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TERMS AND CONDITIONS OF USE

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To the extent permitted by law, we exclude all conditions, warranties, representations or other terms which may apply to our website or any information or content on it, whether express or implied.

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If you have not already been assigned an account to manage affiliates within the MLDS, please send an email to providing your name, email address and related NRC name.

If you have, please go to the login page here - - and enter in the same user name and password that you use to log in to Confluence.

• The landing page for affiliates looking to use SNOMED CT in non-member countries can be found here – https://mlds.ihtsdotools.org

Step 1. Initial Registration

• Click on the Register button and you will be taken to the initial registration screen.

Step 2. Account Activation

• Once you have completed the initial registration, you will be sent an Account Activation email to confirm your email address and allow you to continue your registration. In the email you receive, is the confirmation URL which will take you to the next step:

• You will be asked how you will be using SNOMED CT

  • Commercial

  • Academic

_ &#xNAN;_

• Any information that falls outside of the requested data should be recorded in the Other Activities section. Affiliates are required to notify IHTSDO prior to engaging in any activities that do not fall within the existing categories at which time the IHTSDO will determine the appropriate Fee Structure for the activity in question

• The final section asks for you to confirm that you have read and accept the terms of the SNOMED CT affiliate license ( )before clicking the register button where you will be asked to confirm the information on your application before the final submission.

• At this point, you will now be redirected to your dashboard, where you will be able to see the status of your application and the standing of your account.

• Once your application has been reviewed and approved your Account Information Status will change to Pending Invoice as shown below.

• Once your invoice is paid, your Account Information Status will change to In Good Standing and you will be able to access the SNOMED CT Releases as well as any other extensions or other files that are available.

• Edit Package - enables editing of Release Package name and description

• View License - enables viewing of the license for the Release Package selected, note license must be uploaded via the Edit License option firs t

There are three things that need translating, and the necessary files can be found on this page covering the following parts:

The interface and email messages need to be translated, whilst the third section is optional depending on the Member country preference.

Available tooling

SNOMED International provides an online translation tool, https://translate.snomedtools.org, which can be used to translate the MLDS interface and email messages.

To access the translation tool, you will need to request an account via techsupport@snomed.org, explaining that the account is needed to translate MLDS.

Once you have received the invite, follow the instructions in the email, then go to the MLDS translation project at https://translate.snomedtools.org/projects/mlds/.

You will see the following screen:

Find the language you want to translate and then, looking along the relevant row, click on the Untranslated column, which will open the following screen:

At the top of the page, you can see the English word to translate (in this case, 'Home') and an empty box where you can enter the translation.

Once you have entered the correct translation, change the Review State to Approved, then click the 'Save and Continue' button. This will then take you to the next untranslated phrase.

Once you have completed all the translations, please inform .

• There is no need to complete the translations in one session as they are saved on the server.

• There are also automated translation options further down the page that can speed up the process. If you are happy with one of the translations, click in the 'Accept and Approve' button on the relevant row.

The following files may also need to be translated before they can be added to the site, mainly the terms & conditions and the affiliate license. This is a more straightforward translation of the files' contents, but the choice to translate them is up to the Member country.

Please request more information from if needed.

1. Approved - Application is approved.

2. Declined - Application is declined.

3. Change Requested - An Action has been sent to the Affilate to comply and is under further review before approval is granted.

Working with the SNOMED CT community, SNOMED International produced the following syndication standard, which has now been implemented in MLDS. The feed can be viewed here: https://mlds.ihtsdotools.org/api/feed

Terminology Server Syndication Standard

As part of a strategy to move towards wider adoption of healthcare terminology servers which implement the HL7 FHIR Terminology Services, a more effective way of distributing terminology would be from server to server through a syndication feed.

Based on existing work implemented by the Australian Digital Health Agency, this feed extends the Atom Syndication Standard. It is not specific to SNOMED CT and can be used for any relevant healthcare standard,

The additions here are from SNOMED International and are in the sct namespace, http://snomed.info/syndication/sct-extension/1.0.0, for distributing SNOMED CT content.

SNOMED CT Specific extensions

A live feed is now available from SNOMED International - Members Distribution and Licensing Service

Example feed can be seen in this repo - .

The extensions to the specification are as follows:

These are SNOMED CT specific extensions to specify any package dependency for a given release package that are not included in the package itself. Dependencies can be on editions or other derivatives.

by definition include all their dependencies and therefore do not have a sct:packageDependency element.

always depend on other packages' content not included in the extension package and therefore always have a sct:packageDependency element.

and can therefore be distinguished by the absence or presence of a sct:packageDependency element.

Within a sct:packageDependency element

• sct:editionDependency states any necessary edition dependency and version using the SNOMED CT URI standard, e.g. http://snomed.info/sct/900000000000207008/version/20220731. Where a package is transitively dependent on multiple editions, only the direct non-transitive dependencies should be stated. Downloading packages would complete when there are no further dependencies.

