# hl7.fhir.us.davinci-crd 2.0.1 → 2.2.1 — version-difference evidence pack

The widest coverage expansion here: 31 profiles exist only in 2.2.1, carrying 400 mandatory or must-support elements between them.

This pack is the downloadable form of the public report at `/ig-gap/davinci-crd-2-0-1-to-2-2-1`. 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.davinci-crd#2.0.1` | `977ac1841346de0d9b50896dddd4834175ab41c6e25a58ca12e266f95a1c17fe` |
| Target | `hl7.fhir.us.davinci-crd#2.2.1` | `9ce47b6a53f7c138a5c5952ddea2fbdaf282c346aae1d3a3947664e3e5e16525` |

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

320 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 | 24 |
| Needs review | 208 |
| Indeterminate | 0 |
| Informational | 88 |
| **Total** | **320** |

### Read the element counts as a floor

31 profiles exist only in 2.2.1, and 1 only in 2.0.1. Those have no counterpart to compare against, so they contribute no element-level rows — the element comparison covers the 17 profiles present in both versions. Neither number is a total on its own.

The 400 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/davinci-crd/StructureDefinition/profile-medicationrequest` — 6 critical of 36 changes
- `http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-taskquestionnaire` — 4 critical of 30 changes
- `http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-communicationrequest` — 3 critical of 21 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/davinci-crd/StructureDefinition/profile-coverage` — 33% of 6 changes critical
- `http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-medicationrequest` — 17% of 36 changes critical
- `http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-communicationrequest` — 14% of 21 changes critical

## The other planes

| Plane | Changes | Highest severity present |
|---|---|---|
| Operations | 0 | — |
| Value sets | 41 | needs review |
| Capability statements | 4 | needs review |

## Profile coverage

Compared in both versions: 17 · added in target: 31 · removed from baseline: 1

- PROFILE_ADDED `http://hl7.org/fhir/us/davinci-crd/StructureDefinition/CRDHooksResponse-externalReference`
- PROFILE_ADDED `http://hl7.org/fhir/us/davinci-crd/StructureDefinition/CDSHookServicesExtensionCRDVersion`
- PROFILE_ADDED `http://hl7.org/fhir/us/davinci-crd/StructureDefinition/CRDHooksResponse-formCompletion`
- PROFILE_ADDED `http://hl7.org/fhir/us/davinci-crd/StructureDefinition/CDSHookServiceResponseExtensionIfNoneExist`
- PROFILE_ADDED `http://hl7.org/fhir/us/davinci-crd/StructureDefinition/CRDHooksRequest`
- PROFILE_ADDED `http://hl7.org/fhir/us/davinci-crd/StructureDefinition/CRDOrderDispatchContext`
- PROFILE_ADDED `http://hl7.org/fhir/us/davinci-crd/StructureDefinition/CDSHookServiceResponseExtensionAssociatedResource`
- PROFILE_ADDED `http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-bundle-request`
- PROFILE_ADDED `http://hl7.org/fhir/us/davinci-crd/StructureDefinition/CRDOrderSelectContext`
- PROFILE_ADDED `http://hl7.org/fhir/us/davinci-crd/StructureDefinition/CRDHooksResponse-adjustCoverage`
- PROFILE_ADDED `http://hl7.org/fhir/us/davinci-crd/StructureDefinition/CRDOrderSignContext`
- PROFILE_ADDED `http://hl7.org/fhir/us/davinci-crd/StructureDefinition/CRDHooksResponse`
- PROFILE_ADDED `http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-medication`
- PROFILE_ADDED `http://hl7.org/fhir/us/davinci-crd/StructureDefinition/CRDHooksResponse-launchSMART`
- PROFILE_ADDED `http://hl7.org/fhir/us/davinci-crd/StructureDefinition/CRDHooksResponse-coverageInformation`
- PROFILE_ADDED `http://hl7.org/fhir/us/davinci-crd/StructureDefinition/CRDHooksResponseBase`
- PROFILE_ADDED `http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-task-dispatch`
- PROFILE_ADDED `http://hl7.org/fhir/us/davinci-crd/StructureDefinition/CRDAppointmentBookContext`
- PROFILE_ADDED `http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-appointment-base`
- PROFILE_ADDED `http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-appointment-no-order`
- PROFILE_ADDED `http://hl7.org/fhir/us/davinci-crd/StructureDefinition/CRDHooksResponse-alternateRequest`
- PROFILE_ADDED `http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-timing`
- PROFILE_ADDED `http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-bundle-base`
- PROFILE_ADDED `http://hl7.org/fhir/us/davinci-crd/StructureDefinition/CDSHookServiceRequestExtensionRequestCRDVersion`
- PROFILE_ADDED `http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-bundle-appointment`
- PROFILE_ADDED `http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-appointment-with-order`
- PROFILE_ADDED `http://hl7.org/fhir/us/davinci-crd/StructureDefinition/CRDHooksResponse-additionalOrders`
- PROFILE_ADDED `http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-billing-options`
- PROFILE_REMOVED `http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-appointment`
- PROFILE_ADDED `http://hl7.org/fhir/us/davinci-crd/StructureDefinition/CDSHookServiceRequestExtensionRequestConfig`
- PROFILE_ADDED `http://hl7.org/fhir/us/davinci-crd/StructureDefinition/CRDHooksResponse-instructions`
- PROFILE_ADDED `http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-request-category`

