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Conformance validation

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SHALL/SHOULD/MAY vs. R/R2 vs. Required/Mandatory [see:]

SHALL: Corresponds to HMD "Required" if on XML element (i.e. the element is there, but can be NULL); Corresponds to HMD "Mandatory" if on XML attribute. Corresponds to IHE "R".

SHOULD: Corresponds to IHE "R2".

Where necessary to explicitly preclude NULL (e.g. where you want to preclude NULL on observation/value), can include something like "SHALL NOT include nullFlavor".