• sct:derivativeDependency states any necessary derivative dependency, as they are often published outside of SNOMED CT editions. Similarly, this should also follow the SNOMED CT URI standard for module and version

While all types of entries can be put into one feed, it is also possible to host these entries in separate feeds. For examples

• an editions feed - edition packages of available SNOMED CT Editions/Extensions

• an extensions feed - extension packages of available SNOMED CT Extensions

• a derivatives feed - extension packages of available SNOMED CT Derivatives

Given that most implementers prefer a ready to use package to parts and assembly instructions, most implementers will be interested in edition packages rather than extension packages.

Providing a feed containing only edition packages without extension packages would be the least confusing entry point for most implementers with the least learning and decision making required.

Additional feeds for extension packages and derivatives would be useful for other implementations and are still worth providing.

A complete feed that is the union of these three feeds can also be potentially provided.

The major distinction between extensions and derivatives is that extensions add/modify core components, where derivatives are limited to reference sets providing non-core "bolt on" content.

For editions, most implementers want a ready to use package rather than parts and assembly instructions. Assembling an edition from an extension package and a base edition is not a trivial exercise, requiring content to be combined and a snapshot calculated based on the .

For this reason edition packaging is preferred as the primary distribution method extensions. Extensions may also be provided in extension packaging, however if only one is made availabe edition packaging is preferred.

The rationale for this recommendation is that

• implementers desiring an extension package are in the minority and more capable of disassembiling an edition package if necessary

• the majority of implementers would prefer a ready to use edition package, and the task of assembling that from an extension and base edition package and calculating a snapshot based on the is burdensome.

Derivatives are designed to bolt on to an edition, and as such are either "pre-mixed" into an edition package or provided as an extension package.

When provided by themselves, they make most sense provided as an extension package so they can be "bolted onto" a number of different compatible editions. Therefore the preferred packaging of a derivative is an extension package.

Note that this preference does not preclude prepackaging one or more derivatives in edition packages where useful.

Extensions, as opposed to derivatives, add/modify core components - concepts, descriptions and axioms/relationships. These changes affect the Snapshot state of components, as well as potenitally affecting classification and Necessary Normal Form calculation (for example non-leaf concept addition).

An Extension (adding/modifying core components) published as an extension package should only be a Delta or a Full . Such a package can be applied to a referenced base edition, and then a Snapshot calculated using the . Because an Extension affects the Snapshot state in this way, potentially requiring reclassification and Necessary Normal Form recalculation, a Snapshot extension package of an Extension cannot be simply appended to a base edition's Snapshot. For this reason, the Snapshot Release Type for extension packages of SNOMED CT Extensions should not be used.

In the simpler Derivative case (map, refset, even language translation with additional descriptions) a Snapshot extension package being simply appended to a Snapshot base edition is safe and simple because the derivative simply adds new components and does not affect the state of existing components.

The Snapshot Release Type for an edition package does not have these issues as the base edition content is included in the resolved Snapshot Release Type of the package.

To aid human readability and distinguish between packages, the following naming conventions should be applied.

1. Edition packages

   1. Should contain the word edition

   2. Should NOT contain the word extension

For example, titles following these conventions are

• SNOMED CT-International Edition 2023-04-30 (RF2 SNAPSHOT)

• SNOMED CT-International Spanish Extension 2023-10-31 (RF2 FULL)

Each feed entry should always have one link rel="alternate" link. This will generally be the SNOMED CT package to download.

There can also be one or more link rel="related" entries for any related files, including Release Notes or other relevant files.

Each link will have the following attributes:

• type - the type of file being downloaded, e.g. type="application/zip" or type="application/pdf"

• href - the URL link to download the file

In each feed entry, the category will indicate the type of RF2 package. The expected types are as follows:

• SCT_RF2_ALL: Containing the Snapshot and Full RF2 release files (and potentially the Dela Rf2 files but this is not mandatory)

• SCT_RF2_FULL: Containing only Full RF2 release files

• SCT_RF2_SNAPSHOT: Containing only Snapshot RF2 release files

Most available RF2 packages will contain all the necessary release files and will, therefore, have a feed entry item as follows:

The standard does not mandate any authentication, and this is left to the implementer of the Atom feed provider to implement whatever is needed, depending on any terminology product license requirements.

Syndication of terminologies has a number of use cases. A few examples are:

Automatic distribution of content products by their owners:

• International content products

• National content products

• Regional content products

Automatic import of selected products and dependencies as updates become available:

• Automatic update of existing terminology server instances

  • Browser server containing both published content and daily builds

• Automatic provision of new terminology server instances

If you wish to download either the International Edition of SNOMED CT or any local SNOMED CT extension to use within current SNOMED International Member territories, please see the list below and go to the relevant distribution location.

