Implementation Guide
ePA Medication Service
Version 1.0.5-1 - release

## Resource Profile: EPAMSOperationOutcome - JSON Profile

Active as of 2025-02-28

JSON representation of the epa-ms-operation-outcome resource profile.

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    {
      "resourceType" : "StructureDefinition",
      "id" : "epa-ms-operation-outcome",
      "url" : "https://gematik.de/fhir/epa-medication/StructureDefinition/epa-ms-operation-outcome",
      "version" : "1.0.5-1",
      "name" : "EPAMSOperationOutcome",
      "title" : "EPA Medication Service Operation Outcome",
      "status" : "active",
      "experimental" : false,
      "date" : "2025-02-28",
      "publisher" : "gematik GmbH",
      "contact" : [
        {
          "name" : "gematik GmbH",
          "telecom" : [
            {
              "system" : "url",
              "value" : "https://www.gematik.de"
            },
            {
              "system" : "email",
              "value" : "patientteam [ at ] gematik.de"
            }
          ]
        }
      ],
      "description" : "Das Operation Outcome-Profil für den Medication Service der ePA.",
      "jurisdiction" : [
        {
          "coding" : [
            {
              "system" : "urn:iso:std:iso:3166",
              "code" : "DE"
            }
          ]
        }
      ],
      "fhirVersion" : "4.0.1",
      "mapping" : [
        {
          "identity" : "rim",
          "uri" : "http://hl7.org/v3",
          "name" : "RIM Mapping"
        },
        {
          "identity" : "v2",
          "uri" : "http://hl7.org/v2",
          "name" : "HL7 v2 Mapping"
        }
      ],
      "kind" : "resource",
      "abstract" : false,
      "type" : "OperationOutcome",
      "baseDefinition" : "https://gematik.de/fhir/ti/StructureDefinition/operation-outcome",
      "derivation" : "constraint",
      "snapshot" : {
        "extension" : [
          {
            "url" : "http://hl7.org/fhir/tools/StructureDefinition/snapshot-base-version",
            "valueString" : "1.0.0"
          }
        ],
        "element" : [
          {
            "id" : "OperationOutcome",
            "path" : "OperationOutcome",
            "short" : "Information about the success/failure of an action",
            "definition" : "A collection of error, warning, or information messages that result from a system action.",
            "comment" : "Can result from the failure of a REST call or be part of the response message returned from a request message.",
            "min" : 0,
            "max" : "*",
            "base" : {
              "path" : "OperationOutcome",
              "min" : 0,
              "max" : "*"
            },
            "constraint" : [
              {
                "key" : "dom-2",
                "severity" : "error",
                "human" : "If the resource is contained in another resource, it SHALL NOT contain nested Resources",
                "expression" : "contained.contained.empty()",
                "xpath" : "not(parent::f:contained and f:contained)",
                "source" : "http://hl7.org/fhir/StructureDefinition/DomainResource"
              },
              {
                "key" : "dom-4",
                "severity" : "error",
                "human" : "If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated",
                "expression" : "contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()",
                "xpath" : "not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))",
                "source" : "http://hl7.org/fhir/StructureDefinition/DomainResource"
              },
              {
                "key" : "dom-3",
                "severity" : "error",
                "human" : "If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource",
                "expression" : "contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()",
                "xpath" : "not(exists(for $id in f:contained/*/f:id/@value return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))",
                "source" : "http://hl7.org/fhir/StructureDefinition/DomainResource"
              },
              {
                "extension" : [
                  {
                    "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice",
                    "valueBoolean" : true
                  },
                  {
                    "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice-explanation",
                    "valueMarkdown" : "When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time."
