diff --git a/hapi-fhir-validation/src/test/java/org/hl7/fhir/r4/validation/ConvertedStructureDefinitionValidationTest.java b/hapi-fhir-validation/src/test/java/org/hl7/fhir/r4/validation/ConvertedStructureDefinitionValidationTest.java
new file mode 100644
index 00000000000..b997cdeafec
--- /dev/null
+++ b/hapi-fhir-validation/src/test/java/org/hl7/fhir/r4/validation/ConvertedStructureDefinitionValidationTest.java
@@ -0,0 +1,70 @@
+package org.hl7.fhir.r4.validation;
+
+import ca.uhn.fhir.context.FhirContext;
+import ca.uhn.fhir.context.support.IValidationSupport;
+import ca.uhn.fhir.test.BaseTest;
+import ca.uhn.fhir.validation.FhirValidator;
+import ca.uhn.fhir.validation.ValidationResult;
+import org.hl7.fhir.common.hapi.validation.support.PrePopulatedValidationSupport;
+import org.hl7.fhir.common.hapi.validation.support.ValidationSupportChain;
+import org.hl7.fhir.common.hapi.validation.validator.FhirInstanceValidator;
+import org.hl7.fhir.r4.model.StructureDefinition;
+import org.hl7.fhir.r4.model.Extension;
+import org.hl7.fhir.r4.model.Patient;
+import org.hl7.fhir.r4.model.StringType;
+import org.hl7.fhir.r5.utils.validation.constants.BestPracticeWarningLevel;
+import org.junit.jupiter.api.Test;
+import org.slf4j.Logger;
+import org.slf4j.LoggerFactory;
+
+import static org.junit.jupiter.api.Assertions.assertEquals;
+
+/**
+ * See #6424
+ */
+public class ConvertedStructureDefinitionValidationTest extends BaseTest {
+
+	private static final Logger ourLog = LoggerFactory.getLogger(ConvertedStructureDefinitionValidationTest.class);
+	private final FhirContext myCtx = FhirContext.forR4Cached();
+
+	@Test
+	public void testInvalidateCacheThenValidate() throws Exception {
+
+		// Create a validation support that loads the patient-citizenship extension
+		PrePopulatedValidationSupport val = new PrePopulatedValidationSupport(myCtx);
+		val.addStructureDefinition(loadResource(myCtx, StructureDefinition.class, "r4/extension-patient-citizenship.json"));
+
+		IValidationSupport builtInValidationSupport = myCtx.getValidationSupport();
+		ValidationSupportChain validationSupport = new ValidationSupportChain(val, builtInValidationSupport);
+		FhirInstanceValidator instanceValidator = new FhirInstanceValidator(validationSupport);
+		instanceValidator.setBestPracticeWarningLevel(BestPracticeWarningLevel.Ignore);
+
+		FhirValidator validator = myCtx.newValidator();
+		validator.registerValidatorModule(instanceValidator);
+
+		// Create a patient with an invalid citizenship extension
+		Patient patient = new Patient();
+		patient.setActive(true);
+
+		Extension citizenship = patient.addExtension();
+		citizenship.setUrl("http://hl7.org/fhir/StructureDefinition/patient-citizenship");
+		citizenship.addExtension("period", new StringType("NOT A PERIOD"));
+
+		// Validate once
+		ValidationResult outcome = validator.validateWithResult(patient);
+		ourLog.info(myCtx.newJsonParser().setPrettyPrint(true).encodeResourceToString(outcome.toOperationOutcome()));
+		assertEquals("The Profile 'http://hl7.org/fhir/StructureDefinition/patient-citizenship|5.1.0' definition allows for the type Period but found type string", outcome.getMessages().get(0).getMessage());
+		assertEquals(1, outcome.getMessages().size());
+
+		// Invalidate the caches
+		instanceValidator.invalidateCaches();
+
+		// Validate a second time
+		outcome = validator.validateWithResult(patient);
+		ourLog.info(myCtx.newJsonParser().setPrettyPrint(true).encodeResourceToString(outcome.toOperationOutcome()));
+		assertEquals("The Profile 'http://hl7.org/fhir/StructureDefinition/patient-citizenship|5.1.0' definition allows for the type Period but found type string", outcome.getMessages().get(0).getMessage());
+		assertEquals(1, outcome.getMessages().size());
+
+	}
+
+}
diff --git a/hapi-fhir-validation/src/test/resources/r4/extension-patient-citizenship.json b/hapi-fhir-validation/src/test/resources/r4/extension-patient-citizenship.json
new file mode 100644