If your country is not listed below, please visit .

_last updated - 15 Apr 2025 _

Once your account has been reviewed and, if applicable, any invoice has been paid, you will now be able to see that you application has been approved and your account will be in a 'good standing' process.

Step 1. Access to SNOMED CT

• At this stage you will now have access to download the SNOMED CT International Release by clicking on the 'Releases' link on the top menu or the releases section on your dashboard.

Step 2. Other Available Releases

• From your dashboard you can also apply for access to other products, such as national extensions. If you would like to apply to access any national Member space that can be found on the MLDS, you can click on the relevant country where you will be asked to provide information used by the member to review your application. Once approved by that country you will have access to the your selected release.

1. New Usage Declaration Reports

When an Affiliate completes their application, the usage report can be filled out without completing all of the information. The IHTSDO or Member NRC admin reviews the application and will request additional usage information be completed if required. The Affiliate will see reminder messages that indicate when reports need to be submitted.

After the initial usage report submission, towards the end of every year, and if applicable, the Affiliate will receive a notification via email that they need to provide a report on the current and planned usage of SNOMED CT in non-member countries, and any member countries they have registered with through the MLDS.

• On your dashboard you will see your previously submitted usage reports, as well as where to create a new usage report.

• Click on New Report button.

If for some reason an affiliate wants to correct a usage report that has been submitted, they must first retract the usage report. They can do this by clicking on the usage report they wish to change and then click the Retract Declaration Button. They can then amend their changes and submit. Any previously submitted Usage reports for the same time period will be superseded.

Here is where you will find any new applications that are waiting to be approved. Click on the Review Button where you will be able to review the application (step1 )and then decide (step 2) if the application can be approved, declined or if you wish to request additional information from the Affiliate.

List of Applications

Actions available on an application page

Approve Application

If the everything on the application is acceptable and you wish to approve the application, click the

You will then see the following dialog box:

You can now find that affiliate in the Affiliate Management Page.

Change Requested

If, having reviewed the application, more information or changes are needed from the applicant, then Admin can click on the "Change Requested From Applicant" button. This will result in the following dialog box:

The application will be shown with a 'Change Requested' status in the Pending Applications screen as follows:

When further review of an application is required, the Admin can click the Review Requested from Staff button to flag that application. This button does not work like an on and off flag. In order to remove the Review Requested flag the application must be Approved, a Change Requested from Applicant issued or the application should be Declined.

If, for whatever reason the application is not approved then Admin should click on the 'Decline Application' button. This will show the following confirmation dialog box:

This will change the status of the application to declined and the applicant will see the following screen when they log in:

For further details and questions around licensing, please read the following FAQs - https://ihtsdo.freshdesk.com/support/solutions/4000002199

Other Pages

• MLDS Privacy Policies

• MLDS Terms of Service

In order to get access to the international edition of SNOMED CT and its derivatives, you will need to register and apply for an account. Each application is reviewed by the IHTSDO and follows these steps:

Primary Application - applies only to SNOMED CT International and its derivatives

1. An application is made by user providing information such as type of license requested, proposed or current use of SNOMED CT and the non-member countries where it is being used

2. The application is reviewed by IHTSDO staff, and if applicable, an invoice will be sent based up on the usage of SNOMED CT as detailed in the Affiliate License Agreement (http://www.ihtsdo.org/resource/resource/117). Your account will be put in a pending invoice (payment?) status and you will be able to log in to your account to see the status.

3. If an invoice has been raised, you will need to send payment for the invoice before you are able to access and download SNOMED CT. Once payment has been received, or if there is no need for an invoice, your account will be put into a 'good standing' status and you will be able download the relevant releases.

4. At the end of each year, you will be asked to provide an update on the usage of SNOMED CT in order to continue to have access to the release packages.

1. An application can be made for any other extension, release or derivative other than SNOMED CT while their primary application is under review. Once the application is submitted it will follow the same process as above going into an initial state of Pending until the Member Admin approves that extension application and thier Primary application status changes to "in Good Standing" with payment complete before any downloads are available.

¿Cómo obtengo una Licencia de Afiliación SNOMED CT?

El proceso utilizado depende de donde esté planificando utilizar SNOMED CT:

**a)**Países Miembros

Si usted piensa utilizar, implementar o distribuir SNOMED CT en el territorio de un País Miembro, entonces podrá obtener la licencia desde ese País Miembro. Podrá descargar SNOMED CT desde el sitio web oficial del País Miembro. El uso de SNOMED CT en los Países Miembros es gratuito. Puede encontrar el sitio web oficial de cada País Miembro a través de los enlaces del sitio web de IHTSDO: http://www.ihtsdo.org/members/.

