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 illustrates a local extension module that references content in a national extension, and is therefore dependent on the national extension module; and similarly a national extension module that references content in the  International Edition, and is therefore dependent on the international modules. 

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In this situation, we refer to the local extension as being a 'child' of the national extension 'parent', because the local extension contains a module that is dependent on a module in the national extension. Similarly, the national extension is a 'child' of the International Edition 'parent', because the national extension contains a module that is dependent on a module from the International Edition.

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In this example, a local extension contains a simple reference set that represents a subset of concepts. If one or more of the concepts in this subset belong to the National Extension, the extension reference set will contain rows in which the referencedComponentId refers to concepts from a module in the national extension. In this way, content from the local extension module relies on a module from the National Extension.  illustrates another example in which a content dependency results in a module dependency.

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Adding Concepts

In this example, the extension includes new clinical content. Because all active concepts in an extension must be subsumed by the root concept, |SNOMED CT Concept|, there must exist at least one 

Concept
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t116680003 |is a|
relationship  relationship in the extension with a destinationId that refers to a concept in another module. Clinical content in the extension module must depend on the international core module either directly or indirectly.  illustrates another example in which a content dependency results in a module dependency.

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The extension producer is responsible for specifying the module dependencies for every version of each extension module. Module dependencies are specified by adding rows in the

Concept
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t900000000000534007 |Module dependency reference set|
. For more information on this reference set format, please refer to 4.3.2.4.2 Module Dependency Reference Set.

It is important to note that all dependencies for each module (including transitive dependencies) must be explicitly stated. For example,  illustrates an example in which all 3 dependencies must be explicitly stated: Module C is dependent on Module B, Module B is dependent on Module A and Module C is dependent on Module A.

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