This wireframe is...
There's also an Additional Source Note field in the wiki page for Concept Authority Schema, an addition to the repeatable Additional Source group shown in the wireframe. And every repeatable Term group has a Source Note field, not shown above.
The labels in the columns in the Scope repeatable group might need some checking ...
Finally, the repeatable Term group above has a Date field. That field isn't present in the wiki schema; there is a Term Date field, which may be outside that repeatable group, in the Concept Authority Schema - Better.
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