Si decide utilizar, implementar o distribuir SNOMED CT en otros Países Miembros deberá ingresar al sitio web delMiembro correspondiente para determinar si existen requerimientos para su utilización en ese País Miembro en particular.

Además de obtener la licencia desde el País Miembro, usted puede obtener la licencia directamente desde IHTSDO. Sin embargo, deberá ingresar al sitio web del País Miembro en que desea implementar o distribuir SNOMED CT para determinar si hay algún requerimiento para para su utilización en ese País Miembro en particular.

**b)**Países no-Miembros

Si aun no tiene una licencia para SNOMED CT y planea utilizar, implementar o distribuir SNOMED CT en un País no-Miembro, deberá solicitar una licencia directamente a IHTSDO. Por más información visite el sitio: . Considere que esto podrá implicar costos para el solicitante.

Deberá notificar a IHTSDO sobre la utilización de SNOMED CT en ese País no-Miembro. Esta notificación se realizará a través del centro de distribución y licenciamiento localde SNOMED CT. Considere que esto podrá implicar cargos para el solicitante. Por más información visite el sitio: . Por otra parte, si su oficina registrada o principal lugar de negocios se encuentra en un País Miembro, deberá notificar al mismo de sus planes de utilizar SNOMED CT en un País no-Miembro.

Si decide utilizar, implementar o distribuir SNOMED CT en Países Miembros adicionales deberá ingresar al sitio web del País Miembro en cuestión para determinar si existen requerimientos para su utilización en ese País Miembro en particular.

Puede encontrar el sitio web oficial de cada País Miembro a través de los enlaces de el sitio de IHTSDO: .

Deberá contactarse con IHTSDO directamente enviando un correo electrónico a . Por favor incluya una descripción completa para que sea posible determinar el importe de la licencia.

Deberá contactarse con IHTSDO directamente enviando un correo electrónico a . Por favor incluya una descripción completa para que sea posible determinar el importe de la licencia.

Deberá contactarse con IHTSDO directamente enviando un correo electrónico a . Por favor incluya una descripción completa para que sea posible determinar el importe de la licencia.

IHTSDO Member - Dashboard Menu View or Release Package Menu View

Dashboard Menu View

Step 1. Once you have clicked on an approved release from the Dashboard view you will be brought to that specific Release Package with the ability to download.

Step 2. Click on the checkbox to agree to the licence then you will be able to download the Release Package.

Release Package Menu View

_ _

Step 1 - Click on the Release Package that you wish to access.

_ _

_

Step 2 - At this stage you can download an already approved Release Package or you can apply for any additional ones you want. Refer to the right of any Release Package for Status indication as explained below.

Provide Feedback

Provide Feedback

This section is primarily for staff of SNOMED International or Member Countries who are using the MLDS to manage their affiliates.

Provide Feedback

SNOMED International's MLDS provides a limited number of APIs to support integration with other systems.

For further information on the REST APIs to get access to releases, please go to the page.

All access to the API is over HTTPS to the [mlds.ihtsdotools.org](http://mlds.ihtsdotools.org) domain. All data is sent and received as JSON.

Client errors on API calls will typically result in a 400 Bad Request response.

Error responses can be detected by a status code of 4xx or 5xx. The message value is an optional human description of the problem.

Provide Feedback

The Member Licensing and Distribution Service (MLDS) is SNOMED International's online platform for managing SNOMED CT licensing and distributing SNOMED CT release packages. Available at mlds.ihtsdotools.org, MLDS provides a single point of access for individuals and organizations to register their use of SNOMED CT, apply for affiliate licenses, and download SNOMED CT editions and extensions.

This guide provides step-by-step instructions for using the MLDS platform. It covers registration and the application process, navigating the site and downloading release packages, managing your account and understanding application statuses, submitting usage reports and statements of account, and accessing release packages via the MLDS API. Whether you are a first-time user registering for SNOMED CT access or an NRC administrator managing your country's releases, this guide will help you navigate the platform effectively.

For further details about licensing and what type of license you need, please read the SNOMED International FAQs.

If you want to download SNOMED CT, please review where to get the release files.

Each member organization can make Release Packages available to their approved affiliates for downloading. A Release Package has a current version and past versions. A Release version can contain multiple files that can be individually downloaded by an affiliate.

Release files are not stored in MLDS and instead a URL is provided where the file can be download from on demand. Files are typically stored on the Amazon s3 service. The URL to directly access the release file is not made available to affiliate users, who instead use a MLDS based URL that in turn download the file from the original location.

Client errors on API calls will typically result in a 400 Bad Request response.

Error responses can be detected by a status code of 4xx or 5xx. The message value is an optional human description of the problem.

The public APIs do not require authentication to be supplied.