define "Initial Population":
  "Patients Aged 35 to 70 with an Office Visit During the Measurement Period"
    and ( "Most Recent BMI Equal to or Greater Than 25 and Is Not Asian"
        or "Most Recent BMI Equal to or Greater Than 23 and Is Asian"
    )

define "Denominator":
  "Initial Population"

define "Denominator Exclusions":
  "Has Pregnancy Observation During Measurement Period"
    or exists "Has Pregnancy Diagnosis During Measurement Period"
    or exists "Has Advanced Illness or Limited Life Expectancy"
    or exists "Diabetes Diagnosis Overlaps 2 Year Look Back Period"
    or exists "Prediabetes Diagnosis Overlaps 2 Year Look Back Period"
    or "Has Glycemic Laboratory Test Performed During 2 Year Look Back Period"

define "Numerator":
  exists "Glycemic Laboratory Test Performed During Measurement Period"

define "SDE Sex":
  case
    when Patient.sex() = '248153007' then "Male (finding)"
    when Patient.sex() = '248152002' then "Female (finding)"
    else null
  end

define "SDE Race":
  (Patient.race()) R
    return Tuple {
      codes: R.ombCategory union R.detailed,
      display: R.text
    }

define "SDE Payer":
  [USQualityCore.Coverage: type in "Payer Type"] Payer
    return {
      code: Payer.type,
      period: Payer.period
    }

define "SDE Ethnicity":
  (Patient.ethnicity()) E
    return Tuple {
      codes: { E.ombCategory } union E.detailed,
      display: E.text
    }

/*
@description: Returns an interval of date values extracted from the input interval of date-time values
@comment: This function returns an interval constructed using the `date from` extractor on the start
and end values of the input date-time interval. Note that using a precision specifier such as `day of`
as part of a timing phrase is preferred to communicate intent to perform day-level comparison, as well
as for general readability.
*/
define function "ToDateInterval"(period Interval<DateTime>):
  Interval[date from start of period, date from end of period]

/*
@description: Returns the single extension (if present) on the given resource with the specified url.
@comment: This function uses singleton from to ensure that a run-time exception is thrown if there
is more than one extension on the given resource with the specified url.
*/
define fluent function ext(domainResource DomainResource, url String):
  singleton from domainResource.exts(url)

/*
@description: Returns any extensions defined on the given resource with the specified url
*/
define fluent function exts(domainResource DomainResource, url String):
  domainResource.extension E
    where E.url = url
    return E

/*
@description: Normalizes a value that is a choice of timing-valued types to an equivalent interval
@comment: Normalizes a choice type of FHIR.dateTime, FHIR.Period, FHIR.Timing, FHIR.instance, FHIR.string, FHIR.Age, or FHIR.Range types
to an equivalent interval. This selection of choice types is a superset of the majority of choice types that are used as possible
representations for timing-valued elements in FHIR, allowing this function to be used across any resource.

The input can be provided as a dateTime, Period, Timing, instant, string, Age, or Range.
The intent of this function is to provide a clear and concise mechanism to treat single
elements that have multiple possible representations as intervals so that logic doesn't have to account
for the variability. More complex calculations (such as medication request period or dispense period
calculation) need specific guidance and consideration. That guidance may make use of this function, but
the focus of this function is on single element calculations where the semantics are unambiguous.
If the input is a dateTime, the result a DateTime Interval beginning and ending on that dateTime.
If the input is a Period, the result is a DateTime Interval.
If the input is a Timing, an error is raised indicating a single interval cannot be computed from a Timing.
If the input is an instant, the result is a DateTime Interval beginning and ending on that instant.
If the input is a string, an error is raised indicating a single interval cannot be computed from a string.
If the input is an Age, the result is a DateTime Interval beginning when the patient was the given Age,
and ending immediately prior to when the patient was the given Age plus one year.
If the input is a Range, the result is a DateTime Interval beginning when the patient was the Age given
by the low end of the Range, and ending immediately prior to when the patient was the Age given by the
high end of the Range plus one year.