index 00000000000..24705788be2
--- /dev/null
+++ b/hapi-fhir-validation/src/test/resources/r4/extension-patient-citizenship.json
@@ -0,0 +1,766 @@
+{
+	"resourceType" : "StructureDefinition",
+	"id" : "patient-citizenship",
+	"url" : "http://hl7.org/fhir/StructureDefinition/patient-citizenship",
+	"identifier" : [{
+		"system" : "urn:ietf:rfc:3986",
+		"value" : "urn:oid:2.16.840.1.113883.4.642.5.1330"
+	}],
+	"version" : "5.1.0",
+	"name" : "PatCitizenship",
+	"title" : "Patient Citizenship",
+	"status" : "active",
+	"experimental" : false,
+	"date" : "2020-12-28T16:55:11+11:00",
+	"publisher" : "HL7 International / Patient Administration",
+	"contact" : [{
+		"telecom" : [{
+			"system" : "url",
+			"value" : "http://www.hl7.org/Special/committees/pafm"
+		}]
+	}],
+	"description" : "The patient's legal status as citizen of a country.",
+	"jurisdiction" : [{
+		"coding" : [{
+			"system" : "http://unstats.un.org/unsd/methods/m49/m49.htm",
+			"code" : "001"
+		}]
+	}],
+	"fhirVersion" : "5.0.0",
+	"mapping" : [{
+		"identity" : "rim",
+		"uri" : "http://hl7.org/v3",
+		"name" : "RIM Mapping"
+	}],
+	"kind" : "complex-type",
+	"abstract" : false,
+	"context" : [{
+		"type" : "element",
+		"expression" : "Patient"
+	}],
+	"type" : "Extension",
+	"baseDefinition" : "http://hl7.org/fhir/StructureDefinition/Extension",
+	"derivation" : "constraint",
+	"snapshot" : {
+		"element" : [{
+			"id" : "Extension",
+			"path" : "Extension",
+			"short" : "Nation(s) where the patient claims citizenship",
+			"definition" : "The patient's legal status as citizen of a country.",
+			"min" : 0,
+			"max" : "*",
+			"base" : {
+				"path" : "Extension",
+				"min" : 0,
+				"max" : "*"
+			},
+			"constraint" : [{
+				"key" : "ele-1",
+				"severity" : "error",
+				"human" : "All FHIR elements must have a @value or children",
+				"expression" : "hasValue() or (children().count() > id.count())",
+				"source" : "http://hl7.org/fhir/StructureDefinition/Element"
+			},
+				{
+					"key" : "ext-1",
+					"severity" : "error",
+					"human" : "Must have either extensions or value[x], not both",
+					"expression" : "extension.exists() != value.exists()",
+					"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
+				}],
+			"isModifier" : false
+		},
+			{
+				"id" : "Extension.id",
+				"path" : "Extension.id",
+				"representation" : ["xmlAttr"],
+				"short" : "Unique id for inter-element referencing",
+				"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
+				"min" : 0,
+				"max" : "1",
+				"base" : {
+					"path" : "Element.id",
+					"min" : 0,
+					"max" : "1"
+				},
+				"type" : [{
+					"extension" : [{
+						"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
+						"valueUrl" : "id"
+					}],
+					"code" : "http://hl7.org/fhirpath/System.String"
+				}],
+				"condition" : ["ele-1"],
+				"isModifier" : false,
+				"isSummary" : false,
+				"mapping" : [{
+					"identity" : "rim",
+					"map" : "n/a"
+				}]
+			},
+			{
+				"id" : "Extension.extension",
+				"path" : "Extension.extension",
+				"slicing" : {
+					"discriminator" : [{
+						"type" : "value",
+						"path" : "url"
+					}],
+					"description" : "Extensions are always sliced by (at least) url",
+					"rules" : "open"
+				},
+				"short" : "Additional content defined by implementations",
+				"definition" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
+				"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
+				"alias" : ["extensions",
+					"user content"],
+				"min" : 0,
+				"max" : "*",
+				"base" : {
+					"path" : "Element.extension",
+					"min" : 0,
+					"max" : "*"
+				},
+				"type" : [{
+					"code" : "Extension"
+				}],
+				"constraint" : [{
+					"key" : "ele-1",
+					"severity" : "error",
+					"human" : "All FHIR elements must have a @value or children",
+					"expression" : "hasValue() or (children().count() > id.count())",
+					"source" : "http://hl7.org/fhir/StructureDefinition/Element"
