Implementation Guide
ePA Medication Service
Version 1.0.5-1 - release

## Resource Profile: EPAMSOperationOutcome - XML Profile

Active as of 2025-02-28

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

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    <StructureDefinition xmlns="http://hl7.org/fhir">
      <id value="epa-ms-operation-outcome"/>
      <url
           value="https://gematik.de/fhir/epa-medication/StructureDefinition/epa-ms-operation-outcome"/>
      <version value="1.0.5-1"/>
      <name value="EPAMSOperationOutcome"/>
      <title value="EPA Medication Service Operation Outcome"/>
      <status value="active"/>
      <experimental value="false"/>
      <date value="2025-02-28"/>
      <publisher value="gematik GmbH"/>
      <contact>
        <name value="gematik GmbH"/>
        <telecom>
          <system value="url"/>
          <value value="https://www.gematik.de"/>
        </telecom>
        <telecom>
          <system value="email"/>
          <value value="patientteam [ at ] gematik.de"/>
        </telecom>
      </contact>
      <description
                   value="Das Operation Outcome-Profil für den Medication Service der ePA."/>
      <jurisdiction>
        <coding>
          <system value="urn:iso:std:iso:3166"/>
          <code value="DE"/>
        </coding>
      </jurisdiction>
      <fhirVersion value="4.0.1"/>
      <mapping>
        <identity value="rim"/>
        <uri value="http://hl7.org/v3"/>
        <name value="RIM Mapping"/>
      </mapping>
      <mapping>
        <identity value="v2"/>
        <uri value="http://hl7.org/v2"/>
        <name value="HL7 v2 Mapping"/>
      </mapping>
      <kind value="resource"/>
      <abstract value="false"/>
      <type value="OperationOutcome"/>
      <baseDefinition
                      value="https://gematik.de/fhir/ti/StructureDefinition/operation-outcome"/>
      <derivation value="constraint"/>
      <snapshot>
        <extension
                   url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-base-version">
          <valueString value="1.0.0"/>
        </extension>
        <element id="OperationOutcome">
          <path value="OperationOutcome"/>
          <short value="Information about the success/failure of an action"/>
          <definition
                      value="A collection of error, warning, or information messages that result from a system action."/>
          <comment
                   value="Can result from the failure of a REST call or be part of the response message returned from a request message."/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="OperationOutcome"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <constraint>
            <key value="dom-2"/>
            <severity value="error"/>
            <human
                   value="If the resource is contained in another resource, it SHALL NOT contain nested Resources"/>
            <expression value="contained.contained.empty()"/>
            <xpath value="not(parent::f:contained and f:contained)"/>
            <source
                    value="http://hl7.org/fhir/StructureDefinition/DomainResource"/>
          </constraint>
          <constraint>
            <key value="dom-4"/>
            <severity value="error"/>
            <human
                   value="If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated"/>
            <expression
                        value="contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()"/>
            <xpath
                   value="not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))"/>
            <source
                    value="http://hl7.org/fhir/StructureDefinition/DomainResource"/>
          </constraint>
          <constraint>
            <key value="dom-3"/>
            <severity value="error"/>
            <human
                   value="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
                        value="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
                   value="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
                    value="http://hl7.org/fhir/StructureDefinition/DomainResource"/>
          </constraint>
          <constraint>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice">
              <valueBoolean value="true"/>
            </extension>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice-explanation">
              <valueMarkdown
                             value="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."/>
            </extension>
            <key value="dom-6"/>
            <severity value="warning"/>
            <human
                   value="A resource should have narrative for robust management"/>
            <expression value="text.`div`.exists()"/>
            <xpath value="exists(f:text/h:div)"/>
            <source
                    value="http://hl7.org/fhir/StructureDefinition/DomainResource"/>
          </constraint>
          <constraint>
            <key value="dom-5"/>
            <severity value="error"/>
            <human
                   value="If a resource is contained in another resource, it SHALL NOT have a security label"/>
            <expression value="contained.meta.security.empty()"/>
            <xpath value="not(exists(f:contained/*/f:meta/f:security))"/>
            <source
                    value="http://hl7.org/fhir/StructureDefinition/DomainResource"/>
          </constraint>
          <mapping>
            <identity value="rim"/>
            <map value="Entity. Role, or Act"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map
                 value="Grouping is handled through multiple repetitions from whatever context references the outcomes (no specific grouper required)"/>
          </mapping>
        </element>
        <element id="OperationOutcome.id">
          <path value="OperationOutcome.id"/>
          <short value="Logical id of this artifact"/>
          <definition
                      value="The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes."/>
          <comment
                   value="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 value="0"/>
          <max value="1"/>
          <base>
            <path value="Resource.id"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
