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\[%settitle Version History%\] \[%file newheader%\] \[%file newnavbar%\]

### Version History since DSTU #1

| Responsible Owner: [FHIR Infrastructure](http://www.hl7.org/Special/committees/fiwg/index.cfm) Work Group | [Standards Status](versions#std-process): [Informative](versions#std-process) |
| --- | --- |

For background to this version history, see [FHIR Version Management Policy](versions).

Major Milestones:

| [5.0.0](http://hl7.org/fhir/R5/index.html) | Mar 26, 2023 | Release 5 (Trial use - see below for discussion) |
| --- | --- | --- |
| [4.3.0](http://hl7.org/fhir/R4B/index.html) | Dec 27, 2018 | Release 4B: Staging release of modifications in specific areas |
| [4.0.1](http://hl7.org/fhir/R4/index.html) | Dec 27, 2018 | Release 4 (1st Normative Content + Trial Use Developments) |
| [3.0.2](http://hl7.org/fhir/STU3/index.html) | Feb 21, 2017 | Release 3 (STU - Standard for Trial Use) |
| [1.0.2](http://hl7.org/fhir/DSTU2/index.html) | Oct 24, 2015 | DSTU2 (Second Draft Standard for Trial Use) |
| [0.0.82](http://hl7.org/fhir/DSTU2/index.html) | Sept 30, 2014 | DSTU1 (First Draft Standard for Trial Use) |

| **Version** | **Changes** |
| --- | --- |
| 6.0.0-ballot4 | 
R6 1st Normative Ballot. Significant changes:

-   Move a [set of definitions](ballot-intro#details) out to be [Additional Resources](resource#additional)
-   [Dosage Types](dosage): Rework to handle complex dosing regimes
-   [Signatures](signatures): Rework the way signing works
-   Extensive minor changes across the entire specification
-   Change the status of everything to normative now, except for explicitly marked informative pages

 |
| 6.0.0-ballot3 | 

R6 3rd Draft Ballot. Significant changes:

-   [Additional Resources](resource#additional): Allowing for development of FHIR Resources in other specifications
-   [Group](group): Allowing for groups to act collectively, or receive care collectively - change made based on feedback from LMICs countries, and also for social care
-   New data types: [RelativeTime](datatypes#relativetime)
-   New Resources: [DeviceAlert](devicealert), [InsuranceProduct](insuranceproduct), [MolecularDefinition](https://build.fhir.org/ig/HL7/cg-incubator/StructureDefinition-MolecularDefinition.html), [PersonalRelationship](https://build.fhir.org/ig/HL7/admin-incubator/StructureDefinition-PersonalRelationship.html)
-   Removed Resources: EvidenceReport
-   Significant changes have been made to the [Vital Signs Profiles](observation-vitalsigns), and the profile [Medical Product of Human Origin](medicalproductofhumanorigin) profile has been added
-   The following resources have been updated: [ResearchStudy](researchstudy), [ResearchSubject](researchsubject), [Measure](measure), [MeasureReport](measurereport), [ServiceRequest](servicerequest), [Task](task), [Specimen](specimen), [Observation](observation), [DiagnosticReport](diagnosticreport), [Device](device), [DeviceAssociation](deviceassociation), [DeviceDefinition](devicedefinition), [DeviceMetric](devicemetric), [DeviceAlert](devicealert), [NutritionProduct](nutritionproduct), [NutritionIntake](nutritionintake), [NutritionOrder](nutritionorder), [BiologicallyDerivedProduct](biologicallyderivedproduct), [BiologicallyDerivedProductDispense](https://build.fhir.org/ig/HL7/oo-incubator/StructureDefinition-BiologicallyDerivedProductDispense.html), [SupplyDelivery](https://build.fhir.org/ig/HL7/oo-incubator/StructureDefinition-SupplyDelivery.html), [SupplyRequest](https://build.fhir.org/ig/HL7/oo-incubator/StructureDefinition-SupplyRequest.html), [DocumentReference](documentreference)
-   The following Module Pages have been added or updated: [Diagnostics](diagnostics-module), [Device](device-module), [Nutrition](nutrition-module), [BDP](biologically-derived-product-module)

 |
| 6.0.0-ballot2 | Version Information was not generated for this release |
| 6.0.0-ballot1 | Version Information was not generated for this release |
| 5.0.0 | 

**R5 Milestone**. This version has cumulatively made 1000s of changes from the R4+R4B milestones ([3969 change requests](https://jira.hl7.org/browse/FHIR-5507?filter=19551), including [1840 substantive changes](https://jira.hl7.org/browse/FHIR-7612?filter=19552)). Most of the changes are in response to implementation feedback. There is no comprehensive list, but here is a list of the more significant changes:

-   Complete Rework [Subscriptions framework](subscriptions)
-   Rework the abstract datatypes (new types [Base](types#Base), [DataType](types#DataType), [BackboneType](types#BackboneType)), and introduce [CanonicalResource](canonicalresource) and [MetadataResource](metadataresource) interfaces
-   All the extensions have been moved to a new package `hl7.fhir.uv.extensions` published at [http://hl7.org/fhir/extensions](http://hl7.org/fhir/extensions). They are still published as part of this specification, but they will be released more often
-   A number of clarifications have been made on the [RESTful API](http) and [Search](search) pages, that have resulted in the introduction of new **SHALL** and **SHOULD** conformance statements. Though the new SHALL statements are believed to be clarifications, implementers should review these pages carefully and particularly should note the clarifications around the use of GET/POST on search, and the new SHOULD requirement for clients about timezones
-   New resources: [ActorDefinition](actordefinition), [ArtifactAssessment](artifactassessment), [BiologicallyDerivedProductDispense](https://build.fhir.org/ig/HL7/oo-incubator/StructureDefinition-BiologicallyDerivedProductDispense.html), [ConditionDefinition](https://build.fhir.org/ig/HL7/pc-incubator/StructureDefinition-ConditionDefinition.html), [DeviceAssociation](deviceassociation), [DeviceDispense](https://build.fhir.org/ig/HL7/oo-incubator/StructureDefinition-DeviceDispense.html), [EncounterHistory](https://build.fhir.org/ig/HL7/admin-incubator/StructureDefinition-EncounterHistory.html), [FormularyItem](https://build.fhir.org/ig/HL7/phx-incubator/StructureDefinition-FormularyItem), [GenomicStudy](https://build.fhir.org/ig/HL7/cg-incubator/StructureDefinition-GenomicStudy.html), [ImagingSelection](imagingselection), [InventoryItem](https://build.fhir.org/ig/HL7/oo-incubator/StructureDefinition-InventoryItem.html), [InventoryReport](https://build.fhir.org/ig/HL7/oo-incubator/StructureDefinition-InventoryReport.html), [NutritionIntake](nutritionintake), [NutritionProduct](nutritionproduct), [Permission](https://build.fhir.org/ig/HL7/data-access-policies/StructureDefinition-Permission.html), TestPlan and [Transport](https://build.fhir.org/ig/HL7/oo-incubator/StructureDefinition-Transport.html) + New types: [integer64](datatypes#integer64), [Availability](metadatatypes#Availability) and [ExtendedContactDetail](metadatatypes#ExtendedContactDetail)
-   Renamed resources `DeviceUseStatement` -> [DeviceUsage](https://build.fhir.org/ig/HL7/oo-incubator/StructureDefinition-DeviceUsage.html) and `RequestGroup` -> [RequestOrchestration](requestorchestration)
-   Removed resources CatalogEntry ([R4B](http://hl7.org/fhir/R4B/catalogentry.html)), DocumentManifest ([R4B](http://hl7.org/fhir/R4B/documentmanifest.html)) (use \[\[%List%\]\]), Media ([R4B](http://hl7.org/fhir/R4B/media.html)) (use \[\[%DocumentReference%\]\] or \[\[%Observation%\]\]), EffectEvidenceSynthesis ([R4](http://hl7.org/fhir/R4/effectevidencesynthesis.html)), ResearchDefinition ([R4B](http://hl7.org/fhir/R4B/researchdefinition.html)), ResearchElementDefinition ([R4B](http://hl7.org/fhir/R4B/researchelementdefinition.html)), RiskEvidenceSynthesis ([R4](http://hl7.org/fhir/R4/riskevidencesynthesis.html)), and the type Contributor ([R4B](http://hl7.org/fhir/R4B/metadatatypes.html#Contributor))
-   For the Medication Definition resources, the changes are more complicated:
    -   Renamed in R4B: MedicinalProduct -> \[\[%MedicinalProductDefinition%\]\], MedicinalProductAuthorization -> \[\[%RegulatedAuthorization%\]\], MedicinalProductIngredient -> \[\[%Ingredient%\]\], MedicinalProductManufactured -> \[\[%ManufacturedItemDefinition%\]\], MedicinalProductPackaged -> \[\[%PackagedProductDefinition%\]\], MedicinalProductPharmaceutical -> \[\[%AdministrableProductDefinition%\]\], SubstanceSpecification -> \[\[%SubstanceDefinition%\]\]
    -   Collapsed into \[\[%ClinicalUseDefinition%\]\] in R4B: MedicinalProductContraindication, MedicinalProductIndication, MedicinalProductInteraction, MedicinalProductUndesirableEffect
    -   Removed in R4B: types ProdCharacteristic and SubstanceAmount
    -   Omitted from R4B due to limited scope: SubstanceNucleicAcid, SubstancePolymer, SubstanceProtein, SubstanceReferenceInformation, SubstanceSourceMaterial
-   Moved many code systems and value sets to [terminology.hl7.org](http://terminology.hl7.org)
-   Added [Operations for Large Resources](operations-for-large-resources)
-   Added the ability to define [additional bindings](terminologies#additional) on elements
-   Documented [FHIR NPM Packages](packages)
-   Changes to [reliable messaging](messaging#async) (which identifier elements are used)

