import type { QuestionnaireItem, QuestionnaireResponseItemAnswer } from 'fhir/r4';
type JsonDiffOperator = '+' | '-' | '~' | ' ';
type QuestionnaireResponseItemDiffArray = [JsonDiffOperator, QuestionnaireResponseDiffItem];
type QuestionnaireResponseItemAnswerDiffArray = [JsonDiffOperator, QuestionnaireResponseItemAnswer];
interface QuestionnaireResponseDiffItem {
    linkId: string;
    item: QuestionnaireResponseItemDiffArray[] | undefined;
    answer: QuestionnaireResponseItemAnswer[] | QuestionnaireResponseItemAnswerDiffArray[] | undefined;
}
interface ItemChange {
    linkId: string;
    itemType: string;
    operation: 'add' | 'remove' | 'update';
    value: QuestionnaireResponseItemAnswer;
}
export declare function readFormChanges(formChanges: object, itemMap: Record<string, Omit<QuestionnaireItem, 'item'>>): Record<string, ItemChange | null>;
export declare function readItemChangesRecursive(diffArray: QuestionnaireResponseItemDiffArray, itemMap: Record<string, Omit<QuestionnaireItem, 'item'>>, changedItems: Record<string, ItemChange | null>): Record<string, ItemChange | null>;
export {};