Recommend further updating and clarifying Encounter.reason and Encounter.diagnosis. It seems the intent is to represent reasons for the encounter that can be either diagnoses or procedures in these two attributes, with one being a code and one being a structure. However, the approach is confusing, as is the name (e.g., why is a procedure called a diagnosis?). Also, the Encounter.diagnosis.role (DiagnosisRole) is insufficiently expressive as a 0..1 attribute. For example, the approach does allow saying – facility billing discharge diagnosis. Recommend making this attribute 0..* and adding notions of facility vs. professional billing. Also, recommend clarifying how to rank diagnoses and procedures expressed by the reason attribute. Suggest also reviewing CIMI modeling for this concept for potential synergy.