From 3ba173ba9fbd2f2b3bca73fd4c1cf3ec3092a506 Mon Sep 17 00:00:00 2001 From: Bas van den Heuvel Date: Mon, 8 Jun 2026 10:52:57 +0200 Subject: [PATCH 1/9] FHIR-51041: Clarify Additional Resources heading and custom-resource conformance - Capitalize "Defined" in the Additional Resources heading - Add conformance clarification for custom resources outside the registration process - Keep the edit scoped to resource introduction content only --- source/resource/resource-introduction.xml | 3 ++- 1 file changed, 2 insertions(+), 1 deletion(-) diff --git a/source/resource/resource-introduction.xml b/source/resource/resource-introduction.xml index 66ed925b519..beade78de82 100644 --- a/source/resource/resource-introduction.xml +++ b/source/resource/resource-introduction.xml @@ -46,7 +46,7 @@ Note: there is documentation for the Structure, -

Additional Resources defined Outside This Specification

+

Additional Resources Defined Outside This Specification

This specification defines the base <%res-type-count%> resources that comprise the "FHIR resources". Additional resources may be defined in other specifications, @@ -78,6 +78,7 @@ encountered through this specification:

  • DomainResource.contained
  • Parameters.parameter.resource
    • +

    The introduction of 'custom' resource not defined through the process documented here is not conformant with the FHIR specification. Instances communicating resources not defined in this core specification or via the additional resources registration process cannot be called FHIR conformant.

    Moving Additional Resources to FHIR Core

    From eafe93ae2931378c269e1c875c8048d90be6a7ab Mon Sep 17 00:00:00 2001 From: Bas van den Heuvel Date: Mon, 8 Jun 2026 11:03:36 +0200 Subject: [PATCH 2/9] typo --- source/consent/consent-event-mapping-exceptions.xml | 2 +- 1 file changed, 1 insertion(+), 1 deletion(-) diff --git a/source/consent/consent-event-mapping-exceptions.xml b/source/consent/consent-event-mapping-exceptions.xml index d9aa12ef4c6..30622c892fd 100644 --- a/source/consent/consent-event-mapping-exceptions.xml +++ b/source/consent/consent-event-mapping-exceptions.xml @@ -71,7 +71,7 @@ - <_pattern value="This indicates when the activity actually occurred or is occurring, not when it was asked/requested/ordered to occur. For the latter, look at the occurrence element of the Request this {{event}} is "basedOn". The status code allows differentiation of whether the timing reflects a historic event or an ongoing event. Ongoing events should not include an upper bound in the Period or Timing.bounds. ."/> + <_pattern value="This indicates when the activity actually occurred or is occurring, not when it was asked/requested/ordered to occur. For the latter, look at the occurence element of the Request this {{event}} is "basedOn". The status code allows differentiation of whether the timing reflects a historic event or an ongoing event. Ongoing events should not include an upper bound in the Period or Timing.bounds. ."/> From 4d6b4d406966499ab638d9d0c803424d80dba856 Mon Sep 17 00:00:00 2001 From: Bas van den Heuvel Date: Mon, 8 Jun 2026 11:05:13 +0200 Subject: [PATCH 3/9] FHIR-53909: Clarify reference search support for additionalReference - Add a reference-search note for extension-based references in search.html - Use repository-consistent hyperlink markup for additionalReference extension - Keep the change scoped to the reference search type section --- source/search.html | 4 ++++ 1 file changed, 4 insertions(+) diff --git a/source/search.html b/source/search.html index 088ef713271..7d6abce7d42 100644 --- a/source/search.html +++ b/source/search.html @@ -3255,6 +3255,10 @@

    reference

    SHOULD match instances that match the reference in it contains a versioned reference.

    +

    + Instead of Reference.reference, some elements might instead contain the additionalReference extension. + Systems SHOULD support indexing and searching against content found in this extension as well unless there are constraints in place that ensure that additionalReference is never present. +

    For example, if the base URL of a server is http://example.org/fhir, the search: From fb1156d7aee0853b72f612403993bd53efba8dca Mon Sep 17 00:00:00 2001 From: Bas van den Heuvel Date: Mon, 8 Jun 2026 15:50:24 +0200 Subject: [PATCH 4/9] FHIR-55462: Allow normal references for additional resources Refs: - Confluence minutes topic (WedQ3): https://confluence.hl7.org/spaces/FHIRI/pages/358879917/FHIR+Infrastructure+Minutes+WGM+202509+-+Pittsburgh#FHIRInfrastructureMinutesWGM202509Pittsburgh-WedQ3 - Update additional-reference guidance in references section to separate scenarios - Clarify that normal Reference.reference can be used for additional resources when declared in StructureDefinition - Align wording with the Confluence-approved target-declaration/approval topic for additional-resource references - Keep alternate-reference guidance for future/past-version target scenarios --- source/references.html | 19 +++++++------------ 1 file changed, 7 insertions(+), 12 deletions(-) diff --git a/source/references.html b/source/references.html index 6e5fb57c9e1..1e00441ba62 100644 --- a/source/references.html +++ b/source/references.html @@ -313,22 +313,17 @@

    Additional References

    don't even exist in the version of FHIR being used, in which case the target would be a Basic instance using the inter-version conversion rules.
  • An additional resource has been defined that is a logical target for the element. Core elements - aren't permitted to have resource targets that are additional resources, though profiles might - wish to allow pointing to them.
    • + aren't permitted to have resource targets that are additional resources. When defining additional resources, the + additional-resource-reference-target + extension allows the relevant work group to indicate and approve that a core element (or another additional resource) + may refer to the resource. This allows the use of normal Reference.reference in deployments where both + the core and additional resource definitions are in scope.