                  }
                ],
                "key" : "dom-6",
                "severity" : "warning",
                "human" : "A resource should have narrative for robust management",
                "expression" : "text.`div`.exists()",
                "xpath" : "exists(f:text/h:div)",
                "source" : "http://hl7.org/fhir/StructureDefinition/DomainResource"
              },
              {
                "key" : "dom-5",
                "severity" : "error",
                "human" : "If a resource is contained in another resource, it SHALL NOT have a security label",
                "expression" : "contained.meta.security.empty()",
                "xpath" : "not(exists(f:contained/*/f:meta/f:security))",
                "source" : "http://hl7.org/fhir/StructureDefinition/DomainResource"
              }
            ],
            "mapping" : [
              {
                "identity" : "rim",
                "map" : "Entity. Role, or Act"
              },
              {
                "identity" : "rim",
                "map" : "Grouping is handled through multiple repetitions from whatever context references the outcomes (no specific grouper required)"
              }
            ]
          },
          {
            "id" : "OperationOutcome.id",
            "path" : "OperationOutcome.id",
            "short" : "Logical id of this artifact",
            "definition" : "The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.",
            "comment" : "The only time that a resource does not have an id is when it is being submitted to the server using a create operation.",
            "min" : 0,
            "max" : "1",
            "base" : {
              "path" : "Resource.id",
              "min" : 0,
              "max" : "1"
            },
            "type" : [
              {
                "extension" : [
                  {
                    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
                    "valueUrl" : "id"
                  }
                ],
                "code" : "http://hl7.org/fhirpath/System.String"
              }
            ],
            "isSummary" : true
          },
          {
            "id" : "OperationOutcome.meta",
            "path" : "OperationOutcome.meta",
            "short" : "Metadata about the resource",
            "definition" : "The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.",
            "min" : 0,
            "max" : "1",
            "base" : {
              "path" : "Resource.meta",
              "min" : 0,
              "max" : "1"
            },
            "type" : [
              {
                "code" : "Meta"
              }
            ],
            "condition" : [
              "ele-1"
            ],
            "constraint" : [
              {
                "key" : "ele-1",
                "severity" : "error",
                "human" : "All FHIR elements must have a @value or children",
                "expression" : "hasValue() or (children().count() > id.count())",
                "xpath" : "@value|f:*|h:div",
                "source" : "http://hl7.org/fhir/StructureDefinition/Element"
              }
            ],
            "isSummary" : true,
            "mapping" : [
              {
                "identity" : "rim",
                "map" : "n/a"
              },
              {
                "identity" : "rim",
                "map" : "N/A"
              }
            ]
          },
          {
            "id" : "OperationOutcome.implicitRules",
            "path" : "OperationOutcome.implicitRules",
            "short" : "A set of rules under which this content was created",
            "definition" : "A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.",
            "comment" : "Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.",
            "min" : 0,
            "max" : "1",
            "base" : {
              "path" : "Resource.implicitRules",
              "min" : 0,
              "max" : "1"
            },
            "type" : [
              {
                "code" : "uri"
              }
            ],
            "condition" : [
              "ele-1"
            ],
            "constraint" : [
              {
                "key" : "ele-1",
                "severity" : "error",
                "human" : "All FHIR elements must have a @value or children",
                "expression" : "hasValue() or (children().count() > id.count())",
                "xpath" : "@value|f:*|h:div",
                "source" : "http://hl7.org/fhir/StructureDefinition/Element"
              }
            ],
            "isModifier" : true,
            "isModifierReason" : "This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation",
            "isSummary" : true,
            "mapping" : [
              {
                "identity" : "rim",
                "map" : "n/a"
              }
            ]
          },
          {
            "id" : "OperationOutcome.language",
            "path" : "OperationOutcome.language",
            "short" : "Language of the resource content",
            "definition" : "The base language in which the resource is written.",
            "comment" : "Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies  to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).",
            "min" : 0,
            "max" : "1",
            "base" : {
              "path" : "Resource.language",
              "min" : 0,
              "max" : "1"
            },
            "type" : [
              {
                "code" : "code"
              }
            ],
            "condition" : [
              "ele-1"
            ],
            "constraint" : [
              {
                "key" : "ele-1",
                "severity" : "error",
                "human" : "All FHIR elements must have a @value or children",
                "expression" : "hasValue() or (children().count() > id.count())",