+				},
+					{
+						"key" : "ext-1",
+						"severity" : "error",
+						"human" : "Must have either extensions or value[x], not both",
+						"expression" : "extension.exists() != value.exists()",
+						"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
+					}],
+				"isModifier" : false,
+				"isSummary" : false,
+				"mapping" : [{
+					"identity" : "rim",
+					"map" : "n/a"
+				}]
+			},
+			{
+				"id" : "Extension.extension:code",
+				"path" : "Extension.extension",
+				"sliceName" : "code",
+				"short" : "Nation code of citizenship",
+				"definition" : "Nation code representing the citizenship of patient.",
+				"min" : 0,
+				"max" : "1",
+				"base" : {
+					"path" : "Element.extension",
+					"min" : 0,
+					"max" : "*"
+				},
+				"type" : [{
+					"code" : "Extension"
+				}],
+				"constraint" : [{
+					"key" : "ele-1",
+					"severity" : "error",
+					"human" : "All FHIR elements must have a @value or children",
+					"expression" : "hasValue() or (children().count() > id.count())",
+					"source" : "http://hl7.org/fhir/StructureDefinition/Element"
+				},
+					{
+						"key" : "ext-1",
+						"severity" : "error",
+						"human" : "Must have either extensions or value[x], not both",
+						"expression" : "extension.exists() != value.exists()",
+						"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
+					}],
+				"isModifier" : false,
+				"isSummary" : false
+			},
+			{
+				"id" : "Extension.extension:code.id",
+				"path" : "Extension.extension.id",
+				"representation" : ["xmlAttr"],
+				"short" : "Unique id for inter-element referencing",
+				"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
+				"min" : 0,
+				"max" : "1",
+				"base" : {
+					"path" : "Element.id",
+					"min" : 0,
+					"max" : "1"
+				},
+				"type" : [{
+					"extension" : [{
+						"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
+						"valueUrl" : "id"
+					}],
+					"code" : "http://hl7.org/fhirpath/System.String"
+				}],
+				"condition" : ["ele-1"],
+				"isModifier" : false,
+				"isSummary" : false,
+				"mapping" : [{
+					"identity" : "rim",
+					"map" : "n/a"
+				}]
+			},
+			{
+				"id" : "Extension.extension:code.extension",
+				"path" : "Extension.extension.extension",
+				"slicing" : {
+					"discriminator" : [{
+						"type" : "value",
+						"path" : "url"
+					}],
+					"description" : "Extensions are always sliced by (at least) url",
+					"rules" : "open"
+				},
+				"short" : "Extension",
+				"definition" : "An Extension",
+				"min" : 0,
+				"max" : "0",
+				"base" : {
+					"path" : "Element.extension",
+					"min" : 0,
+					"max" : "*"
+				},
+				"type" : [{
+					"code" : "Extension"
+				}],
+				"constraint" : [{
+					"key" : "ele-1",
+					"severity" : "error",
+					"human" : "All FHIR elements must have a @value or children",
+					"expression" : "hasValue() or (children().count() > id.count())",
+					"source" : "http://hl7.org/fhir/StructureDefinition/Element"
+				},
+					{
+						"key" : "ext-1",
+						"severity" : "error",
+						"human" : "Must have either extensions or value[x], not both",
+						"expression" : "extension.exists() != value.exists()",
+						"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
+					}],
+				"isModifier" : false,
+				"isSummary" : false
+			},
+			{
+				"id" : "Extension.extension:code.url",
+				"path" : "Extension.extension.url",
+				"representation" : ["xmlAttr"],
+				"short" : "identifies the meaning of the extension",
+				"definition" : "Source of the definition for the extension code - a logical name or a URL.",
+				"comment" : "The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.",
+				"min" : 1,
+				"max" : "1",
+				"base" : {
+					"path" : "Extension.url",
+					"min" : 1,
+					"max" : "1"
+				},
+				"type" : [{
+					"code" : "uri"
+				}],
+				"fixedUri" : "code",
+				"isModifier" : false,
+				"isSummary" : false,
