define "Initial Population":
  AgeInYearsAt(date from start of "Measurement Period") >= 18
    and exists ( ( ( [ConditionProblemsHealthConcerns: "Heart Failure"]
          union [ConditionEncounterDiagnosis: "Heart Failure"]
      ).verified ( ) ) HeartFailure
        where HeartFailure.onset.toInterval ( ) overlaps before day of "Measurement Period"
    )
    and exists ( "Outpatient Encounters with at least one subsequent Outpatient Encounter during Measurement Period" )

define "Denominator":
  "Initial Population"

define "Denominator Exclusions":
  Hospice."Has Hospice Services"
    or exists ( ( ( [ConditionProblemsHealthConcerns: "Severe cognitive impairment (finding)"]
          union [ConditionEncounterDiagnosis: "Severe cognitive impairment (finding)"]
      ).verified ( ) ) SevereCognitiveImpairment
        where SevereCognitiveImpairment.onset.toInterval ( ) overlaps day of "Measurement Period"
    )

define "Numerator":
  ( "Has Encounter with Initial and Follow Up PROMIS10 Assessments" )
    or ( "Has Encounter with Initial and Follow Up PROMIS29 Assessments" )
    or ( "Has Encounter with Initial and Follow Up VR12 Oblique Assessments" )
    or ( "Has Encounter with Initial and Follow Up VR12 Orthogonal Assessments" )
    or ( "Has Encounter with Initial and Follow Up VR36 Oblique Assessments" )
    or ( "Has Encounter with Initial and Follow Up VR36 Orthogonal Assessments" )
    or ( "Has Encounter with Initial and Follow Up MLHFQ Assessments" )
    or ( "Has Encounter with Initial and Follow Up KCCQ12 Assessments" )
    or ( "Has Encounter with Initial and Follow Up KCCQ Domain Score Assessments" )
    or ( "Has Encounter with Initial and Follow Up KCCQ Total Score Assessments" )

define "Has Hospice Services":
  exists ((([USQualityCore.Encounter: "Encounter Inpatient"]).isEncounterPerformed()) InpatientEncounter
      where (InpatientEncounter.hospitalization.dischargeDisposition ~ "Discharge to home for hospice care (procedure)"
          or InpatientEncounter.hospitalization.dischargeDisposition ~ "Discharge to healthcare facility for hospice care (procedure)"
      )
        and InpatientEncounter.period ends during day of "Measurement Period"
  )
    or exists ((([USQualityCore.Encounter: "Hospice Encounter"]).isEncounterPerformed()) HospiceEncounter
        where HospiceEncounter.period overlaps day of "Measurement Period"
    )
    // TODO: Shouldn't need to specify a code path here (see https://jira.hl7.org/browse/FHIR-53941)
    or exists ((([USQualityCore.ObservationScreeningAssessment: code ~ "Hospice care [Minimum Data Set]"]).isAssessmentPerformed()) HospiceAssessment
        where HospiceAssessment.value ~ "Yes (qualifier value)"
          and HospiceAssessment.effective.toInterval() overlaps day of "Measurement Period"
    )
    or exists ((([USQualityCore.ServiceRequest: "Hospice Care Ambulatory"]).isInterventionOrder()) HospiceOrder
        where HospiceOrder.authoredOn during day of "Measurement Period"
    )
    or exists ((([USQualityCore.Procedure: "Hospice Care Ambulatory"]).isInterventionPerformed()) HospicePerformed
        where HospicePerformed.performed.toInterval() overlaps day of "Measurement Period"
    )
    // TODO: Consider whether to keep this as the union of Problems and EncounterDiagnosis
    or exists ((([FHIR.Condition: "Hospice Diagnosis"]).verified()) HospiceCareDiagnosis
        where HospiceCareDiagnosis.prevalenceInterval() overlaps day of "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 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
    }

