define "Initial Population":
  "Qualifying Encounter during Measurement Period" QualifyingEncounter
    where AgeInYearsAt(date from start of "Measurement Period") >= 18

define "Denominator":
  "Initial Population"

define "Denominator Exclusions":
  "Qualifying Encounter during Measurement Period" QualifyingEncounter
    with [ConditionProblemsHealthConcerns: "Diagnosis of Hypertension"] Hypertension
      such that Hypertension.prevalenceInterval ( ) starts before or on day of QualifyingEncounter.period
        and Hypertension.isVerified ( )

define "Denominator Exceptions":
  "Encounter with Medical Reason for Not Obtaining or Patient Declined Blood Pressure Measurement"
    union "Encounter with Order for Hypertension Follow Up Declined by Patient"

define "Numerator":
  "Encounter with Normal Blood Pressure Reading"
    union ( "Encounter with Elevated Blood Pressure Reading SBP 120 to 129 AND DBP less than 80 and Interventions" )
    union ( "Encounter with First Hypertensive Reading SBP Greater than or Equal to 130 OR DBP Greater than or Equal to 80 and Interventions" )
    union ( "Encounter with Second Hypertensive Reading SBP 130 to 139 OR DBP 80 to 89 and Interventions" )
    union ( "Encounter with Second Hypertensive Reading SBP Greater than or Equal to 140 OR DBP Greater than or Equal to 90 and Interventions" )

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

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
    }

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

/*
@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 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 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 an interval representing the normalized prevalence period of a given Condition resource.
@comment: Uses the toInterval and toAbatementInterval functions to determine the widest potential interval from
onset to abatement as specified in the given Condition.
*/
define fluent function prevalenceInterval(condition Condition):
if condition.clinicalStatus ~ "active"
  or condition.clinicalStatus ~ "recurrence"
  or condition.clinicalStatus ~ "relapse" then
  Interval[start of condition.onset.toInterval(), end of condition.abatementInterval()]
else
  (end of condition.abatementInterval()) abatementDate
    return 
	  if abatementDate is null then
        Interval[start of condition.onset.toInterval(), abatementDate)
      else
        Interval[start of condition.onset.toInterval(), abatementDate]

/*
@description: Returns an interval representing the normalized Abatement of a given Condition resource.
@comment: @comment: If the abatement element of the Condition is represented as a DateTime, the result
is an interval beginning and ending on that DateTime.
If the abatement is represented as a Quantity, the quantity is expected to be a calendar-duration and is interpreted as the age of the patient. The
result is an interval from the date the patient turned that age to immediately before one year later.
If the abatement is represented as a Quantity Interval, the quantities are expected to be calendar-durations and are interpreted as an age range during
which the abatement occurred. The result is an interval from the date the patient turned the starting age of the quantity interval, and ending immediately
before one year later than the date the patient turned the ending age of the quantity interval.

NOTE: Due to the complexity of determining an interval from a String, this function will throw
a run-time exception if used with a Condition instance that has a String as the abatement value.
*/
define fluent function abatementInterval(condition Condition):
  if condition.abatement is FHIR.dateTime then
    Interval[FHIRHelpers.ToDateTime(condition.abatement as FHIR.dateTime), FHIRHelpers.ToDateTime(condition.abatement as FHIR.dateTime)]
  else if condition.abatement is FHIR.Period then
    FHIRHelpers.ToInterval(condition.abatement as FHIR.Period)
  else if condition.abatement 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 if condition.abatement is FHIR.Age then
    Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(condition.abatement as FHIR.Age),
      FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(condition.abatement as FHIR.Age) + 1 year)
  else if condition.abatement is FHIR.Range then
    Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((condition.abatement as FHIR.Range).low),
      FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((condition.abatement as FHIR.Range).high) + 1 year)
  else if condition.abatement is FHIR.boolean then
    Interval[end of condition.onset.toInterval(), condition.recordedDate)
  else 
    null

