In the Risk Concern Act, there are thre Entry Reference slices.  The first one has a REFR typeCode:

• The following entryRelationship represents the relationship between two Health Concern Acts where there is a general relationship between the source and the target (Health Concern RELATES TO Health Concern). The Entry Reference template is used here because the target Health Concern Act will be defined elsewhere in the Health Concerns Section and thus a reference to that template is all that is required.
  MAY contain zero or more [0..*] entryRelationship (CONF:1198-32182) such that it
  • SHALL contain exactly one [1..1] @typeCode="REFR" Refers to (CodeSystem: HL7ActRelationshipType [ 2.16.840.1.113883.5.1002|https://terminology.hl7.org/1.0.0/CodeSystem-v3-ActRelationshipType.html]) (CONF:1198-32230).
  • SHALL contain exactly one [1..1] Entry Reference (identifier: 2.16.840.1.113883.10.20.22.4.122) (CONF:1198-32231).

The second one has a COMP typeCode:

• The following entryRelationship represents the relationship between two Health Concern Acts where the target is a component of the source (Health Concern HAS COMPONENT Health Concern). The Enry Reference template is used here because the target Health Concern Act will be defined elsewhere in the Health Concerns Section and thus a reference to that template is all that is required.

MAY contain zero or more [0..*] entryRelationship (CONF:1198-32183) such that it

• • {}SHALL{} contain exactly one [1..1] @typeCode="COMP" Has component (CodeSystem: HL7ActRelationshipType 2.16.840.1.113883.5.1002) (CONF:1198-32232).
  • {}SHALL{} contain exactly one [1..1] Entry Reference (identifier: 2.16.840.1.113883.10.20.22.4.122) (CONF:1198-32233).

Those are fine, but the third one is equivalent to the first one with the REFR typeCode:

• Where a Health Concern needs to reference another entry already described in the CDA document instance, rather than repeating the full content of the entry, the Entry Reference template may be used to reference this entry.
  MAY contain zero or more [0..*] entryRelationship (CONF:1198-32217) such that it
  • SHALL contain exactly one [1..1] @typeCode="REFR" Refers to (CodeSystem: HL7ActRelationshipType [ 2.16.840.1.113883.5.1002|https://terminology.hl7.org/1.0.0/CodeSystem-v3-ActRelationshipType.html]) (CONF:1198-32301).
  • SHALL contain exactly one [1..1] Entry Reference (identifier: 2.16.840.1.113883.10.20.22.4.122) (CONF:1198-32302).

We need to remove the third slice because there is no way to distinguish between the 1st slice and the 3rd slice. We should change the description of the first slice to be the following:

The following entryRelationship represents the relationship between two Health Concern Acts where there is a general relationship between the source and the target (Health Concern RELATES TO Health Concern). It can also represent the relationship between a Health Concern and another entry already described in the CDA document instance. The Entry Reference template is used here because the target entry will be defined elsewhere and thus a reference to that instance is all that is required.