WHO Antenatal Care Guideline Implementation Guide
0.3.0 - CI Build International flag

WHO Antenatal Care Guideline Implementation Guide, published by World Health Organization (WHO). This guide is not an authorized publication; it is the continuous build for version 0.3.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/WorldHealthOrganization/smart-anc/ and changes regularly. See the Directory of published versions

: ANC.DT.06 Physical symptoms and exam results requiring referral - XML Representation

Active as of 2025-06-24

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<PlanDefinition xmlns="http://hl7.org/fhir">
  <id value="ANCDT06"/>
  <text>
    <status value="extensions"/>
    <div xmlns="http://www.w3.org/1999/xhtml">
<div>
    <table class="grid dict">
        
        <tr>
            <th scope="row"><b>Id: </b></th>
            <td style="padding-left: 4px;">ANCDT06</td>
        </tr>
        

        
        <tr>
            <th scope="row"><b>Url: </b></th>
            <td style="padding-left: 4px;"><a href="PlanDefinition-ANCDT06.html">ANC.DT.06 Physical symptoms and exam results requiring referral</a></td>
        </tr>
        

        
        <tr>
            <th scope="row"><b>Version: </b></th>
            <td style="padding-left: 4px;">0.3.0</td>
        </tr>
        

        
        <tr>
            <th scope="row">
                <b>
                    
                        Official
                    
                </b>
            </th>
            <td style="padding-left: 4px;">
                
                <p style="margin-bottom: 5px;">
                    <span>ANC.DT.06</span>
                </p>
                
            </td>
        </tr>
        

        
        <tr>
            <th scope="row"><b>Title: </b></th>
            <td style="padding-left: 4px;">ANC.DT.06 Physical symptoms and exam results requiring referral</td>
        </tr>
        

        

        

        

        
        <tr>
            <th scope="row"><b>Type: </b></th>
            <td style="padding-left: 4px;">
                
                    
                        
                        <p style="margin-bottom: 5px;">
                            <b>system: </b> <span><a href="http://terminology.hl7.org/6.4.0/CodeSystem-plan-definition-type.html">http://terminology.hl7.org/CodeSystem/plan-definition-type</a></span>
                        </p>
                        
                        
                        <p style="margin-bottom: 5px;">
                            <b>code: </b> <span>eca-rule</span>
                        </p>
                        
                        
                    
                
                
            </td>
        </tr>
        

        

        
        <tr>
            <th scope="row"><b>Date: </b></th>
            <td style="padding-left: 4px;">2025-06-24 13:58:48-0600</td>
        </tr>
        

        
        <tr>
            <th scope="row"><b>Publisher: </b></th>
            <td style="padding-left: 4px;">World Health Organization (WHO)</td>
        </tr>
        

        
        <tr>
            <th scope="row"><b>Description: </b></th>
            <td style="padding-left: 4px;"><div><p>If the woman has any of the following physical exam results, refer to the hospital</p>
</div></td>
        </tr>
        

        

        

        
        <tr>
            <th scope="row"><b>Use Context: </b></th>
            <td style="padding-left: 4px;">
                <table class="grid-dict">
                    <tr>
                        <th><b>code</b></th>
                        <th><b>value</b></th>
                    </tr>
                    
                        <tr>
                            <td>task</td>
                            <td/>
                        </tr>
                    
                </table>
            </td>
        </tr>
        

        
        <tr>
            <th scope="row"><b>Jurisdiction: </b></th>
            <td style="padding-left: 4px;">001</td>
        </tr>
        

        

        

        

        

        

        

        

        
        <tr>
            <th scope="row"><b>Libraries: </b></th>
            <td style="padding-left: 4px;">
                <table class="grid-dict">
                    
                    <tr>
                        <td><a href="Library-ANCDT06.html">ANC.DT.06 Physical symptoms and exam results requiring referral</a></td>
                    </tr>
                    
                </table>
            </td>
        </tr>
        

        
        <tr>
            <th scope="row"><b>Actions: </b></th>
            <td style="padding-left: 4px;">
                <table class="grid-dict">
                    
                    <tr>
                        <td>
                            
                            <b> ANC.DT.06 Physical symptoms and exam results requiring referral:</b> 
                            
                            <br/>
                            
                            <b>When:</b>
                            
                            <i>Named Event:</i> ANC.B8. Conduct physical exam
                            <br/>
                            
                            
                            
                            
                            <b>Then:</b>
                            <table class="grid-dict">
                                
                                <tr>
                                    <td>
                                        
                                        Woman has a fever – provide treatment and refer urgently to hospital!
Procedure:
– Insert an IV line
– Give fluids slowly
                                        
                                        <br/>
                                        
                                        
                                        <b>If:</b>
                                        
                                        <i>Applicability:</i>
                                        
                                        (&quot;Body temperature&quot; ≥ 38°C)
  AND (&quot;Second body temperature&quot; ≥ 38°C)
                                        
                                        <i>(Should Conduct further investigation and, if necessary, refer urgently if treatment not available at your facility )</i>
                                        <br/>
                                        
                                        
                                        
                                        
                                        
                                    </td>
                                </tr>
                                
                                <tr>
                                    <td>
                                        
                                        Abnormal pulse rate – refer for further investigation
Procedure:
– Check for fever, infection, respiratory distress, arrhythmia
– Refer for further investigation
                                        
                                        <br/>
                                        
                                        
                                        <b>If:</b>
                                        
                                        <i>Applicability:</i>
                                        
                                        60 bpm &gt; &quot;Second pulse rate&quot; &gt; 100 bpm
                                        
                                        <i>(Should Refer to a hospital)</i>
                                        <br/>
                                        
                                        
                                        
                                        
                                        
                                    </td>
                                </tr>
                                
                                <tr>
                                    <td>
                                        
                                        Woman has respiratory distress – refer urgently to the hospital!
                                        
                                        <br/>
                                        
                                        
                                        <b>If:</b>
                                        
                                        <i>Applicability:</i>
                                        
                                        ((((((&quot;Respiratory exam result&quot; = &quot;Dyspnoea&quot;)
  OR (&quot;Respiratory exam result&quot; = &quot;Cough&quot;))
  OR (&quot;Respiratory exam result&quot; = &quot;Rapid breathing&quot;))
  OR (&quot;Respiratory exam result&quot; = &quot;Slow breathing&quot;))
  OR (&quot;Respiratory exam result&quot; = &quot;Wheezing&quot;))
  OR (&quot;Respiratory exam result&quot; = &quot;Rales&quot;))
  OR (&quot;Respiratory exam result&quot; = &quot;Other abnormal respiratory exam result (specify)&quot;)
                                        