**About Normative content in the R5 release**

The 5th Major release of the FHIR specification is labeled as 'trial-use' because the entire ballot cycle that led to this release was performed under the HL7 STU (Standard for Trial Use). None of the content in this specification is considered ["Normative"](versions#normative), but the content that was previously normative in [Release 4](http://hl7.org/fhir/R4/index.html) is still labelled as Normative to preserve the status through the publication and implementation of this release.

A few new artifacts (such as [CanonicalResource](canonicalresource)) are labelled as Normative because they were created by moving existing normative content to a new type.

 |
| 5.0.0-draft-final | R5 Draft: Final QA Version (for internal review by HL7). |
| 5.0.0-snapshot3 | R5 Snapshot 3 - Connectathon 32 Base. This stable version for the connectathon and final publication preparation has many changes since the ballot. Some particularly significant changes:

-   Add [Obligations](obligations) and [Additional Bindings](terminologies#additional) for finer grained control over application behavior

 |
| 5.0.0-ballot | R5 Ballot - Sept/Oct 2022 Ballot. This ballot has 1000s of changes. Some particularly significant changes:

-   Change the way version numbering works
-   New Resources: [Transport](https://build.fhir.org/ig/HL7/oo-incubator/StructureDefinition-Transport.html), [NutritionIntake](nutritionintake), [ActorDefinition](actordefinition), [Requirements](requirements), [GenomicStudy](https://build.fhir.org/ig/HL7/cg-incubator/StructureDefinition-GenomicStudy.html) and [FormularyItem](https://build.fhir.org/ig/HL7/phx-incubator/StructureDefinition-FormularyItem)
-   New Data Types: [Availability](metadatatypes#Availability), [ExtendedContactDetail](metadatatypes#ExtendedContactDetail), [MonetaryComponent](metadatatypes#MonetaryComponent) and [VirtualServiceDetail](metadatatypes#VirtualServiceDetail)
-   Complete Rework [Subscriptions framework](subscriptions)
-   Hundreds of clarifications, technical corrections etc.
-   [3157 change requests](https://jira.hl7.org/browse/FHIR-5507?filter=19551) were applied to R5, of which [1486 changes](https://jira.hl7.org/browse/FHIR-7612?filter=19552) were considered substantive.

 |
| 4.6.0 | Draft Ballot for R5 - May 2021 Ballot (Apr 14-20 2021). Significant changes:

-   Add [RatioRange](datatypes#RatioRange) datatype
-   Rename DeviceUseStatement to [DeviceUsage](https://build.fhir.org/ig/HL7/oo-incubator/StructureDefinition-DeviceUsage.html)
-   New resources [InventoryReport](https://build.fhir.org/ig/HL7/oo-incubator/StructureDefinition-InventoryReport.html), [Citation](https://build.fhir.org/ig/HL7/ebm/StructureDefinition-Citation.html), EvidenceReport, and ClinicalUseIssue
-   Updates for [subscriptions](subscription), [medication definitions](medication-definition-module), and [evidence based medicine](evidence)
-   Ongoing development of other resources

 |
| 4.5.0 | 3rd Milestone for R5 - September 2020 Virtual Connectathon Stable Version (Aug-20 2020). Significant changes:

-   Ongoing development of less mature resources
-   Finish removing content moved to http://terminology.hl7.org

 |
| 4.4.0 | 2nd Milestone for R5 - May 2020 Virtual Connectathon Stable Version. Significant changes:

-   Further Development of the Subscription framework ([SubjectStatus](subscriptionstatus), rename Topic to SubscriptionTopic)
-   Add new Resources [Permission](https://build.fhir.org/ig/HL7/data-access-policies/StructureDefinition-Permission.html), [NutritionProduct](nutritionproduct), [Citation](https://build.fhir.org/ig/HL7/ebm/StructureDefinition-Citation.html), and EvidenceReport