+				"mapping" : [{
+					"identity" : "rim",
+					"map" : "N/A"
+				}]
+			},
+			{
+				"id" : "Extension.extension:code.value[x]",
+				"path" : "Extension.extension.value[x]",
+				"short" : "Value of extension",
+				"definition" : "Value of extension - must be one of a constrained set of the data types (see [Extensibility](http://hl7.org/fhir/R5/extensibility.html) for a list).",
+				"min" : 1,
+				"max" : "1",
+				"base" : {
+					"path" : "Extension.value[x]",
+					"min" : 0,
+					"max" : "1"
+				},
+				"type" : [{
+					"code" : "CodeableConcept"
+				}],
+				"condition" : ["ext-1"],
+				"constraint" : [{
+					"key" : "ele-1",
+					"severity" : "error",
+					"human" : "All FHIR elements must have a @value or children",
+					"expression" : "hasValue() or (children().count() > id.count())",
+					"source" : "http://hl7.org/fhir/StructureDefinition/Element"
+				}],
+				"isModifier" : false,
+				"isSummary" : false,
+				"mapping" : [{
+					"identity" : "rim",
+					"map" : "N/A"
+				}]
+			},
+			{
+				"id" : "Extension.extension:period",
+				"path" : "Extension.extension",
+				"sliceName" : "period",
+				"short" : "Time period of citizenship",
+				"definition" : "Period when citizenship was effective.",
+				"min" : 0,
+				"max" : "1",
+				"base" : {
+					"path" : "Element.extension",
+					"min" : 0,
+					"max" : "*"
+				},
+				"type" : [{
+					"code" : "Extension"
+				}],
+				"constraint" : [{
+					"key" : "ele-1",
+					"severity" : "error",
+					"human" : "All FHIR elements must have a @value or children",
+					"expression" : "hasValue() or (children().count() > id.count())",
+					"source" : "http://hl7.org/fhir/StructureDefinition/Element"
+				},
+					{
+						"key" : "ext-1",
+						"severity" : "error",
+						"human" : "Must have either extensions or value[x], not both",
+						"expression" : "extension.exists() != value.exists()",
+						"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
+					}],
+				"isModifier" : false,
+				"isSummary" : false
+			},
+			{
+				"id" : "Extension.extension:period.id",
+				"path" : "Extension.extension.id",
+				"representation" : ["xmlAttr"],
+				"short" : "Unique id for inter-element referencing",
+				"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
+				"min" : 0,
+				"max" : "1",
+				"base" : {
+					"path" : "Element.id",
+					"min" : 0,
+					"max" : "1"
+				},
+				"type" : [{
+					"extension" : [{
+						"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
+						"valueUrl" : "id"
+					}],
+					"code" : "http://hl7.org/fhirpath/System.String"
+				}],
+				"condition" : ["ele-1"],
+				"isModifier" : false,
+				"isSummary" : false,
+				"mapping" : [{
+					"identity" : "rim",
+					"map" : "n/a"
+				}]
+			},
+			{
+				"id" : "Extension.extension:period.extension",
+				"path" : "Extension.extension.extension",
+				"slicing" : {
+					"discriminator" : [{
+						"type" : "value",
+						"path" : "url"
+					}],
+					"description" : "Extensions are always sliced by (at least) url",
+					"rules" : "open"
+				},
+				"short" : "Extension",
+				"definition" : "An Extension",
+				"min" : 0,
+				"max" : "0",
+				"base" : {
+					"path" : "Element.extension",
+					"min" : 0,
+					"max" : "*"
+				},
+				"type" : [{
+					"code" : "Extension"
+				}],
+				"constraint" : [{
+					"key" : "ele-1",
+					"severity" : "error",
+					"human" : "All FHIR elements must have a @value or children",
+					"expression" : "hasValue() or (children().count() > id.count())",
+					"source" : "http://hl7.org/fhir/StructureDefinition/Element"
+				},
+					{
+						"key" : "ext-1",
+						"severity" : "error",
+						"human" : "Must have either extensions or value[x], not both",
+						"expression" : "extension.exists() != value.exists()",
+						"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
+					}],
+				"isModifier" : false,
+				"isSummary" : false
+			},
+			{