                "xpath" : "@value|f:*|h:div",
                "source" : "http://hl7.org/fhir/StructureDefinition/Element"
              }
            ],
            "binding" : {
              "extension" : [
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet",
                  "valueCanonical" : "http://hl7.org/fhir/ValueSet/all-languages"
                },
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
                  "valueString" : "Language"
                }
              ],
              "strength" : "preferred",
              "description" : "A human language.",
              "valueSet" : "http://hl7.org/fhir/ValueSet/languages"
            },
            "mapping" : [
              {
                "identity" : "rim",
                "map" : "n/a"
              }
            ]
          },
          {
            "id" : "OperationOutcome.text",
            "path" : "OperationOutcome.text",
            "short" : "Text summary of the resource, for human interpretation",
            "definition" : "A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it \"clinically safe\" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.",
            "comment" : "Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied).  This may be necessary for data from legacy systems where information is captured as a \"text blob\" or where text is additionally entered raw or narrated and encoded information is added later.",
            "alias" : [
              "narrative",
              "html",
              "xhtml",
              "display"
            ],
            "min" : 0,
            "max" : "1",
            "base" : {
              "path" : "DomainResource.text",
              "min" : 0,
              "max" : "1"
            },
            "type" : [
              {
                "code" : "Narrative"
              }
            ],
            "condition" : [
              "ele-1"
            ],
            "constraint" : [
              {
                "key" : "ele-1",
                "severity" : "error",
                "human" : "All FHIR elements must have a @value or children",
                "expression" : "hasValue() or (children().count() > id.count())",
                "xpath" : "@value|f:*|h:div",
                "source" : "http://hl7.org/fhir/StructureDefinition/Element"
              }
            ],
            "mapping" : [
              {
                "identity" : "rim",
                "map" : "n/a"
              },
              {
                "identity" : "rim",
                "map" : "N/A"
              },
              {
                "identity" : "rim",
                "map" : "Act.text?"
              }
            ]
          },
          {
            "id" : "OperationOutcome.contained",
            "path" : "OperationOutcome.contained",
            "short" : "Contained, inline Resources",
            "definition" : "These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.",
            "comment" : "This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.",
            "alias" : [
              "inline resources",
              "anonymous resources",
              "contained resources"
            ],
            "min" : 0,
            "max" : "*",
            "base" : {
              "path" : "DomainResource.contained",
              "min" : 0,
              "max" : "*"
            },
            "type" : [
              {
                "code" : "Resource"
              }
            ],
            "mapping" : [
              {
                "identity" : "rim",
                "map" : "Entity. Role, or Act"
              },
              {
                "identity" : "rim",
                "map" : "N/A"
              }
            ]
          },
          {
            "id" : "OperationOutcome.extension",
            "extension" : [
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
                "valueCode" : "normative"
              },
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
                "valueCode" : "4.0.0"
              }
            ],
            "path" : "OperationOutcome.extension",
            "slicing" : {
              "discriminator" : [
                {
                  "type" : "value",
                  "path" : "url"
                }
              ],
              "description" : "Extensions are always sliced by (at least) url",
              "rules" : "open"
            },
            "short" : "Additional content defined by implementations",
            "definition" : "May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance  applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
            "comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
            "alias" : [
              "extensions",
              "user content"
            ],
            "min" : 0,
            "max" : "*",
            "base" : {
              "path" : "DomainResource.extension",
              "min" : 0,
              "max" : "*"
            },
            "type" : [
              {
                "code" : "Extension"
              }
            ],
            "condition" : [
              "ele-1"
            ],
            "constraint" : [
              {
                "key" : "ele-1",
                "severity" : "error",
                "human" : "All FHIR elements must have a @value or children",
                "expression" : "hasValue() or (children().count() > id.count())",
                "xpath" : "@value|f:*|h:div",
                "source" : "http://hl7.org/fhir/StructureDefinition/Element"
              },
              {
                "key" : "ext-1",
                "severity" : "error",
                "human" : "Must have either extensions or value[x], not both",
                "expression" : "extension.exists() != value.exists()",
                "xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
