define "Initial Population":   Global."CalendarAgeInYearsAt" ( FHIRHelpers.ToDate ( Patient.birthDate ), start of "Measurement Period" ) >= 65       and exists "Qualifying Encounters"

define "Denominator":   "Initial Population"

define "Denominator Exclusions":   Hospice."Has Hospice"

define "Numerator":   exists ( [Immunization: "Pneumococcal Vaccine"] PneumococcalVaccine         where PneumococcalVaccine.status = 'completed'           and PneumococcalVaccine.occurrence as dateTime on or before           end of "Measurement Period"     )       or exists ( [Procedure: "Pneumococcal Vaccine Administered"] PneumococcalVaccineGiven           where PneumococcalVaccineGiven.status = 'completed'             and PneumococcalVaccineGiven.performed as Period on or before             end of "Measurement Period"       )

define "Has Hospice":  exists (     [Encounter: "Encounter Inpatient"] DischargeHospice    where DischargeHospice.status = 'finished'       and (          DischargeHospice.hospitalization.dischargeDisposition ~ "Discharge to home for hospice care (procedure)"         or DischargeHospice.hospitalization.dischargeDisposition ~ "Discharge to healthcare facility for hospice care (procedure)"       )     and DischargeHospice.period ends during "Measurement Period"  )     or exists (       [ServiceRequest: "Hospice care ambulatory"] HospiceOrder         where HospiceOrder.intent = 'order'             and HospiceOrder.authoredOn in "Measurement Period"     )     or exists (       [Procedure: "Hospice care ambulatory"] HospicePerformed         where HospicePerformed.status = 'completed'           and Global."Normalize Interval"(HospicePerformed.performed) overlaps "Measurement Period"     )

define "SDE Sex":   case       when Patient.gender = 'male' then Code { code: 'M', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Male' }       when Patient.gender = 'female' then Code { code: 'F', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Female' }       else null     end

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

define "SDE Ethnicity":   (flatten (       Patient.extension Extension         where Extension.url = 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity'           return Extension.extension     )) E       where E.url = 'ombCategory'         or E.url = 'detailed'       return E.value as Coding

define "SDE Race":   (flatten (       Patient.extension Extension         where Extension.url = 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-race'           return Extension.extension     )) E       where E.url = 'ombCategory'         or E.url = 'detailed'       return E.value as Coding

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

define "Numerator":   exists ( [Immunization: "Pneumococcal Vaccine"] PneumococcalVaccine         where PneumococcalVaccine.status = 'completed'           and PneumococcalVaccine.occurrence as dateTime on or before           end of "Measurement Period"     )       or exists ( [Procedure: "Pneumococcal Vaccine Administered"] PneumococcalVaccineGiven           where PneumococcalVaccineGiven.status = 'completed'             and PneumococcalVaccineGiven.performed as Period on or before             end of "Measurement Period"       )

define "Qualifying Encounters":   ( [Encounter: "Office Visit"]       union [Encounter: "Annual Wellness Visit"]       union [Encounter: "Preventive Care Services - Established Office Visit, 18 and Up"]       union [Encounter: "Preventive Care Services-Initial Office Visit, 18 and Up"]       union [Encounter: "Home Healthcare Services"]       union [Encounter: "Discharge Services - Nursing Facility"]       union [Encounter: "Nursing Facility Visit"]       union [Encounter: "Care Services in Long-Term Residential Facility"] ) ValidEncounter       where ValidEncounter.period during "Measurement Period"         and ValidEncounter.status = 'finished'

define "Initial Population":   Global."CalendarAgeInYearsAt" ( FHIRHelpers.ToDate ( Patient.birthDate ), start of "Measurement Period" ) >= 65       and exists "Qualifying Encounters"

define "Denominator":   "Initial Population"

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

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

define "Denominator Exclusions":   Hospice."Has Hospice"

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

define function "CalendarAgeInYearsAt"(BirthDateTime DateTime, AsOf DateTime):  years between ToDate(BirthDateTime)and ToDate(AsOf)

define function "ToDate"(Value DateTime):  DateTime(year from Value, month from Value, day from Value, 0, 0, 0, 0, timezoneoffset from Value)

define function ToString(value AdministrativeGender): value.value

define function ToString(value ImmunizationStatus): value.value

define function ToDateTime(value dateTime): value.value

define function ToString(value ProcedureStatus): 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 ToDate(value date): value.value

define function ToString(value EncounterStatus): value.value

define function ToString(value uri): 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         }

/* @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 ServiceRequestIntent): value.value