 |
| 4.3.0 | 

**Release R4B**: May 28, 2022:

-   Though the changes listed here seem quite extensive, they are limited to particular areas of the specification. See the [explanation about R4B](http://hl7.org/fhir/R4B/r4b-explanation.html) for further details
-   Add [CodeableReference](references#codeablereference) and [RatioRange](datatypes#RatioRange) types
-   Add [NutritionProduct](nutritionproduct "A food or fluid product that is consumed by patients.") Resource
-   Add [SubscriptionStatus](subscriptionstatus "The SubscriptionStatus resource describes the state of a Subscription during notifications.") and [SubscriptionTopic](subscriptiontopic "Describes a stream of resource state changes identified by trigger criteria and annotated with labels useful to filter projections from this topic.") Resources
-   Add new Resources [AdministrableProductDefinition](administrableproductdefinition "A medicinal product in the final form which is suitable for administering to a patient (after any mixing of multiple components, dissolution etc. has been performed)."), [ClinicalUseDefinition](clinicalusedefinition "A single issue - either an indication, contraindication, interaction or an undesirable effect for a medicinal product, medication, device or procedure."), [PackagedProductDefinition](packagedproductdefinition "A medically related item or items, in a container or package."), [ManufacturedItemDefinition](manufactureditemdefinition "The definition and characteristics of a medicinal manufactured item, such as a tablet or capsule, as contained in a packaged medicinal product.") and [RegulatedAuthorization](regulatedauthorization "Regulatory approval, clearance or licencing related to a regulated product, treatment, facility or activity that is cited in a guidance, regulation, rule or legislative act. An example is Market Authorization relating to a Medicinal Product.")
-   Rework [MarketingStatus](marketingstatus) (relax cardinality constraints) and [ProductShelfLife](productshelflife) Types
-   Rework & rename MedicinalProduct -> [MedicinalProductDefinition](medicinalproductdefinition "Detailed definition of a medicinal product, typically for uses other than direct patient care (e.g., regulatory use, drug catalogs, to support prescribing, adverse events management etc.).")
-   Rework & rename MedicinalProductIngredient -> [Ingredient](ingredient "An ingredient of a manufactured item or pharmaceutical product.")
-   Rework & rename SubstanceSpecification -> [SubstanceDefinition](substancedefinition "The detailed description of a substance, typically at a level beyond what is used for prescribing.")
-   Rework [Evidence](evidence "The Evidence Resource provides a machine-interpretable expression of an evidence concept including the evidence variables (eg population, exposures/interventions, comparators, outcomes, measured variables, confounding variables), the statistics, and the certainty of this evidence.") and [EvidenceVariable](evidencevariable "The EvidenceVariable resource describes an element that knowledge (Evidence) is about.") Resources
-   Add [Citation](https://build.fhir.org/ig/HL7/ebm/StructureDefinition-Citation.html "The Citation Resource enables reference to any knowledge artifact for purposes of identification and attribution. The Citation Resource supports existing reference structures and developing publication practices such as versioning, expressing complex contributorship roles, and referencing computable resources.") and EvidenceReport Resources
-   Remove EffectEvidenceSynthesis and RiskEvidenceSynthesis Resources
-   Add canonical as an allowed type for `subject[x]` to [ActivityDefinition](activitydefinition "This resource allows for the definition of some activity to be performed, independent of a particular patient, practitioner, or other performance context.") and [PlanDefinition](plandefinition "This resource allows for the definition of various types of plans as a sharable, consumable, and executable artifact. The resource is general enough to support the description of a broad range of clinical and non-clinical artifacts such as clinical decision support rules, order sets, protocols, and drug quality specifications.")
-   Remove MedicinalProductAuthorization, MedicinalProductContraindication, MedicinalProductIndication, MedicinalProductInteraction, MedicinalproductManufactured, MedicinalproductPackaged, MedicinalproductPharmaceutical, MedicinalproductUndesirableEffect, SubstanceAmount, SubstanceNucleicAcid, SubstancePolymer, SubstanceProtein, SubstanceReferenceInformation and SubstanceSourceMaterial resources
-   Refine some invariants that behaved erroneously with missing data (no new restrictions were introduced)

Note that Release 4B was a derivative of Release 4. Release 5 is a direct development from Release 4, with many of the changes found in Release 4B incorporated and further developed.

 |
| 4.2.0 | 1st Milestone for R5 - Sydney Connectathon Stable Version. Significant changes:

-   Rework the abstact datatypes (new types [Base](types#Base), [DataType](types#DataType), [BackboneType](types#BackboneType)), and introduce [CanonicalResource](canonicalresource) and [MetadataResource](metadataresource) interfaces
-   Major upgrade to [Subscription](subscription) resource and the pub/sub patterns

 |
| 4.1.0 | Current build after 4.1.0 release |
| 4.0.1 | 

**Release 4**: Dec 27, 2018. First Normative content, with many significant changes

Note that between R3 and R4, nearly 3000 change proposals were applied to the specification, including >1000 substantive changes, of which 339 were labeled 'non-compatible'. As such, providing a comprehensive list of changes between specifications is not appropriate. To help see and understand the differences between the specification releases, implementers can:

-   consult the [R3/R4 difference analysis](diff)
-   review (or use) the R3/R4 transforms
-   Use the ![](compare-to-r3.png) link at the foot of every page

To help implementers, the more significant changes are listed here:

-   Some content marked Normative using [N](versions#std-process "Normative Content") - see [Documentation](documentation) and [Resource](resourcelist) indexes. The meaning of normative is described at length in the [Rules for Inter-version change](versions#change).
-   New Resources:
    -   [BiologicallyDerivedProduct](biologicallyderivedproduct)
    -   [ChargeItemDefinition](https://build.fhir.org/ig/HL7/admin-incubator/StructureDefinition-ChargeItemDefinition.html)
    -   [DeviceDefinition](devicedefinition)
    -   EffectEvidenceSynthesis
    -   [EventDefinition](eventdefinition)
    -   [Evidence](evidence)
    -   [EvidenceVariable](evidencevariable)
    -   [ExampleScenario](examplescenario)
    -   [ImmunizationEvaluation](https://build.fhir.org/ig/HL7/immunization-incubator/en/StructureDefinition-ImmunizationEvaluation.html)
    -   [InsurancePlan](insuranceplan)
    -   [Invoice](invoice)
    -   MedicationKnowledge
    -   MedicinalProduct
    -   MedicinalProductAuthorization
    -   MedicinalProductContraindication
    -   MedicinalProductIndication
    -   MedicinalProductIngredient
    -   MedicinalProductInteraction
    -   MedicinalProductManufactured
    -   MedicinalProductPackaged
    -   MedicinalProductPharmaceutical
    -   MedicinalProductUndesirableEffect
    -   [ObservationDefinition](observationdefinition)
    -   [OrganizationAffiliation](organizationaffiliation)
    -   ResearchDefinition
    -   ResearchElementDefinition
    -   RiskEvidenceSynthesis
    -   [SpecimenDefinition](specimendefinition)
    -   SubstancePolymer
    -   SubstanceReferenceInformation
    -   SubstanceSpecification
    -   [TerminologyCapabilities](terminologycapabilities)
    -   [VerificationResult](https://build.fhir.org/ig/HL7/admin-incubator/StructureDefinition-VerificationResult.html)
-   Renamed Resources:
    -   `BodySite` -> [BodyStructure](bodystructure)
    -   `EligibilityRequest` -> [CoverageEligibilityRequest](coverageeligibilityrequest)
    -   `EligibilityResponse` -> [CoverageEligibilityResponse](coverageeligibilityresponse)
    -   `Sequence` -> MolecularSequence
    -   `ReferralRequest` & `ProcedureRequest` -> [ServiceRequest](servicerequest)
-   Deleted Resources:
    -   `DeviceComponent`
    -   `ImagingManifest`
-   Clarification of the meaning and use of [IsModifier](conformance-rules#isModifier)
-   Considerable development of the [Version Management Policy](versions#versions), and support for [multiple FHIR versions](versioning) (specifically, the [FHIR Version parameter](http#version-parameter))
-   Datatypes: Rework [Money](datatypes#Money) (no longer a constraint on [Quantity](datatypes#Quantity)), and add [Expression](metadatatypes#Expression)

 |
| 3.6.0 | Current build after 3.5.0 release |
| 3.5.0 | 

**Release R4 Ballot #1**: Sept 20, 2018. R4 ballot #2

Major changes from R4 Ballot 1 (3.3.0):