                "source" : "http://hl7.org/fhir/StructureDefinition/Element"
              }
            ],
            "mapping" : [
              {
                "identity" : "rim",
                "map" : "n/a"
              },
              {
                "identity" : "rim",
                "map" : "N/A"
              }
            ]
          },
          {
            "id" : "OperationOutcome.modifierExtension",
            "extension" : [
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
                "valueCode" : "normative"
              },
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
                "valueCode" : "4.0.0"
              }
            ],
            "path" : "OperationOutcome.modifierExtension",
            "slicing" : {
              "discriminator" : [
                {
                  "type" : "value",
                  "path" : "url"
                }
              ],
              "description" : "Extensions are always sliced by (at least) url",
              "rules" : "open"
            },
            "short" : "Extensions that cannot be ignored",
            "definition" : "May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
            "comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
            "requirements" : "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored.  This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).",
            "alias" : [
              "extensions",
              "user content"
            ],
            "min" : 0,
            "max" : "*",
            "base" : {
              "path" : "DomainResource.modifierExtension",
              "min" : 0,
              "max" : "*"
            },
            "type" : [
              {
                "code" : "Extension"
              }
            ],
            "condition" : [
              "ele-1"
            ],
            "constraint" : [
              {
                "key" : "ele-1",
                "severity" : "error",
                "human" : "All FHIR elements must have a @value or children",
                "expression" : "hasValue() or (children().count() > id.count())",
                "xpath" : "@value|f:*|h:div",
                "source" : "http://hl7.org/fhir/StructureDefinition/Element"
              },
              {
                "key" : "ext-1",
                "severity" : "error",
                "human" : "Must have either extensions or value[x], not both",
                "expression" : "extension.exists() != value.exists()",
                "xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
                "source" : "http://hl7.org/fhir/StructureDefinition/Element"
              }
            ],
            "isModifier" : true,
            "isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them",
            "mapping" : [
              {
                "identity" : "rim",
                "map" : "n/a"
              },
              {
                "identity" : "rim",
                "map" : "N/A"
              }
            ]
          },
          {
            "id" : "OperationOutcome.issue",
            "path" : "OperationOutcome.issue",
            "short" : "A single issue associated with the action",
            "definition" : "An error, warning, or information message that results from a system action.",
            "min" : 1,
            "max" : "*",
            "base" : {
              "path" : "OperationOutcome.issue",
              "min" : 1,
              "max" : "*"
            },
            "type" : [
              {
                "code" : "BackboneElement"
              }
            ],
            "condition" : [
              "ele-1"
            ],
            "constraint" : [
              {
                "key" : "ele-1",
                "severity" : "error",
                "human" : "All FHIR elements must have a @value or children",
                "expression" : "hasValue() or (children().count() > id.count())",
                "xpath" : "@value|f:*|h:div",
                "source" : "http://hl7.org/fhir/StructureDefinition/Element"
              }
            ],
            "isSummary" : true,
            "mapping" : [
              {
                "identity" : "rim",
                "map" : "n/a"
              },
              {
                "identity" : "v2",
                "map" : "ERR"
              },
              {
                "identity" : "rim",
                "map" : "AcknowledgementDetail or Observation[classCode=\"ALRT\" and moodCode=\"EVN\"]"
              }
            ]
          },
          {
            "id" : "OperationOutcome.issue.id",
            "path" : "OperationOutcome.issue.id",
            "representation" : [
              "xmlAttr"
            ],
            "short" : "Unique id for inter-element referencing",
            "definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
            "min" : 0,
            "max" : "1",
            "base" : {
              "path" : "Element.id",
              "min" : 0,
              "max" : "1"
            },
            "type" : [
              {
                "extension" : [
                  {
                    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
                    "valueUrl" : "string"
                  }
                ],
                "code" : "http://hl7.org/fhirpath/System.String"
              }
            ],
            "mapping" : [
              {
                "identity" : "rim",
                "map" : "n/a"
              }
            ]
          },
          {
            "id" : "OperationOutcome.issue.extension",
            "extension" : [
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
                "valueCode" : "normative"
              },
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
                "valueCode" : "4.0.0"
              }
            ],
            "path" : "OperationOutcome.issue.extension",