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

define "Qualifying Encounters":
  ( ( [Encounter: "Office Visit"]
      union [Encounter: "Telephone Visits"]
      union [Encounter: "Virtual Encounter"]
  ).isEncounterPerformed ( ) ) ValidEncounter
    where ValidEncounter.period during day of "Measurement Period"

define "Date PROMIS10 Total Assessment Completed":
  from
    ( ( [ObservationScreeningAssessment: "PROMIS-10 Global Mental Health (GMH) score T-score"] ).isAssessmentPerformed ( ) ) PROMIS10MentalScore,
    ( ( [ObservationScreeningAssessment: "PROMIS-10 Global Physical Health (GPH) score T-score"] ).isAssessmentPerformed ( ) ) PROMIS10PhysicalScore
    let PROMIS10MentalScoreDate: date from start of PROMIS10MentalScore.effective.toInterval ( ),
    PROMIS10PhysicalScoreDate: date from start of PROMIS10PhysicalScore.effective.toInterval ( )
    where PROMIS10MentalScoreDate same day as PROMIS10PhysicalScoreDate
      and ( PROMIS10MentalScore as ObservationScreeningAssessment ).value is not null
      and ( PROMIS10PhysicalScore as ObservationScreeningAssessment ).value is not null
    return PROMIS10MentalScoreDate

define "Has Encounter with Initial and Follow Up PROMIS10 Assessments":
  exists ( from
      "Qualifying Encounters" ValidEncounters,
      "Date PROMIS10 Total Assessment Completed" InitialPROMIS10Date,
      "Date PROMIS10 Total Assessment Completed" FollowupPROMIS10Date
      where ValidEncounters.period ends 180 days or more before day of end of "Measurement Period"
        and InitialPROMIS10Date 14 days or less on or before day of end of ValidEncounters.period
        and date from FollowupPROMIS10Date during day of Interval[date from InitialPROMIS10Date + 30 days, date from InitialPROMIS10Date + 180 days]
      return ValidEncounters
  )

define "Date PROMIS29 Total Assessment Completed":
  from
    ( ( [ObservationScreeningAssessment: "PROMIS-29 Sleep disturbance score T-score"] ).isAssessmentPerformed ( ) ) Promis29Sleep,
    ( ( [ObservationScreeningAssessment: "PROMIS-29 Satisfaction with participation in social roles score T-score"] ).isAssessmentPerformed ( ) ) Promis29SocialRoles,
    ( ( [ObservationScreeningAssessment: "PROMIS-29 Physical function score T-score"] ).isAssessmentPerformed ( ) ) Promis29Physical,
    ( ( [ObservationScreeningAssessment: "PROMIS-29 Pain interference score T-score"] ).isAssessmentPerformed ( ) ) Promis29Pain,
    ( ( [ObservationScreeningAssessment: "PROMIS-29 Fatigue score T-score"] ).isAssessmentPerformed ( ) ) Promis29Fatigue,
    ( ( [ObservationScreeningAssessment: "PROMIS-29 Depression score T-score"] ).isAssessmentPerformed ( ) ) Promis29Depression,
    ( ( [ObservationScreeningAssessment: "PROMIS-29 Anxiety score T-score"] ).isAssessmentPerformed ( ) ) Promis29Anxiety
    let Promis29SleepDate: date from start of Promis29Sleep.effective.toInterval ( ),
    Promis29SocialRolesDate: date from start of Promis29SocialRoles.effective.toInterval ( ),
    Promis29PhysicalDate: date from start of Promis29Physical.effective.toInterval ( ),
    Promis29PainDate: date from start of Promis29Pain.effective.toInterval ( ),
    Promis29FatigueDate: date from start of Promis29Fatigue.effective.toInterval ( ),
    Promis29DepressionDate: date from start of Promis29Depression.effective.toInterval ( ),
    Promis29AnxietyDate: date from start of Promis29Anxiety.effective.toInterval ( )
    where Promis29SleepDate same day as Promis29SocialRolesDate
      and Promis29SocialRoles.value is not null
      and Promis29SleepDate same day as Promis29PhysicalDate
      and Promis29Physical.value is not null
      and Promis29SleepDate same day as Promis29PainDate
      and Promis29Pain.value is not null
      and Promis29SleepDate same day as Promis29FatigueDate
      and Promis29Fatigue.value is not null
      and Promis29SleepDate same day as Promis29DepressionDate
      and Promis29Depression.value is not null
      and Promis29SleepDate same day as Promis29AnxietyDate
      and Promis29Anxiety.value is not null
      and Promis29Sleep.value is not null
    return Promis29SleepDate

