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    <status value="generated"/><div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: ImplementationGuide sequoia.fhir.us.rce</b></p><a name="sequoia.fhir.us.rce"> </a><a name="hcsequoia.fhir.us.rce"> </a><h2>RCEIG</h2><p>The official URL for this implementation guide is: </p><pre>https://sequoiaproject.org/fhir/rce/ImplementationGuide/sequoia.fhir.us.rce</pre></div>
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  <title value="Recognized Coordinating Entity (RCE) Implementation Guide"/>
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  <date value="2025-12-22T10:07:35-05:00"/>
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        <valueString value="true"/>
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      <extension url="code">
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    <resource>
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        <valueString value="OperationDefinition"/>
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      <reference>
        <reference value="OperationDefinition/activate-hierarchy"/>
      </reference>
      <name value="Activate Hierarchy"/>
      <description value="This operation changes the Organization.active element to true for the specified Organization and all Organizations that descend from it (directly or indirectly) via Organization.partOf."/>
      <exampleBoolean value="false"/>
    </resource>
    <resource>
      <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information">
        <valueString value="StructureDefinition:resource"/>
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      <reference>
        <reference value="StructureDefinition/Child"/>
      </reference>
      <name value="Child"/>
      <description value="The Child profile represents the individual components (such as member organizations, facilities, locations, etc.) that make up a QHIN, Participant, or Subparticipant. A Child can be the parent of other Child organizations. A Child can not be an endpoint (node). It can be part of an endpoint (node) but does not meet the definition of an endpoint (node) itself. The maximum cardinality for an endpoint (node) element under a child is 0."/>
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      <name value="Deactivate Hierarchy"/>
      <description value="This operation changes the Organization.active element to false for the specified Organization and all Organizations that descend from it (directly or indirectly) via Organization.partOf."/>
      <exampleBoolean value="false"/>
    </resource>
    <resource>
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        <valueString value="Organization"/>
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      <reference>
        <reference value="Organization/RCE-Child-example"/>
      </reference>
      <name value="General RCE Child Example"/>
      <description value="Example RCE Child Organization instance.  This example shows a 3rd-level organization below the RCE Subparticipant example."/>
      <exampleCanonical value="https://sequoiaproject.org/fhir/rce/StructureDefinition/Child"/>
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    <resource>
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        <valueString value="Endpoint"/>
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      <reference>
        <reference value="Endpoint/RCE-orgEndpoint"/>
      </reference>
      <name value="General RCE Endpoint Example"/>
      <description value="Example RCE Endpoint instance. Note that the RCE Directory currently expects Endpoint instances to be contained resources within an Organization resource."/>
      <exampleCanonical value="https://sequoiaproject.org/fhir/rce/StructureDefinition/RCE-Endpoint"/>
    </resource>
    <resource>
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        <valueString value="Organization"/>
      </extension>
      <reference>
        <reference value="Organization/1.2.3.4.5"/>
      </reference>
      <name value="General RCE Participant Example"/>
      <description value="Example RCE Participant Organization instance. This example shows a top level organization participating in a QHIN, which is the direct parent of the RCE Subparticipant example. In includes a contained FHIR Endpoint."/>
      <exampleCanonical value="https://sequoiaproject.org/fhir/rce/StructureDefinition/Participant"/>
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    <resource>
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        <valueString value="Organization"/>
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      <reference>
        <reference value="Organization/QHIN-example"/>
      </reference>
      <name value="General RCE QHIN Example"/>
      <description value="Example RCE QHIN Organization instance. This example shows a TEFCA Qualified Health Information Network (QHIN) organization in the RCE directory. It is the top-level parent of the other examples in this IG, and the direct parent of the RCE Participant example."/>