            "slicing" : {
              "discriminator" : [
                {
                  "type" : "value",
                  "path" : "url"
                }
              ],
              "description" : "Extensions are always sliced by (at least) url",
              "rules" : "open"
            },
            "short" : "Additional content defined by implementations",
            "definition" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance  applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
            "comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
            "alias" : [
              "extensions",
              "user content"
            ],
            "min" : 0,
            "max" : "*",
            "base" : {
              "path" : "Element.extension",
              "min" : 0,
              "max" : "*"
            },
            "type" : [
              {
                "code" : "Extension"
              }
            ],
            "condition" : [
              "ele-1"
            ],
            "constraint" : [
              {
                "key" : "ele-1",
                "severity" : "error",
                "human" : "All FHIR elements must have a @value or children",
                "expression" : "hasValue() or (children().count() > id.count())",
                "xpath" : "@value|f:*|h:div",
                "source" : "http://hl7.org/fhir/StructureDefinition/Element"
              },
              {
                "key" : "ext-1",
                "severity" : "error",
                "human" : "Must have either extensions or value[x], not both",
                "expression" : "extension.exists() != value.exists()",
                "xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
                "source" : "http://hl7.org/fhir/StructureDefinition/Element"
              }
            ],
            "mapping" : [
              {
                "identity" : "rim",
                "map" : "n/a"
              },
              {
                "identity" : "rim",
                "map" : "N/A"
              }
            ]
          },
          {
            "id" : "OperationOutcome.issue.modifierExtension",
            "path" : "OperationOutcome.issue.modifierExtension",
            "short" : "Extensions that cannot be ignored even if unrecognized",
            "definition" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
            "comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
            "requirements" : "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored.  This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).",
            "alias" : [
              "extensions",
              "user content",
              "modifiers"
            ],
            "min" : 0,
            "max" : "*",
            "base" : {
              "path" : "BackboneElement.modifierExtension",
              "min" : 0,
              "max" : "*"
            },
            "type" : [
              {
                "code" : "Extension"
              }
            ],
            "condition" : [
              "ele-1"
            ],
            "constraint" : [
              {
                "key" : "ele-1",
                "severity" : "error",
                "human" : "All FHIR elements must have a @value or children",
                "expression" : "hasValue() or (children().count() > id.count())",
                "xpath" : "@value|f:*|h:div",
                "source" : "http://hl7.org/fhir/StructureDefinition/Element"
              },
              {
                "key" : "ext-1",
                "severity" : "error",
                "human" : "Must have either extensions or value[x], not both",
                "expression" : "extension.exists() != value.exists()",
                "xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
                "source" : "http://hl7.org/fhir/StructureDefinition/Element"
              }
            ],
            "isModifier" : true,
            "isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
            "isSummary" : true,
            "mapping" : [
              {
                "identity" : "rim",
                "map" : "n/a"
              },
              {
                "identity" : "rim",
                "map" : "N/A"
              }
            ]
          },
          {
            "id" : "OperationOutcome.issue.severity",
            "path" : "OperationOutcome.issue.severity",
            "short" : "fatal | error | warning | information",
            "definition" : "Indicates whether the issue indicates a variation from successful processing.",
            "comment" : "This is labeled as \"Is Modifier\" because applications should not confuse hints and warnings with errors.",
            "requirements" : "Indicates how relevant the issue is to the overall success of the action.",
            "min" : 1,
            "max" : "1",
            "base" : {
              "path" : "OperationOutcome.issue.severity",
              "min" : 1,
              "max" : "1"
            },
            "type" : [
              {
                "code" : "code"
              }
            ],
            "condition" : [
              "ele-1"
            ],
            "constraint" : [
              {
                "key" : "ele-1",
                "severity" : "error",
                "human" : "All FHIR elements must have a @value or children",
                "expression" : "hasValue() or (children().count() > id.count())",
                "xpath" : "@value|f:*|h:div",
                "source" : "http://hl7.org/fhir/StructureDefinition/Element"
              }
            ],
            "mustSupport" : true,
            "isSummary" : true,
            "binding" : {
              "extension" : [
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
                  "valueString" : "IssueSeverity"
                }
              ],
