Modify QI-Core ServiceNotRequested as follows (to align with US Core and to address element usage in existing measures). Note, all items identified as KEEP in this table should have MS flags only if they exist in the US Core ServiceRequest (and therefore the FHIR-41483 QI-Core Service Request version 6.0 proposed profile; other items listed as KEEP should appear in the QI-Core Key Elements table for ServiceNotRequested but NOT include a MS flag: QI-Core Profile-based path Action Include in QI-Core 6.0 Justification QICoreServiceNotRequested.authoredOn Keep YES Consistent with QI-Core ServiceRequest updates suggested in  FHIR-41483 QICoreServiceNotRequested.code Keep YES Consistent with QI-Core ServiceRequest updates suggested in  FHIR-41483 QICoreServiceNotRequested.intent Keep YES Consistent with QI-Core ServiceRequest updates suggested in  FHIR-41483 QICoreServiceNotRequested.status Keep YES Consistent with QI-Core ServiceRequest updates suggested in  FHIR-41483 QICoreServiceNotRequested. reasonCode Keep YES  Present in US Core Key Element Table but with cardinality of 0..{ } { } However, QICoreServiceNotRequested uses the extension *QICoreServiceNotRequested.extension: reasonRefused for the reaon. Therefore, the element should be present with cardinality of 0.. * Hence, need to retain the element in QICoreServiceNotRequested Key Element Table with the binding suggested in  with the same cardinality of 0..{ } {*} AND the Pattern for ServiceNotRequested should NOT contain ServiceNot.Requested.reasonCode    [ value set binding details: US Core has extensible binding to  US Core Condition Codes . The QI-Core Key Element table reference to reasonCode has an example binding to  ProcedureReasonCodes . Suggest CHANGE to retain US Core Condition Code extensible binding.] QICoreServiceNotRequested.extension: reasonRefused Keep YES Required in existing CMS program measures QICoreServiceNotRequested. approachBodyStructure (extension) Remove NO Not in use and not addressed in US Core QICoreServiceNotRequested. appropriatenessScore (extension) Remove NO Not in use and not addressed in US Core. Originally intended to address orders by adding the RAND appropriateness score to address CMS rules for specific procedures (imaging) QICoreServiceNotRequested.  Slices for modifierExtension Remove NO Not addressed in US Core and since the existing 2 extensions are to be removed from QI-Core, no longer needed. Inherit US Core 6.0  modifierExtension QICoreServiceNotRequested. modifierExtension:isElective Remove NO Not addressed in US Core and since the existing 2 extensions are to be removed from QI-Core, no longer needed QICoreServiceNotRequested.  Slices for category Keep YES Identical to US Core including category:USCore QICoreServiceNotRequested. doNotPerform Keep YES (Fixed value = True) Keep with fixed value = true - accommodates disjoint QICoreServiceNotRequested (also in Key Element table for US Core without constraint to fixed value) QICoreServiceNotRequested. subject Keep YES (reference QICorePatient) Same as US Core except references QICorePatient rather than USCorePatient, retain reference to QICorePatient QICoreServiceNotRequested. encounter Remove NO Not in US Core Key Element table and not used in existing measures QICoreServiceNotRequested. occurrence[x] Keep YES Present in US Core Key Element table; however, US Core lists only Occurence.period. Therefore, align directly with US Core and only list Occurrence.period in Key Element Table (I.e., not list OccurrenceDateTime or OccurrenceTiming). Rationale - not used.  NOTE - Definition of Occurrence is time when event should occur so it does not address the time the ServiceRequest was created. QICoreServiceNotRequested. asNeeded[x] Remove NO Not in US Core Key Element table and not used in existing measures. Definition: A coded concept identifying the pre-condition that should hold prior to performing a procedure. For example "pain", "on flare-up", etc. QICoreServiceNotRequested. requester Keep YES Same as US Core QICoreServiceNotRequested. performer Remove NO Not in US Core Key Element table and not used in existing measures. Definition: Requested performer ---- was initially included in QICore to address attribution but not in use. QICoreServiceNotRequested. reasonReference Keep YES (QI-Core references  QICore Condition Encounter Diagnosis  and  QICore Condition Problems Health Concerns ) Present in US Core Key Element Table.  Delta is the US Core References include Condition, Observation, DiagnosticReport, DocumentReference (Note, these are not referencing US Core profiles for  any  of these referenced items). QI-Core references  QICore Condition Encounter Diagnosis  and  QICore Condition Problems Health Concerns .  Suggest retain the existing QI-Core references rather than those listed in the US Core 6.1.0 profile especially since their references are to base FHIR resources. QICoreServiceNotRequested. specimen Remove NO Not in US Core Key Element table and not used in existing measures.  QICoreServiceNotRequested. bodySite Remove NO Not in US Core Key Element table and not used in existing measures.