                                        <i>(Should Refer urgently to a hospital)</i>
                                        <br/>
                                        
                                        
                                        
                                        
                                        
                                    </td>
                                </tr>
                                
                                <tr>
                                    <td>
                                        
                                        Woman has low oximetry (&lt;92%) – she should be referred urgently to the hospital
                                        
                                        <br/>
                                        
                                        
                                        <b>If:</b>
                                        
                                        <i>Applicability:</i>
                                        
                                        &quot;Oximetry&quot; &lt; 92%
                                        
                                        <i>(Should Refer urgently to a hospital 2)</i>
                                        <br/>
                                        
                                        
                                        
                                        
                                        
                                    </td>
                                </tr>
                                
                                <tr>
                                    <td>
                                        
                                        Woman's cardiac condition is abnormal and she should be referred urgently to the hospital
                                        
                                        <br/>
                                        
                                        
                                        <b>If:</b>
                                        
                                        <i>Applicability:</i>
                                        
                                        (((((((&quot;Cardiac exam result&quot; = &quot;Heart murmur&quot;)
  OR (&quot;Cardiac exam result&quot; = &quot;Weak pulse&quot;))
  OR (&quot;Cardiac exam result&quot; = &quot;Tachycardia&quot;))
  OR (&quot;Cardiac exam result&quot; = &quot;Bradycardia&quot;))
  OR (&quot;Cardiac exam result&quot; = &quot;Arrhythmia&quot;))
  OR (&quot;Cardiac exam result&quot; = &quot;Cyanosis&quot;))
  OR (&quot;Cardiac exam result&quot; = &quot;Cold sweats&quot;))
  OR (&quot;Cardiac exam result&quot; = &quot;Other abnormal cardiac exam result (specify)&quot;)
                                        
                                        <i>(Should Refer urgently to a hospital 3)</i>
                                        <br/>
                                        
                                        
                                        
                                        
                                        
                                    </td>
                                </tr>
                                
                                <tr>
                                    <td>
                                        
                                        Woman's breast exam was abnormal and she should be referred to hospital for further investigation
                                        
                                        <br/>
                                        
                                        
                                        <b>If:</b>
                                        
                                        <i>Applicability:</i>
                                        
                                        ((((((&quot;Breast exam result&quot; = &quot;Nodule&quot;)
  OR (&quot;Breast exam result&quot; = &quot;Discharge&quot;))
  OR (&quot;Breast exam result&quot; = &quot;Flushing&quot;))
  OR (&quot;Breast exam result&quot; = &quot;Local pain&quot;))
  OR (&quot;Breast exam result&quot; = &quot;Bleeding&quot;))
  OR (&quot;Breast exam result&quot; = &quot;Increased temperature&quot;))
  OR (&quot;Breast exam result&quot; = &quot;Other breast exam result (specify)&quot;)
                                        
                                        <i>(Should Conduct further investigation and, if necessary, refer urgently to a hospital)</i>
                                        <br/>
                                        
                                        
                                        
                                        
                                        
                                    </td>
                                </tr>
                                
                                <tr>
                                    <td>
                                        
                                        Woman's abdominal exam was abnormal and she should be referred or further evaluated
                                        
                                        <br/>
                                        
                                        
                                        <b>If:</b>
                                        
                                        <i>Applicability:</i>
                                        
                                        (((((((((((((((((&quot;Abdominal exam result&quot; = &quot;Mass/tumour&quot;)
  OR (&quot;Abdominal exam result&quot; = &quot;Pain on superficial palpation&quot;))
  OR (&quot;Abdominal exam result&quot; = &quot;Pain on deep palpation&quot;))
  OR (&quot;Abdominal exam result&quot; = &quot;Painful decompression&quot;))
  OR (&quot;Abdominal exam result&quot; = &quot;Other abnormal abdominal exam result (specify)&quot;))
  OR (&quot;Pelvic exam result (visual)&quot; = &quot;Abnormal vaginal discharge&quot;))
  OR (&quot;Pelvic exam result (visual)&quot; = &quot;Evidence of amniotic fluid&quot;))
  OR (&quot;Pelvic exam result (visual)&quot; = &quot;Foul-smelling vaginal discharge&quot;))
  OR (&quot;Pelvic exam result (visual)&quot; = &quot;Clusters of erythematous papules&quot;))
  OR (&quot;Pelvic exam result (visual)&quot; = &quot;Vesicles&quot;))
  OR (&quot;Pelvic exam result (visual)&quot; = &quot;Genital ulcer&quot;))
  OR (&quot;Pelvic exam result (visual)&quot; = &quot;Genital pain&quot;))
  OR (&quot;Pelvic exam result (visual)&quot; = &quot;Tender bilateral inguinal and femoral lymphadenopathy&quot;))
  OR (&quot;Pelvic exam result (visual)&quot; = &quot;Cervical friability&quot;))
  OR (&quot;Pelvic exam result (visual)&quot; = &quot;Mucopurulent cervicitis&quot;))
  OR (&quot;Pelvic exam result (visual)&quot; = &quot;Tender unilateral lymphadenopathy&quot;))
  OR (&quot;Pelvic exam result (visual)&quot; = &quot;Curd-like vaginal discharge&quot;))
  OR (&quot;Pelvic exam result (visual)&quot; = &quot;Other abnormal pelvic exam (visual) result (specify)&quot;)
                                        
                                        <i>(Should Refer to a hospital 2)</i>
                                        <br/>
                                        
                                        
                                        
                                        
                                        
                                    </td>
                                </tr>
                                
                                <tr>
                                    <td>
                                        
                                        Woman should be referred urgently if there is evidence of amniotic fluid, which could indicate the start of labour
                                        
                                        <br/>
                                        
                                        
                                        <b>If:</b>
                                        
                                        <i>Applicability:</i>
                                        
                                        (&quot;Pelvic exam result (visual)&quot; = &quot;Evidence of amniotic fluid&quot;)
  AND (&quot;Gestational age&quot; &lt; 37 weeks)
                                        
                                        <i>(Should Refer urgently to a hospital 4)</i>
                                        <br/>
                                        
                                        
                                        
                                        
                                        
                                    </td>
                                </tr>
                                
                                <tr>
                                    <td>
                                        
                                        If no fetal heartbeat is observed, inform the woman that there might be a problem and that she needs to be referred to the hospital for further examination and next steps.