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

define "Qualifying Encounter during Measurement Period":
  [Encounter: "Encounter to Screen for Blood Pressure"] ValidEncounter
    where ValidEncounter.period ends during day of "Measurement Period"
      and ValidEncounter.status ~ 'finished'
      and ValidEncounter.class !~ "virtual"

define "Encounter with Normal Blood Pressure Reading":
  "Qualifying Encounter during Measurement Period" QualifyingEncounter
    let EncounterLastBP: Last([USCore.BloodPressureProfile] BloodPressure
        where BloodPressure.effective.toInterval ( ) ends during day of QualifyingEncounter.period
          and BloodPressure.status in { 'final', 'amended', 'corrected' }
        sort by start of effective.toInterval ( )
    )
    where ( singleton from ( EncounterLastBP.component C
          where C.code ~ "Systolic blood pressure"
      )
    ).value in Interval[1 'mm[Hg]', 120 'mm[Hg]' )
      and ( singleton from ( EncounterLastBP.component C
            where C.code ~ "Diastolic blood pressure"
        )
      ).value in Interval[1 'mm[Hg]', 80 'mm[Hg]' )

define "Encounter with Elevated Blood Pressure Reading SBP 120 to 129 AND DBP less than 80":
  "Qualifying Encounter during Measurement Period" QualifyingEncounter
    let EncounterLastBP: Last([USCore.BloodPressureProfile] BloodPressure
        where BloodPressure.effective.toInterval ( ) ends during day of QualifyingEncounter.period
          and BloodPressure.status in { 'final', 'amended', 'corrected' }
        sort by start of effective.toInterval ( )
    )
    where ( ( singleton from ( EncounterLastBP.component C
            where C.code ~ "Systolic blood pressure"
        )
      ).value in Interval[120 'mm[Hg]', 129 'mm[Hg]']
        and ( singleton from ( EncounterLastBP.component C
              where C.code ~ "Diastolic blood pressure"
          )
        ).value in Interval[1 'mm[Hg]', 80 'mm[Hg]' )
    )

define "Follow up with Rescreen Within 6 Months":
  [ServiceRequest: "Follow Up Within 6 Months"] FollowUp
    where FollowUp.intent ~ 'order'

define "NonPharmacological Interventions":
  ( [ServiceRequest: "Lifestyle Recommendation"]
    union [ServiceRequest: "Weight Reduction Recommended"]
    union [ServiceRequest: "Dietary Recommendations"]
    union [ServiceRequest: "Recommendation to Increase Physical Activity"]
    union [ServiceRequest: "Referral or Counseling for Alcohol Consumption"] ) NonPharmaInterventions
    where NonPharmaInterventions.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }

define "Referral to Alternate or Primary Healthcare Professional for Hypertensive Reading":
  [ServiceRequest: "Referral to Primary Care or Alternate Provider"] Referral
    where Referral.reasonCode in "Finding of Elevated Blood Pressure or Hypertension"
      and Referral.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }

define "Encounter with Elevated Blood Pressure Reading SBP 120 to 129 AND DBP less than 80 and Interventions":
  ( "Encounter with Elevated Blood Pressure Reading SBP 120 to 129 AND DBP less than 80" ElevatedEncounter
      with "Follow up with Rescreen Within 6 Months" Twoto6MonthRescreen
        such that Twoto6MonthRescreen.authoredOn during day of ElevatedEncounter.period
      with "NonPharmacological Interventions" NonPharmInterventions
        such that NonPharmInterventions.authoredOn during day of ElevatedEncounter.period
  )
    union ( "Encounter with Elevated Blood Pressure Reading SBP 120 to 129 AND DBP less than 80" ElevatedEncounter
        with "Referral to Alternate or Primary Healthcare Professional for Hypertensive Reading" Referral
          such that Referral.authoredOn during day of ElevatedEncounter.period
    )

define "Encounter with Hypertensive Reading Within Year Prior":
  ( "Qualifying Encounter during Measurement Period" QualifyingEncounter
      let EncounterLastBP: Last([USCore.BloodPressureProfile] BloodPressure
          where BloodPressure.effective.toInterval ( ) ends 1 year or less before or on start of QualifyingEncounter.period
            and BloodPressure.status in { 'final', 'amended', 'corrected' }
          sort by start of effective.toInterval ( )
      )
      where ( ( singleton from ( EncounterLastBP.component C
              where C.code ~ "Systolic blood pressure"
          )
        ).value > 0 'mm[Hg]'
          and ( singleton from ( EncounterLastBP.component C
                where C.code ~ "Diastolic blood pressure"
            )
          ).value > 0 'mm[Hg]'
          and ( ( singleton from ( EncounterLastBP.component C
                  where C.code ~ "Systolic blood pressure"
              )
            ).value >= 130 'mm[Hg]'
              or ( singleton from ( EncounterLastBP.component C
                    where C.code ~ "Diastolic blood pressure"
                )
              ).value >= 80 'mm[Hg]'
          )
      )
  )