              <valueUrl value="id"/>
            </extension>
            <code value="http://hl7.org/fhirpath/System.String"/>
          </type>
          <isSummary value="true"/>
        </element>
        <element id="OperationOutcome.meta">
          <path value="OperationOutcome.meta"/>
          <short value="Metadata about the resource"/>
          <definition
                      value="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 value="0"/>
          <max value="1"/>
          <base>
            <path value="Resource.meta"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="Meta"/>
          </type>
          <condition value="ele-1"/>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <isSummary value="true"/>
          <mapping>
            <identity value="rim"/>
            <map value="n/a"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value="N/A"/>
          </mapping>
        </element>
        <element id="OperationOutcome.implicitRules">
          <path value="OperationOutcome.implicitRules"/>
          <short value="A set of rules under which this content was created"/>
          <definition
                      value="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
                   value="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 value="0"/>
          <max value="1"/>
          <base>
            <path value="Resource.implicitRules"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="uri"/>
          </type>
          <condition value="ele-1"/>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <isModifier value="true"/>
          <isModifierReason
                            value="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 value="true"/>
          <mapping>
            <identity value="rim"/>
            <map value="n/a"/>
          </mapping>
        </element>
        <element id="OperationOutcome.language">
          <path value="OperationOutcome.language"/>
          <short value="Language of the resource content"/>
          <definition
                      value="The base language in which the resource is written."/>
          <comment
                   value="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 value="0"/>
          <max value="1"/>
          <base>
            <path value="Resource.language"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="code"/>
          </type>
          <condition value="ele-1"/>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <binding>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet">
              <valueCanonical value="http://hl7.org/fhir/ValueSet/all-languages"/>
            </extension>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
              <valueString value="Language"/>
            </extension>
            <strength value="preferred"/>
            <description value="A human language."/>
            <valueSet value="http://hl7.org/fhir/ValueSet/languages"/>
          </binding>
          <mapping>
            <identity value="rim"/>
            <map value="n/a"/>
          </mapping>
        </element>
        <element id="OperationOutcome.text">
          <path value="OperationOutcome.text"/>
          <short value="Text summary of the resource, for human interpretation"/>
          <definition
                      value="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 &quot;clinically safe&quot; 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
                   value="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 &quot;text blob&quot; or where text is additionally entered raw or narrated and encoded information is added later."/>
          <alias value="narrative"/>
          <alias value="html"/>
          <alias value="xhtml"/>
          <alias value="display"/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="DomainResource.text"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="Narrative"/>
          </type>
          <condition value="ele-1"/>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <mapping>
            <identity value="rim"/>
            <map value="n/a"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value="N/A"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value="Act.text?"/>
          </mapping>
        </element>
        <element id="OperationOutcome.contained">
          <path value="OperationOutcome.contained"/>
          <short value="Contained, inline Resources"/>
          <definition
                      value="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
                   value="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 value="inline resources"/>
          <alias value="anonymous resources"/>
          <alias value="contained resources"/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="DomainResource.contained"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="Resource"/>
          </type>
          <mapping>
            <identity value="rim"/>
            <map value="Entity. Role, or Act"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value="N/A"/>
          </mapping>
        </element>
        <element id="OperationOutcome.extension">
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status">
            <valueCode value="normative"/>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version">
            <valueCode value="4.0.0"/>
          </extension>
          <path value="OperationOutcome.extension"/>
          <slicing>
            <discriminator>
              <type value="value"/>
              <path value="url"/>
            </discriminator>
            <description value="Extensions are always sliced by (at least) url"/>
            <rules value="open"/>
          </slicing>
          <short value="Additional content defined by implementations"/>
          <definition
                      value="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
                   value="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 value="extensions"/>
          <alias value="user content"/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="DomainResource.extension"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="Extension"/>
          </type>
          <condition value="ele-1"/>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <constraint>
