinition/PractitionerRole","http://hl7.org/fhir/StructureDefinition/Organization","http://hl7.org/fhir/StructureDefinition/CareTeam","http://hl7.org/fhir/StructureDefinition/Patient","http://hl7.org/fhir/StructureDefinition/RelatedPerson"] → ["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/StructureDefinition/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-immunization|Immunization.encounter||TARGET_PROFILE||:TARGET_PROFILE_NARROWED`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization`
  - element: `Immunization.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-medicationdispense|MedicationDispense.context||TARGET_PROFILE||:TARGET_PROFILE_NARROWED`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationdispense`
  - element: `MedicationDispense.context` · target profile narrowed · critical
  - ["http://hl7.org/fhir/StructureDefinition/Encounter","http://hl7.org/fhir/StructureDefinition/EpisodeOfCare"] → ["http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter","http://hl7.org/fhir/StructureDefinition/EpisodeOfCare"]
- `req:http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest|MedicationRequest.requester||TARGET_PROFILE||:TARGET_PROFILE_NARROWED`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest`
  - element: `MedicationRequest.requester` · target profile narrowed · critical
  - ["http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner","http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient","http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization","http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitionerrole","http://hl7.org/fhir/us/core/StructureDefinition/us-core-relatedperson","http://hl7.org/fhir/StructureDefinition/Device"] → ["http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner","http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient","http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization","http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitionerrole","http://hl7.org/fhir/us/core/StructureDefinition/us-core-relatedperson","http://hl7.org/fhir/us/core/StructureDefinition/us-core-device"]
- `req:http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-clinical-result|Observation.encounter||TARGET_PROFILE||:TARGET_PROFILE_NARROWED`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-clinical-result`
  - element: `Observation.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.encounter||TARGET_PROFILE||:TARGET_PROFILE_NARROWED`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab`
  - element: `Observation.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-occupation|Observation.performer||TARGET_PROFILE||:TARGET_PROFILE_NARROWED`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-occupation`
  - element: `Observation.performer` · target profile narrowed · critical
  - ["http://hl7.org/fhir/StructureDefinition/Practitioner","http://hl7.org/fhir/StructureDefinition/PractitionerRole","http://hl7.org/fhir/StructureDefinition/Organization","http://hl7.org/fhir/StructureDefinition/CareTeam","http://hl7.org/fhir/StructureDefinition/Patient","http://hl7.org/fhir/StructureDefinition/RelatedPerson"] → ["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/StructureDefinition/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-observation-pregnancyintent|Observation.performer||TARGET_PROFILE||:TARGET_PROFILE_NARROWED`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-pregnancyintent`
  - element: `Observation.performer` · target profile narrowed · critical
  - ["http://hl7.org/fhir/StructureDefinition/Practitioner","http://hl7.org/fhir/StructureDefinition/PractitionerRole","http://hl7.org/fhir/StructureDefinition/Organization","http://hl7.org/fhir/StructureDefinition/CareTeam","http://hl7.org/fhir/StructureDefinition/Patient","http://hl7.org/fhir/StructureDefinition/RelatedPerson"] → ["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/StructureDefinition/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-observation-pregnancystatus|Observation.performer||TARGET_PROFILE||:TARGET_PROFILE_NARROWED`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-pregnancystatus`
  - element: `Observation.performer` · target profile narrowed · critical
  - ["http://hl7.org/fhir/StructureDefinition/Practitioner","http://hl7.org/fhir/StructureDefinition/PractitionerRole","http://hl7.org/fhir/StructureDefinition/Organization","http://hl7.org/fhir/StructureDefinition/CareTeam","http://hl7.org/fhir/StructureDefinition/Patient","http://hl7.org/fhir/StructureDefinition/RelatedPerson"] → ["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/StructureDefinition/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-procedure|Procedure.encounter||TARGET_PROFILE||:TARGET_PROFILE_NARROWED`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure`