## Changes by effect

| Effect | Count |
|---|---|
| binding added | 1 |
| binding strength changed | 5 |
| informational change | 6 |
| invariant added | 37 |
| invariant changed | 29 |
| invariant removed | 6 |
| newly required | 4 |
| new support expectation | 53 |
| no longer required | 3 |
| profile inheritance changed | 9 |
| reference requirement changed | 27 |
| slice added | 46 |
| slice cardinality changed | 5 |
| slice removed | 5 |
| support expectation removed | 9 |
| target profile expanded | 9 |
| target profile narrowed | 18 |
| type narrowed | 1 |
| unknown | 1 |
| valueset reference changed | 46 |

## Sampled evidence rows

Every count above is complete. The rows below are a bounded, deterministic sample of 40 (280 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/davinci-crd/StructureDefinition/CRDMetricData|CRDMetricData.tokenUse||MIN_CARDINALITY||:NEWLY_REQUIRED`
  - profile: `http://hl7.org/fhir/us/davinci-crd/StructureDefinition/CRDMetricData`
  - element: `CRDMetricData.tokenUse` · newly required · critical
  - 0 → 1
- `req:http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-communicationrequest|CommunicationRequest.recipient||TARGET_PROFILE||:TARGET_PROFILE_NARROWED`
  - profile: `http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-communicationrequest`
  - element: `CommunicationRequest.recipient` · target profile narrowed · critical
  - ["http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-practitioner","http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitionerrole","http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization"] → ["http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-practitioner","http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-practitionerrole","http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-organization"]
- `req:http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-communicationrequest|CommunicationRequest.requester||TARGET_PROFILE||:TARGET_PROFILE_NARROWED`
  - profile: `http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-communicationrequest`
  - element: `CommunicationRequest.requester` · target profile narrowed · critical
  - ["http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-practitioner","http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitionerrole"] → ["http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-practitioner","http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-practitionerrole"]
- `req:http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-communicationrequest|CommunicationRequest.sender||TARGET_PROFILE||:TARGET_PROFILE_NARROWED`
  - profile: `http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-communicationrequest`
  - element: `CommunicationRequest.sender` · target profile narrowed · critical
  - ["http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-practitioner","http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitionerrole","http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization"] → ["http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-practitioner","http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-practitionerrole","http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-organization"]
- `req:http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-coverage|Coverage.payor||TARGET_PROFILE||:TARGET_PROFILE_NARROWED`
  - profile: `http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-coverage`
  - element: `Coverage.payor` · target profile narrowed · critical
  - ["http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-patient","http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-organization"] → ["http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-organization"]
- `req:http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-coverage|Coverage.relationship||MIN_CARDINALITY||:NEWLY_REQUIRED`
  - profile: `http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-coverage`
  - element: `Coverage.relationship` · newly required · critical
  - 0 → 1
- `req:http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-devicerequest|DeviceRequest.performer||TARGET_PROFILE||:TARGET_PROFILE_NARROWED`
  - profile: `http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-devicerequest`
  - element: `DeviceRequest.performer` · target profile narrowed · critical
  - ["http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-practitioner","http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitionerrole"] → ["http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-practitioner","http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-practitionerrole"]
- `req:http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-devicerequest|DeviceRequest.requester||TARGET_PROFILE||:TARGET_PROFILE_NARROWED`
  - profile: `http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-devicerequest`
  - element: `DeviceRequest.requester` · target profile narrowed · critical
  - ["http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-practitioner","http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitionerrole"] → ["http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-practitioner","http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-practitionerrole"]