+				"id" : "Extension.extension:period.url",
+				"path" : "Extension.extension.url",
+				"representation" : ["xmlAttr"],
+				"short" : "identifies the meaning of the extension",
+				"definition" : "Source of the definition for the extension code - a logical name or a URL.",
+				"comment" : "The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.",
+				"min" : 1,
+				"max" : "1",
+				"base" : {
+					"path" : "Extension.url",
+					"min" : 1,
+					"max" : "1"
+				},
+				"type" : [{
+					"code" : "uri"
+				}],
+				"fixedUri" : "period",
+				"isModifier" : false,
+				"isSummary" : false,
+				"mapping" : [{
+					"identity" : "rim",
+					"map" : "N/A"
+				}]
+			},
+			{
+				"id" : "Extension.extension:period.value[x]",
+				"path" : "Extension.extension.value[x]",
+				"short" : "Value of extension",
+				"definition" : "Value of extension - must be one of a constrained set of the data types (see [Extensibility](http://hl7.org/fhir/R5/extensibility.html) for a list).",
+				"min" : 1,
+				"max" : "1",
+				"base" : {
+					"path" : "Extension.value[x]",
+					"min" : 0,
+					"max" : "1"
+				},
+				"type" : [{
+					"code" : "Period"
+				}],
+				"condition" : ["ext-1"],
+				"constraint" : [{
+					"key" : "ele-1",
+					"severity" : "error",
+					"human" : "All FHIR elements must have a @value or children",
+					"expression" : "hasValue() or (children().count() > id.count())",
+					"source" : "http://hl7.org/fhir/StructureDefinition/Element"
+				}],
+				"isModifier" : false,
+				"isSummary" : false,
+				"mapping" : [{
+					"identity" : "rim",
+					"map" : "N/A"
+				}]
+			},
+			{
+				"id" : "Extension.url",
+				"path" : "Extension.url",
+				"representation" : ["xmlAttr"],
+				"short" : "identifies the meaning of the extension",
+				"definition" : "Source of the definition for the extension code - a logical name or a URL.",
+				"comment" : "The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.",
+				"min" : 1,
+				"max" : "1",
+				"base" : {
+					"path" : "Extension.url",
+					"min" : 1,
+					"max" : "1"
+				},
+				"type" : [{
+					"extension" : [{
+						"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
+						"valueUrl" : "uri"
+					}],
+					"code" : "http://hl7.org/fhirpath/System.String"
+				}],
+				"fixedUri" : "http://hl7.org/fhir/StructureDefinition/patient-citizenship",
+				"isModifier" : false,
+				"isSummary" : false,
+				"mapping" : [{
+					"identity" : "rim",
+					"map" : "N/A"
+				}]
+			},
+			{
+				"id" : "Extension.value[x]",
+				"path" : "Extension.value[x]",
+				"short" : "Value of extension",
+				"definition" : "Value of extension - must be one of a constrained set of the data types (see [Extensibility](http://hl7.org/fhir/R5/extensibility.html) for a list).",
+				"min" : 0,
+				"max" : "0",
+				"base" : {
+					"path" : "Extension.value[x]",
+					"min" : 0,
+					"max" : "1"
+				},
+				"type" : [{
+					"code" : "base64Binary"
+				},
+					{
+						"code" : "boolean"
+					},
+					{
+						"code" : "canonical"
+					},
+					{
+						"code" : "code"
+					},
+					{
+						"code" : "date"
+					},
+					{
+						"code" : "dateTime"
+					},
+					{
+						"code" : "decimal"
+					},
+					{
+						"code" : "id"
+					},
+					{
+						"code" : "instant"
+					},
+					{
+						"code" : "integer"
+					},
+					{
+						"code" : "integer64"
+					},
+					{
+						"code" : "markdown"
+					},
+					{
+						"code" : "oid"
+					},
+					{
+						"code" : "positiveInt"
+					},
+					{
+						"code" : "string"
+					},
+					{
+						"code" : "time"
+					},
+					{
+						"code" : "unsignedInt"
+					},
+					{
+						"code" : "uri"
+					},
+					{
+						"code" : "url"
+					},
+					{
+						"code" : "uuid"
+					},
+					{
+						"code" : "Address"
+					},
+					{
+						"code" : "Age"
+					},
+					{
+						"code" : "Annotation"
+					},
+					{
+						"code" : "Attachment"
+					},
+					{
