/**
 * German Extension Validator
 *
 * Validates German-specific extension requirements:
 * - Gender extension (gender-amtlich-de) required when gender is "other"
 * - Other conditional extension requirements for German profiles
 */
import type { ValidationIssue } from '../types';
interface Extension {
    url: string;
    valueCode?: string;
    valueCoding?: {
        system?: string;
        code?: string;
    };
    [key: string]: unknown;
}
interface PatientResource {
    resourceType: 'Patient';
    gender?: 'male' | 'female' | 'other' | 'unknown';
    _gender?: {
        extension?: Extension[];
    };
    extension?: Extension[];
}
export declare class GermanExtensionValidator {
    /**
     * Validate German extension requirements for a resource
     *
     * @param resource - FHIR resource to validate
     * @param profileUrl - Profile URL for issue reporting
     * @returns Array of validation issues
     */
    validateExtensions(resource: PatientResource, profileUrl: string): ValidationIssue[];
    /**
     * Validate that gender extension is present when gender = "other"
     *
     * Per German profiles (MII, KBV), when Patient.gender is "other",
     * the gender-amtlich-de extension MUST be present to specify the
     * administrative gender (D = divers, X = unbestimmt).
     */
    private validateGenderExtension;
    /**
     * Check if a resource has a specific extension
     *
     * Checks multiple locations where extensions can appear:
     * - Resource.extension (root level)
     * - Resource._gender.extension (primitive extension)
     */
    private hasExtension;
    /**
     * Check if a profile URL suggests German content
     * Uses same logic as GermanIdentifierValidator for consistency
     */
    isGermanProfile(profileUrl: string): boolean;
}
export {};
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