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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 

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. 
Caption ref
IdA content dependency based on hierarchical relationship
 illustrates another example in which a content dependency results in a module dependency.