Procedure:
– Inform the woman that you cannot find the heartbeat and need to refer her to check if there's a problem
– Refer to hospital
                                        
                                        <br/>
                                        
                                        
                                        <b>If:</b>
                                        
                                        <i>Applicability:</i>
                                        
                                        (&quot;Fetal heartbeat present&quot; = FALSE)
  AND (&quot;Gestational age&quot; ≥ 20 weeks)
                                        
                                        <i>(Should Refer to a hospital 3)</i>
                                        <br/>
                                        
                                        
                                        
                                        
                                        
                                    </td>
                                </tr>
                                
                                <tr>
                                    <td>
                                        
                                        Fetal heart rate is abnormal after two readings: the woman should be referred to hospital
                                        
                                        <br/>
                                        
                                        
                                        <b>If:</b>
                                        
                                        <i>Applicability:</i>
                                        
                                        (100 bpm &gt; &quot;Second fetal heart rate&quot; &gt; 180 bpm)
  AND (&quot;Gestational age&quot; ≥ 20 weeks)
                                        
                                        <i>(Should Refer to a hospital 4)</i>
                                        <br/>
                                        
                                        
                                        
                                        
                                        
                                    </td>
                                </tr>
                                
                            </table>
                            
                        </td>
                    </tr>
                    
                </table>
            </td>
        </tr>
        
    </table>
</div>
</div>
  </text>
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      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display value="Value set Breast exam result - Local pain Choices"/>
        <resource value="http://smart.who.int/anc/ValueSet/anc-b8-de67"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display value="Value set Breast exam result - Bleeding Choices"/>
        <resource value="http://smart.who.int/anc/ValueSet/anc-b8-de68"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display
                 value="Value set Breast exam result - Increased temperature Choices"/>
        <resource value="http://smart.who.int/anc/ValueSet/anc-b8-de69"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display
                 value="Value set Breast exam result - Other breast exam result (specify) Choices"/>
        <resource value="http://smart.who.int/anc/ValueSet/anc-b8-de70"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display value="Value set Second fetal heart rate"/>
        <resource value="http://smart.who.int/anc/ValueSet/anc-b8-de108"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display value="Value set Fetal heartbeat present"/>
        <resource value="http://smart.who.int/anc/ValueSet/anc-b8-de106"/>
      </relatedArtifact>
      <parameter>
        <name value="encounter"/>
        <use value="in"/>
        <min value="0"/>
        <max value="1"/>
        <type value="string"/>
      </parameter>
      <parameter>
        <name value="Should Refer urgently to a hospital"/>
        <use value="out"/>
        <min value="0"/>
        <max value="1"/>
        <type value="boolean"/>
      </parameter>
      <parameter>
        <name value="Should Refer to a hospital"/>
        <use value="out"/>
        <min value="0"/>
        <max value="1"/>
        <type value="boolean"/>
      </parameter>
      <parameter>
        <name
              value="Should Conduct further investigation and, if necessary, refer urgently if treatment not available at your facility "/>
        <use value="out"/>
        <min value="0"/>
        <max value="1"/>
        <type value="boolean"/>
      </parameter>
      <parameter>
        <name value="Should Refer to a hospital 2"/>
        <use value="out"/>
        <min value="0"/>
        <max value="1"/>
        <type value="boolean"/>
      </parameter>
      <parameter>
        <name value="Should Refer urgently to a hospital 4"/>
        <use value="out"/>
        <min value="0"/>
        <max value="1"/>
        <type value="boolean"/>
      </parameter>
      <parameter>
        <name value="Should Refer urgently to a hospital 3"/>
        <use value="out"/>
        <min value="0"/>
        <max value="1"/>
        <type value="boolean"/>
      </parameter>
      <parameter>
        <name value="Should Refer urgently to a hospital 2"/>
        <use value="out"/>
        <min value="0"/>
        <max value="1"/>
        <type value="boolean"/>
      </parameter>
      <parameter>
        <name
              value="Should Conduct further investigation and, if necessary, refer urgently to a hospital"/>
        <use value="out"/>
        <min value="0"/>
        <max value="1"/>
        <type value="boolean"/>
      </parameter>
      <parameter>
        <name value="Should Refer to a hospital 4"/>
        <use value="out"/>
        <min value="0"/>
        <max value="1"/>
        <type value="boolean"/>
      </parameter>
      <parameter>
        <name value="Should Refer to a hospital 3"/>
        <use value="out"/>
        <min value="0"/>
        <max value="1"/>
        <type value="boolean"/>
      </parameter>
      <dataRequirement>
        <type value="Observation"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/Observation"/>
        <mustSupport value="code"/>