define "Has Encounter with Initial and Follow Up PROMIS29 Assessments":
  exists ( from
      "Qualifying Encounters" ValidEncounters,
      "Date PROMIS29 Total Assessment Completed" InitialPROMIS29Date,
      "Date PROMIS29 Total Assessment Completed" FollowupPROMIS29Date
      where ValidEncounters.period ends 180 days or more before day of end of "Measurement Period"
        and InitialPROMIS29Date 14 days or less on or before day of end of ValidEncounters.period
        and date from FollowupPROMIS29Date during day of Interval[date from InitialPROMIS29Date + 30 days, date from InitialPROMIS29Date + 180 days]
      return ValidEncounters
  )

define "Date VR12 Oblique Total Assessment Completed":
  from
    ( ( [ObservationScreeningAssessment: "VR-12 Mental component summary (MCS) score - oblique method T-score"] ).isAssessmentPerformed ( ) ) VR12MentalAssessment,
    ( ( [ObservationScreeningAssessment: "VR-12 Physical component summary (PCS) score - oblique method T-score"] ).isAssessmentPerformed ( ) ) VR12PhysicalAssessment
    let VR12MentalAssessmentDate: date from start of VR12MentalAssessment.effective.toInterval ( ),
    VR12PhysicalAssessmentDate: date from start of VR12PhysicalAssessment.effective.toInterval ( )
    where VR12MentalAssessmentDate same day as VR12PhysicalAssessmentDate
      and ( VR12MentalAssessment as ObservationScreeningAssessment ).value is not null
      and ( VR12PhysicalAssessment as ObservationScreeningAssessment ).value is not null
    return VR12MentalAssessmentDate

define "Has Encounter with Initial and Follow Up VR12 Oblique Assessments":
  exists ( from
      "Qualifying Encounters" ValidEncounters,
      "Date VR12 Oblique Total Assessment Completed" InitialVR12ObliqueDate,
      "Date VR12 Oblique Total Assessment Completed" FollowupVR12ObliqueDate
      where ValidEncounters.period ends 180 days or more before day of end of "Measurement Period"
        and InitialVR12ObliqueDate 14 days or less on or before day of end of ValidEncounters.period
        and date from FollowupVR12ObliqueDate during day of Interval[date from InitialVR12ObliqueDate + 30 days, date from InitialVR12ObliqueDate + 180 days]
      return ValidEncounters
  )

define "Date VR12 Orthogonal Total Assessment Completed":
  from
    ( ( [ObservationScreeningAssessment: "VR-12 Mental component summary (MCS) score - orthogonal method T-score"] ).isAssessmentPerformed ( ) ) VR12MentalAssessment,
    ( ( [ObservationScreeningAssessment: "VR-12 Physical component summary (PCS) score - orthogonal method T-score"] ).isAssessmentPerformed ( ) ) VR12PhysicalAssessment
    let VR12MentalAssessmentDate: date from start of VR12MentalAssessment.effective.toInterval ( ),
    VR12PhysicalAssessmentDate: date from start of VR12PhysicalAssessment.effective.toInterval ( )
    where VR12MentalAssessmentDate same day as VR12PhysicalAssessmentDate
      and ( VR12MentalAssessment as ObservationScreeningAssessment ).value is not null
      and ( VR12PhysicalAssessment as ObservationScreeningAssessment ).value is not null
    return VR12MentalAssessmentDate