              "strength" : "required",
              "description" : "How the issue affects the success of the action.",
              "valueSet" : "http://hl7.org/fhir/ValueSet/issue-severity|4.0.1"
            },
            "mapping" : [
              {
                "identity" : "rim",
                "map" : "n/a"
              },
              {
                "identity" : "v2",
                "map" : "ERR-4"
              },
              {
                "identity" : "rim",
                "map" : "./typeCode[parent::AcknowledgmentDetail] or unique(./inboundRelationship[parent::Observation and typeCode='SUBJ' and isNormalActRelationship()]/source[classCode=\"OBS\" and moodCode=\"EVN\" and implies(code, ActCode#SEV and isNormalAct())/value[xsi:type=\"CD\"]"
              }
            ]
          },
          {
            "id" : "OperationOutcome.issue.code",
            "path" : "OperationOutcome.issue.code",
            "short" : "Error or warning code",
            "definition" : "Describes the type of the issue. The system that creates an OperationOutcome SHALL choose the most applicable code from the IssueType value set, and may additional provide its own code for the error in the details element.",
            "comment" : "Note that FHIR strings SHALL NOT exceed 1MB in size",
            "requirements" : "Expresses the issue in a human and computer-friendly way, allowing the requesting system to behave differently based on the type of issue.\n\nThe required element provides a base level of computable interoperability across all systems for processing an outcome, allowing systems to respond appropriately regardless of the internal system error codes returned.",
            "min" : 1,
            "max" : "1",
            "base" : {
              "path" : "OperationOutcome.issue.code",
              "min" : 1,
              "max" : "1"
            },
            "type" : [
              {
                "code" : "code"
              }
            ],
            "condition" : [
              "ele-1"
            ],
            "constraint" : [
              {
                "key" : "ele-1",
                "severity" : "error",
                "human" : "All FHIR elements must have a @value or children",
                "expression" : "hasValue() or (children().count() > id.count())",
                "xpath" : "@value|f:*|h:div",
                "source" : "http://hl7.org/fhir/StructureDefinition/Element"
              }
            ],
            "mustSupport" : true,
            "isSummary" : true,
            "binding" : {
              "extension" : [
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
                  "valueString" : "IssueType"
                }
              ],
              "strength" : "required",
              "description" : "A code that describes the type of issue.",
              "valueSet" : "http://hl7.org/fhir/ValueSet/issue-type|4.0.1"
            },
            "mapping" : [
              {
                "identity" : "rim",
                "map" : "n/a"
              },
              {
                "identity" : "v2",
                "map" : "ERR-3"
              },
              {
                "identity" : "rim",
                "map" : "./code"
              }
            ]
          },
          {
            "id" : "OperationOutcome.issue.details",
            "path" : "OperationOutcome.issue.details",
            "short" : "Additional details about the error",
            "definition" : "Additional details about the error. This may be a text description of the error or a system code that identifies the error.",
            "comment" : "A human readable description of the error issue SHOULD be placed in details.text.",
            "min" : 1,
            "max" : "1",
            "base" : {
              "path" : "OperationOutcome.issue.details",
              "min" : 0,
              "max" : "1"
            },
            "type" : [
              {
                "code" : "CodeableConcept"
              }
            ],
            "condition" : [
              "ele-1"
            ],
            "constraint" : [
              {
                "key" : "ele-1",
                "severity" : "error",
                "human" : "All FHIR elements must have a @value or children",
                "expression" : "hasValue() or (children().count() > id.count())",
                "xpath" : "@value|f:*|h:div",
                "source" : "http://hl7.org/fhir/StructureDefinition/Element"
              }
            ],
            "mustSupport" : true,
            "isSummary" : true,
            "binding" : {
              "strength" : "required",
              "valueSet" : "https://gematik.de/fhir/epa-medication/ValueSet/epa-ms-operation-outcome-details"
            },
            "mapping" : [
              {
                "identity" : "rim",
                "map" : "n/a"
              },
              {
                "identity" : "v2",
                "map" : "CE/CNE/CWE"
              },
              {
                "identity" : "rim",
                "map" : "CD"
              },
              {
                "identity" : "orim",
                "map" : "fhir:CodeableConcept rdfs:subClassOf dt:CD"
              },
              {
                "identity" : "v2",
                "map" : "ERR-5"
              },
              {
                "identity" : "rim",
                "map" : "./code"
              }
            ]
          },
          {
            "id" : "OperationOutcome.issue.diagnostics",
            "path" : "OperationOutcome.issue.diagnostics",
            "short" : "Additional diagnostic information about the issue",
            "definition" : "Additional diagnostic information about the issue.",
            "comment" : "This may be a description of how a value is erroneous, a stack dump to help trace the issue or other troubleshooting information.",
            "min" : 0,