        <mustSupport value="status"/>
        <mustSupport value="encounter"/>
        <mustSupport value="encounter.reference"/>
        <codeFilter>
          <path value="code"/>
          <valueSet value="http://smart.who.int/anc/ValueSet/anc-b8-de39"/>
        </codeFilter>
      </dataRequirement>
      <dataRequirement>
        <type value="Observation"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/Observation"/>
        <mustSupport value="code"/>
        <mustSupport value="status"/>
        <mustSupport value="encounter"/>
        <mustSupport value="encounter.reference"/>
        <codeFilter>
          <path value="code"/>
          <valueSet value="http://smart.who.int/anc/ValueSet/anc-b8-de37"/>
        </codeFilter>
      </dataRequirement>
      <dataRequirement>
        <type value="Observation"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/Observation"/>
        <mustSupport value="code"/>
        <mustSupport value="status"/>
        <mustSupport value="encounter"/>
        <mustSupport value="encounter.reference"/>
        <codeFilter>
          <path value="code"/>
          <valueSet value="http://smart.who.int/anc/ValueSet/anc-b8-de34"/>
        </codeFilter>
      </dataRequirement>
      <dataRequirement>
        <type value="Observation"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/Observation"/>
        <mustSupport value="code"/>
        <mustSupport value="status"/>
        <mustSupport value="encounter"/>
        <mustSupport value="encounter.reference"/>
        <codeFilter>
          <path value="code"/>
          <valueSet value="http://smart.who.int/anc/ValueSet/anc-b8-de35"/>
        </codeFilter>
      </dataRequirement>
      <dataRequirement>
        <type value="Observation"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/Observation"/>
        <mustSupport value="code"/>
        <mustSupport value="status"/>
        <mustSupport value="encounter"/>
        <mustSupport value="encounter.reference"/>
        <codeFilter>
          <path value="code"/>
          <valueSet value="http://smart.who.int/anc/ValueSet/anc-b8-de71"/>
        </codeFilter>
      </dataRequirement>
      <dataRequirement>
        <type value="Observation"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/Observation"/>
        <mustSupport value="code"/>
        <mustSupport value="status"/>
        <mustSupport value="encounter"/>
        <mustSupport value="encounter.reference"/>
        <codeFilter>
          <path value="code"/>
          <valueSet value="http://smart.who.int/anc/ValueSet/anc-b8-de79"/>
        </codeFilter>
      </dataRequirement>
      <dataRequirement>
        <type value="Observation"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/Observation"/>
        <mustSupport value="code"/>
        <mustSupport value="status"/>
        <mustSupport value="encounter"/>
        <mustSupport value="encounter.reference"/>
        <codeFilter>
          <path value="code"/>
          <valueSet value="http://smart.who.int/anc/ValueSet/anc-b6-de17"/>
        </codeFilter>
      </dataRequirement>
      <dataRequirement>
        <type value="Observation"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/Observation"/>
        <mustSupport value="code"/>
        <mustSupport value="status"/>
        <mustSupport value="encounter"/>
        <mustSupport value="encounter.reference"/>
        <codeFilter>
          <path value="code"/>
          <valueSet value="http://smart.who.int/anc/ValueSet/anc-b8-de50"/>
        </codeFilter>
      </dataRequirement>
      <dataRequirement>
        <type value="Observation"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/Observation"/>
        <mustSupport value="code"/>
        <mustSupport value="status"/>
        <mustSupport value="encounter"/>
        <mustSupport value="encounter.reference"/>
        <codeFilter>
          <path value="code"/>
          <valueSet value="http://smart.who.int/anc/ValueSet/anc-b8-de49"/>
        </codeFilter>
      </dataRequirement>
      <dataRequirement>
        <type value="Observation"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/Observation"/>
        <mustSupport value="code"/>
        <mustSupport value="status"/>
        <mustSupport value="encounter"/>
        <mustSupport value="encounter.reference"/>
        <codeFilter>
          <path value="code"/>
          <valueSet value="http://smart.who.int/anc/ValueSet/anc-b8-de61"/>
        </codeFilter>
      </dataRequirement>
      <dataRequirement>
        <type value="Observation"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/Observation"/>
        <mustSupport value="code"/>
        <mustSupport value="status"/>
        <mustSupport value="encounter"/>
        <mustSupport value="encounter.reference"/>
        <codeFilter>
          <path value="code"/>
          <valueSet value="http://smart.who.int/anc/ValueSet/anc-b8-de108"/>
        </codeFilter>
      </dataRequirement>
      <dataRequirement>
        <type value="Observation"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/Observation"/>
        <mustSupport value="code"/>
        <mustSupport value="status"/>
        <mustSupport value="encounter"/>
        <mustSupport value="encounter.reference"/>
        <codeFilter>
          <path value="code"/>
          <valueSet value="http://smart.who.int/anc/ValueSet/anc-b8-de106"/>
        </codeFilter>
      </dataRequirement>
    </Library>
  </contained>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
    <extension url="libraryName">
      <valueString value="ANCContactDataElements"/>
    </extension>
    <extension url="name">
      <valueString value="Respiratory exam result"/>
    </extension>
    <extension url="statement">
      <valueString
                   value="/*
  @dataElement: ANC.B8.DE39 Respiratory exam result
  @activity: ANC.B8 Physical exam
  @description: The woman's respiratory condition based on respiratory exam
*/
define &quot;Respiratory exam result&quot;:
  WC.Only(
  [Observation: Cx.&quot;Respiratory exam result&quot;] O
    where O.status in { 'final', 'amended', 'corrected' }
      and Coalesce(WC.ModifierExtension(O, 'who-notDone').value, false) is false
      and Last(Split(O.encounter.reference, '/')) = Last(Split(encounter, '/'))
  ).value as FHIR.CodeableConcept"/>
    </extension>
    <extension url="displaySequence">
