{
  "types": [
    "Substance"
  ],
  "Substance": {
    "elements": {
      "Substance.status": {
        "modifier": "added"
      },
      "Substance.ingredient.substance[x]": {
        "removed-types": [
          "Reference(Substance)"
        ],
        "added-types": [
          "Reference(Substance)"
        ]
      }
    },
    "status": "changed"
  }
}