I will admit right up front that I am not sure about this feedback, but since the deadline is today, I would like to get it in for discussion. I have sent an e-mail to some people more knowledgeable than I and I will close this if it turns out I am incorrect when I hear back from them.

I think that SNOMED CT concepts that are qualifiers are not to be used independantly, so they shouldn't be in a value set of findings, disorders, or procedures as qualifiers cannot stand on their own and should always be attached to a SNOMED CT concept that can stand alone. For example, in the Patient Reason 2.16.840.1.113883.3.117.1.7.1.474 value set, it may not be appropriate to have 443390004 Refused (qualifier value) and 385648002 Rejected by recipient (qualifier value).