define "Has Encounter with Initial and Follow Up VR12 Orthogonal Assessments":
  exists ( from
      "Qualifying Encounters" ValidEncounters,
      "Date VR12 Orthogonal Total Assessment Completed" InitialVR12OrthogonalDate,
      "Date VR12 Orthogonal Total Assessment Completed" FollowupVR12OrthogonalDate
      where ValidEncounters.period ends 180 days or more before day of end of "Measurement Period"
        and InitialVR12OrthogonalDate 14 days or less on or before day of end of ValidEncounters.period
        and date from FollowupVR12OrthogonalDate during day of Interval[date from InitialVR12OrthogonalDate + 30 days, date from InitialVR12OrthogonalDate + 180 days]
      return ValidEncounters
  )

define "Date VR36 Oblique Total Assessment Completed":
  from
    ( ( [ObservationScreeningAssessment: "VR-36 Mental component summary (MCS) score - oblique method T-score"] ).isAssessmentPerformed ( ) ) VR36MentalAssessment,
    ( ( [ObservationScreeningAssessment: "VR-36 Physical component summary (PCS) score - oblique method T-score"] ).isAssessmentPerformed ( ) ) VR36PhysicalAssessment
    let VR36MentalAssessmentDate: date from start of VR36MentalAssessment.effective.toInterval ( ),
    VR36PhysicalAssessmentDate: date from start of VR36PhysicalAssessment.effective.toInterval ( )
    where VR36MentalAssessmentDate same day as VR36PhysicalAssessmentDate
      and ( VR36MentalAssessment as ObservationScreeningAssessment ).value is not null
      and ( VR36PhysicalAssessment as ObservationScreeningAssessment ).value is not null
    return VR36MentalAssessmentDate

define "Has Encounter with Initial and Follow Up VR36 Oblique Assessments":
  exists ( from
      "Qualifying Encounters" ValidEncounters,
      "Date VR36 Oblique Total Assessment Completed" InitialVR36ObliqueDate,
      "Date VR36 Oblique Total Assessment Completed" FollowupVR36ObliqueDate
      where ValidEncounters.period ends 180 days or more before day of end of "Measurement Period"
        and InitialVR36ObliqueDate 14 days or less on or before day of end of ValidEncounters.period
        and date from FollowupVR36ObliqueDate during day of Interval[date from InitialVR36ObliqueDate + 30 days, date from InitialVR36ObliqueDate + 180 days]
      return ValidEncounters
  )

define "Date VR36 Orthogonal Total Assessment Completed":
  from
    ( ( [ObservationScreeningAssessment: "VR-36 Mental component summary (MCS) score - orthogonal method T-score"] ).isAssessmentPerformed ( ) ) VR36MentalAssessment,
    ( ( [ObservationScreeningAssessment: "VR-36 Physical component summary (PCS) score - orthogonal method T-score"] ).isAssessmentPerformed ( ) ) VR36PhysicalAssessment
    let VR36MentalAssessmentDate: date from start of VR36MentalAssessment.effective.toInterval ( ),
    VR36PhysicalAssessmentDate: date from start of VR36PhysicalAssessment.effective.toInterval ( )
    where VR36MentalAssessmentDate same day as VR36PhysicalAssessmentDate
      and ( VR36MentalAssessment as ObservationScreeningAssessment ).value is not null
      and ( VR36PhysicalAssessment as ObservationScreeningAssessment ).value is not null
    return VR36MentalAssessmentDate

define "Has Encounter with Initial and Follow Up VR36 Orthogonal Assessments":
  exists ( from
      "Qualifying Encounters" ValidEncounters,
      "Date VR36 Orthogonal Total Assessment Completed" InitialVR36OrthogonalDate,
      "Date VR36 Orthogonal Total Assessment Completed" FollowupVR36OrthogonalDate
      where ValidEncounters.period ends 180 days or more before day of end of "Measurement Period"
        and InitialVR36OrthogonalDate 14 days or less on or before day of end of ValidEncounters.period
        and date from FollowupVR36OrthogonalDate during day of Interval[date from InitialVR36OrthogonalDate + 30 days, date from InitialVR36OrthogonalDate + 180 days]
      return ValidEncounters
  )