      <valueInteger value="0"/>
    </extension>
  </extension>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
    <extension url="libraryName">
      <valueString value="ANCDT06"/>
    </extension>
    <extension url="name">
      <valueString value="Should Refer urgently to a hospital"/>
    </extension>
    <extension url="statement">
      <valueString
                   value="/*
((((((&quot;Respiratory exam result&quot; = &quot;Dyspnoea&quot;)
  OR (&quot;Respiratory exam result&quot; = &quot;Cough&quot;))
  OR (&quot;Respiratory exam result&quot; = &quot;Rapid breathing&quot;))
  OR (&quot;Respiratory exam result&quot; = &quot;Slow breathing&quot;))
  OR (&quot;Respiratory exam result&quot; = &quot;Wheezing&quot;))
  OR (&quot;Respiratory exam result&quot; = &quot;Rales&quot;))
  OR (&quot;Respiratory exam result&quot; = &quot;Other abnormal respiratory exam result (specify)&quot;)
*/
define &quot;Should Refer urgently to a hospital&quot;:
   ContactData.&quot;Respiratory exam result&quot; in Cx.&quot;Respiratory exam result - Dyspnoea Choices&quot;
     or ContactData.&quot;Respiratory exam result&quot; in Cx.&quot;Respiratory exam result - Cough Choices&quot;
     or ContactData.&quot;Respiratory exam result&quot; in Cx.&quot;Respiratory exam result - Rapid breathing Choices&quot;
     or ContactData.&quot;Respiratory exam result&quot; in Cx.&quot;Respiratory exam result - Slow breathing Choices&quot;
     or ContactData.&quot;Respiratory exam result&quot; in Cx.&quot;Respiratory exam result - Wheezing Choices&quot;
     or ContactData.&quot;Respiratory exam result&quot; in Cx.&quot;Respiratory exam result - Rales Choices&quot;
     or ContactData.&quot;Respiratory exam result&quot; in Cx.&quot;Respiratory exam result - Other abnormal result (specify) Choices&quot;"/>
    </extension>
    <extension url="displaySequence">
      <valueInteger value="1"/>
    </extension>
  </extension>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
    <extension url="libraryName">
      <valueString value="ANCContactDataElements"/>
    </extension>
    <extension url="name">
      <valueString value="Second pulse rate"/>
    </extension>
    <extension url="statement">
      <valueString
                   value="/*
  @dataElement: ANC.B8.DE37 Second pulse rate
  @activity: ANC.B8 Physical exam
  @description: The woman's second pulse rate in beats per minute (bpm)
*/
define &quot;Second pulse rate&quot;:
  WC.MostRecent(
  [Observation: Cx.&quot;Second pulse rate&quot;] O
    where O.status in { 'final', 'amended', 'corrected' }
      and Coalesce(WC.ModifierExtension(O, 'who-notDone').value, false) is false
      and Last(Split(O.encounter.reference, '/')) = Last(Split(encounter, '/'))
  ).value as FHIR.Quantity"/>
    </extension>
    <extension url="displaySequence">
      <valueInteger value="2"/>
    </extension>
  </extension>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
    <extension url="libraryName">
      <valueString value="ANCDT06"/>
    </extension>
    <extension url="name">
      <valueString value="Should Refer to a hospital"/>
    </extension>
    <extension url="statement">
      <valueString
                   value="/*
60 bpm &gt; &quot;Second pulse rate&quot; &gt; 100 bpm
*/
define &quot;Should Refer to a hospital&quot;:
  ContactData.&quot;Second pulse rate&quot; &lt; 60
    or ContactData.&quot;Second pulse rate&quot; &gt; 100"/>
    </extension>
    <extension url="displaySequence">
      <valueInteger value="3"/>
    </extension>
  </extension>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
    <extension url="libraryName">
      <valueString value="ANCContactDataElements"/>
    </extension>
    <extension url="name">
      <valueString value="Body temperature"/>
    </extension>
    <extension url="statement">
      <valueString
                   value="/*
  @dataElement: ANC.B8.DE34 Body temperature
  @activity: ANC.B8 Physical exam
  @description: The woman's body temperature in degrees Celsius  (°C) (first reading)
*/
define &quot;Body temperature&quot;:
  WC.Earliest(
  [Observation: Cx.&quot;Body temperature&quot;] O
    where O.status in { 'final', 'amended', 'corrected' }
      and Coalesce(WC.ModifierExtension(O, 'who-notDone').value, false) is false
      and Last(Split(O.encounter.reference, '/')) = Last(Split(encounter, '/'))
  ).value as FHIR.Quantity"/>
    </extension>
    <extension url="displaySequence">
      <valueInteger value="4"/>
    </extension>
  </extension>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
    <extension url="libraryName">
      <valueString value="ANCContactDataElements"/>
    </extension>
    <extension url="name">
      <valueString value="Second body temperature"/>
    </extension>
    <extension url="statement">
      <valueString
                   value="/*
  @dataElement: ANC.B8.DE35 Second body temperature
  @activity: ANC.B8 Physical exam
  @description: The woman's body temperature in degrees Celsius (°C) (second reading)
*/
define &quot;Second body temperature&quot;:
  WC.MostRecent(
  [Observation: Cx.&quot;Second body temperature&quot;] O
    where O.status in { 'final', 'amended', 'corrected' }
      and Coalesce(WC.ModifierExtension(O, 'who-notDone').value, false) is false
      and Last(Split(O.encounter.reference, '/')) = Last(Split(encounter, '/'))
  ).value as FHIR.Quantity"/>
    </extension>
    <extension url="displaySequence">
      <valueInteger value="5"/>
    </extension>
  </extension>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
    <extension url="libraryName">
      <valueString value="ANCDT06"/>
    </extension>
    <extension url="name">
      <valueString
                   value="Should Conduct further investigation and, if necessary, refer urgently if treatment not available at your facility "/>
    </extension>
    <extension url="statement">
      <valueString
                   value="/*
(&quot;Body temperature&quot; ≥ 38°C)
  AND (&quot;Second body temperature&quot; ≥ 38°C)
*/
define &quot;Should Conduct further investigation and, if necessary, refer urgently if treatment not available at your facility &quot;:
  ContactData.&quot;Body temperature&quot; &gt;= 38 'Cel'
    and ContactData.&quot;Second body temperature&quot; &gt;= 38 'Cel'"/>
    </extension>
    <extension url="displaySequence">
      <valueInteger value="6"/>
    </extension>