| **Description** | **Committee + Tasks** | **Pages** |
| --- | --- | --- |
| **All Ballots** |
| Change the canonical URL for all v2 and v3 CodeSystems and ValueSets (and some FHIR ones too), to  
`http://terminology.hl7.org` (from the Unified Terminology Process) **Breaking change!** | (no task: Vocab committee decision) | todo |
| **Normative / Infrastructure** |
| Added reference.type | FHIR-I: \[%GF#13543%\] | \[%diff references.html#type References between Resources%\] |
| Clarify definition of is-modifier + impacts on modifier extensions. Note: this lead to **breaking changes**  
on a few extensions (changed from modifierExtension to normal extension) | FHIR-I: \[%GF#16188%\] | \[%diff conformance-rules.html Conformance Rules%\], \[%diff extensibility.html#modifiers Extensibility%\] |
| Add mode parameter to /metadata | FHIR-I: \[%GF#14444%\] | \[%diff http.html RESTful API%\] |
| Enhance/extend rules around changes between versions | FHIR-I: \[%GF#13089%\] | \[%diff versions.html#rules Version Management Policy%\] |
| Add fhirVersion parameter to application/fhir mime type | FHIR-I: \[%GF#16165%\] | \[%diff http.html#version-parameter RESTful API%\] |
| Add the $versions operation | FHIR-I: \[%GF#17009%\] | \[%diff capabilitystatement-operations.html Capability Statement Operations%\] |
| Allow exponential form for decimals (with corresponding consequences for precision) | FHIR-I: \[%GF#16874%\] | \[%diff datatypes.html#decimal Datatypes%\], \[%diff xml.html#decimal XML%\] |
| Describe use of exponential form when searching numbers (+ clarifications for precision) | FHIR-I: \[%GF#16369%\] | \[%diff search.html#decimal Search%\] |
| Remove support for operations on historical resources **Breaking change!** | FHIR-I: \[%GF#17258%\] | \[%diff operations.html Operations%\] |
| Change Money Type to make it simpler **Breaking change!** | FHIR-I: \[%GF#16297%\] | \[%diff datatypes.html#Money Datatypes%\] |
| Change ElementDefinition.binding.valueSet to only be of type canonical **Breaking change!** | FHIR-I: \[%GF#16055%\] | \[%diff elementdefinition.html Element Definition%\] |
| Remove restriction on Bundle containing multiple versions of the same resource **Breaking change!** | FHIR-I: \[%GF#17085%\] | \[%diff bundle.html Bundle%\] |
| Rename Binary.content to Binary.data and exclude it from summary (which makes it optional) **Breaking change!** | FHIR-I: \[%GF#16998%\], \[%GF#16898%\] | \[%diff binary.html Binary Resource%\] |
| **Normative / Conformance + Terminology** |
| Remove ValueSet.$expand profile parameter, and add parameters from ExpansionProfile **Breaking change!** | Vocab: \[%GF#16337%\] & \[%GF#16490%\] | \[%diff valueset-operation-expand.html ValueSet.$expand%\] |
| Remove ValueSet.$expand.limitedExpansion parameter, and document how to use count instead **Breaking change!** | Vocab: \[%GF#16449%\] | \[%diff valueset-operation-expand.html ValueSet $expand operation%\] |
| Move ValueSet.extensible to an extension | Vocab: \[%GF#16427%\] | \[%diff valueset.html ValueSet%\] |
| Add [CapabilityStatement.implementation.custodian](capabilitystatement-definitions#CapabilityStatement.implementation.custodian) | FHIR-I: \[%GF#16342%\] | \[%diff capabilitystatement.html CapabilityStatement%\] |
| Add CapabilityStatement.imports | FHIR-I: \[%GF#14299%\] | \[%diff capabilitystatement.html CapabilityStatement%\] |
| **Normative / Observation** |
| Update definition of `subject` and add note [safety page](safety) the `focus` element | OO: \[%GF#16136%\] | \[%diff observation.html Observation%\] |
| Changed cardinality of `Observation.interpretation` and  
`Observation.component.interpretation` from 0..1 to 0..\* | OO: \[%GF#16231%\] | \[%diff observation.html Observation%\] |
| Changed `Observation.context` to `Observation.encounter` with type `Reference(Encounter)`. **Breaking change!** | OO: \[%GF#17661%\] | \[%diff observation.html Observation%\] |

**This is only the major changes**. More comprehensive lists can be found in the ballot introduction (later removed).

Major changes in the other parts of the specification:

-   New Resources: MedicationKnowledge, [DeviceDefinition](devicedefinition), [ChargeItemDefinition](https://build.fhir.org/ig/HL7/admin-incubator/StructureDefinition-ChargeItemDefinition.html)
-   Renamed Resources: `OrgnizationRole` to [OrganizationAffiliation](organizationaffiliation), `EligibilityRequest` to [CoverageEligibilityRequest](coverageeligibilityrequest), `EligibilityResponse` to [CoverageEligibilityResponse](coverageeligibilityresponse), and `ProductPlan` to [InsurancePlan](insuranceplan)
-   Significant rework around devices - in the [Device](device) resource, remove `DeviceComponent` + new resource [DeviceDefinition](devicedefinition)
-   Update maps/diffs to R3 (see [note](#maps) above)
-   New page listing [best practices](best-practices)
-   A sweeping change to code system and value set URLs to align with new terminology infrastructure
-   Add [information](versioning) and [operations](capabilitystatement-operation-versions) related to supporting multiple versions of FHIR
-   Rewrite [Asynchronous Pattern Operation](async)
-   New [security notes](security) about suggested best practices, and new [safety notes](safety) about deleting records
-   Lots of changes to [Financial Resources](financial-module) (especially [Contract](contract))

 |
| 3.4.0 | Current build after 3.3.0 release |
| 3.3.0 | 

**Release R4 Ballot #1**: Apr 3, 2018. R4 ballot #1. Major changes from R3:

-   Mark all content with a standards status - Normative, Trial use, Draft, or external
-   Many minor & major changes to datatypes, resources, operations
-   New Resources: [BiologicallyDerivedProduct](biologicallyderivedproduct), [EventDefinition](eventdefinition), [ExampleScenario](examplescenario), [ImmunizationEvaluation](https://build.fhir.org/ig/HL7/immunization-incubator/en/StructureDefinition-ImmunizationEvaluation.html), [Invoice](invoice), ItemInstance, [ObservationDefinition](observationdefinition), OccupationalData, [OrganizationAffiliation](organizationaffiliation), [SpecimenDefinition](specimendefinition), [TerminologyCapabilities](terminologycapabilities), UserSession and [VerificationResult](https://build.fhir.org/ig/HL7/admin-incubator/StructureDefinition-VerificationResult.html), and a new set of resources for medication knowledge management: MedicinalProduct, MedicinalProductAuthorization, MedicinalProductClinicals, MedicinalProductDeviceSpec, MedicinalProductIngredient, MedicinalProductPackaged, MedicinalProductPharmaceutical, [InsurancePlan](insuranceplan), SubstancePolymer, SubstanceReferenceInformation and SubstanceSpecification.
-   Renamed Resources: ProcedureRequest to [ServiceRequest](servicerequest) & BodySite to [BodyStructure](bodystructure)
-   Removed Resources: DataElement, ImagingManifest and ServiceDefinition
-   New Pages: [Asynchronous Use](async), [Persistence/Data bases](storage), [FiveWs Pattern](fivews) and [Multi-language support](languages)