define "Encounter with First Hypertensive Reading SBP Greater than or Equal to 130 OR DBP Greater than or Equal to 80":
  ( "Qualifying Encounter during Measurement Period" QualifyingEncounter
      let EncounterLastBP: Last([USCore.BloodPressureProfile] BloodPressure
          where BloodPressure.effective.toInterval ( ) ends during day of QualifyingEncounter.period
            and BloodPressure.status in { 'final', 'amended', 'corrected' }
          sort by start of effective.toInterval ( )
      )
      where ( ( ( singleton from ( EncounterLastBP.component C
                where C.code ~ "Systolic blood pressure"
            )
          ).value > 0 'mm[Hg]'
            and ( singleton from ( EncounterLastBP.component C
                  where C.code ~ "Diastolic blood pressure"
              )
            ).value > 0 'mm[Hg]'
        )
          and ( ( singleton from ( EncounterLastBP.component C
                  where C.code ~ "Systolic blood pressure"
              )
            ).value >= 130 'mm[Hg]'
              or ( singleton from ( EncounterLastBP.component C
                    where C.code ~ "Diastolic blood pressure"
                )
              ).value >= 80 'mm[Hg]'
          )
      )
  )
    except "Encounter with Hypertensive Reading Within Year Prior"

define "First Hypertensive Reading Interventions or Referral to Alternate Professional":
  ( [ServiceRequest: "Follow Up Within 4 Weeks"] FourWeekRescreen
      with "NonPharmacological Interventions" NonPharmInterventionsHTN
        such that FourWeekRescreen.authoredOn during day of "Measurement Period"
          and NonPharmInterventionsHTN.authoredOn during day of "Measurement Period"
          and FourWeekRescreen.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
  )
    union ( "Referral to Alternate or Primary Healthcare Professional for Hypertensive Reading" )

define "Encounter with First Hypertensive Reading SBP Greater than or Equal to 130 OR DBP Greater than or Equal to 80 and Interventions":
  "Encounter with First Hypertensive Reading SBP Greater than or Equal to 130 OR DBP Greater than or Equal to 80" FirstHTNEncounter
    with "First Hypertensive Reading Interventions or Referral to Alternate Professional" FirstHTNIntervention
      such that FirstHTNIntervention.authoredOn during day of FirstHTNEncounter.period

define "Encounter with Second Hypertensive Reading SBP 130 to 139 OR DBP 80 to 89":
  ( ( "Qualifying Encounter during Measurement Period" QualifyingEncounter
        let EncounterLastBP: Last([USCore.BloodPressureProfile] BloodPressure
            where BloodPressure.effective.toInterval ( ) ends during day of QualifyingEncounter.period
              and BloodPressure.status in { 'final', 'amended', 'corrected' }
            sort by start of effective.toInterval ( )
        )
        where ( ( ( singleton from ( EncounterLastBP.component C
                  where C.code ~ "Systolic blood pressure"
              )
            ).value in Interval[130 'mm[Hg]', 139 'mm[Hg]']
              or ( singleton from ( EncounterLastBP.component C
                    where C.code ~ "Diastolic blood pressure"
                )
              ).value in Interval[80 'mm[Hg]', 89 'mm[Hg]']
          )
            and not ( ( singleton from ( EncounterLastBP.component C
                    where C.code ~ "Systolic blood pressure"
                )
              ).value >= 140 'mm[Hg]'
                or ( singleton from ( EncounterLastBP.component C
                      where C.code ~ "Diastolic blood pressure"
                  )
                ).value >= 90 'mm[Hg]'
            )
        )
    )
      intersect "Encounter with Hypertensive Reading Within Year Prior"
  )

define "Laboratory Test or ECG for Hypertension":
  ( [ServiceRequest: "12 lead EKG panel"]
    union [ServiceRequest: "EKG study"]
    union [ServiceRequest: "Laboratory Tests for Hypertension"] ) EKGLab
    where EKGLab.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }

define "Second Hypertensive Reading SBP 130 to 139 OR DBP 80 to 89 and Interventions":
  "Follow up with Rescreen Within 6 Months" Rescreen2to6
    with "Laboratory Test or ECG for Hypertension" LabECGIntervention
      such that Rescreen2to6.authoredOn during day of "Measurement Period"
        and LabECGIntervention.authoredOn during day of "Measurement Period"
    with "NonPharmacological Interventions" NonPharmSecondIntervention
      such that NonPharmSecondIntervention.authoredOn during day of "Measurement Period"

define "Encounter with Second Hypertensive Reading SBP 130 to 139 OR DBP 80 to 89 and Interventions":
  ( "Encounter with Second Hypertensive Reading SBP 130 to 139 OR DBP 80 to 89" SecondHTNEncounterReading
      with "Second Hypertensive Reading SBP 130 to 139 OR DBP 80 to 89 and Interventions" EncounterInterventions
        such that EncounterInterventions.authoredOn during day of SecondHTNEncounterReading.period
  )
    union ( "Encounter with Second Hypertensive Reading SBP 130 to 139 OR DBP 80 to 89" SecondHTNEncounterReading
        with "Referral to Alternate or Primary Healthcare Professional for Hypertensive Reading" ReferralForHTN
          such that ReferralForHTN.authoredOn during day of SecondHTNEncounterReading.period
    )

define "Encounter with Second Hypertensive Reading SBP Greater than or Equal to 140 OR DBP Greater than or Equal to 90":
  ( ( "Qualifying Encounter during Measurement Period" QualifyingEncounter
        let EncounterLastBP: Last([USCore.BloodPressureProfile] BloodPressure
            where BloodPressure.effective.toInterval ( ) ends during day of QualifyingEncounter.period
              and BloodPressure.status in { 'final', 'amended', 'corrected' }
            sort by start of effective.toInterval ( )
        )
        where ( ( singleton from ( EncounterLastBP.component C
                where C.code ~ "Systolic blood pressure"
            )
          ).value > 0 'mm[Hg]'
            and ( singleton from ( EncounterLastBP.component C
                  where C.code ~ "Diastolic blood pressure"
              )
            ).value > 0 'mm[Hg]'
            and ( ( singleton from ( EncounterLastBP.component C
                    where C.code ~ "Systolic blood pressure"
                )
              ).value >= 140 'mm[Hg]'
                or ( singleton from ( EncounterLastBP.component C
                      where C.code ~ "Diastolic blood pressure"
                  )
                ).value >= 90 'mm[Hg]'
            )
        )
    )
      intersect "Encounter with Hypertensive Reading Within Year Prior"
  )

define "Second Hypertensive Reading SBP Greater than or Equal to 140 OR DBP Greater than or Equal to 90 Interventions":
  ( [ServiceRequest: "Follow Up Within 4 Weeks"] WeeksRescreen
      with "Laboratory Test or ECG for Hypertension" ECGLabTest
        such that WeeksRescreen.authoredOn during day of "Measurement Period"
          and ECGLabTest.authoredOn during day of "Measurement Period"
          and WeeksRescreen.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
          and ECGLabTest.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
      with "NonPharmacological Interventions" HTNInterventions
        such that HTNInterventions.authoredOn during day of "Measurement Period"
      with ["MedicationRequest": "Pharmacologic Therapy for Hypertension"] Medications
        such that Medications.authoredOn during day of "Measurement Period"
          and Medications.status in { 'active', 'completed' }
  )

define "Encounter with Second Hypertensive Reading SBP Greater than or Equal to 140 OR DBP Greater than or Equal to 90 and Interventions":
  ( "Encounter with Second Hypertensive Reading SBP Greater than or Equal to 140 OR DBP Greater than or Equal to 90" SecondHTNEncounterReading140Over90
      with "Second Hypertensive Reading SBP Greater than or Equal to 140 OR DBP Greater than or Equal to 90 Interventions" SecondHTN140Over90Interventions
        such that SecondHTN140Over90Interventions.authoredOn during day of SecondHTNEncounterReading140Over90.period
  )
    union "Encounter with Second Hypertensive Reading SBP Greater than or Equal to 140 OR DBP Greater than or Equal to 90" SecondHTNEncounterReading140Over90
      with "Referral to Alternate or Primary Healthcare Professional for Hypertensive Reading" ReferralToProfessional
        such that ReferralToProfessional.authoredOn during day of SecondHTNEncounterReading140Over90.period