      <exampleCanonical value="https://sequoiaproject.org/fhir/rce/StructureDefinition/QHIN"/>
    </resource>
    <resource>
      <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information">
        <valueString value="Organization"/>
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      <reference>
        <reference value="Organization/5.4.3.2.1"/>
      </reference>
      <name value="General RCE Subparticipant Example"/>
      <description value="Example RCE Participant Organization instance. This example shows a 2nd level organization below an RCE Participant organization. This example is the direct parent of the RCE Child example. It includes a contained XCDR Endpoint."/>
      <exampleCanonical value="https://sequoiaproject.org/fhir/rce/StructureDefinition/SubParticipant"/>
    </resource>
    <resource>
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        <valueString value="StructureDefinition:resource"/>
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      <reference>
        <reference value="StructureDefinition/Participant"/>
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      <name value="Participant"/>
      <description value="The Participant profile represents a Participant as defined in the Common Agreement. A Participant can be the parent of Subparticipant and Child organizations."/>
      <exampleBoolean value="false"/>
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    <resource>
      <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information">
        <valueString value="Organization"/>
      </extension>
      <reference>
        <reference value="Organization/Q.A.P.1"/>
      </reference>
      <name value="Participant 1"/>
      <description value="This example shows Participant 1, a top level organization participating in a QHIN A. Participant 1 maintains an eMPI/Record Locator Service (RLS) over its Subparticipants, Sub Y and Sub Z, but returns individual patient IDs per Subparticipant and passes down subsequent Queries for documents."/>
      <exampleCanonical value="https://sequoiaproject.org/fhir/rce/StructureDefinition/Participant"/>
    </resource>
    <resource>
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        <valueString value="Organization"/>
      </extension>
      <reference>
        <reference value="Organization/Q.A.P.2"/>
      </reference>
      <name value="Participant 2"/>
      <description value="This example shows Participant 2, a top level organization participating in a QHIN A. Participant 2 maintains a complete clinical data repository and Responds for all transactions for its Subparticipant, Sub X."/>
      <exampleCanonical value="https://sequoiaproject.org/fhir/rce/StructureDefinition/Participant"/>
    </resource>
    <resource>
      <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information">
        <valueString value="Organization"/>
      </extension>
      <reference>
        <reference value="Organization/Q.B.P.3"/>
      </reference>
      <name value="Participant 3"/>
      <description value="This example shows Participant 3, a top level organization participating in a QHIN B. Participant 3 is a fully federated Passthrough Node, passing all transactions to its Subparticipants, Sub U, Sub V, and Sub W."/>
      <exampleCanonical value="https://sequoiaproject.org/fhir/rce/StructureDefinition/Participant"/>
    </resource>
    <resource>
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        <valueString value="StructureDefinition:resource"/>
      </extension>
      <reference>
        <reference value="StructureDefinition/QHIN"/>
      </reference>
      <name value="QHIN"/>
      <description value="The QHIN profile represents a Qualified Health Information Network as defined in the Common Agreement. A QHIN can be the parent of Participant, Subparticipant, and Child organizations.&#xA;There will be exactly one QHIN Organization resource per Designated QHIN."/>
      <exampleBoolean value="false"/>
    </resource>
    <resource>
      <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information">
        <valueString value="Organization"/>
      </extension>
      <reference>
        <reference value="Organization/Q.A.0.0"/>
      </reference>
      <name value="QHIN A"/>
      <description value="This example shows QHIN A, which is fully federated (no centralized data or patient index) and passes all transactions to its participants, Participant 1 and Participant 2."/>
      <exampleCanonical value="https://sequoiaproject.org/fhir/rce/StructureDefinition/QHIN"/>
    </resource>
    <resource>
      <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information">
        <valueString value="Organization"/>
      </extension>
      <reference>
        <reference value="Organization/Q.B.0.0"/>
      </reference>
      <name value="QHIN B"/>