define "Date MLHFQ Total Assessment Completed":
  from
    ( ( [ObservationScreeningAssessment: "Physical score [MLHFQ]"] ).isAssessmentPerformed ( ) ) MLHFQPhysical,
    ( ( [ObservationScreeningAssessment: "Emotional score [MLHFQ]"] ).isAssessmentPerformed ( ) ) MLHFQEmotional
    let MLHFQPhysicalDate: date from start of MLHFQPhysical.effective.toInterval ( ),
    MLHFQEmotionalDate: date from start of MLHFQEmotional.effective.toInterval ( )
    where MLHFQPhysicalDate same day as MLHFQEmotionalDate
      and ( MLHFQPhysical as ObservationScreeningAssessment ).value is not null
      and ( MLHFQEmotional as ObservationScreeningAssessment ).value is not null
    return MLHFQPhysicalDate

define "Has Encounter with Initial and Follow Up MLHFQ Assessments":
  exists ( from
      "Qualifying Encounters" ValidEncounters,
      "Date MLHFQ Total Assessment Completed" InitialMLHFQDate,
      "Date MLHFQ Total Assessment Completed" FollowupMLHFQDate
      where ValidEncounters.period ends 180 days or more before day of end of "Measurement Period"
        and InitialMLHFQDate 14 days or less on or before day of end of ValidEncounters.period
        and date from FollowupMLHFQDate during day of Interval[date from InitialMLHFQDate + 30 days, date from InitialMLHFQDate + 180 days]
      return ValidEncounters
  )

define "Date KCCQ12 Total Assessment Completed":
  from
    ( ( [ObservationScreeningAssessment: "Kansas City Cardiomyopathy Questionnaire - 12 item [KCCQ-12]"] ).isAssessmentPerformed ( ) ) KCCQ12Item,
    ( ( [ObservationScreeningAssessment: "Overall summary score [KCCQ-12]"] ).isAssessmentPerformed ( ) ) KCCQ12Summary
    let KCCQ12ItemDate: date from start of KCCQ12Item.effective.toInterval ( ),
    KCCQ12SummaryDate: date from start of KCCQ12Summary.effective.toInterval ( )
    where KCCQ12ItemDate same day as KCCQ12SummaryDate
      and ( KCCQ12Item as ObservationScreeningAssessment ).value is not null
      and ( KCCQ12Summary as ObservationScreeningAssessment ).value is not null
    return KCCQ12ItemDate

define "Has Encounter with Initial and Follow Up KCCQ12 Assessments":
  exists ( from
      "Qualifying Encounters" ValidEncounters,
      "Date KCCQ12 Total Assessment Completed" InitialKCCQ12Date,
      "Date KCCQ12 Total Assessment Completed" FollowupKCCQ12Date
      where ValidEncounters.period ends 180 days or more before day of end of "Measurement Period"
        and InitialKCCQ12Date 14 days or less on or before day of end of ValidEncounters.period
        and date from FollowupKCCQ12Date during day of Interval[date from InitialKCCQ12Date + 30 days, date from InitialKCCQ12Date + 180 days]
      return ValidEncounters
  )