define "Numerator":
  "Encounter with Normal Blood Pressure Reading"
    union ( "Encounter with Elevated Blood Pressure Reading SBP 120 to 129 AND DBP less than 80 and Interventions" )
    union ( "Encounter with First Hypertensive Reading SBP Greater than or Equal to 130 OR DBP Greater than or Equal to 80 and Interventions" )
    union ( "Encounter with Second Hypertensive Reading SBP 130 to 139 OR DBP 80 to 89 and Interventions" )
    union ( "Encounter with Second Hypertensive Reading SBP Greater than or Equal to 140 OR DBP Greater than or Equal to 90 and Interventions" )

define "Initial Population":
  "Qualifying Encounter during Measurement Period" QualifyingEncounter
    where AgeInYearsAt(date from start of "Measurement Period") >= 18

define "Denominator":
  "Initial Population"

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

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

define "Denominator Exclusions":
  "Qualifying Encounter during Measurement Period" QualifyingEncounter
    with [ConditionProblemsHealthConcerns: "Diagnosis of Hypertension"] Hypertension
      such that Hypertension.prevalenceInterval ( ) starts before or on day of QualifyingEncounter.period
        and Hypertension.isVerified ( )

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

define "Encounter with Medical Reason for Not Obtaining or Patient Declined Blood Pressure Measurement":
  "Qualifying Encounter during Measurement Period" QualifyingEncounter
    with ( [ObservationCancelled: code ~ "Blood pressure panel with all children optional"]
      union [ObservationCancelled: code ~ "Systolic blood pressure"]
      union [ObservationCancelled: code ~ "Diastolic blood pressure"] ) NoBPScreen
      such that NoBPScreen.issued during day of QualifyingEncounter.period
        and ( NoBPScreen.notDoneReason () in "Patient Declined"
            or NoBPScreen.notDoneReason () in "Medical Reason"
        )

define "NonPharmacological Intervention Not Ordered":
  ( [ServiceNotRequested: "Lifestyle Recommendation"]
    union [ServiceNotRequested: "Weight Reduction Recommended"]
    union [ServiceNotRequested: "Dietary Recommendations"]
    union [ServiceNotRequested: "Recommendation to Increase Physical Activity"]
    union [ServiceNotRequested: "Referral or Counseling for Alcohol Consumption"] ) NonPharmIntervention
    where NonPharmIntervention.status in { 'active', 'completed', 'on-hold' }
      and NonPharmIntervention.reasonCode in "Patient Declined"

define "Laboratory Test or ECG for Hypertension Not Ordered":
  ( [ServiceNotRequested: code = "12 lead EKG panel"]
    union [ServiceNotRequested: code = "EKG study"]
    union [ServiceNotRequested: "Laboratory Tests for Hypertension"] ) LabECGNotDone
    where LabECGNotDone.status in { 'active', 'completed', 'on-hold' }
      and LabECGNotDone.reasonCode in "Patient Declined"

define "Second Hypertensive Reading SBP 130 to 139 OR DBP 80 to 89 Interventions Declined":
  ( ( [ServiceNotRequested: "Referral to Primary Care or Alternate Provider"]
      union [ServiceNotRequested: "Follow Up Within 6 Months"] ) SecondHTNDeclinedReferralAndFollowUp
      where SecondHTNDeclinedReferralAndFollowUp.status in { 'active', 'completed', 'on-hold' }
        and SecondHTNDeclinedReferralAndFollowUp.reasonCode in "Patient Declined"
  )
    union "Laboratory Test or ECG for Hypertension Not Ordered"
    union "NonPharmacological Intervention Not Ordered"

define "Second Hypertensive Reading SBP Greater than or Equal to 140 OR DBP Greater than or Equal to 90 Interventions Declined":
  ( ( ( [ServiceNotRequested: "Referral to Primary Care or Alternate Provider"]
        union [ServiceNotRequested: "Follow Up Within 4 Weeks"] ) SecondHTN140Over90ReferralFollowUpNotDone
        where SecondHTN140Over90ReferralFollowUpNotDone.status in { 'active', 'completed', 'on-hold' }
          and SecondHTN140Over90ReferralFollowUpNotDone.reasonCode in "Patient Declined"
    )
      union ( [MedicationNotRequested: "Pharmacologic Therapy for Hypertension"] MedicationRequestNotOrdered
          where MedicationRequestNotOrdered.status in { 'active', 'completed' }
      )
      union "Laboratory Test or ECG for Hypertension Not Ordered"
      union "NonPharmacological Intervention Not Ordered"
  )

