Smart4Health Implementation Guide (IG)

This implementation guide covers the use cases that form part of the Smart4Health project.

Note that the web-based IG always represents the current build and may thus differ from the version that is deployed on running systems. Stable, versioned snapshots of the artifacts in this IG are provided by the released FHIR packages from the project.

The associated FHIR artifacts were developed by the Smart4Health consortium with the following contributing partners:

The research leading to these results has received funding from the Horizon 2020 Programme of the European Commission under Grant Agreement No. 826117.


Though great care has been taken in the preparation of this implementation guide, this implementation guide is provided "as is“ without warranty of any kind and D4L data4life gGmbH, as well as cooperation partners, shall in no event be liable for any claims, direct or indirect damages and the like arising from, out of or in connection with the implementation guide or its use.

The material in this specification is public. Users are free to copy, modify, and redistribute this material without any restrictions.

The above copyright notice, the disclaimer and this permission notice shall be included in all copies or substantial portions of this implementation guide.

This implementation guide copyright © 2021 D4L data4life gGmbH.


The HL7® FHIR® standard is Copyright © 2011+ HL7 and is used under the FHIR license terms


This product includes all, or a portion of, or is derived from content from LOINC that is subject to a license from Regenstrief Institute, Inc. Your use of the LOINC content also is subject to this license, a copy of which is available at The current complete distribution is available for download at The LOINC Table and LOINC codes are copyright © 1995-2019, Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee. The LOINC Table, LOINC Table Core, LOINC Panels and Forms File, LOINC Answer File, LOINC Part File, LOINC Group File, LOINC Document Ontology File, LOINC Document Ontology OWL File, LOINC Hierarchies, LOINC Linguistic Variants File, LOINC/RSNA Radiology Playbook, LOINC/IEEE Medical Device Code Mapping Table, and LOINC Consumer Name File, and LOINC Change Snapshot File are copyright © 1995-2019, Regenstrief Institute, Inc. All rights reserved. THE LOINC TABLE (IN ALL FORMATS), LOINC TABLE CORE, LOINC PANELS AND FORMS FILE, LOINC ANSWER FILE, LOINC PART FILE, LOINC GROUP FILE, LOINC DOCUMENT ONTOLOGY FILE, LOINC DOCUMENT ONTOLOGY OWL FILE, LOINC HIERARCHIES, LOINC LINGUISTIC VARIANTS FILE, LOINC/RSNA RADIOLOGY PLAYBOOK, LOINC/IEEE MEDICAL DEVICE CODE MAPPING TABLE, LOINC CONSUMER NAME FILE, AND LOINC CHANGE SNAPSHOT FILE ARE PROVIDED "AS IS." ANY EXPRESS OR IMPLIED WARRANTIES ARE DISCLAIMED, INCLUDING, BUT NOT LIMITED TO, THE IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE. LOINC® is a registered United States trademark of Regenstrief Institute, Inc. A small portion of LOINC content may include content (e.g., survey instruments) that is subject to copyrights owned by third parties. Such content has been mapped to LOINC terms under applicable copyright and terms of use. Notice of such third-party copyright and license terms would need to be included if such content is included.


All SNOMED CT codes in this project come from the SNOMED Global Patient Set (GPS) which is available under the following license terms:

"The GPS is produced by SNOMED International under the terms of the Creative Commons Attribution 4.0 International Public License

Additional information about this license specific to SNOMED International’s release of the GPS:

  • SNOMED CT is © and ® SNOMED International. The right to maintain the GPS remains vested exclusively in SNOMED International.
  • The Licensee can redistribute the GPS.
  • The Licensee can create derivatives or implementation-related products and services based on the GPS.
  • The Licensee cannot claim that SNOMED International or any of its Members endorses the Licensee’s derivative because it uses content from the GPS.
  • Neither SNOMED International nor any of the contributors accept any liability for the Licensee’s use or redistribution of the GPS.
  • SNOMED CT® was originally created by the College of American Pathologists.

Without obtaining prior written permission from SNOMED International, you are expressly prohibited from using, distributing or reproducing the SNOMED International, SNOMED CT or SNOMED GPS logo, service mark or trademark. Please review all terms and conditions of use here."

EDQM Standard Terms

This implementation guide uses terms from the EDQM Standard Terms database ( They are reproduced with the permission of the European Directorate for the Quality of Medicines & HealthCare, Council of Europe (EDQM). The version of the term used is that used in the STU1 release of the International Patient Summary (IPS) FHIR implementation guide.