NOTE: Due to the
complexity of determining a single interval from a Timing or String type, this function will throw a run-time exception if it is used
with a Timing or String.
*/
define fluent function toInterval(choice Choice<FHIR.dateTime, FHIR.Period, FHIR.Timing, FHIR.instant, FHIR.string, FHIR.Age, FHIR.Range>):
  case
    when choice is FHIR.dateTime then
      Interval[FHIRHelpers.ToDateTime(choice as FHIR.dateTime), FHIRHelpers.ToDateTime(choice as FHIR.dateTime)]
    when choice is FHIR.Period then
      FHIRHelpers.ToInterval(choice as FHIR.Period)
    when choice is FHIR.instant then
      Interval[FHIRHelpers.ToDateTime(choice as FHIR.instant), FHIRHelpers.ToDateTime(choice as FHIR.instant)]
    when choice is FHIR.Age then
      Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(choice as FHIR.Age),
        FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(choice as FHIR.Age) + 1 year)
    when choice is FHIR.Range then
      Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((choice as FHIR.Range).low),
        FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((choice as FHIR.Range).high) + 1 year)
    when choice is FHIR.Timing then
      Message(null as Interval<DateTime>, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a Timing value is not supported')
    when choice is FHIR.string then
      Message(null as Interval<DateTime>, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a String value is not supported')
    else
      null as Interval<DateTime>
  end

/*
@description: Returns any extensions defined on the given element with the specified url.
*/
define fluent function exts(element Element, url String):
  element.extension E
    where E.url = url
    return E

/*
@description: Returns the single extension (if present) on the given element with the specified url.
@comment: This function uses singleton from to ensure that a run-time exception is thrown if there
is more than one extension on the given element with the specified url.
*/
define fluent function ext(element Element, url String):
  singleton from element.exts(url)

/*
@description: Returns the sex element as defined for the USCore patient profile
*/
define fluent function sex(patient Patient):
  patient.ext('http://hl7.org/fhir/us/core/StructureDefinition/us-core-sex').value as FHIR.code

define fluent function race(patient Patient):
  (patient.ext('http://hl7.org/fhir/us/core/StructureDefinition/us-core-race')) E
    return {
      ombCategory: (E.exts('ombCategory')) o return o.value as FHIR.Coding,
      detailed: (E.exts('detailed')) d return d.value as FHIR.Coding,
      text: E.ext('text').value as FHIR.string
    }

define fluent function ethnicity(patient Patient):
  (patient.ext('http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity')) E
    return {
      ombCategory: E.ext('ombCategory').value as FHIR.Coding,
      detailed: (E.exts('detailed')) d return d.value as FHIR.Coding,
      text: E.ext('text').value as FHIR.string
    }

define function ToString(value string): value.value

define function ToString(value uri): value.value

/*
@description: Converts the given [Period](https://hl7.org/fhir/datatypes.html#Period)
value to a CQL DateTime Interval
@comment: If the start value of the given period is unspecified, the starting
boundary of the resulting interval will be open (meaning the start of the interval
is unknown, as opposed to interpreted as the beginning of time).
*/
define function ToInterval(period FHIR.Period):
    if period is null then
        null
    else
        if period."start" is null then
            Interval(period."start".value, period."end".value]
        else
            Interval[period."start".value, period."end".value]

