Existing Wording: appended: The composition has been modified subsequent to being marked and/or released as "final" and is complete and verified by an authorized person. The modifications added new information to the composition, but did not revise existing content

Proposed Wording: As currently designed FHIR does not support append relationships between FHIR documents.

Comment:

Appended documents have been previously defined at HL7 as separate documents, that have their own life cycle and providence.

FHIR defines an appended as a specialized type of revision of an existing document.

Re: CDA R2.0 & V3 Medical Records: An addendum is a separate document that references the parent document, and may extend or alter the observations in the prior document. The parent document remains a current component of the patient record, and the addendum and its parent are both read by report recipients. ...

Re: HL7 V2.31

9.1.1.1 Addendum:

An appendage to an existing document that contains supplemental information. The parent document remains

in place and its content is unaltered.

FHIR has defined Appended documents as a specialized type of amended documents. Appended documents in HL7 V2, HL7 V3 and CDA have always been separate documents that are viewed with the original (parent) document. If FHIR does not want to support Appended documents, that is fine, however it should not redefine appended.