      <description value="This example shows QHIN B, which maintains an eMPI/RLS and returns a consolidated patient ID, followed by an aggregated document list. It passes down subsequent Queries for documents to its participant, Participant 3."/>
      <exampleCanonical value="https://sequoiaproject.org/fhir/rce/StructureDefinition/QHIN"/>
    </resource>
    <resource>
      <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information">
        <valueString value="StructureDefinition:resource"/>
      </extension>
      <reference>
        <reference value="StructureDefinition/RCE-Endpoint"/>
      </reference>
      <name value="RCE Endpoint"/>
      <description value="This profile on the FHIR Endpoint resource represents information about the endpoints provided by Organizations participating in TEFCA exchange. The endpoints described can use any QTF-supported protocol, such as IHE XCA, and need not be FHIR endpoints."/>
      <exampleBoolean value="false"/>
    </resource>
    <resource>
      <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information">
        <valueString value="StructureDefinition:resource:abstract"/>
      </extension>
      <reference>
        <reference value="StructureDefinition/RCE-Organization"/>
      </reference>
      <name value="RCE Organization"/>
      <description value="This profile on the FHIR Organization resource is an abstract base profile that defines shared constraints for all other profiles on the Organization resource in this implementation guide. It is not intended to be used directly, rather end users should create instances conforming to the QHIN, Participant, Subparticipant, or Child profiles."/>
      <exampleBoolean value="false"/>
    </resource>
    <resource>
      <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information">
        <valueString value="Organization"/>
      </extension>
      <reference>
        <reference value="Organization/Q.B.P.3.1.1"/>
      </reference>
      <name value="Sub U"/>
      <description value="This example shows Sub U, a Subparticipant (3rd level organization) of Sub W. It only sees Document Retrieval Queries and Responds independently (XCA Responds), since Sub W and Participant 3 are fully federated Passthrough Nodes and QHIN B maintains its patient demographics and document list."/>
      <exampleCanonical value="https://sequoiaproject.org/fhir/rce/StructureDefinition/SubParticipant"/>
    </resource>
    <resource>
      <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information">
        <valueString value="Organization"/>
      </extension>
      <reference>
        <reference value="Organization/Q.B.P.3.2"/>
      </reference>
      <name value="Sub V"/>
      <description value="This example shows Sub V, a Subparticipant (2nd level organization) of Participant 3. It only sees Document Retrieval Queries and Responds independently (XCA Responds), since Participant 3 is a fully federated Passthrough Node and QHIN B maintains its patient demographics and document list."/>
      <exampleCanonical value="https://sequoiaproject.org/fhir/rce/StructureDefinition/SubParticipant"/>
    </resource>
    <resource>
      <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information">
        <valueString value="Organization"/>
      </extension>
      <reference>
        <reference value="Organization/Q.B.P.3.1"/>
      </reference>
      <name value="Sub W"/>
      <description value="This example shows Sub W, a Subparticipant (2nd level organization) of Participant 3. It is a fully federated Passthrough Node, passing all transactions to its Subparticipant, Sub U."/>
      <exampleCanonical value="https://sequoiaproject.org/fhir/rce/StructureDefinition/SubParticipant"/>
    </resource>
    <resource>
      <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information">
        <valueString value="Organization"/>
      </extension>
      <reference>
        <reference value="Organization/Q.A.P.2.1"/>
      </reference>
      <name value="Sub X"/>
      <description value="This example shows a Child (a 2nd-level organization with no Endpoint) of Participant 2, called 'Sub X'. It never sees or Responds directly to TEFCA transactions, since Participant 2 maintains a complete clinical data repository and Responds for all transactions for all of its Child sorganization."/>
      <exampleCanonical value="https://sequoiaproject.org/fhir/rce/StructureDefinition/Child"/>
    </resource>
    <resource>
      <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information">
        <valueString value="Organization"/>
      </extension>
      <reference>
        <reference value="Organization/Q.A.P.1.2"/>
      </reference>
      <name value="Sub Y"/>
      <description value="This example shows Sub Y, a Subparticipant (2nd level organization) of Participant 1. It sees only Document Query and Document Retrieval Queries from Participant 1, and it Respond independently (XCA Queries and Responds), since Participant 1 only maintains its patient demographics."/>
      <exampleCanonical value="https://sequoiaproject.org/fhir/rce/StructureDefinition/SubParticipant"/>