  - element: `Procedure.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-provenance|Provenance.agent.onBehalfOf|ProvenanceTransmitter|TARGET_PROFILE||:TARGET_PROFILE_NARROWED`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/us-core-provenance`
  - element: `Provenance.agent.onBehalfOf` · target profile narrowed · critical
  - ["http://hl7.org/fhir/StructureDefinition/Practitioner","http://hl7.org/fhir/StructureDefinition/PractitionerRole","http://hl7.org/fhir/StructureDefinition/RelatedPerson","http://hl7.org/fhir/StructureDefinition/Patient","http://hl7.org/fhir/StructureDefinition/Device","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-pulse-oximetry|Observation.performer||TARGET_PROFILE||:TARGET_PROFILE_NARROWED`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/us-core-pulse-oximetry`
  - element: `Observation.performer` · target profile narrowed · critical
  - ["http://hl7.org/fhir/StructureDefinition/Practitioner","http://hl7.org/fhir/StructureDefinition/PractitionerRole","http://hl7.org/fhir/StructureDefinition/Organization","http://hl7.org/fhir/StructureDefinition/CareTeam","http://hl7.org/fhir/StructureDefinition/Patient","http://hl7.org/fhir/StructureDefinition/RelatedPerson"] → ["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/StructureDefinition/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-respiratory-rate|Observation.performer||TARGET_PROFILE||:TARGET_PROFILE_NARROWED`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/us-core-respiratory-rate`
  - element: `Observation.performer` · target profile narrowed · critical
  - ["http://hl7.org/fhir/StructureDefinition/Practitioner","http://hl7.org/fhir/StructureDefinition/PractitionerRole","http://hl7.org/fhir/StructureDefinition/Organization","http://hl7.org/fhir/StructureDefinition/CareTeam","http://hl7.org/fhir/StructureDefinition/Patient","http://hl7.org/fhir/StructureDefinition/RelatedPerson"] → ["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/StructureDefinition/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-servicerequest|ServiceRequest.encounter||TARGET_PROFILE||:TARGET_PROFILE_NARROWED`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/us-core-servicerequest`
  - element: `ServiceRequest.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-smokingstatus|Observation.performer||TARGET_PROFILE||:TARGET_PROFILE_NARROWED`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/us-core-smokingstatus`
  - element: `Observation.performer` · target profile narrowed · critical
  - ["http://hl7.org/fhir/StructureDefinition/Practitioner","http://hl7.org/fhir/StructureDefinition/PractitionerRole","http://hl7.org/fhir/StructureDefinition/Organization","http://hl7.org/fhir/StructureDefinition/CareTeam","http://hl7.org/fhir/StructureDefinition/Patient","http://hl7.org/fhir/StructureDefinition/RelatedPerson"] → ["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/StructureDefinition/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-vital-signs|Observation.performer||TARGET_PROFILE||:TARGET_PROFILE_NARROWED`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/us-core-vital-signs`
  - element: `Observation.performer` · target profile narrowed · critical
  - ["http://hl7.org/fhir/StructureDefinition/Practitioner","http://hl7.org/fhir/StructureDefinition/PractitionerRole","http://hl7.org/fhir/StructureDefinition/Organization","http://hl7.org/fhir/StructureDefinition/CareTeam","http://hl7.org/fhir/StructureDefinition/Patient","http://hl7.org/fhir/StructureDefinition/RelatedPerson"] → ["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/StructureDefinition/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/head-occipital-frontal-circumference-percentile|Observation.effective[x]||INVARIANT|vs-1|:INVARIANT_CHANGED`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/head-occipital-frontal-circumference-percentile`
  - element: `Observation.effective[x]` · invariant changed · needs review
  - {"key":"vs-1","severity":"error","human":"if Observation.effective[x] is dateTime and has a value then that value shall be precise to the day","expression":"($this as dateTime).toString().length() >= 8","xpath":"f:effectiveDateTime[matches(@value, '^\\d{4}-\\d{2}-\\d{2}')]","source":"http://hl7.org/fhir/StructureDefinition/vitalsigns"} → {"key":"vs-1","severity":"error","human":"if Observation.effective[x] is dateTime and has a value then that value shall be precise to the day","expression":"$this is dateTime implies $this.toString().length() >= 10","xpath":"f:effectiveDateTime[matches(@value, '^\\d{4}-\\d{2}-\\d{2}')]","source":"http://hl7.org/fhir/StructureDefinition/vitalsigns"}