  </extension>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
    <extension url="libraryName">
      <valueString value="ANCContactDataElements"/>
    </extension>
    <extension url="name">
      <valueString value="Abdominal exam result"/>
    </extension>
    <extension url="statement">
      <valueString
                   value="/*
  @dataElement: ANC.B8.DE71 Abdominal exam result
  @activity: ANC.B8 Physical exam
  @description: Whether or not the result of the abdominal exam is normal
*/
define &quot;Abdominal exam result&quot;:
  WC.Only(
  [Observation: Cx.&quot;Abdominal exam result&quot;] O
    where O.status in { 'final', 'amended', 'corrected' }
      and Coalesce(WC.ModifierExtension(O, 'who-notDone').value, false) is false
      and Last(Split(O.encounter.reference, '/')) = Last(Split(encounter, '/'))
  ).value as FHIR.CodeableConcept"/>
    </extension>
    <extension url="displaySequence">
      <valueInteger value="7"/>
    </extension>
  </extension>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
    <extension url="libraryName">
      <valueString value="ANCContactDataElements"/>
    </extension>
    <extension url="name">
      <valueString value="Pelvic exam result (visual)"/>
    </extension>
    <extension url="statement">
      <valueString
                   value="/*
  @dataElement: ANC.B8.DE79 Pelvic exam result (visual)
  @activity: ANC.B8 Physical exam
  @description: Whether or not the result of the pelvic exam is normal
*/
define &quot;Pelvic exam result (visual)&quot;:
  WC.Only(
  [Observation: Cx.&quot;Pelvic exam result (visual)&quot;] O
    where O.status in { 'final', 'amended', 'corrected' }
      and Coalesce(WC.ModifierExtension(O, 'who-notDone').value, false) is false
      and Last(Split(O.encounter.reference, '/')) = Last(Split(encounter, '/'))
  ).value as FHIR.CodeableConcept"/>
    </extension>
    <extension url="displaySequence">
      <valueInteger value="8"/>
    </extension>
  </extension>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
    <extension url="libraryName">
      <valueString value="ANCDT06"/>
    </extension>
    <extension url="name">
      <valueString value="Should Refer to a hospital 2"/>
    </extension>
    <extension url="statement">
      <valueString
                   value="/*
(((((((((((((((((&quot;Abdominal exam result&quot; = &quot;Mass/tumour&quot;)
  OR (&quot;Abdominal exam result&quot; = &quot;Pain on superficial palpation&quot;))
  OR (&quot;Abdominal exam result&quot; = &quot;Pain on deep palpation&quot;))
  OR (&quot;Abdominal exam result&quot; = &quot;Painful decompression&quot;))
  OR (&quot;Abdominal exam result&quot; = &quot;Other abnormal abdominal exam result (specify)&quot;))
  OR (&quot;Pelvic exam result (visual)&quot; = &quot;Abnormal vaginal discharge&quot;))
  OR (&quot;Pelvic exam result (visual)&quot; = &quot;Evidence of amniotic fluid&quot;))
  OR (&quot;Pelvic exam result (visual)&quot; = &quot;Foul-smelling vaginal discharge&quot;))
  OR (&quot;Pelvic exam result (visual)&quot; = &quot;Clusters of erythematous papules&quot;))
  OR (&quot;Pelvic exam result (visual)&quot; = &quot;Vesicles&quot;))
  OR (&quot;Pelvic exam result (visual)&quot; = &quot;Genital ulcer&quot;))
  OR (&quot;Pelvic exam result (visual)&quot; = &quot;Genital pain&quot;))
  OR (&quot;Pelvic exam result (visual)&quot; = &quot;Tender bilateral inguinal and femoral lymphadenopathy&quot;))
  OR (&quot;Pelvic exam result (visual)&quot; = &quot;Cervical friability&quot;))
  OR (&quot;Pelvic exam result (visual)&quot; = &quot;Mucopurulent cervicitis&quot;))
  OR (&quot;Pelvic exam result (visual)&quot; = &quot;Tender unilateral lymphadenopathy&quot;))
  OR (&quot;Pelvic exam result (visual)&quot; = &quot;Curd-like vaginal discharge&quot;))
  OR (&quot;Pelvic exam result (visual)&quot; = &quot;Other abnormal pelvic exam (visual) result (specify)&quot;)
*/
define &quot;Should Refer to a hospital 2&quot;:
  ContactData.&quot;Abdominal exam result&quot; in Cx.&quot;Abdominal exam result - Mass/tumour Choices&quot;
    or ContactData.&quot;Abdominal exam result&quot; in Cx.&quot;Abdominal exam result - Pain on superficial palpation Choices&quot;
    or ContactData.&quot;Abdominal exam result&quot; in Cx.&quot;Abdominal exam result - Pain on deep palpation Choices&quot;
    or ContactData.&quot;Abdominal exam result&quot; in Cx.&quot;Abdominal exam result - Painful decompression Choices&quot;
    or ContactData.&quot;Abdominal exam result&quot; in Cx.&quot;Abdominal exam result - Other abnormal abdominal exam result (specify) Choices&quot;
    or ContactData.&quot;Pelvic exam result (visual)&quot; in Cx.&quot;Pelvic exam result (visual) - Abnormal vaginal discharge Choices&quot;
    or ContactData.&quot;Pelvic exam result (visual)&quot; in Cx.&quot;Pelvic exam result (visual) - Evidence of amniotic fluid Choices&quot;
    or ContactData.&quot;Pelvic exam result (visual)&quot; in Cx.&quot;Pelvic exam result (visual) - Abnormal vaginal discharge Choices&quot;
    or ContactData.&quot;Pelvic exam result (visual)&quot; in Cx.&quot;Pelvic exam result (visual) - Clusters of erythematous papules Choices&quot;
    or ContactData.&quot;Pelvic exam result (visual)&quot; in Cx.&quot;Pelvic exam result (visual) - Vesicles Choices&quot;
    or ContactData.&quot;Pelvic exam result (visual)&quot; in Cx.&quot;Pelvic exam result (visual) - Genital ulcer Choices&quot;
    or ContactData.&quot;Pelvic exam result (visual)&quot; in Cx.&quot;Pelvic exam result (visual) - Genital pain Choices&quot;
    or ContactData.&quot;Pelvic exam result (visual)&quot; in Cx.&quot;Pelvic exam result (visual) - Lymphadenopathy (pelvic - unilateral or bilateral) Choices&quot;
    or ContactData.&quot;Pelvic exam result (visual)&quot; in Cx.&quot;Pelvic exam result (visual) - Cervical friability Choices&quot;
    or ContactData.&quot;Pelvic exam result (visual)&quot; in Cx.&quot;Pelvic exam result (visual) - Mucopurulent cervicitis Choices&quot;
    or ContactData.&quot;Pelvic exam result (visual)&quot; in Cx.&quot;Pelvic exam result (visual) - Lymphadenopathy (pelvic - unilateral or bilateral) Choices&quot;
    or ContactData.&quot;Pelvic exam result (visual)&quot; in Cx.&quot;Pelvic exam result (visual) - Abnormal vaginal discharge Choices&quot;
    or ContactData.&quot;Pelvic exam result (visual)&quot; in Cx.&quot;Pelvic exam result (visual) - Other abnormal pelvic exam (visual) result (specify) Choices&quot;"/>