    -In both of these cases, the solution is to use the alternate-reference extension. It allows -referencing any type of resource - including additional resources. The targetProfile used when -profiling this extension is free to point to a narrower profile than a resource - e.g., a specific +When the approach mentioned above does not apply, the solution is to use the alternate-reference extension. +The targetProfile used when profiling the extension is free to point to a narrower profile than a resource - e.g., a specific inter-version resource profile on Basic.

    -

    -In some cases, an additional resource may migrate to be a core resource and become allowed as a -target resource. Systems that have not yet updated to support that new core resource may -struggle with the migration of the reference from the additional-reference to the standard -Reference.reference element. Communication partners will need to manage this transition." -

    -

    Canonical URLs

    From 18e6cd26337fb00fe3e599934a31a062c7ef325b Mon Sep 17 00:00:00 2001 From: Bas van den Heuvel Date: Mon, 8 Jun 2026 16:18:56 +0200 Subject: [PATCH 5/9] FHIR-54055: Update CapabilityStatement notes wording - Change linked phrase in `source/capabilitystatement/capabilitystatement-notes.xml` from "additional resource" to "additional resources" - Update the sentence under "Using additional resources in CapabilityStatements" - Matches the typo correction requested in FHIR-54055 --- source/capabilitystatement/capabilitystatement-notes.xml | 2 +- 1 file changed, 1 insertion(+), 1 deletion(-) diff --git a/source/capabilitystatement/capabilitystatement-notes.xml b/source/capabilitystatement/capabilitystatement-notes.xml index f712d5ad638..0dd4d662b1b 100644 --- a/source/capabilitystatement/capabilitystatement-notes.xml +++ b/source/capabilitystatement/capabilitystatement-notes.xml @@ -108,7 +108,7 @@ For a discussion of the use of these two types of resources, see

    Using additional resources in CapabilityStatements

    -CapabilityStatements may represent the use of additional resource. +CapabilityStatements may represent the use of additional resources. When doing so, CapabilityStatement.rest.resource.type contains the type of the resource as defined in the HL7 registry, along with a reference to the definition of the resource in CapabilityStatement.rest.resource.definition. From 6a39afe59357c02aa63a9c0620192bbd5ed4a875 Mon Sep 17 00:00:00 2001 From: Bas van den Heuvel Date: Mon, 8 Jun 2026 23:42:49 +0200 Subject: [PATCH 6/9] FHIR-57565: Require hl7.org canonical space for additional resource definitions - Update additional-resource canonical URL rule in structuredefinition notes to require http://hl7.org/fhir - Align the embedded StructureDefinition example url value with the revised canonical-space rule - Align the embedded StructureDefinition example type value with the revised canonical-space rule --- source/structuredefinition/structuredefinition-notes.xml | 6 +++--- 1 file changed, 3 insertions(+), 3 deletions(-) diff --git a/source/structuredefinition/structuredefinition-notes.xml b/source/structuredefinition/structuredefinition-notes.xml index 25648c0bff5..daccbe535ef 100644 --- a/source/structuredefinition/structuredefinition-notes.xml +++ b/source/structuredefinition/structuredefinition-notes.xml @@ -231,7 +231,7 @@ This technique has many uses: following these rules:

      -
    • The canonical URL of the definition is in some other canonical space than http://hl7.org/fhir
      • +
    • The canonical URL of the definition is in the canonical space http://hl7.org/fhir
    • The fhirVersion SHALL be 6.0.0 or a subsequent published version of FHIR
    • The kind SHALL be resource
    • abstract SHALL be false
      • @@ -252,11 +252,11 @@ Here is an example with other properties removed: 
       {
   "resourceType" : "StructureDefinition",
-  "url" : "http://hl7.org/fhir/uv/sql-on-fhir/StructureDefinition/ViewDefinition",
+  "url" : "http://hl7.org/fhir/StructureDefinition/ViewDefinition",
   "fhirVersion" : "6.0.0",
   "kind" : "resource",
   "abstract" : false,
-  "type" : "http://hl7.org/fhir/uv/sql-on-fhir/StructureDefinition/ViewDefinition",
+  "type" : "http://hl7.org/fhir/StructureDefinition/ViewDefinition",
   "baseDefinition" : "http://hl7.org/fhir/StructureDefinition/CanonicalResource",
   "derivation" : "specialization",
   "differential" : {