- `req:http://hl7.org/fhir/us/core/StructureDefinition/head-occipital-frontal-circumference-percentile|Observation.performer||MUST_SUPPORT||:NEW_SUPPORT_EXPECTATION`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/head-occipital-frontal-circumference-percentile`
  - element: `Observation.performer` · new support expectation · needs review
  - false → true
- `req:http://hl7.org/fhir/us/core/StructureDefinition/pediatric-bmi-for-age|Observation.effective[x]||INVARIANT|vs-1|:INVARIANT_CHANGED`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/pediatric-bmi-for-age`
  - element: `Observation.effective[x]` · invariant changed · needs review
  - {"key":"vs-1","severity":"error","human":"if Observation.effective[x] is dateTime and has a value then that value shall be precise to the day","expression":"($this as dateTime).toString().length() >= 8","xpath":"f:effectiveDateTime[matches(@value, '^\\d{4}-\\d{2}-\\d{2}')]","source":"http://hl7.org/fhir/StructureDefinition/vitalsigns"} → {"key":"vs-1","severity":"error","human":"if Observation.effective[x] is dateTime and has a value then that value shall be precise to the day","expression":"$this is dateTime implies $this.toString().length() >= 10","xpath":"f:effectiveDateTime[matches(@value, '^\\d{4}-\\d{2}-\\d{2}')]","source":"http://hl7.org/fhir/StructureDefinition/vitalsigns"}
- `req:http://hl7.org/fhir/us/core/StructureDefinition/pediatric-bmi-for-age|Observation.performer||MUST_SUPPORT||:NEW_SUPPORT_EXPECTATION`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/pediatric-bmi-for-age`
  - element: `Observation.performer` · new support expectation · needs review
  - false → true
- `req:http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex|Extension.value[x]||VALUESET_REFERENCE||:VALUESET_REFERENCE_CHANGED`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex`
  - element: `Extension.value[x]` · valueset reference changed · needs review
  - {"strength":"required","description":"Code for sex assigned at birth","valueSet":"http://hl7.org/fhir/us/core/ValueSet/birthsex"} → {"strength":"required","description":"Code for sex assigned at birth","valueSet":"http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1021.24"}
- `req:http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis|Condition.clinicalStatus||VALUESET_REFERENCE||:VALUESET_REFERENCE_CHANGED`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis`
  - element: `Condition.clinicalStatus` · valueset reference changed · needs review
  - {"strength":"required","valueSet":"http://hl7.org/fhir/ValueSet/condition-clinical"} → {"extension":[{"url":"http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName","valueString":"ConditionClinicalStatus"}],"strength":"required","description":"The clinical status of the condition or diagnosis.","valueSet":"http://hl7.org/fhir/ValueSet/condition-clinical|4.0.1"}
- `req:http://hl7.org/fhir/us/core/StructureDefinition/us-core-careplan|CarePlan.category|AssessPlan|SLICING|AssessPlan|:SLICE_REMOVED`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/us-core-careplan`
  - element: `CarePlan.category` · slice removed · informational
  - {"sliceName":"AssessPlan","min":1,"max":"1"} → —
- `req:http://hl7.org/fhir/us/core/StructureDefinition/us-core-careplan|CarePlan.category||MIN_CARDINALITY||:NO_LONGER_REQUIRED`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/us-core-careplan`
  - element: `CarePlan.category` · no longer required · informational
  - 1 → 0
- `req:http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis|Condition.abatement[x]||MUST_SUPPORT||:SUPPORT_EXPECTATION_REMOVED`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis`
  - element: `Condition.abatement[x]` · support expectation removed · informational
  - true → false
- `req:http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis|Condition.clinicalStatus||MUST_SUPPORT||:SUPPORT_EXPECTATION_REMOVED`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis`
  - element: `Condition.clinicalStatus` · support expectation removed · informational
  - true → false
- `req:http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient|Patient.gender||MIN_CARDINALITY||:NO_LONGER_REQUIRED`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient`
  - element: `Patient.gender` · no longer required · informational
  - 1 → 0
- `req:http://hl7.org/fhir/us/core/StructureDefinition/us-core-smokingstatus|Observation.effective[x]||TYPE||:TYPE_EXPANDED`
  - profile: `http://hl7.org/fhir/us/core/StructureDefinition/us-core-smokingstatus`
  - element: `Observation.effective[x]` · type expanded · informational
  - ["dateTime"] → ["Period","dateTime"]

## 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.