diff --git a/src/Microsoft.Health.Fhir.Core/Features/Persistence/SoftDeletedFhirPathExtension.cs b/src/Microsoft.Health.Fhir.Core/Features/Persistence/SoftDeletedFhirPathExtension.cs
new file mode 100644
index 0000000000..aba64a3a9a
--- /dev/null
+++ b/src/Microsoft.Health.Fhir.Core/Features/Persistence/SoftDeletedFhirPathExtension.cs
@@ -0,0 +1,19 @@
+// -------------------------------------------------------------------------------------------------
+// Copyright (c) Microsoft Corporation. All rights reserved.
+// Licensed under the MIT License (MIT). See LICENSE in the repo root for license information.
+// -------------------------------------------------------------------------------------------------
+
+using Microsoft.Health.Fhir.Core.Models;
+
+namespace Microsoft.Health.Fhir.Core.Features.Persistence;
+
+public static class SoftDeletedFhirPathExtension
+{
+    /// <summary>
+    /// Return true if this resource contains the Azure 'soft-deleted' extension in meta data
+    /// </summary>
+    public static bool IsSoftDeleted(this ResourceElement resourceElement)
+    {
+        return resourceElement.Predicate(KnownFhirPaths.IsSoftDeletedExtension);
+    }
+}
diff --git a/src/Microsoft.Health.Fhir.Core/Models/KnownFhirPaths.cs b/src/Microsoft.Health.Fhir.Core/Models/KnownFhirPaths.cs
index 5685d3a7a1..498cdb8ff0 100644
--- a/src/Microsoft.Health.Fhir.Core/Models/KnownFhirPaths.cs
+++ b/src/Microsoft.Health.Fhir.Core/Models/KnownFhirPaths.cs
@@ -7,6 +7,8 @@ namespace Microsoft.Health.Fhir.Core.Models
 {
     public static class KnownFhirPaths
     {
+        internal const string AzureSoftDeletedExtensionUrl = "http://azurehealthcareapis.com/data-extensions/deleted-state";
+
         public const string BundleEntries = "Resource.entry.resource";
 
         public const string BundleNextLink = "Resource.link.where(relation = 'next').url";
@@ -16,5 +18,7 @@ public static class KnownFhirPaths
         public const string BundleType = "Resource.type";
 
         public const string ResourceNarrative = "text.div";
+
+        public const string IsSoftDeletedExtension = $"Resource.meta.extension.where(url = '{AzureSoftDeletedExtensionUrl}').where(value='soft-deleted').exists()";
     }
 }
diff --git a/src/Microsoft.Health.Fhir.Shared.Core.UnitTests/Extensions/KnowFhirPathsTests.cs b/src/Microsoft.Health.Fhir.Shared.Core.UnitTests/Extensions/KnowFhirPathsTests.cs
new file mode 100644
index 0000000000..f523bf475f
--- /dev/null
+++ b/src/Microsoft.Health.Fhir.Shared.Core.UnitTests/Extensions/KnowFhirPathsTests.cs
@@ -0,0 +1,32 @@
+// -------------------------------------------------------------------------------------------------
+// Copyright (c) Microsoft Corporation. All rights reserved.
+// Licensed under the MIT License (MIT). See LICENSE in the repo root for license information.
+// -------------------------------------------------------------------------------------------------
+
+using Microsoft.Health.Fhir.Core.Extensions;
+using Microsoft.Health.Fhir.Core.Features.Persistence;
+using Microsoft.Health.Fhir.Core.Models;
+using Microsoft.Health.Fhir.Tests.Common;
+using Microsoft.Health.Test.Utilities;
+using Xunit;
+
+namespace Microsoft.Health.Fhir.Shared.Core.UnitTests.Extensions;
+
+[Trait(Traits.OwningTeam, OwningTeam.Fhir)]
+[Trait(Traits.Category, Categories.Import)]
+public class KnowFhirPathsTests
+{
+    [Fact]
+    public void GivenAResource_WhenEvaluatingIfSoftDeleted_ThenTheCorrectFlagIsReturned()
+    {
+        ResourceElement patient = Samples.GetDefaultPatient();
+
+        var isDeleted = patient.IsSoftDeleted();
+        Assert.False(isDeleted);
+
+        ResourceElement withExtension = patient.TryAddSoftDeletedExtension();
+
+        isDeleted = withExtension.IsSoftDeleted();
+        Assert.True(isDeleted);
+    }
+}
diff --git a/src/Microsoft.Health.Fhir.Shared.Core.UnitTests/Microsoft.Health.Fhir.Shared.Core.UnitTests.projitems b/src/Microsoft.Health.Fhir.Shared.Core.UnitTests/Microsoft.Health.Fhir.Shared.Core.UnitTests.projitems
index af51a256fb..d9d8c9cc7b 100644
--- a/src/Microsoft.Health.Fhir.Shared.Core.UnitTests/Microsoft.Health.Fhir.Shared.Core.UnitTests.projitems
+++ b/src/Microsoft.Health.Fhir.Shared.Core.UnitTests/Microsoft.Health.Fhir.Shared.Core.UnitTests.projitems
@@ -10,6 +10,7 @@
   <ItemGroup>
     <Compile Include="$(MSBuildThisFileDirectory)AssemblyInfo.cs" />
     <Compile Include="$(MSBuildThisFileDirectory)AssemblyValidationsTests.cs" />
+    <Compile Include="$(MSBuildThisFileDirectory)Extensions\KnowFhirPathsTests.cs" />
     <Compile Include="$(MSBuildThisFileDirectory)Features\Compartment\CompartmentIndexerTests.cs" />
     <Compile Include="$(MSBuildThisFileDirectory)Features\Compartment\SearchCompartmentHandlerTests.cs" />
     <Compile Include="$(MSBuildThisFileDirectory)Features\Conformance\ConformanceBuilderTests.cs" />
diff --git a/src/Microsoft.Health.Fhir.Shared.Core/Extensions/ModelExtensions.cs b/src/Microsoft.Health.Fhir.Shared.Core/Extensions/ModelExtensions.cs
index 3f976bad19..88187468e2 100644
--- a/src/Microsoft.Health.Fhir.Shared.Core/Extensions/ModelExtensions.cs
+++ b/src/Microsoft.Health.Fhir.Shared.Core/Extensions/ModelExtensions.cs
@@ -130,6 +130,26 @@ public static ResourceElement UpdateLastUpdated(this ResourceElement resource, D
             return poco.ToResourceElement();
         }
 
+        public static ResourceElement TryAddSoftDeletedExtension(this ResourceElement resource)
+        {
+            EnsureArg.IsNotNull(resource, nameof(resource));
+
+            Resource poco = resource.ToPoco();
+            poco.Meta ??= new Meta();
+
+            if (!poco.Meta.Extension.Any(x => string.Equals(x.Url, KnownFhirPaths.AzureSoftDeletedExtensionUrl, StringComparison.OrdinalIgnoreCase)))
+            {
+                poco.Meta.Extension.Add(
+                    new Extension
+                    {
+                        Url = KnownFhirPaths.AzureSoftDeletedExtensionUrl,
+                        Value = new FhirString("soft-deleted"),
+                    });
+            }
+
+            return poco.ToResourceElement();
+        }
+
         public static SearchParameterInfo ToInfo(this SearchParameter searchParam)
         {
             EnsureArg.IsNotNull(searchParam, nameof(searchParam));