 |
| 3.2.0 | 

**Release R4 Draft**: Dec 21, 2017. R4 draft ballot. Major changes:

-   Ensure that all pages have a standards status, and enforce standards status throughout. Add dependency analysis
-   Many minor changes to datatypes, resources, operations
-   New Resources: [SpecimenDefinition](specimendefinition), [ObservationDefinition](observationdefinition), [ExampleScenario](examplescenario), [TerminologyCapabilities](terminologycapabilities), UserSession, [Invoice](invoice), [InsurancePlan](insuranceplan), OccupationalData, [OrganizationAffiliation](organizationaffiliation), [VerificationResult](https://build.fhir.org/ig/HL7/admin-incubator/StructureDefinition-VerificationResult.html), MedicinalProduct, MedicinalProductAuthorization, MedicinalProductClinicals, MedicinalProductIngredient, MedicinalProductPackaged, MedicinalProductPharmaceutical, MedicinalProductDeviceSpec, SubstanceSpecification, SubstancePolymer, SubstanceReferenceInformation, [BiologicallyDerivedProduct](biologicallyderivedproduct), ItemInstance
-   Add draft support for bulk data ([Asynchronous API](async) + [nd-json format](nd-json))

 |
| 3.1.0 | R4 development begins |
| 3.0.0 | 

**Release 3**: Mar 21, 2017. STU3

This is the full FHIR Release 3 (R3). R3 is a complete overhaul of the specification from R2, with over 2400 change proposals process, and applied in R3. Of those changes, 380+ are labeled as a breaking change. Given this level of change, there is no useful way to present a single change list. Users can use the R2/R3 difference comparison, the R2 <-> R3 transforms, or the "Compare to R2" link at the foot of every page to help visualise the differences between R2 and R3.

Many of the changes made in this release (since 1.8.0) are in response to Quality Assurance processes in HL7, with a goal of readying the specification for Normative processes in R4:

-   Reorder many resources and improve their definitions and bindings (Quality Assurance work)
-   Add draft resources [AdverseEvent](adverseevent) and [GraphDefinition](http://build.fhir.org/HL7/api-incubator/StructureDefinition-GraphDefinition)
-   Change to the [way discriminators work](profiling#discriminator) in profiles (for profile/tooling authors)
-   Finalization of the [Turtle (RDF) format, along with JSON-LD (later removed)](rdf)
-   Consolidation of Version management issues into a single [Version Policy](versions) page, and update to current policy
-   Add [rules about how missing data](search#missing) in search

Roll up: Of all the many changes (thousands) between R2 and R3, these are the most significant:

-   Change the [FHIR mime type](http#mime-type) to application/fhir+xml|json instead of application/xml|json+fhir (**breaking change**, for conformance to W3C+IETF rules)
-   Rename the "Conformance" resource to "[CapabilityStatement](capabilitystatement)" and Deprecate use of the OPTIONS command to retrieve the CapabilityStatement
-   [Search](search) Changes around [errors in search parameters](search#errors), [missing data](search#missing), [sorting](search#sort)
-   Change [HumanName](datatypes#HumanName).family from 0..\* to 0..1
-   [CodeSystem](codesystem) now separated out from [ValueSet](valueset)

 |
| 1.9.0 | 

**FHIR Rolling Build, 2016 Dec onwards**

 |
| 1.8.0 | 

**FHIR QA Release, Dec 6, 2016**

STU 3 Candidate, and also the basis for several implementation guide ballots and the [San Antonio Jan 2017 Connectathon](https://confluence.hl7.org/display/FHIR/Connectathon+14)

**Breaking Changes Summary:**

-   Change [HumanName](datatypes#HumanName).family from 0..\* to 0..1
-   Rename MedicationOrder and DiagnosticOrder to [MedicationRequest](medicationrequest) and DiagnosticRequest and make a series of changes to align with the [Request Pattern](request)
-   Add cross resource search + rework composite parameter expressions
-   Harmonize resource metadata across the Terminology, Conformance, and Knowledge resources
-   Change the way [versioned references to canonical URLs](references#canonical) are handled
-   REST - servers must [return a location header](http#create) on a create
-   [Condition](condition) status elements reworked

These are only the more significant changes, there were many 100s of changes made in response to ballot comments and ongoing implementation experience. These include breaking changes to may resources. Structural changes are [summarized here](diff), and `Transforms between DSTU 2 and STU 3` are provided for many resources.

 |
| 1.6.0 | 

**FHIR STU3 ballot, Aug 11, 2016**

STU 3 ballot version, and also the basis for the [Baltimore Sept 2016 Connectathon](https://confluence.hl7.org/display/FHIR/Connectathon+13)

**Publication Changes:**

-   Move the US Realm implementation guides out of the specification (see [http://www.fhir.org/guides/registry](http://www.fhir.org/guides/registry))
-   Rework the home page, and introduce modules as a way to navigate the specification + add significant new implementer advice (e.g., "[Getting Started](modules)")
-   Change the Navigation menu to focus on indexes to the content in the specification
-   Move FHIRPath expression language to its [long term home](http://hl7.org/fhirpath)

**Technical Changes:**

-   RESTful API
    -   Change the [FHIR mime type](http#mime-type) to application/fhir+xml|json instead of application/xml|json+fhir (**breaking change**, for conformance to W3C+IETF rules)
    -   Add new uses for the Prefer header (return OperationOutcome, and manage behavior related to unknown / unsupported search parameters
    -   Deprecate use of the OPTIONS command to retrieve the CapabilityStatement
    -   Add support for conditional references to the transaction interaction
    -   Add reverse chaining
-   Formats: No change to XML + JSON formats. Add [Turtle Format](rdf), and related validation tools
-   For Datatypes and Resources, there is [formal difference](diff) analysis from DSTU2 (also found throughout the specification), and `transforms between DSTU 2 and STU 3` are provided for many resources

 |
| 1.5.0 | 

**FHIR Current Build Update, July 8 2016**

Update current version to 1.5 to prevent confusion with implementations still running the May 2016 version.

-   There are many changes in this version from 1.4.0, but no formal list is provided. A formal list will be provided for 1.6 (as a diff to 1.4)

 |
| 1.4.0 | 

**FHIR Connectathon 12 Snapshot, Mar 30 2016**

Frozen base for Connectathon 12 & For Comment ballots:

-   FHIR API and Serialization Format Enhancement

    -   The [\_sort parameter](search#sort) has been reworked
    -   New or extended search parameters for read, search or history: \_type, \_at, \_summary, \_elements
    -   Change [Turtle representation](rdf) - now ready for trial

-   Conformance resources with significant breaking changes and behavior:
    -   [StructureDefinition](structuredefinition) - Type Handling: Changes to how the structure definition types work: **baseType** _replaces_ **constrainedType** (now type) & **baseDefinition** _replaces_ **base**
    -   [CodeSystem](codesystem) now separated out from [ValueSet](valueset): CodeSystem is now a first class resource type in order to support use throughout the FHIR eco-system, such as to support value set expansion and validation. It is intended to be used for distributing the smaller ad-hoc code systems that are ubiquitously encountered throughout the healthcare process.
-   Other resources with significant breaking changes and behavior:

    -   [AllergyIntolerance](allergyintolerance)
    -   [Appointment](appointment)
    -   [AuditEvent](auditevent)
    -   [Claim](claim)
    -   [ClaimResponse](claimresponse)
    -   [Device](device)
    -   [ConceptMap](conceptmap)
    -   [Conformance](capabilitystatement) (now CapabilityStatement)
    -   [Contract](contract)
    -   [CoverageEligibilityRequest](coverageeligibilityrequest)
    -   [CoverageEligibilityResponse](coverageeligibilityresponse)
    -   [Device](device)
    -   DiagnosticRequest
    -   [ExplanationOfBenefit](explanationofbenefit)
    -   [Library](library)
    -   [Measure](measure)
    -   [Medication](medication)
    -   [MedicationAdministration](medicationadministration)
    -   MedicationStatement
    -   [Observation](observation): the introduction of the Vital Signs Profile (proposed to be mandatory)
    -   [OperationDefinition](operationdefinition)
    -   [Patient](patient)
    -   [PaymentNotice](paymentnotice)
    -   [PaymentReconciliation](paymentreconciliation)
    -   [Practitioner](practitioner)
    -   [Provenance](provenance)
    -   ReferralRequest
    -   [Schedule](schedule)
    -   [Slot](slot)
    -   [StructureDefinition](structuredefinition)
    -   TestScript
    -   [ValueSet](valueset)

-   Add new **draft** resources:
    -   [CareTeam](careteam)
    -   [CodeSystem](codesystem)
    -   [CompartmentDefinition](compartmentdefinition)
    -   [Linkage](https://build.fhir.org/ig/HL7/pc-incubator/StructureDefinition-Linkage.html)
    -   [MeasureReport](measurereport)
    -   [PractitionerRole](practitionerrole)
    -   Protocol
    -   [StructureMap](structuremap)
    -   [Task](task)

 |
| 1.2.0 | 

**FHIR Connectathon 11 Snapshot, Dec 11 2015**

Frozen base for Connectathon 11:

-   Remove GuidanceRequest
-   Add new **draft** resource: ExpansionProfile
-   Modifications to Financial Resource & TestScript resource

Note: this version is temporary, and was removed after Connectathon 11 was complete

 |
| 1.1.0 | 

**GAO Ballot + technical corrections, Dec 2 2015**

A ballot publication for the `GAO Ballot` that also includes:

-   Various technical corrections to the generated snapshots
-   Populate FHIRPath expressions in extensions for all search parameters and invariants
-   Add new **draft** resources: `GuidanceRequest`, [GuidanceResponse](guidanceresponse), `ModuleMetadata`, `ModuleDefinition`, [Library](library), `DecisionSupportServiceModule`, `DecisionSupportRule`, `OrderSet`, [Measure](measure)
-   Major restructure of [Questionnaire](questionnaire)

 |
| 1.0.2 | 

**Technical Correction 1, Oct 24 2015**

A series of technical corrections to the specification following extensive review:

-   Corrections to Extension cardinalities in implementation guides
-   Corrections in the conformance resources that support the specifications
-   Correct several erroneous invariants
-   Various typos, broken links, and fixes in examples
-   For a comprehensive list of corrections, see the [Task list for FHIR DSTU2 Technical Correction 1](https://confluence.hl7.org/display/FHIR/DSTU2+Technical+Correction+1+Tasks)

 |
| 1.0.1 | 

**DSTU 2, Sept 23 2015**

Changes of significance during the QA process:

-   Remove the Clinical Quality Improvement Framework (CQIF) from this published version
-   made fixes to generated schematrons
-   updated generated conformance resources (StructureDefinitions and SearchParameters) so they were consistent with the specification
-   Many spelling / grammar / broken link fixes

 |
| 1.0.0 | 

**DSTU 2 QA Preview, Aug 31 2015**

This version had extensive change as a result of the May 2015 DSTU ballot, ongoing testing, and the open change proposals (1317 tasks). The extent of the changes is best illustrated by the number of the [list of changes labeled 'breaking change'](https://confluence.hl7.org/display/FHIR/DSTU2+Ballot+to+Final+breaking+changes) - 158 changes of 1317 total tasks. Below is a list of the most important changes:

-   General: introduced the [maturity framework](versions#maturity)
-   [RESTful API](http): add batch, several clarifications around versioning & transactional integrity, changed Bundle URL resolution rules
-   [Search](search): changed the way <> etc.works, added \_list parameter, changed rules around contained and included resources
-   Formats: added a [note about whitespace in XML](xml), added [code generation schemas](xml#schema-gen)
-   Datatypes:
    -   New datatypes: [markdown](datatypes#markdown), [Annotation](datatypes#Annotation),
    -   changed datatypes: [Coding](datatypes#Coding), [Quantity](datatypes#Quantity), [Signature](datatypes#Signature), [Timing](datatypes#Timing), [Address](datatypes#Address), [ContactPoint](datatypes#ContactPoint)
    -   changes to [ElementDefinition](elementdefinition): add base, make type.profile repeat, remove invariant.name and replace with invariant.requirements, remove binding.name, add min/max value
-   Resources:
    -   New resources: [Account](account), [ImplementationGuide](implementationguide), TestScript
    -   renamed: Contraindication -> [DetectedIssue](detectedissue), MedicationPrescription -> [MedicationRequest](medicationrequest), QuestionnaireAnswers -> [QuestionnaireResponse](questionnaireresponse)
    -   removed: Supply
    -   changed: almost all resources - too many to list (1317 tasks worth of changes) - add, remove elements, change types, references, definitions & value sets, re-order elements, provide much more documentation and new examples
-   Implementation Guide:
    -   Move [Argonaut content](http://argonautwiki.hl7.org/index.php?title=Main_Page) out

 |
| 0.5.0 | 

**DSTU Ballot, May 2015**

This version had extensive change as a result of the January 2015 Draft ballot, ongoing testing, and the open change proposals (over 800 tasks). The list below is a summary of the major changes to resource content. It shows only a limited number of the overall changes.

**Enumerations**

-   All spaces removed
-   Extensive content changes not noted here

**New Datatypes**

-   [unsignedInt](datatypes#unsignedInt)
-   [positiveInt](datatypes#positiveInt)
-   [Signature](datatypes#Signature)
-   [Meta](resource#Meta)

**Changed Datatypes**

-   [Coding](datatypes#Coding) - remove valueSet property
-   [Attachment](datatypes#Attachment) - add creation
-   [Identifier](datatypes#Identifier) - replace label with type
-   [Timing](datatypes#Timing) - major rework of content
-   [ElementDefinition](elementdefinition) - add label, code, rename 'formal' to definition, rename synonym to alias, add language to mapping, remove conformance and isExtensible and replace with strength

**New Resources**

-   BodySite
-   [Claim](claim)

**Removed Resources**

-   CarePlan2 -> collapsed into CarePlan
-   FamilyHistory -> broken up into FamilyMemberHistory
-   InstitutionalClaim, OralHealthClaim, PharmacyClaim, ProfessionalClaim, VisionClaim -> collapsed into Claim
-   Other - use Basic instead
-   PendedRequest,Readjudicate, Reversal, StatusRequest, StatusResponse - use ProcessRequest/Response instead
-   SupportingDocumentation - use DocumentReference instead
-   ProcessRequest, ProcessResponse - use Task instead

**Renamed Resources**

-   Alert -> Flag: 'alert' made people think it was an action like an alarm
-   SecurityEvent -> AuditEvent: it wasn't just for security purposes
-   ClinicalAssessment -> ClinicalImpression: people got confused with 'assessment' tools like APGAR score
-   Profile -> StructureDefinition: 'Profile' is the process, a package of statements