            <key value="ext-1"/>
            <severity value="error"/>
            <human value="Must have either extensions or value[x], not both"/>
            <expression value="extension.exists() != value.exists()"/>
            <xpath
                   value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <mapping>
            <identity value="rim"/>
            <map value="n/a"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value="N/A"/>
          </mapping>
        </element>
        <element id="OperationOutcome.modifierExtension">
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status">
            <valueCode value="normative"/>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version">
            <valueCode value="4.0.0"/>
          </extension>
          <path value="OperationOutcome.modifierExtension"/>
          <slicing>
            <discriminator>
              <type value="value"/>
              <path value="url"/>
            </discriminator>
            <description value="Extensions are always sliced by (at least) url"/>
            <rules value="open"/>
          </slicing>
          <short value="Extensions that cannot be ignored"/>
          <definition
                      value="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.

    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/>
          <comment
                   value="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
                        value="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 value="extensions"/>
          <alias value="user content"/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="DomainResource.modifierExtension"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="Extension"/>
          </type>
          <condition value="ele-1"/>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <constraint>
            <key value="ext-1"/>
            <severity value="error"/>
            <human value="Must have either extensions or value[x], not both"/>
            <expression value="extension.exists() != value.exists()"/>
            <xpath
                   value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <isModifier value="true"/>
          <isModifierReason
                            value="Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them"/>
          <mapping>
            <identity value="rim"/>
            <map value="n/a"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value="N/A"/>
          </mapping>
        </element>
        <element id="OperationOutcome.issue">
          <path value="OperationOutcome.issue"/>
          <short value="A single issue associated with the action"/>
          <definition
                      value="An error, warning, or information message that results from a system action."/>
          <min value="1"/>
          <max value="*"/>
          <base>
            <path value="OperationOutcome.issue"/>
            <min value="1"/>
            <max value="*"/>
          </base>
          <type>
            <code value="BackboneElement"/>
          </type>
          <condition value="ele-1"/>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <isSummary value="true"/>
          <mapping>
            <identity value="rim"/>
            <map value="n/a"/>
          </mapping>
          <mapping>
            <identity value="v2"/>
            <map value="ERR"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map
                 value="AcknowledgementDetail or Observation[classCode=&quot;ALRT&quot; and moodCode=&quot;EVN&quot;]"/>
          </mapping>
        </element>
        <element id="OperationOutcome.issue.id">
          <path value="OperationOutcome.issue.id"/>
          <representation value="xmlAttr"/>
          <short value="Unique id for inter-element referencing"/>
          <definition
                      value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Element.id"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
              <valueUrl value="string"/>
            </extension>
            <code value="http://hl7.org/fhirpath/System.String"/>
          </type>
          <mapping>
            <identity value="rim"/>
            <map value="n/a"/>
          </mapping>
        </element>
        <element id="OperationOutcome.issue.extension">
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status">
            <valueCode value="normative"/>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version">
            <valueCode value="4.0.0"/>
          </extension>
          <path value="OperationOutcome.issue.extension"/>
          <slicing>
            <discriminator>
              <type value="value"/>
              <path value="url"/>
            </discriminator>
            <description value="Extensions are always sliced by (at least) url"/>
            <rules value="open"/>
          </slicing>
          <short value="Additional content defined by implementations"/>
          <definition
                      value="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
                   value="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 value="extensions"/>
          <alias value="user content"/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="Element.extension"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="Extension"/>
          </type>
          <condition value="ele-1"/>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <constraint>
            <key value="ext-1"/>
            <severity value="error"/>
            <human value="Must have either extensions or value[x], not both"/>
            <expression value="extension.exists() != value.exists()"/>
            <xpath
                   value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <mapping>
            <identity value="rim"/>
            <map value="n/a"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value="N/A"/>
          </mapping>
        </element>
        <element id="OperationOutcome.issue.modifierExtension">
          <path value="OperationOutcome.issue.modifierExtension"/>
          <short value="Extensions that cannot be ignored even if unrecognized"/>
          <definition
                      value="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.

