The mandatory search parameter section for MedicationRequest has this requirement:

SHALL support searching using the combination of the patient and intent search parameters:

• including support for composite OR search on intent (e.g.intent={system|}[code],{system|}[code],...)

The composite OR requirement for intent imposes an indirect requirement that any compliant server must support MedicationRequest resources that have different intents.   (Inferno requires that resources with different intent values be returned in order to validate that the server supports composite OR).

A server that only supports a single value for intent (e.g. "order") can never by compliant.

I recommend we make the composite OR requirement optional.  I reviewed all the profiles in US Core 4.0.0, and the only resources that have a non-optional composite OR in a SHALL mandatory search are MedicationRequest.intent and CareTeam.status.

We already got a CCG clarification from ONC that we didn't need to handle CareTeam.status (since there isn't a requirement that more than one CareTeam ever be supported).  I'm submitting another clarification request for MedicationRequest.intent, but I think we probably want to address this implicit requirement in US Core directly as well.