- `req:http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-encounter|Encounter.serviceProvider||TARGET_PROFILE||:TARGET_PROFILE_NARROWED`
  - profile: `http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-encounter`
  - element: `Encounter.serviceProvider` · target profile narrowed · critical
  - ["http://hl7.org/fhir/StructureDefinition/Organization"] → ["http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization|7.0.0"]
- `req:http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-medicationrequest|MedicationRequest.dispenseRequest.performer||TARGET_PROFILE||:TARGET_PROFILE_NARROWED`
  - profile: `http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-medicationrequest`
  - element: `MedicationRequest.dispenseRequest.performer` · target profile narrowed · critical
  - ["http://hl7.org/fhir/StructureDefinition/Organization"] → ["http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-organization"]
- `req:http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-medicationrequest|MedicationRequest.medication[x]||TARGET_PROFILE||:TARGET_PROFILE_NARROWED`
  - profile: `http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-medicationrequest`
  - element: `MedicationRequest.medication[x]` · target profile narrowed · critical
  - ["http://hl7.org/fhir/us/core/StructureDefinition/us-core-medication"] → ["http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-medication"]
- `req:http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-medicationrequest|MedicationRequest.performer||TARGET_PROFILE||:TARGET_PROFILE_NARROWED`
  - profile: `http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-medicationrequest`
  - element: `MedicationRequest.performer` · target profile narrowed · critical
  - ["http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-practitioner","http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitionerrole"] → ["http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-practitioner","http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-practitionerrole"]
- `req:http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-medicationrequest|MedicationRequest.reasonReference||TARGET_PROFILE||:TARGET_PROFILE_NARROWED`
  - profile: `http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-medicationrequest`
  - element: `MedicationRequest.reasonReference` · target profile narrowed · critical
  - ["http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition","http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab"] → ["http://hl7.org/fhir/StructureDefinition/Condition","http://hl7.org/fhir/StructureDefinition/Observation"]
- `req:http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-medicationrequest|MedicationRequest.reported[x]||TARGET_PROFILE||:TARGET_PROFILE_NARROWED`
  - profile: `http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-medicationrequest`
  - element: `MedicationRequest.reported[x]` · target profile narrowed · critical
  - ["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/davinci-crd/StructureDefinition/profile-patient","http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-practitioner","http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-organization"]
- `req:http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-medicationrequest|MedicationRequest.requester||TARGET_PROFILE||:TARGET_PROFILE_NARROWED`
  - profile: `http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-medicationrequest`
  - element: `MedicationRequest.requester` · target profile narrowed · critical
  - ["http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-practitioner","http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitionerrole"] → ["http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-practitioner"]
- `req:http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-nutritionorder|NutritionOrder.allergyIntolerance||TARGET_PROFILE||:TARGET_PROFILE_NARROWED`
  - profile: `http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-nutritionorder`
  - element: `NutritionOrder.allergyIntolerance` · target profile narrowed · critical
  - ["http://hl7.org/fhir/StructureDefinition/AllergyIntolerance"] → ["http://hl7.org/fhir/us/core/StructureDefinition/us-core-allergyintolerance|7.0.0"]
- `req:http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-nutritionorder|NutritionOrder.orderer||TARGET_PROFILE||:TARGET_PROFILE_NARROWED`
  - profile: `http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-nutritionorder`
  - element: `NutritionOrder.orderer` · target profile narrowed · critical
  - ["http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-practitioner","http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitionerrole"] → ["http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-practitioner","http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-practitionerrole"]
- `req:http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-organization|Organization.identifier||MIN_CARDINALITY||:NEWLY_REQUIRED`
  - profile: `http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-organization`
  - element: `Organization.identifier` · newly required · critical
  - 0 → 1
- `req:http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-servicerequest|ServiceRequest.requester||TARGET_PROFILE||:TARGET_PROFILE_NARROWED`