define function ToString(value ObservationStatus): value.value

define function ToString(value EncounterStatus): value.value

define function ToDate(value date): value.value

/*
@description: Converts the given FHIR [Quantity](https://hl7.org/fhir/datatypes.html#Quantity) 
value to a CQL Quantity
@comment: If the given quantity has a comparator specified, a runtime error is raised. If the given quantity
has a system other than UCUM (i.e. `http://unitsofmeasure.org`) or CQL calendar units (i.e. `http://hl7.org/fhirpath/CodeSystem/calendar-units`)
an error is raised. For UCUM to calendar units, the `ToCalendarUnit` function is used.
@seealso: ToCalendarUnit
*/
define function ToQuantity(quantity FHIR.Quantity):
    case
        when quantity is null then null
        when quantity.value is null then null
        when quantity.comparator is not null then
            Message(null, true, 'FHIRHelpers.ToQuantity.ComparatorQuantityNotSupported', 'Error', 'FHIR Quantity value has a comparator and cannot be converted to a System.Quantity value.')
        when quantity.system is null or quantity.system.value = 'http://unitsofmeasure.org'
              or quantity.system.value = 'http://hl7.org/fhirpath/CodeSystem/calendar-units' then
            System.Quantity { value: quantity.value.value, unit: ToCalendarUnit(Coalesce(quantity.code.value, quantity.unit.value, '1')) }
        else
            Message(null, true, 'FHIRHelpers.ToQuantity.InvalidFHIRQuantity', 'Error', 'Invalid FHIR Quantity code: ' & quantity.unit.value & ' (' & quantity.system.value & '|' & quantity.code.value & ')')
    end

/*
@description: Converts a UCUM definite duration unit to a CQL calendar duration
unit using conversions specified in the [quantities](https://cql.hl7.org/02-authorsguide.html#quantities) 
topic of the CQL specification.
@comment: Note that for durations above days (or weeks), the conversion is understood to be approximate
*/
define function ToCalendarUnit(unit System.String):
    case unit
        when 'ms' then 'millisecond'
        when 's' then 'second'
        when 'min' then 'minute'
        when 'h' then 'hour'
        when 'd' then 'day'
        when 'wk' then 'week'
        when 'mo' then 'month'
        when 'a' then 'year'
        else unit
    end

define function ToDateTime(value dateTime): value.value

define function ToDateTime(value instant): value.value

/*
@description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code.
*/
define function ToCode(coding FHIR.Coding):
    if coding is null then
        null
    else
        System.Code {
          code: coding.code.value,
          system: coding.system.value,
          version: coding.version.value,
          display: coding.display.value
        }

/*
@description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept.
*/
define function ToConcept(concept FHIR.CodeableConcept):
    if concept is null then
        null
    else
        System.Concept {
            codes: concept.coding C return ToCode(C),
            display: concept.text.value
        }

define "SDE Sex":
  SDE."SDE Sex"

define "Glycemic Laboratory Test Performed During Measurement Period":
  [LaboratoryResultObservation: "Glycemic Screening Tests"] LabTestPerformed
    where CQMCommon.ToDateInterval ( LabTestPerformed.effective ) during day of "Measurement Period"
      and LabTestPerformed.status in { 'final', 'amended', 'corrected' }

define "Numerator":
  exists "Glycemic Laboratory Test Performed During Measurement Period"

define "Preventive Care Outpatient Visits During Measurement Period":
  [Encounter: "Preventative Clinical Encounters"] PreventiveCare
    where PreventiveCare.period ends during day of "Measurement Period"
      and PreventiveCare.status = 'finished'

define "Office Visit During the Measurement Period":
  [Encounter: "Outpatient Clinical Encounters"] OfficeVisit
    where OfficeVisit.period during day of "Measurement Period"
      and OfficeVisit.status = 'finished'

define "Aged 35 to 70 at Start of Measurement Period":
  "AgeInYearsAt"(date from start of "Measurement Period") between 35 and 70

define "Patients Aged 35 to 70 with an Office Visit During the Measurement Period":
  ( exists ( "Preventive Care Outpatient Visits During Measurement Period" )
      or Count("Office Visit During the Measurement Period") >= 2
  )
    and "Aged 35 to 70 at Start of Measurement Period" is true

define "Most Recent BMI":
  First([USCore.BMIProfile] BMI
      where BMI.status in { 'final', 'amended', 'corrected' }
      sort by start of effective.toInterval() desc
  )

define "Patient is Asian":
  exists ( SDE."SDE Race".codes C
      where C ~ "Asian"
  )

define "Patient is not Asian":
  not ( "Patient is Asian" )

define "Most Recent BMI Equal to or Greater Than 25 and Is Not Asian":
  "Most Recent BMI".value >= 25 'kg/m2'
    and "Patient is not Asian"

