Existing Wording: The final mode - a changes list, may include deleted items. A typical case is a medication list in a discharge summary, where the list includes items that have been both added and deleted. In order to ensure that the list is safe to process, any item where the flag implies that the item has actually been deleted SHALL have the deleted element set to true.

Proposed Wording: The changes list indicates where there are changes, but may also include deleted items as well as items that have not changed. A typical case is a medication list in a discharge summary, where the list includes items that have been added (new), deleted (stopped), and continued (unchanged). In order to ensure that a "changes" list is safe to process, any item where the flag implies that the item has actually been deleted SHALL have the deleted element set to true.

Comment:

Remove "the final mode" which sounds like it's another mode ("final") in itself. Also clarified the medications list to be more accurate to what must be on a med list (not just changes). Finally, reworded "the list" to "a changes list" so that it does not refer specifically to the medication list example.