define "Encounter with Order for Hypertension Follow Up Declined by Patient":
  ( ( "Encounter with Elevated Blood Pressure Reading SBP 120 to 129 AND DBP less than 80" ElevatedBPEncounter
        with ( [ServiceNotRequested: "Referral to Primary Care or Alternate Provider"]
          union [ServiceNotRequested: "Follow Up Within 6 Months"] ) ElevatedBPDeclinedInterventions
          such that ElevatedBPDeclinedInterventions.authoredOn during day of ElevatedBPEncounter.period
            and ElevatedBPDeclinedInterventions.status in { 'active', 'completed', 'on-hold' }
            and ElevatedBPDeclinedInterventions.reasonCode in "Patient Declined"
    )
      union ( "Encounter with Elevated Blood Pressure Reading SBP 120 to 129 AND DBP less than 80" ElevatedBPEncounter
          with "NonPharmacological Intervention Not Ordered" NotOrdered
            such that NotOrdered.authoredOn during day of ElevatedBPEncounter.period
      )
      union ( "Encounter with First Hypertensive Reading SBP Greater than or Equal to 130 OR DBP Greater than or Equal to 80" FirstHTNEncounter
          with ( [ServiceNotRequested: "Follow Up Within 4 Weeks"]
            union [ServiceNotRequested: "Referral to Primary Care or Alternate Provider"] ) FirstHTNDeclinedInterventions
            such that FirstHTNDeclinedInterventions.authoredOn during day of FirstHTNEncounter.period
              and FirstHTNDeclinedInterventions.status in { 'active', 'completed', 'on-hold' }
              and FirstHTNDeclinedInterventions.reasonCode in "Patient Declined"
      )
      union ( "Encounter with First Hypertensive Reading SBP Greater than or Equal to 130 OR DBP Greater than or Equal to 80" FirstHTNEncounter
          with "NonPharmacological Intervention Not Ordered" NoNonPharm
            such that NoNonPharm.authoredOn during day of FirstHTNEncounter.period
      )
      union ( "Encounter with Second Hypertensive Reading SBP 130 to 139 OR DBP 80 to 89" SecondHTNEncounter
          with "Second Hypertensive Reading SBP 130 to 139 OR DBP 80 to 89 Interventions Declined" SecondHTNDeclinedInterventions
            such that SecondHTNDeclinedInterventions.authoredOn during day of SecondHTNEncounter.period
      )
      union ( "Encounter with Second Hypertensive Reading SBP Greater than or Equal to 140 OR DBP Greater than or Equal to 90" SecondHTN140Over90Encounter
          with "Second Hypertensive Reading SBP Greater than or Equal to 140 OR DBP Greater than or Equal to 90 Interventions Declined" SecondHTN140Over90DeclinedInterventions
            such that SecondHTN140Over90DeclinedInterventions.authoredOn during day of SecondHTN140Over90Encounter.period
      )
  )

define "Denominator Exceptions":
  "Encounter with Medical Reason for Not Obtaining or Patient Declined Blood Pressure Measurement"
    union "Encounter with Order for Hypertension Follow Up Declined by Patient"

/*
@description: Returns true if the given condition either has no verification status or has a verification status of confirmed, unconfirmed, provisional, or differential
*/


define fluent function isVerified(condition Choice<ConditionProblemsHealthConcerns, ConditionEncounterDiagnosis>):
  condition.verificationStatus is not null implies ( condition.verificationStatus ~ Status."confirmed"
      or condition.verificationStatus ~ Status."unconfirmed"
      or condition.verificationStatus ~ Status."provisional"
      or condition.verificationStatus ~ Status."differential"
  )

/*
@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 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 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
    }

/*
@description: Returns the notDoneReason for an ObservationCancelled
*/
define fluent function notDoneReason(observationCancelled ObservationCancelled):
  observationCancelled.ext('http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-notDoneReason').value as FHIR.CodeableConcept

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 EncounterStatus): 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
        }

define function ToDateTime(value dateTime): value.value

define function ToDateTime(value instant): 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 ToString(value ObservationStatus): value.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 function ToString(value ServiceRequestIntent): value.value

define function ToString(value MedicationRequestStatus): value.value

define function ToString(value ServiceRequestStatus): value.value