  - profile: `http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-servicerequest`
  - element: `ServiceRequest.requester` · target profile narrowed · critical
  - ["http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-practitioner","http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitionerrole"] → ["http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-practitioner","http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-practitionerrole"]
- `req:http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-taskquestionnaire|Task.for||TARGET_PROFILE||:TARGET_PROFILE_NARROWED`
  - profile: `http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-taskquestionnaire`
  - element: `Task.for` · target profile narrowed · critical
  - ["http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient"] → ["http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-patient"]
- `req:http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-taskquestionnaire|Task.input.value[x]|responseEndpoint|TYPE||:TYPE_NARROWED`
  - profile: `http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-taskquestionnaire`
  - element: `Task.input.value[x]` · type narrowed · critical
  - ["Address","Age","Annotation","Attachment","CodeableConcept","Coding","ContactDetail","ContactPoint","Contributor","Count","DataRequirement","Distance","Dosage","Duration","Expression","HumanName","Identifier","Meta","Money","ParameterDefinition","Period","Quantity","Range","Ratio","Reference","RelatedArtifact","SampledData","Signature","Timing","TriggerDefinition","UsageContext","base64Binary","boolean","canonical","code","date","dateTime","decimal","id","instant","integer","markdown","oid","positiveInt","string","time","unsignedInt","uri","url","uuid"] → ["url"]
- `req:http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-taskquestionnaire|Task.input|questionnaire|MIN_CARDINALITY||:NEWLY_REQUIRED`
  - profile: `http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-taskquestionnaire`
  - element: `Task.input` · newly required · critical
  - 0 → 1
- `req:http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-visionprescription|VisionPrescription.prescriber||TARGET_PROFILE||:TARGET_PROFILE_NARROWED`
  - profile: `http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-visionprescription`
  - element: `VisionPrescription.prescriber` · target profile narrowed · critical
  - ["http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-practitioner","http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitionerrole"] → ["http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-practitioner","http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-practitionerrole"]
- `req:http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information|Extension.extension.extension|category/detail|SLICING|category|:SLICE_ADDED`
  - profile: `http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information`
  - element: `Extension.extension.extension` · slice added · needs review
  - — → {"sliceName":"category","min":1,"max":"1"}
- `req:http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information|Extension.extension|billingCode|MUST_SUPPORT||:NEW_SUPPORT_EXPECTATION`
  - profile: `http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information`
  - element: `Extension.extension` · new support expectation · needs review
  - false → true
- `req:http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information|Extension.extension|contact|MUST_SUPPORT||:NEW_SUPPORT_EXPECTATION`
  - profile: `http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information`
  - element: `Extension.extension` · new support expectation · needs review
  - false → true
- `req:http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information|Extension||INVARIANT|crd-ci-q1|:INVARIANT_CHANGED`
  - profile: `http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information`
  - element: `Extension` · invariant changed · needs review
  - {"key":"crd-ci-q1","severity":"error","human":"Questionnaire and QuestionnaireResponse are only allowed when doc-needed exists and not equal to 'no-doc'","expression":"extension.where(url='questionnaire' or url='response').exists() implies (extension.where(url = 'doc-needed').exists() and extension.where(url = 'doc-needed').all(value != 'no-doc'))","source":"http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information"} → {"key":"crd-ci-q1","severity":"error","human":"Questionnaire is only allowed when doc-needed exists","expression":"extension.where(url='questionnaire').exists() implies extension.where(url = 'doc-needed').exists()","source":"http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information"}
- `req:http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information|Extension||INVARIANT|crd-ci-q2|:INVARIANT_CHANGED`
  - profile: `http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information`
  - element: `Extension` · invariant changed · needs review
  - {"key":"crd-ci-q2","severity":"error","human":"If covered is set to 'not-covered', then 'pa-needed' should not exist.","expression":"extension.where(url = 'covered' and value != 'not-covered') implies extension.where(url = 'pa-needed').exists()","source":"http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information"} → {"key":"crd-ci-q2","severity":"error","human":"If covered is set to 'not-covered', then 'pa-needed' must not exist.","expression":"extension.where(url = 'covered' and value = 'not-covered').exists() implies extension.where(url = 'pa-needed').exists().not()","source":"http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information"}