            "max" : "1",
            "base" : {
              "path" : "OperationOutcome.issue.diagnostics",
              "min" : 0,
              "max" : "1"
            },
            "type" : [
              {
                "code" : "string"
              }
            ],
            "condition" : [
              "ele-1"
            ],
            "constraint" : [
              {
                "key" : "ele-1",
                "severity" : "error",
                "human" : "All FHIR elements must have a @value or children",
                "expression" : "hasValue() or (children().count() > id.count())",
                "xpath" : "@value|f:*|h:div",
                "source" : "http://hl7.org/fhir/StructureDefinition/Element"
              }
            ],
            "isSummary" : true,
            "mapping" : [
              {
                "identity" : "rim",
                "map" : "n/a"
              },
              {
                "identity" : "v2",
                "map" : "ERR-8"
              },
              {
                "identity" : "rim",
                "map" : "./text[parent::AcknowledgmentDetail]"
              }
            ]
          },
          {
            "id" : "OperationOutcome.issue.location",
            "path" : "OperationOutcome.issue.location",
            "short" : "Deprecated: Path of element(s) related to issue",
            "definition" : "This element is deprecated because it is XML specific. It is replaced by issue.expression, which is format independent, and simpler to parse. \n\nFor resource issues, this will be a simple XPath limited to element names, repetition indicators and the default child accessor that identifies one of the elements in the resource that caused this issue to be raised.  For HTTP errors, will be \"http.\" + the parameter name.",
            "comment" : "The root of the XPath is the resource or bundle that generated OperationOutcome.  Each XPath SHALL resolve to a single node.  This element is deprecated, and is being replaced by expression.",
            "requirements" : "Allows systems to highlight or otherwise guide users to elements implicated in issues to allow them to be fixed more easily.",
            "min" : 0,
            "max" : "*",
            "base" : {
              "path" : "OperationOutcome.issue.location",
              "min" : 0,
              "max" : "*"
            },
            "type" : [
              {
                "code" : "string"
              }
            ],
            "condition" : [
              "ele-1"
            ],
            "constraint" : [
              {
                "key" : "ele-1",
                "severity" : "error",
                "human" : "All FHIR elements must have a @value or children",
                "expression" : "hasValue() or (children().count() > id.count())",
                "xpath" : "@value|f:*|h:div",
                "source" : "http://hl7.org/fhir/StructureDefinition/Element"
              }
            ],
            "isSummary" : true,
            "mapping" : [
              {
                "identity" : "rim",
                "map" : "n/a"
              },
              {
                "identity" : "v2",
                "map" : "ERR-2"
              },
              {
                "identity" : "rim",
                "map" : "./location[parent::AcknowledgmentDetail]"
              }
            ]
          },
          {
            "id" : "OperationOutcome.issue.expression",
            "path" : "OperationOutcome.issue.expression",
            "short" : "FHIRPath of element(s) related to issue",
            "definition" : "A [simple subset of FHIRPath](http://hl7.org/fhir/R4/fhirpath.html#simple) limited to element names, repetition indicators and the default child accessor that identifies one of the elements in the resource that caused this issue to be raised.",
            "comment" : "The root of the FHIRPath is the resource or bundle that generated OperationOutcome.  Each FHIRPath SHALL resolve to a single node.",
            "requirements" : "Allows systems to highlight or otherwise guide users to elements implicated in issues to allow them to be fixed more easily.",
            "min" : 0,
            "max" : "*",
            "base" : {
              "path" : "OperationOutcome.issue.expression",
              "min" : 0,
              "max" : "*"
            },
            "type" : [
              {
                "code" : "string"
              }
            ],
            "condition" : [
              "ele-1"
            ],
            "constraint" : [
              {
                "key" : "ele-1",
                "severity" : "error",
                "human" : "All FHIR elements must have a @value or children",
                "expression" : "hasValue() or (children().count() > id.count())",
                "xpath" : "@value|f:*|h:div",
                "source" : "http://hl7.org/fhir/StructureDefinition/Element"
              }
            ],
            "isSummary" : true,
            "mapping" : [
              {
                "identity" : "rim",
                "map" : "n/a"
              },
              {
                "identity" : "v2",
                "map" : "ERR-2"
              },
              {
                "identity" : "rim",
                "map" : "./location[parent::AcknowledgmentDetail]"
              }
            ]
          }
        ]
      },
      "differential" : {
        "element" : [
          {
            "id" : "OperationOutcome",
            "path" : "OperationOutcome"
          },
          {
            "id" : "OperationOutcome.issue.details",
            "path" : "OperationOutcome.issue.details",
            "min" : 1,
            "binding" : {
              "strength" : "required",
              "valueSet" : "https://gematik.de/fhir/epa-medication/ValueSet/epa-ms-operation-outcome-details"
            }
          }
        ]
      }
    }