The Implementer Note (regarding the use of SNOMED CT) in the Designation Use value set (http://build.fhir.org/valueset-designation-use.html) needs to be updated given the following:

1. The SNOMED CT concepts referenced may now be free to use under HL7 and SNOMED International agreements.

2. The wording suggests that a variation on the usual meaning of an extensible binding which may not be required, or should at least be further clarified.