    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/>
          <comment
                   value="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
                        value="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 value="extensions"/>
          <alias value="user content"/>
          <alias value="modifiers"/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="BackboneElement.modifierExtension"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="Extension"/>
          </type>
          <condition value="ele-1"/>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <constraint>
            <key value="ext-1"/>
            <severity value="error"/>
            <human value="Must have either extensions or value[x], not both"/>
            <expression value="extension.exists() != value.exists()"/>
            <xpath
                   value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <isModifier value="true"/>
          <isModifierReason
                            value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/>
          <isSummary value="true"/>
          <mapping>
            <identity value="rim"/>
            <map value="n/a"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value="N/A"/>
          </mapping>
        </element>
        <element id="OperationOutcome.issue.severity">
          <path value="OperationOutcome.issue.severity"/>
          <short value="fatal | error | warning | information"/>
          <definition
                      value="Indicates whether the issue indicates a variation from successful processing."/>
          <comment
                   value="This is labeled as &quot;Is Modifier&quot; because applications should not confuse hints and warnings with errors."/>
          <requirements
                        value="Indicates how relevant the issue is to the overall success of the action."/>
          <min value="1"/>
          <max value="1"/>
          <base>
            <path value="OperationOutcome.issue.severity"/>
            <min value="1"/>
            <max value="1"/>
          </base>
          <type>
            <code value="code"/>
          </type>
          <condition value="ele-1"/>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <mustSupport value="true"/>
          <isSummary value="true"/>
          <binding>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
              <valueString value="IssueSeverity"/>
            </extension>
            <strength value="required"/>
            <description
                         value="How the issue affects the success of the action."/>
            <valueSet value="http://hl7.org/fhir/ValueSet/issue-severity|4.0.1"/>
          </binding>
          <mapping>
            <identity value="rim"/>
            <map value="n/a"/>
          </mapping>
          <mapping>
            <identity value="v2"/>
            <map value="ERR-4"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map
                 value="./typeCode[parent::AcknowledgmentDetail] or unique(./inboundRelationship[parent::Observation and typeCode='SUBJ' and isNormalActRelationship()]/source[classCode=&quot;OBS&quot; and moodCode=&quot;EVN&quot; and implies(code, ActCode#SEV and isNormalAct())/value[xsi:type=&quot;CD&quot;]"/>
          </mapping>
        </element>
        <element id="OperationOutcome.issue.code">
          <path value="OperationOutcome.issue.code"/>
          <short value="Error or warning code"/>
          <definition
                      value="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 value="Note that FHIR strings SHALL NOT exceed 1MB in size"/>
          <requirements
                        value="Expresses the issue in a human and computer-friendly way, allowing the requesting system to behave differently based on the type of issue.