**Changes Inside Resources**

-   [Parameters](parameters) - allow parameter.part to contain a resource
-   [AllergyIntolerance](allergyintolerance) - rename subject to patient
-   [Appointment](appointment) - remove lastModifiedBy/lastModified, add location
-   [AppointmentResponse](appointmentresponse) - remove lastModifiedBy/lastModified, add rename individual to actor
-   [AuditEvent](auditevent) - add .event.purposeOfEvent, participant.location, .policy, and .purposeOfUse
-   [Bundle](bundle) - major reorganization
-   [CarePlan](careplan) - pull goal out + other reorganization
-   [ClinicalImpression](https://build.fhir.org/ig/HL7/pc-incubator/StructureDefinition-ClinicalAssessment.html) - add status, replace careplan & referral with trigger, rename diagnosis to finding, make plan 0..\*,
-   [Composition](composition) - change .section.content to refer to List only, not any
-   [ConceptMap](conceptmap) - change identifier to url, add useContext, change telecom to contact,
-   [Condition](condition) - rename subject to patient, rename status to clinicalStatus, change to bodySite = code or Reference(BodySite), rename .codeableConcept to .code
-   [Conformance](capabilitystatement) (now CapabilityStatement) - change identifier to url, add useContext, change telecom to contact, add requirements and copyright, add support for conditional operations,
-   [Contract](contract) - extensive rewrite
-   [Coverage](coverage) - add bin, subscriberId
-   DataElement (now [StructureDefinition](structuredefinition)) - total rewrite to use ElementDefinition
-   [Device](device) - add status, manufactureDate
-   [DeviceMetric](devicemetric) - rename operationalState to operationalStatus, add measurementMode, rename calibrationInfo to calibration, change color to an enumerations
-   [DeviceRequest](devicerequest)/[DeviceUsage](https://build.fhir.org/ig/HL7/oo-incubator/StructureDefinition-DeviceUsage.html) - change to bodySite = code or Reference(BodySite)
-   DiagnosticRequest- change to bodySite = code or Reference(BodySite)
-   [DiagnosticReport](diagnosticreport) - add encounter
-   [DocumentReference](documentreference) - add format, remove policyManager, make content : Attachment, and remove several related attributes, remove service reference and add context.practiceSetting, sourcePatientInfo, and related
-   [Encounter](encounter) - add incomingReferralRequest, allow reason to repeat, rename diet to dietPreference
-   [EpisodeOfCare](episodeofcare) - rename currentStatus to status, allow referralRequest to repeat,
-   [Flag](flag) - rename subject to patient, change from note to code
-   [Goal](goal) - add targetDate, statusDate, author, priority
-   [HealthcareService](healthcareservice) - extensive rewrite
-   `ImagingObjectSelection` - remove retrieveAETitle, rename retrieveUrl to url, add frames
-   [ImagingStudy](imagingstudy) - add laterality, change url to attachment
-   [Immunization](immunization) - add encounter, rename subject to patient, rename refusedIndicator to wasNotGiven, rename refusalReason to reasonNotGiven
-   [List](list) - add title, status, change ordered to orderedBy, add note
-   [Location](location) - remove status
-   [Medication](medication) - add batch
-   [MedicationAdministration](medicationadministration) - add reasonGiven, note, text. remove timing & maxDosePerPeriod
-   [MedicationDispense](medicationdispense) - collapse to a single dispense, add daysSupply, note and substitution, change quantity to allow range
-   [MedicationRequest](medicationrequest) - add note, change quantity to allow range,
-   MedicationStatement - add informationSource, status, dateAsserted, replace whenGiven with effective\[x\], remove device, add dosage.text
-   [NamingSystem](namingsystem) - add date, publisher,
-   [NutritionOrder](nutritionorder) - extensive rewrite
-   [Observation](observation) - change name to code, allow more types of value\[x\], change type of dataAbsentReason, change to bodySite = code or Reference(BodySite), allow identifier to repeat, add device,
-   [OperationDefinition](operationdefinition) - change identifier to url, add useContext, change telecom to contact, change name to title, add reuqirements, idempotent,
-   [OperationOutcome](operationoutcome) - change type of .issue.type
-   `OrderResponse` - rename code to orderStatus
-   [Organization](organization) - remove location and contact.gender
-   [Patient](patient) - communication to allow 'preferred'
-   [Person](person) - rename other to target
-   [Practitioner](practitioner) - change type of birthDate, allow multiple roles per practitioner
-   [Procedure](procedure) - add status and category, change to bodySite = code or Reference(BodySite), allow date to be period too, add location, change followUp to code 0..\*, add device tracking
-   [ServiceRequest](servicerequest) - change to bodySite = code or Reference(BodySite)
-   [Provenance](provenance) - change integritySignature to signature & make it a type, allow reference by Reference as well as URI
-   [Questionnaire](questionnaire) - add telecom
-   [Schedule](schedule) - move lastModified
-   [SearchParameter](searchparameter) - change telecom to contact, add status, experimental, date,
-   [Slot](slot) - move lastModified
-   [Specimen](specimen) - change source to parent, change to bodySite = code or Reference(BodySite)
-   [StructureDefinition](structuredefinition) - complete rewrite
-   [Subscription](subscription) - change type of tag, reanme url to endPoint,
-   [ValueSet](valueset) - change identifier to url, add useContext, change telecom to contact, replace purpose with useContext, add requirements, rename stableDate to lockedDate, change type of expansion.identifier, add expansion parameters

 |
| 0.4.0 | 

**Draft For Comment, January 2015 Ballot**

Breaking Changes (full list):

