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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.  illustrates another example in which a content dependency results in a module dependency.