- `req:http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-device|Device.definition||TARGET_PROFILE||:REFERENCE_REQUIREMENT_CHANGED`
  - profile: `http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-device`
  - element: `Device.definition` · reference requirement changed · needs review
  - ["http://hl7.org/fhir/StructureDefinition/DeviceDefinition"] → ["http://hl7.org/fhir/StructureDefinition/DeviceDefinition|4.0.1"]
- `req:http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-location|Location.identifier||MUST_SUPPORT||:NEW_SUPPORT_EXPECTATION`
  - profile: `http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-location`
  - element: `Location.identifier` · new support expectation · needs review
  - false → true
- `req:http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-medicationrequest|MedicationRequest.dosageInstruction.doseAndRate.dose[x]||BINDING||:BINDING_ADDED`
  - profile: `http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-medicationrequest`
  - element: `MedicationRequest.dosageInstruction.doseAndRate.dose[x]` · binding added · needs review
  - — → {"extension":[{"url":"http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet","valueCanonical":"http://hl7.org/fhir/ValueSet/ucum-units"}],"strength":"preferred","valueSet":"http://hl7.org/fhir/ValueSet/ucum-common"}
- `req:http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-medicationrequest|MedicationRequest.intent||VALUESET_REFERENCE||:VALUESET_REFERENCE_CHANGED`
  - profile: `http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-medicationrequest`
  - element: `MedicationRequest.intent` · valueset reference changed · needs review
  - {"extension":[{"url":"http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName","valueString":"MedicationRequestIntent"}],"strength":"required","description":"The kind of medication order.","valueSet":"http://hl7.org/fhir/ValueSet/medicationrequest-intent|4.0.1"} → {"strength":"required","description":"The kind of medication order.","valueSet":"http://hl7.org/fhir/ValueSet/medicationrequest-intent"}
- `req:http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-patient|Patient.extension|genderIdentity|SLICING|genderIdentity|:SLICE_ADDED`
  - profile: `http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-patient`
  - element: `Patient.extension` · slice added · needs review
  - — → {"sliceName":"genderIdentity","min":0,"max":"*"}
- `req:http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-practitioner|Practitioner.address||MUST_SUPPORT||:NEW_SUPPORT_EXPECTATION`
  - profile: `http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-practitioner`
  - element: `Practitioner.address` · new support expectation · needs review
  - false → true
- `req:http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information|Extension.extension|doc-needed|MAX_CARDINALITY||:INFORMATIONAL_CHANGE`
  - profile: `http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information`
  - element: `Extension.extension` · informational change · informational
  - 1 → *
- `req:http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information|Extension.extension|doc-needed|SLICE_CARDINALITY|doc-needed|:SLICE_CARDINALITY_CHANGED`
  - profile: `http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information`
  - element: `Extension.extension` · slice cardinality changed · informational
  - {"min":0,"max":"1"} → {"min":0,"max":"*"}
- `req:http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-location|Location.address||MIN_CARDINALITY||:NO_LONGER_REQUIRED`
  - profile: `http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-location`
  - element: `Location.address` · no longer required · informational
  - 1 → 0
- `req:http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-patient|Patient.address.period||MUST_SUPPORT||:SUPPORT_EXPECTATION_REMOVED`
  - profile: `http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-patient`
  - element: `Patient.address.period` · support expectation removed · informational
  - true → false
- `req:http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-patient|Patient.communication||MUST_SUPPORT||:SUPPORT_EXPECTATION_REMOVED`
  - profile: `http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-patient`
  - element: `Patient.communication` · support expectation removed · informational
  - true → false
- `req:http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-patient|Patient.identifier.type||MIN_CARDINALITY||:NO_LONGER_REQUIRED`
  - profile: `http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-patient`
  - element: `Patient.identifier.type` · no longer required · informational
  - 1 → 0

## 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) — register records a recommended version of `2.2.1` — 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 / Financial Management (owner) — https://www.hl7.org/Special/committees/fm · https://hl7.org/fhir/us/davinci-pas/en/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.