-   Replace atom and taglist with a native [Bundle](bundle) format ([3728](https://jira.hl7.org/projects/FHIR/issues/FHIR-3728), [3558](https://jira.hl7.org/projects/FHIR/issues/FHIR-3558), [2889](https://jira.hl7.org/projects/FHIR/issues/FHIR-2889)) (and also [Binary](binary))
-   JSON: change how extensions are represented ([3471](https://jira.hl7.org/projects/FHIR/issues/FHIR-3471))
-   RESTful API: change how version specific upgrades work ([3451](https://jira.hl7.org/projects/FHIR/issues/FHIR-3451))
-   DataTypes:
-   Rename Schedule to [Timing](datatypes#Timing) ([3536](https://jira.hl7.org/projects/FHIR/issues/FHIR-3536), [3236](https://jira.hl7.org/projects/FHIR/issues/FHIR-3236))
-   Rename Contact to [ContactPoint](datatypes#ContactPoint) ([3533](https://jira.hl7.org/projects/FHIR/issues/FHIR-3533)) and swap order of elements ([3108](https://jira.hl7.org/projects/FHIR/issues/FHIR-3108)))
-   [Address](datatypes#Address) - change zip to postCode ([2888](https://jira.hl7.org/projects/FHIR/issues/FHIR-2888))
-   [Quantity](datatypes#Quantity): Correct schema spelling for "QuantityCompararator" ([3531](https://jira.hl7.org/projects/FHIR/issues/FHIR-3531))
-   Change allowable values for the [id](datatypes#id) type to include capital letters, and allow up to 64 chars ([3750](https://jira.hl7.org/projects/FHIR/issues/FHIR-3750))
-   Restructure Profile - only one structure, and pull [ExtensionDefinition](structuredefinition) out of Profile (3647, 3498), and pull [SearchParameter](searchparameter) out ([3626](https://jira.hl7.org/projects/FHIR/issues/FHIR-3626))
-   Profile: allow 0..\* discriminator ([3131](https://jira.hl7.org/projects/FHIR/issues/FHIR-3131)), and change the way discriminators work across resource boundaries ([3124](https://jira.hl7.org/projects/FHIR/issues/FHIR-3124)) + generate multiple types properly ([2856](https://jira.hl7.org/projects/FHIR/issues/FHIR-2856))
-   remove \_validate interaction, and replace with $validate operation ([3686](https://jira.hl7.org/projects/FHIR/issues/FHIR-3686))
-   [Patient](patient): separate birth time from birthDate ([3731](https://jira.hl7.org/projects/FHIR/issues/FHIR-3731)), Change Administrative Gender from a CodableConcept to a Code. Also fixed the values as male|female|other|unknown with mappings to v2 and v3 ([3070](https://jira.hl7.org/projects/FHIR/issues/FHIR-3070))
-   [DocumentReference](documentreference): change encoding of Hash to Base64 ([3291](https://jira.hl7.org/projects/FHIR/issues/FHIR-3291))
-   [Group](group): rename header to title ([3126](https://jira.hl7.org/projects/FHIR/issues/FHIR-3126))
-   [Condition](condition): split relatedItem into two ([3111](https://jira.hl7.org/projects/FHIR/issues/FHIR-3111))
-   [Questionnaire](questionnaire): drop questionnaire.group.question.remarks ([3255](https://jira.hl7.org/projects/FHIR/issues/FHIR-3255)) and move omitReason from extension to base resource ([3260](https://jira.hl7.org/projects/FHIR/issues/FHIR-3260))
-   [QuestionnaireResponse](questionnaireresponse): allow multiple answers ([3146](https://jira.hl7.org/projects/FHIR/issues/FHIR-3146))
-   [ValueSet](valueset): replace ValueSet.compose.include.code with ValueSet.compose.include.concept ([3258](https://jira.hl7.org/projects/FHIR/issues/FHIR-3258)), added new rules about expansion content ([3138](https://jira.hl7.org/projects/FHIR/issues/FHIR-3138))
-   Remove DeviceObservationReport and Query
-   Collapse AdverseReaction into [AllergyIntolerance](allergyintolerance)
-   [Appointment](appointment) changes - individual field renamed to actor, and added mappings to [HL7 V2](http://www.hl7.org/implement/standards/product_brief.cfm?product_id=185) and [HL7 v3](https://www.hl7.org/implement/standards/product_brief.cfm?product_id=186)
-   [FamilyMemberHistory](familymemberhistory) combined with [List](list) replaces FamilyHistory (with corresponding updates to related profiles)
-   [Flag](flag) replaces Alert including improved clarification of how it is used and replacement of "note" with "code"
-   [CarePlan](careplan) significantly refactored including splitting Goal out as a distinct resource, moving elements between activity and detail, introduction of several new elements and supported relationship types

New Resources:

-   [Appointment](appointment)
-   [AppointmentResponse](appointmentresponse)
-   [Basic](basic)
-   [ClaimResponse](claimresponse)
-   [ClinicalImpression](https://build.fhir.org/ig/HL7/pc-incubator/StructureDefinition-ClinicalAssessment.html)
-   [Communication](communication)
-   [CommunicationRequest](communicationrequest)
-   [Contract](contract)
-   [Contraindication](detectedissue)
-   [Coverage](coverage)
-   [CoverageEligibilityRequest](coverageeligibilityrequest)
-   [CoverageEligibilityResponse](coverageeligibilityresponse)
-   DataElement (now [StructureDefinition](structuredefinition))
-   [DeviceMetric](devicemetric)
-   [DeviceRequest](devicerequest)
-   [DeviceUsage](https://build.fhir.org/ig/HL7/oo-incubator/StructureDefinition-DeviceUsage.html)
-   [EnrollmentRequest](enrollmentrequest)
-   [EnrollmentResponse](enrollmentresponse)
-   [EpisodeOfCare](episodeofcare)
-   [ExplanationOfBenefit](explanationofbenefit)
-   [StructureDefinition](structuredefinition)
-   [Goal](goal)
-   [HealthcareService](healthcareservice)
-   `ImagingObjectSelection`
-   [InstitutionalClaim](claim)
-   [NamingSystem](namingsystem)
-   [NutritionOrder](nutritionorder)
-   [OperationDefinition](operationdefinition)
-   [OralHealthClaim](claim)
-   [PaymentNotice](paymentnotice)
-   [PaymentReconciliation](paymentreconciliation)
-   [Person](person)
-   [PharmacyClaim](claim)
-   [ServiceRequest](servicerequest)
-   [ProfessionalClaim](claim)
-   [QuestionnaireResponse](questionnaireresponse)
-   ReferralRequest
-   [RiskAssessment](riskassessment)
-   [SearchParameter](searchparameter)
-   [Schedule](schedule)
-   [Slot](slot)
-   [Subscription](subscription)
-   SupportingDocumentation
-   [VisionClaim](claim)
-   [VisionPrescription](visionprescription)

New Implementation Guides (see `discussion of status`)

-   `Argonaut Project`
-   `Data Access Framework`
-   `Structured Data Capture` & `Structured Data Capture - Data Element Exchange`
-   US Laboratory `Order`, `Report` & `Report to Public Health`

 |
| 0.3.0 | 

-   Renamed Namespace to NamingSystem
-   Split [QuestionnaireResponse](questionnaireresponse) from [Questionnaire](questionnaire) and significantly revamped the [Questionnaire](questionnaire) in response to feedback from the Connectathon.
-   Added DataElement (now [StructureDefinition](structuredefinition)) resource (has been previously discussed as ObservationDefinition)
-   Defined [Subscription](subscription) resource for evaluation
-   Add [time](datatypes#time) datatype
-   Define RPC-type [operations](operations) on the RESTful interface, and add [Operation Definition](operationdefinition)
-   Defined operations on several resources including [ConceptMap](conceptmap), [Questionnaire](questionnaire) and [ValueSet](valueset)
-   [Conformance](capabilitystatement) (now CapabilityStatement): Change Conformance.rest.operation to Conformance.rest.interaction and Conformance.rest.resource.operation to Conformance.rest.resource.interaction, and add Conformance.rest.operation to point to [Operation Definition](operationdefinition)
-   Profile: add Profile.url, Profile.structure.snapshot and Profile.structure.differential, and remove query definition (now in OperationDefinition)
-   Add pages for LOINC, RxNorm, and SNOMED CT
-   Significant rework for [ConceptMap](conceptmap) so it can be used to map between structures as well as value sets
-   Add [Contraindication](detectedissue) and [Risk Assessment](riskassessment) and added examples to other resources in support of these
-   Add Referral Request
-   Add supportingInformation to DiagnosticRequest
-   Add fulfills to [Encounter](encounter)
-   Add date and age\[x\] to [FamilyHistory](familymemberhistory)
-   Change cardinality of [Location](location).identifier to 0..\*
-   Change cardinality of [Practitioner](practitioner).address to 0..\*
-   Add [Observation](observation).encounter to 0..\*
-   Temporarily added content for the [Structured Data Capture implementation guide](http://hl7.org/fhir/us/sdc/index.html), including profiles on several resources, conformance instances, etc. This content will be moved to an external specification once the necessary tooling is in place to support that form of publication.

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| 0.2.1 | 

-   Minor new optional elements on value set for metadata, new extensions for all the rest of the VSD project metadata, formal profile to express basic minimum metadata for value set

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| **0.2.0** | 

-   Namespace: adjustments based on Grahame's feedback

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| 0.1.0 | 

-   Add [Appointment](appointment), [Appointment Response](appointmentresponse), [Schedule](schedule) and [Slot](slot)
-   Add _Namespace_

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Note: a useful tool for displaying the differences between pages is the [W3C HTML Diff engine](http://services.w3.org/htmldiff).

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