    </resource>
    <resource>
      <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information">
        <valueString value="Organization"/>
      </extension>
      <reference>
        <reference value="Organization/Q.A.P.1.1"/>
      </reference>
      <name value="Sub Z"/>
      <description value="This example shows Sub Z, a Subparticipant (2nd level organization) of Participant 1. It sees only Document Query and Document Retrieval Queries from Participant 1, and it Respond independently (XCA Queries and Responds), since Participant 1 only maintains its patient demographics."/>
      <exampleCanonical value="https://sequoiaproject.org/fhir/rce/StructureDefinition/SubParticipant"/>
    </resource>
    <resource>
      <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information">
        <valueString value="StructureDefinition:resource"/>
      </extension>
      <reference>
        <reference value="StructureDefinition/SubParticipant"/>
      </reference>
      <name value="Subparticipant"/>
      <description value="The Subparticipant profile represents a Subparticipant as defined in the Common Agreement. A Subparticipant can be the parent of Subparticipant and Child organizations."/>
      <exampleBoolean value="false"/>
    </resource>
    <resource>
      <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information">
        <valueString value="OperationDefinition"/>
      </extension>
      <reference>
        <reference value="OperationDefinition/update-tefcaid"/>
      </reference>
      <name value="Update TEFCAID for Entry and Children"/>
      <description value="This operation updates the TEFCAID identifier for the specified Organization and all Child Organizations that descend from it (directly or indirectly through other Children) via Organization.partOf."/>
      <exampleBoolean value="false"/>
    </resource>
    <page>
      <extension url="http://hl7.org/fhir/tools/StructureDefinition/ig-page-name">
        <valueUrl value="toc.html"/>
      </extension>
      <nameUrl value="toc.html"/>
      <title value="Table of Contents"/>
      <generation value="html"/>
      <page>
        <extension url="http://hl7.org/fhir/tools/StructureDefinition/ig-page-name">
          <valueUrl value="index.html"/>
        </extension>
        <nameUrl value="index.html"/>
        <title value="Introduction"/>
        <generation value="markdown"/>
      </page>
      <page>
        <extension url="http://hl7.org/fhir/tools/StructureDefinition/ig-page-name">
          <valueUrl value="rce_specification.html"/>
        </extension>
        <nameUrl value="rce_specification.html"/>
        <title value="Specification"/>
        <generation value="markdown"/>
      </page>
      <page>
        <extension url="http://hl7.org/fhir/tools/StructureDefinition/ig-page-name">
          <valueUrl value="change_log.html"/>
        </extension>
        <nameUrl value="change_log.html"/>
        <title value="Change Log"/>
        <generation value="markdown"/>
      </page>
      <page>
        <extension url="http://hl7.org/fhir/tools/StructureDefinition/ig-page-name">
          <valueUrl value="downloads.html"/>
        </extension>
        <nameUrl value="downloads.html"/>
        <title value="Downloads"/>
        <generation value="markdown"/>
      </page>
    </page>
    <parameter>
      <code value="path-resource"/>
      <value value="input/capabilities"/>
    </parameter>
    <parameter>
      <code value="path-resource"/>
      <value value="input/examples"/>
    </parameter>
    <parameter>
      <code value="path-resource"/>
      <value value="input/extensions"/>
    </parameter>
    <parameter>
      <code value="path-resource"/>
      <value value="input/models"/>
    </parameter>
    <parameter>
      <code value="path-resource"/>
      <value value="input/operations"/>
    </parameter>
    <parameter>
      <code value="path-resource"/>
      <value value="input/profiles"/>
    </parameter>
    <parameter>
      <code value="path-resource"/>
      <value value="input/resources"/>
    </parameter>
    <parameter>
      <code value="path-resource"/>
      <value value="input/vocabulary"/>
    </parameter>
    <parameter>
      <code value="path-resource"/>
      <value value="input/maps"/>
    </parameter>
    <parameter>
      <code value="path-resource"/>
      <value value="input/testing"/>
    </parameter>
    <parameter>
      <code value="path-resource"/>
      <value value="input/history"/>
    </parameter>
    <parameter>
      <code value="path-resource"/>
      <value value="fsh-generated/resources"/>
    </parameter>
    <parameter>
      <code value="path-pages"/>
      <value value="template/config"/>
    </parameter>
    <parameter>
      <code value="path-pages"/>
      <value value="input/images"/>
    </parameter>
    <parameter>
      <code value="path-tx-cache"/>
      <value value="input-cache/txcache"/>
    </parameter>
  </definition>
</ImplementationGuide>