define "Date KCCQ Domain Assessment Completed":
  from
    ( ( [ObservationScreeningAssessment: "Quality of life score [KCCQ]"] ).isAssessmentPerformed ( ) ) KCCQLifeQuality,
    ( ( [ObservationScreeningAssessment: "Symptom stability score [KCCQ]"] ).isAssessmentPerformed ( ) ) KCCQSymptomStability,
    ( ( [ObservationScreeningAssessment: "Self-efficacy score [KCCQ]"] ).isAssessmentPerformed ( ) ) KCCQSelfEfficacy,
    ( ( [ObservationScreeningAssessment: "Total symptom score [KCCQ]"] ).isAssessmentPerformed ( ) ) KCCQSymptoms,
    ( ( [ObservationScreeningAssessment: "Physical limitation score [KCCQ]"] ).isAssessmentPerformed ( ) ) KCCQPhysicalLimits,
    ( ( [ObservationScreeningAssessment: "Social limitation score [KCCQ]"] ).isAssessmentPerformed ( ) ) KCCQSocialLimits
    let KCCQLifeQualityDate: date from start of KCCQLifeQuality.effective.toInterval ( ),
    KCCQSymptomStabilityDate: date from start of KCCQSymptomStability.effective.toInterval ( ),
    KCCQSelfEfficacyDate: date from start of KCCQSelfEfficacy.effective.toInterval ( ),
    KCCQSymptomsDate: date from start of KCCQSymptoms.effective.toInterval ( ),
    KCCQPhysicalLimitsDate: date from start of KCCQPhysicalLimits.effective.toInterval ( ),
    KCCQSocialLimitsDate: date from start of KCCQSocialLimits.effective.toInterval ( )
    where KCCQLifeQualityDate same day as KCCQSymptomStabilityDate
      and ( KCCQSymptomStability as ObservationScreeningAssessment ).value is not null
      and KCCQLifeQualityDate same day as KCCQSelfEfficacyDate
      and ( KCCQSelfEfficacy as ObservationScreeningAssessment ).value is not null
      and KCCQLifeQualityDate same day as KCCQSymptomsDate
      and ( KCCQSymptoms as ObservationScreeningAssessment ).value is not null
      and KCCQLifeQualityDate same day as KCCQPhysicalLimitsDate
      and ( KCCQPhysicalLimits as ObservationScreeningAssessment ).value is not null
      and KCCQLifeQualityDate same day as KCCQSocialLimitsDate
      and ( KCCQSocialLimits as ObservationScreeningAssessment ).value is not null
      and ( KCCQLifeQuality as ObservationScreeningAssessment ).value is not null
    return KCCQLifeQualityDate

define "Has Encounter with Initial and Follow Up KCCQ Domain Score Assessments":
  exists ( from
      "Qualifying Encounters" ValidEncounters,
      "Date KCCQ Domain Assessment Completed" InitialKCCQAssessmentDate,
      "Date KCCQ Domain Assessment Completed" FollowupKCCQAssessmentDate
      where ValidEncounters.period ends 180 days or more before day of end of "Measurement Period"
        and InitialKCCQAssessmentDate 14 days or less on or before day of end of ValidEncounters.period
        and date from FollowupKCCQAssessmentDate during day of Interval[date from InitialKCCQAssessmentDate + 30 days, date from InitialKCCQAssessmentDate + 180 days]
      return ValidEncounters
  )

define "Date KCCQ Total Assessment Completed":
  ( ( [ObservationScreeningAssessment: "Overall summary score [KCCQ]"] ).isAssessmentPerformed ( ) ) KCCQSummaryScore
    where ( KCCQSummaryScore as ObservationScreeningAssessment ).value is not null
    return date from start of KCCQSummaryScore.effective.toInterval ( )

define "Has Encounter with Initial and Follow Up KCCQ Total Score Assessments":
  exists ( from
      "Qualifying Encounters" ValidEncounters,
      "Date KCCQ Total Assessment Completed" InitialKCCQTotalScore,
      "Date KCCQ Total Assessment Completed" FollowupKCCQTotalScore
      where ValidEncounters.period ends 180 days or more before day of end of "Measurement Period"
        and InitialKCCQTotalScore 14 days or less on or before day of end of ValidEncounters.period
        and date from FollowupKCCQTotalScore during day of Interval[date from InitialKCCQTotalScore + 30 days, date from InitialKCCQTotalScore + 180 days]
      return ValidEncounters
  )