    The 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 value="1"/>
          <max value="1"/>
          <base>
            <path value="OperationOutcome.issue.code"/>
            <min value="1"/>
            <max value="1"/>
          </base>
          <type>
            <code value="code"/>
          </type>
          <condition value="ele-1"/>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <mustSupport value="true"/>
          <isSummary value="true"/>
          <binding>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
              <valueString value="IssueType"/>
            </extension>
            <strength value="required"/>
            <description value="A code that describes the type of issue."/>
            <valueSet value="http://hl7.org/fhir/ValueSet/issue-type|4.0.1"/>
          </binding>
          <mapping>
            <identity value="rim"/>
            <map value="n/a"/>
          </mapping>
          <mapping>
            <identity value="v2"/>
            <map value="ERR-3"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value="./code"/>
          </mapping>
        </element>
        <element id="OperationOutcome.issue.details">
          <path value="OperationOutcome.issue.details"/>
          <short value="Additional details about the error"/>
          <definition
                      value="Additional details about the error. This may be a text description of the error or a system code that identifies the error."/>
          <comment
                   value="A human readable description of the error issue SHOULD be placed in details.text."/>
          <min value="1"/>
          <max value="1"/>
          <base>
            <path value="OperationOutcome.issue.details"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="CodeableConcept"/>
          </type>
          <condition value="ele-1"/>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <mustSupport value="true"/>
          <isSummary value="true"/>
          <binding>
            <strength value="required"/>
            <valueSet
                      value="https://gematik.de/fhir/epa-medication/ValueSet/epa-ms-operation-outcome-details"/>
          </binding>
          <mapping>
            <identity value="rim"/>
            <map value="n/a"/>
          </mapping>
          <mapping>
            <identity value="v2"/>
            <map value="CE/CNE/CWE"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value="CD"/>
          </mapping>
          <mapping>
            <identity value="orim"/>
            <map value="fhir:CodeableConcept rdfs:subClassOf dt:CD"/>
          </mapping>
          <mapping>
            <identity value="v2"/>
            <map value="ERR-5"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value="./code"/>
          </mapping>
        </element>
        <element id="OperationOutcome.issue.diagnostics">
          <path value="OperationOutcome.issue.diagnostics"/>
          <short value="Additional diagnostic information about the issue"/>
          <definition value="Additional diagnostic information about the issue."/>
          <comment
                   value="This may be a description of how a value is erroneous, a stack dump to help trace the issue or other troubleshooting information."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="OperationOutcome.issue.diagnostics"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="string"/>
          </type>
          <condition value="ele-1"/>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <isSummary value="true"/>
          <mapping>
            <identity value="rim"/>
            <map value="n/a"/>
          </mapping>
          <mapping>
            <identity value="v2"/>
            <map value="ERR-8"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value="./text[parent::AcknowledgmentDetail]"/>
          </mapping>
        </element>
        <element id="OperationOutcome.issue.location">
          <path value="OperationOutcome.issue.location"/>
          <short value="Deprecated: Path of element(s) related to issue"/>
          <definition
                      value="This element is deprecated because it is XML specific. It is replaced by issue.expression, which is format independent, and simpler to parse.

    For 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 &quot;http.&quot; + the parameter name."/>
          <comment
                   value="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
                        value="Allows systems to highlight or otherwise guide users to elements implicated in issues to allow them to be fixed more easily."/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="OperationOutcome.issue.location"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="string"/>
          </type>
          <condition value="ele-1"/>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <isSummary value="true"/>
          <mapping>
            <identity value="rim"/>
            <map value="n/a"/>
          </mapping>
          <mapping>
            <identity value="v2"/>
            <map value="ERR-2"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value="./location[parent::AcknowledgmentDetail]"/>
          </mapping>
        </element>
        <element id="OperationOutcome.issue.expression">
          <path value="OperationOutcome.issue.expression"/>
          <short value="FHIRPath of element(s) related to issue"/>
          <definition
                      value="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
                   value="The root of the FHIRPath is the resource or bundle that generated OperationOutcome.  Each FHIRPath SHALL resolve to a single node."/>
          <requirements
                        value="Allows systems to highlight or otherwise guide users to elements implicated in issues to allow them to be fixed more easily."/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="OperationOutcome.issue.expression"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="string"/>
          </type>
          <condition value="ele-1"/>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <isSummary value="true"/>
          <mapping>
            <identity value="rim"/>
            <map value="n/a"/>
          </mapping>
          <mapping>
            <identity value="v2"/>
            <map value="ERR-2"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value="./location[parent::AcknowledgmentDetail]"/>
          </mapping>
        </element>
      </snapshot>
      <differential>
        <element id="OperationOutcome">
          <path value="OperationOutcome"/>
        </element>
        <element id="OperationOutcome.issue.details">
          <path value="OperationOutcome.issue.details"/>
          <min value="1"/>
          <binding>
            <strength value="required"/>
            <valueSet
                      value="https://gematik.de/fhir/epa-medication/ValueSet/epa-ms-operation-outcome-details"/>
          </binding>
        </element>
      </differential>
    </StructureDefinition>