define "Most Recent BMI Equal to or Greater Than 23 and Is Asian":
  "Most Recent BMI".value >= 23 'kg/m2'
    and "Patient is Asian"

define "Initial Population":
  "Patients Aged 35 to 70 with an Office Visit During the Measurement Period"
    and ( "Most Recent BMI Equal to or Greater Than 25 and Is Not Asian"
        or "Most Recent BMI Equal to or Greater Than 23 and Is Asian"
    )

define "Denominator":
  "Initial Population"

define "SDE Payer":
  SDE."SDE Payer"

define "SDE Ethnicity":
  SDE."SDE Ethnicity"

define "Has Pregnancy Observation During Measurement Period":
  exists ( [USCore.ObservationPregnancyStatusProfile] PregnantObservation
      where PregnantObservation.value in "Pregnancy"
        and PregnantObservation.effective.toInterval ( ) overlaps day of "Measurement Period"
  )

define "Has Pregnancy Diagnosis During Measurement Period":
  ( ( [ConditionProblemsHealthConcerns: "Pregnancy"]
      union [ConditionEncounterDiagnosis: "Pregnancy"]
  ).verified ( ) ) PregnancyDx
    where PregnancyDx.onset.toInterval ( ) overlaps day of "Measurement Period"

define "Has Advanced Illness or Limited Life Expectancy":
  ( ( ["ConditionProblemsHealthConcerns": "Advanced Illness"]
      union ["ConditionEncounterDiagnosis": "Advanced Illness"]
      union ["ConditionProblemsHealthConcerns": "Limited Life Expectancy"]
      union ["ConditionEncounterDiagnosis": "Limited Life Expectancy"]
  ).verified ( ) ) AdvancedIllness
    where "AdvancedIllness".onset before day of end of "Measurement Period"

define "Look Back Period":
  Interval[start of "Measurement Period" - 2 years, start of "Measurement Period" )

define "Diabetes Diagnosis Overlaps 2 Year Look Back Period":
  ( ( ["ConditionProblemsHealthConcerns": "Diabetes"]
      union [ConditionEncounterDiagnosis: "Diabetes"]
  ).verified ( ) ) PriorDiabetes
    where "PriorDiabetes".onset.toInterval ( ) overlaps day of "Look Back Period"

define "Prediabetes Diagnosis Overlaps 2 Year Look Back Period":
  ( ( ["ConditionProblemsHealthConcerns": "Prediabetes (Borderline Diabetes)"]
      union [ConditionEncounterDiagnosis: "Prediabetes (Borderline Diabetes)"]
  ).verified ( ) ) PriorPrediabetes
    where "PriorPrediabetes".onset.toInterval ( ) overlaps day of "Look Back Period"

define "Has Glycemic Laboratory Test Performed During 2 Year Look Back Period":
  exists ( [LaboratoryResultObservation: "Glycemic Screening Tests"] LabTestPerformed
      where CQMCommon.ToDateInterval ( LabTestPerformed.effective ) during day of "Look Back Period"
        and LabTestPerformed.status in { 'final', 'amended', 'corrected' }
  )

define "Denominator Exclusions":
  "Has Pregnancy Observation During Measurement Period"
    or exists "Has Pregnancy Diagnosis During Measurement Period"
    or exists "Has Advanced Illness or Limited Life Expectancy"
    or exists "Diabetes Diagnosis Overlaps 2 Year Look Back Period"
    or exists "Prediabetes Diagnosis Overlaps 2 Year Look Back Period"
    or "Has Glycemic Laboratory Test Performed During 2 Year Look Back Period"

define "SDE Race":
  SDE."SDE Race"

define fluent function verified(conditions List<Choice<ConditionProblemsHealthConcerns, ConditionEncounterDiagnosis>>):
  conditions C
    where C.verificationStatus is not null implies ( C.verificationStatus ~ "confirmed"
        or C.verificationStatus ~ "unconfirmed"
        or C.verificationStatus ~ "provisional"
        or C.verificationStatus ~ "differential"
    )