define "Numerator":
  ( "Has Encounter with Initial and Follow Up PROMIS10 Assessments" )
    or ( "Has Encounter with Initial and Follow Up PROMIS29 Assessments" )
    or ( "Has Encounter with Initial and Follow Up VR12 Oblique Assessments" )
    or ( "Has Encounter with Initial and Follow Up VR12 Orthogonal Assessments" )
    or ( "Has Encounter with Initial and Follow Up VR36 Oblique Assessments" )
    or ( "Has Encounter with Initial and Follow Up VR36 Orthogonal Assessments" )
    or ( "Has Encounter with Initial and Follow Up MLHFQ Assessments" )
    or ( "Has Encounter with Initial and Follow Up KCCQ12 Assessments" )
    or ( "Has Encounter with Initial and Follow Up KCCQ Domain Score Assessments" )
    or ( "Has Encounter with Initial and Follow Up KCCQ Total Score Assessments" )

define "Outpatient Encounters with at least one subsequent Outpatient Encounter during Measurement Period":
  from
    "Qualifying Encounters" OfficeVisit1
    with "Qualifying Encounters" OfficeVisit2
      such that OfficeVisit2.period starts 1 day or more after day of end of OfficeVisit1.period

define "Initial Population":
  AgeInYearsAt(date from start of "Measurement Period") >= 18
    and exists ( ( ( [ConditionProblemsHealthConcerns: "Heart Failure"]
          union [ConditionEncounterDiagnosis: "Heart Failure"]
      ).verified ( ) ) HeartFailure
        where HeartFailure.onset.toInterval ( ) overlaps before day of "Measurement Period"
    )
    and exists ( "Outpatient Encounters with at least one subsequent Outpatient Encounter during Measurement Period" )

define "Denominator":
  "Initial Population"

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

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

define "Denominator Exclusions":
  Hospice."Has Hospice Services"
    or exists ( ( ( [ConditionProblemsHealthConcerns: "Severe cognitive impairment (finding)"]
          union [ConditionEncounterDiagnosis: "Severe cognitive impairment (finding)"]
      ).verified ( ) ) SevereCognitiveImpairment
        where SevereCognitiveImpairment.onset.toInterval ( ) overlaps day of "Measurement Period"
    )

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

//Encounter, Performed
//General usage unless required otherwise by measure intent (e.g., follow-up encounters)
define fluent function isEncounterPerformed(Enc List<FHIR.Encounter>):
  Enc E
    where E.status = 'finished'

//Assessment, Performed
define fluent function isAssessmentPerformed(Obs List<ObservationScreeningAssessment>):
  Obs O
    where O.status in { 'final', 'amended', 'corrected' }

// TODO: Deprecate because this is now in FHIRCommon
//Condition
/*
@description: Returns conditions in the given list that either have no verification status or have a verification status of confirmed, unconfirmed, provisional, or differential
@deprecated: Use the USCoreCommon verified function insteada
*/
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"
      )

//Intervention, Order
define fluent function isInterventionOrder(ServiceRequest List<FHIR.ServiceRequest>):
  ServiceRequest S
    where S.status in { 'active', 'completed' }
      and S.intent in {'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order'}

//Intervention, Performed
define fluent function isInterventionPerformed(Proc List<FHIR.Procedure>):
  Proc P
    where P.status ~ 'completed'

define function ToString(value string): value.value

define function ToString(value uri): value.value

define function ToString(value EncounterStatus): 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 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

/*
@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
        }

/*
@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 ToString(value ServiceRequestStatus): value.value

define function ToString(value ServiceRequestIntent): value.value

define function ToString(value ProcedureStatus): value.value

/*
@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 conditions in the given list that either have no verification status or have a verification status of confirmed, unconfirmed, provisional, or differential
*/
define fluent function verified(conditions List<FHIR.Condition>):
  conditions C
    where C.verificationStatus is not null implies
      (C.verificationStatus ~ "confirmed"
        or C.verificationStatus ~ "unconfirmed"
        or C.verificationStatus ~ "provisional"
        or C.verificationStatus ~ "differential"
      )

/*
@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

/*
@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
    }