From fccaf6629a0cf0355e5166075855a3d13ab2c00a Mon Sep 17 00:00:00 2001
From: Bas van den Heuvel 
Date: Tue, 9 Jun 2026 00:03:12 +0200
Subject: [PATCH 7/9] FHIR-50572: Tighten conformance wording for additional
 resources rule

- Replace must with SHALL in the third Additional Resources rule sentence
- Limit the edit to source/resource/resource-introduction.xml for minimal scope
- Align rule language with ticket-approved normative requirement strength
---
 source/resource/resource-introduction.xml | 2 +-
 1 file changed, 1 insertion(+), 1 deletion(-)

diff --git a/source/resource/resource-introduction.xml b/source/resource/resource-introduction.xml
index beade78de82..15d8aebef5f 100644
--- a/source/resource/resource-introduction.xml
+++ b/source/resource/resource-introduction.xml
@@ -56,7 +56,7 @@ other resources, or find that they need to, the following rules apply:
 
        
  
      • Additional Resources to be used like this SHALL be registered with HL7
        • 
  
      • Unapproved resources SHALL NOT be used
        • 
- 
      • Registered and approved resources are given a name by HL7, and this is the name that must be used for the resource
        • 
+ 
      • Registered and approved resources are given a name by HL7, and this is the name that SHALL be used for the resource
        • 
  
      • All such registered and approved resources SHALL have a publicly available definition using a StructureDefinition
    published as part of an ImplementationGuide, published at the canonical URL. Note that the definitions will be reviewed for quality by HL7 prior to approval
        • 
 
      

From e6349996f033988bec85d86d35513fab01d7c2f8 Mon Sep 17 00:00:00 2001
From: Bas van den Heuvel 
Date: Tue, 9 Jun 2026 00:19:16 +0200
Subject: [PATCH 8/9] FHIR-54000: Update SearchParameter base/target for
 additional resources

- Change SearchParameter.base datatype from code to uri
- Change SearchParameter.target datatype from code to uri
- Bind both elements to ValueSet/extended-resource-types with additional-resource wording
---
 .../structuredefinition-SearchParameter.xml          | 12 ++++++------
 1 file changed, 6 insertions(+), 6 deletions(-)

diff --git a/source/searchparameter/structuredefinition-SearchParameter.xml b/source/searchparameter/structuredefinition-SearchParameter.xml
index e9b0a7c6bd1..81123867e8b 100644
--- a/source/searchparameter/structuredefinition-SearchParameter.xml
+++ b/source/searchparameter/structuredefinition-SearchParameter.xml
@@ -510,7 +510,7 @@
 			
 			
 			
-				
+				
 			
 			
 			
@@ -518,8 +518,8 @@
 					
 				
 				
-				
-				
+				
+				
 				
 				  
 					
@@ -601,15 +601,15 @@
 			
 			
 			
-				
+				
 			
 			
 				
 					
 				
 				
-				
-				
+				
+				
 				
 				  
 					

From b5e146cbc9b74edddcbfc0da45b2a302f85326ff Mon Sep 17 00:00:00 2001
From: Bas van den Heuvel 
Date: Tue, 9 Jun 2026 01:01:53 +0200
Subject: [PATCH 9/9] Update SearchParameter base type to Patient and change
 type from token to uri

---
 .../searchparameter/bundle-SearchParameter-search-params.xml  | 4 ++--
 source/searchparameter/searchparameter-example.xml            | 2 +-
 source/searchparameter/searchparameter-filter.xml             | 2 +-
 3 files changed, 4 insertions(+), 4 deletions(-)

diff --git a/source/searchparameter/bundle-SearchParameter-search-params.xml b/source/searchparameter/bundle-SearchParameter-search-params.xml
index 5595f9c2093..2fd6d519104 100644
--- a/source/searchparameter/bundle-SearchParameter-search-params.xml
+++ b/source/searchparameter/bundle-SearchParameter-search-params.xml
@@ -15,7 +15,7 @@
         
         
         
-        
+        
         
         
       
@@ -348,7 +348,7 @@
         
         
         
-        
+        
         
         
       
diff --git a/source/searchparameter/searchparameter-example.xml b/source/searchparameter/searchparameter-example.xml
index 77522754470..21f231e9f6d 100644
--- a/source/searchparameter/searchparameter-example.xml
+++ b/source/searchparameter/searchparameter-example.xml
@@ -41,7 +41,7 @@
   
   
   
-  
+  
   
   
   
diff --git a/source/searchparameter/searchparameter-filter.xml b/source/searchparameter/searchparameter-filter.xml
index 5570c6246d1..4359f4c9225 100644
--- a/source/searchparameter/searchparameter-filter.xml
+++ b/source/searchparameter/searchparameter-filter.xml
@@ -20,6 +20,6 @@
   
   
   
-  
+  
   
 
\ No newline at end of file