+						"code" : "CodeableConcept"
+					},
+					{
+						"code" : "CodeableReference"
+					},
+					{
+						"code" : "Coding"
+					},
+					{
+						"code" : "ContactPoint"
+					},
+					{
+						"code" : "Count"
+					},
+					{
+						"code" : "Distance"
+					},
+					{
+						"code" : "Duration"
+					},
+					{
+						"code" : "HumanName"
+					},
+					{
+						"code" : "Identifier"
+					},
+					{
+						"code" : "Money"
+					},
+					{
+						"code" : "Period"
+					},
+					{
+						"code" : "Quantity"
+					},
+					{
+						"code" : "Range"
+					},
+					{
+						"code" : "Ratio"
+					},
+					{
+						"code" : "RatioRange"
+					},
+					{
+						"code" : "Reference"
+					},
+					{
+						"code" : "SampledData"
+					},
+					{
+						"code" : "Signature"
+					},
+					{
+						"code" : "Timing"
+					},
+					{
+						"code" : "ContactDetail"
+					},
+					{
+						"code" : "DataRequirement"
+					},
+					{
+						"code" : "Expression"
+					},
+					{
+						"code" : "ParameterDefinition"
+					},
+					{
+						"code" : "RelatedArtifact"
+					},
+					{
+						"code" : "TriggerDefinition"
+					},
+					{
+						"code" : "UsageContext"
+					},
+					{
+						"code" : "Availability"
+					},
+					{
+						"code" : "ExtendedContactDetail"
+					},
+					{
+						"code" : "Dosage"
+					},
+					{
+						"code" : "Meta"
+					}],
+				"condition" : ["ext-1"],
+				"constraint" : [{
+					"key" : "ele-1",
+					"severity" : "error",
+					"human" : "All FHIR elements must have a @value or children",
+					"expression" : "hasValue() or (children().count() > id.count())",
+					"source" : "http://hl7.org/fhir/StructureDefinition/Element"
+				}],
+				"isModifier" : false,
+				"isSummary" : false,
+				"mapping" : [{
+					"identity" : "rim",
+					"map" : "N/A"
+				}]
+			}]
+	},
+	"differential" : {
+		"element" : [{
+			"id" : "Extension",
+			"path" : "Extension",
+			"short" : "Nation(s) where the patient claims citizenship",
+			"definition" : "The patient's legal status as citizen of a country.",
+			"min" : 0,
+			"max" : "*"
+		},
+			{
+				"id" : "Extension.extension:code",
+				"path" : "Extension.extension",
+				"sliceName" : "code",
+				"short" : "Nation code of citizenship",
+				"definition" : "Nation code representing the citizenship of patient.",
+				"min" : 0,
+				"max" : "1",
+				"type" : [{
+					"code" : "Extension"
+				}]
+			},
+			{
+				"id" : "Extension.extension:code.extension",
+				"path" : "Extension.extension.extension",
+				"max" : "0"
+			},
+			{
+				"id" : "Extension.extension:code.url",
+				"path" : "Extension.extension.url",
+				"type" : [{
+					"code" : "uri"
+				}],
+				"fixedUri" : "code"
+			},
+			{
+				"id" : "Extension.extension:code.value[x]",
+				"path" : "Extension.extension.value[x]",
+				"min" : 1,
+				"type" : [{
+					"code" : "CodeableConcept"
+				}]
+			},
+			{
+				"id" : "Extension.extension:period",
+				"path" : "Extension.extension",
+				"sliceName" : "period",
+				"short" : "Time period of citizenship",
+				"definition" : "Period when citizenship was effective.",
+				"min" : 0,
+				"max" : "1",
+				"type" : [{
+					"code" : "Extension"
+				}]
+			},
+			{
+				"id" : "Extension.extension:period.extension",
+				"path" : "Extension.extension.extension",
+				"max" : "0"
+			},
+			{
+				"id" : "Extension.extension:period.url",
+				"path" : "Extension.extension.url",
+				"type" : [{
+					"code" : "uri"
+				}],
+				"fixedUri" : "period"
+			},
+			{
+				"id" : "Extension.extension:period.value[x]",
+				"path" : "Extension.extension.value[x]",
+				"min" : 1,
+				"type" : [{
+					"code" : "Period"
+				}]
+			},
+			{
+				"id" : "Extension.url",
+				"path" : "Extension.url",
+				"fixedUri" : "http://hl7.org/fhir/StructureDefinition/patient-citizenship"
+			},
+			{
+				"id" : "Extension.value[x]",
+				"path" : "Extension.value[x]",
+				"min" : 0,
+				"max" : "0"
+			}]
+	}
+}