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The substanceAdministration in 'Changed Medication Treatment Plan Item' is empty. It should probably contain/inherit from/extend the 'Medication Treatment Plan Item Entry Content Module'.
There also is an issue with the IHE Pharm PADV profile numbering: starting with 'Reference to Pharmaceutical Advice Concerns', there is an offset of 1 in the section reference. E.g. 'Changed Medication Treatment Plan Item' is described in section 22.214.171.124.12, not .11.
The definition of the substanceAdministration in "Changed or Recommended Prescription Items" is inherited from "IHE Prescription Item Entry Content Module" and is different than the definition given in "Prescription Item Entry Content Module". The latter should probably be used here.
In the template, the hl7:entryRelationship "Changed Medication Treatment Plan Item" has a cardinality of 0…*. According to IHE PHARM PADV §126.96.36.199.3.12, it should be 0…1:
(1) Only one element SHALL be present, if the status of the Pharmaceutical Advice (<code> Element) is set to “CHANGE” and a reference to a Medication Treatment Plan Item is given.(2) In all other cases this element SHALL NOT be present.