    </extension>
    <extension url="displaySequence">
      <valueInteger value="9"/>
    </extension>
  </extension>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
    <extension url="libraryName">
      <valueString value="ANCContactDataElements"/>
    </extension>
    <extension url="name">
      <valueString value="Gestational age"/>
    </extension>
    <extension url="statement">
      <valueString
                   value="/*
  @dataElement: ANC.B6.DE17 Gestational age
  @activity: ANC.B6 Profile
  @description: Gestational age in weeks and/or days depending on the source of gestational age
*/
define &quot;Gestational age&quot;:
  WC.MostRecent(
  [Observation: Cx.&quot;Gestational age&quot;] O
    where O.status in { 'final', 'amended', 'corrected' }
      and Coalesce(WC.ModifierExtension(O, 'who-notDone').value, false) is false
      and Last(Split(O.encounter.reference, '/')) = Last(Split(encounter, '/'))
  ).value as FHIR.Quantity"/>
    </extension>
    <extension url="displaySequence">
      <valueInteger value="10"/>
    </extension>
  </extension>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
    <extension url="libraryName">
      <valueString value="ANCDT06"/>
    </extension>
    <extension url="name">
      <valueString value="Should Refer urgently to a hospital 4"/>
    </extension>
    <extension url="statement">
      <valueString
                   value="/*
(&quot;Pelvic exam result (visual)&quot; = &quot;Evidence of amniotic fluid&quot;)
  AND (&quot;Gestational age&quot; &lt; 37 weeks)
*/
define &quot;Should Refer urgently to a hospital 4&quot;:
  ContactData.&quot;Pelvic exam result (visual)&quot; in Cx.&quot;Pelvic exam result (visual) - Evidence of amniotic fluid Choices&quot;
    and ContactData.&quot;Gestational age&quot; &lt; 37 'weeks'"/>
    </extension>
    <extension url="displaySequence">
      <valueInteger value="11"/>
    </extension>
  </extension>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
    <extension url="libraryName">
      <valueString value="ANCContactDataElements"/>
    </extension>
    <extension url="name">
      <valueString value="Cardiac exam result"/>
    </extension>
    <extension url="statement">
      <valueString
                   value="/*
  @dataElement: ANC.B8.DE50 Cardiac exam result
  @activity: ANC.B8 Physical exam
  @description: The woman's cardiac condition
*/
define &quot;Cardiac exam result&quot;:
  WC.Only(
  [Observation: Cx.&quot;Cardiac exam result&quot;] O
    where O.status in { 'final', 'amended', 'corrected' }
      and Coalesce(WC.ModifierExtension(O, 'who-notDone').value, false) is false
      and Last(Split(O.encounter.reference, '/')) = Last(Split(encounter, '/'))
  ).value as FHIR.CodeableConcept"/>
    </extension>
    <extension url="displaySequence">
      <valueInteger value="12"/>
    </extension>
  </extension>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
    <extension url="libraryName">
      <valueString value="ANCDT06"/>
    </extension>
    <extension url="name">
      <valueString value="Should Refer urgently to a hospital 3"/>
    </extension>
    <extension url="statement">
      <valueString
                   value="/*
(((((((&quot;Cardiac exam result&quot; = &quot;Heart murmur&quot;)
  OR (&quot;Cardiac exam result&quot; = &quot;Weak pulse&quot;))
  OR (&quot;Cardiac exam result&quot; = &quot;Tachycardia&quot;))
  OR (&quot;Cardiac exam result&quot; = &quot;Bradycardia&quot;))
  OR (&quot;Cardiac exam result&quot; = &quot;Arrhythmia&quot;))
  OR (&quot;Cardiac exam result&quot; = &quot;Cyanosis&quot;))
  OR (&quot;Cardiac exam result&quot; = &quot;Cold sweats&quot;))
  OR (&quot;Cardiac exam result&quot; = &quot;Other abnormal cardiac exam result (specify)&quot;)
*/
define &quot;Should Refer urgently to a hospital 3&quot;:
  ContactData.&quot;Cardiac exam result&quot; in Cx.&quot;Cardiac exam result - Heart murmur Choices&quot;
    or ContactData.&quot;Cardiac exam result&quot; in Cx.&quot;Cardiac exam result - Weak pulse Choices&quot;
    or ContactData.&quot;Cardiac exam result&quot; in Cx.&quot;Cardiac exam result - Tachycardia Choices&quot;
    or ContactData.&quot;Cardiac exam result&quot; in Cx.&quot;Cardiac exam result - Bradycardia Choices&quot;
    or ContactData.&quot;Cardiac exam result&quot; in Cx.&quot;Cardiac exam result - Arrhythmia Choices&quot;
    or ContactData.&quot;Cardiac exam result&quot; in Cx.&quot;Cardiac exam result - Peripheral cyanosis Choices&quot;
    or ContactData.&quot;Cardiac exam result&quot; in Cx.&quot;Cardiac exam result - Cold sweats Choices&quot;
    or ContactData.&quot;Cardiac exam result&quot; in Cx.&quot;Cardiac exam result - Other abnormal cardiac exam result (specify) Choices&quot;"/>
    </extension>
    <extension url="displaySequence">
      <valueInteger value="13"/>
    </extension>
  </extension>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
    <extension url="libraryName">
      <valueString value="ANCContactDataElements"/>
    </extension>
    <extension url="name">
      <valueString value="Oximetry"/>
    </extension>
    <extension url="statement">
      <valueString
                   value="/*
  @dataElement: ANC.B8.DE49 Oximetry
  @activity: ANC.B8 Physical exam
  @description: The measure of the oxygen saturation (%) in the woman's blood: this is usually measured using a pulse oximeter medical device
*/
define &quot;Oximetry&quot;:
  WC.Only(
  [Observation: Cx.&quot;Respiratory exam result - Oximetry&quot;] O
    where O.status in { 'final', 'amended', 'corrected' }
      and Coalesce(WC.ModifierExtension(O, 'who-notDone').value, false) is false
      and Last(Split(O.encounter.reference, '/')) = Last(Split(encounter, '/'))
  ).value as FHIR.Quantity"/>
    </extension>
    <extension url="displaySequence">
      <valueInteger value="14"/>
    </extension>
  </extension>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
    <extension url="libraryName">
      <valueString value="ANCDT06"/>
    </extension>
    <extension url="name">
      <valueString value="Should Refer urgently to a hospital 2"/>
    </extension>
    <extension url="statement">
      <valueString
                   value="/*
&quot;Oximetry&quot; &lt; 92%
*/
define &quot;Should Refer urgently to a hospital 2&quot;:
  ContactData.&quot;Oximetry&quot; &lt; 92 '%'"/>
    </extension>
    <extension url="displaySequence">
      <valueInteger value="15"/>
    </extension>
  </extension>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
    <extension url="libraryName">
      <valueString value="ANCContactDataElements"/>
    </extension>
    <extension url="name">
      <valueString value="Breast exam result"/>
    </extension>
    <extension url="statement">
      <valueString
                   value="/*
  @dataElement: ANC.B8.DE61 Breast exam result
  @activity: ANC.B8 Physical exam
  @description: Whether or not the result of the breast exam is normal
*/
define &quot;Breast exam result&quot;:
  WC.Only(
  [Observation: Cx.&quot;Breast exam result&quot;] O
    where O.status in { 'final', 'amended', 'corrected' }
      and Coalesce(WC.ModifierExtension(O, 'who-notDone').value, false) is false
      and Last(Split(O.encounter.reference, '/')) = Last(Split(encounter, '/'))
  ).value as FHIR.CodeableConcept"/>
    </extension>
    <extension url="displaySequence">
      <valueInteger value="16"/>
    </extension>
  </extension>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
    <extension url="libraryName">
      <valueString value="ANCDT06"/>
    </extension>
    <extension url="name">
      <valueString
                   value="Should Conduct further investigation and, if necessary, refer urgently to a hospital"/>
    </extension>
    <extension url="statement">
      <valueString
                   value="/*
((((((&quot;Breast exam result&quot; = &quot;Nodule&quot;)
  OR (&quot;Breast exam result&quot; = &quot;Discharge&quot;))
  OR (&quot;Breast exam result&quot; = &quot;Flushing&quot;))
  OR (&quot;Breast exam result&quot; = &quot;Local pain&quot;))
  OR (&quot;Breast exam result&quot; = &quot;Bleeding&quot;))
  OR (&quot;Breast exam result&quot; = &quot;Increased temperature&quot;))
  OR (&quot;Breast exam result&quot; = &quot;Other breast exam result (specify)&quot;)
*/
define &quot;Should Conduct further investigation and, if necessary, refer urgently to a hospital&quot;:
  ContactData.&quot;Breast exam result&quot; in Cx.&quot;Breast exam result - Nodule Choices&quot;
    or ContactData.&quot;Breast exam result&quot; in Cx.&quot;Breast exam result - Discharge Choices&quot;
    or ContactData.&quot;Breast exam result&quot; in Cx.&quot;Breast exam result - Flushing Choices&quot;
    or ContactData.&quot;Breast exam result&quot; in Cx.&quot;Breast exam result - Local pain Choices&quot;
    or ContactData.&quot;Breast exam result&quot; in Cx.&quot;Breast exam result - Bleeding Choices&quot;
    or ContactData.&quot;Breast exam result&quot; in Cx.&quot;Breast exam result - Increased temperature Choices&quot;
    or ContactData.&quot;Breast exam result&quot; in Cx.&quot;Breast exam result - Other breast exam result (specify) Choices&quot;"/>
    </extension>
    <extension url="displaySequence">
      <valueInteger value="17"/>
    </extension>
  </extension>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
    <extension url="libraryName">
      <valueString value="ANCContactDataElements"/>
    </extension>
    <extension url="name">
      <valueString value="Second fetal heart rate"/>
    </extension>
    <extension url="statement">
      <valueString
                   value="/*
  @dataElement: ANC.B8.DE108 Second fetal heart rate
  @activity: ANC.B8 Physical exam
  @description: The second fetal heart rate reading in beats per minute (bpm)
*/
define &quot;Second fetal heart rate&quot;:
  WC.MostRecent(
  [Observation: Cx.&quot;Second fetal heart rate&quot;] O
    where O.status in { 'final', 'amended', 'corrected' }
      and Coalesce(WC.ModifierExtension(O, 'who-notDone').value, false) is false
      and Last(Split(O.encounter.reference, '/')) = Last(Split(encounter, '/'))
  ).value as FHIR.Quantity"/>
    </extension>
    <extension url="displaySequence">
      <valueInteger value="18"/>
    </extension>
  </extension>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
    <extension url="libraryName">
      <valueString value="ANCDT06"/>
    </extension>
    <extension url="name">
      <valueString value="Should Refer to a hospital 4"/>
    </extension>
    <extension url="statement">
      <valueString
                   value="/*
(100 bpm &gt; &quot;Second fetal heart rate&quot; &gt; 180 bpm)
  AND (&quot;Gestational age&quot; ≥ 20 weeks)
*/
define &quot;Should Refer to a hospital 4&quot;:
  (ContactData.&quot;Second fetal heart rate&quot; &lt; 100
    or ContactData.&quot;Second fetal heart rate&quot; &gt; 180)
    and ContactData.&quot;Gestational age&quot; &gt;= 20 'weeks'"/>
    </extension>
    <extension url="displaySequence">
      <valueInteger value="19"/>
    </extension>
  </extension>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
    <extension url="libraryName">
      <valueString value="ANCContactDataElements"/>
    </extension>
    <extension url="name">
      <valueString value="Fetal heartbeat present"/>
    </extension>
    <extension url="statement">
      <valueString
                   value="/*
  @dataElement: ANC.B8.DE106 Fetal heartbeat present
  @activity: ANC.B8 Physical exam
  @description: Whether or not the health worker observes a fetal heartbeat
*/
define &quot;Fetal heartbeat present&quot;:
  WC.Only(
  [Observation: Cx.&quot;Fetal heartbeat present&quot;] O
    where O.status in { 'final', 'amended', 'corrected' }
      and Coalesce(WC.ModifierExtension(O, 'who-notDone').value, false) is false
      and Last(Split(O.encounter.reference, '/')) = Last(Split(encounter, '/'))
  ).value as FHIR.boolean"/>
    </extension>
    <extension url="displaySequence">
      <valueInteger value="20"/>
    </extension>
  </extension>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
    <extension url="libraryName">
      <valueString value="ANCDT06"/>
    </extension>
    <extension url="name">
      <valueString value="Should Refer to a hospital 3"/>
    </extension>
    <extension url="statement">
      <valueString
                   value="/*
(&quot;Fetal heartbeat present&quot; = FALSE)
  AND (&quot;Gestational age&quot; ≥ 20 weeks)
*/
define &quot;Should Refer to a hospital 3&quot;:
  ContactData.&quot;Fetal heartbeat present&quot; is false
    and ContactData.&quot;Gestational age&quot; &gt;= 20 'weeks'"/>
    </extension>
    <extension url="displaySequence">
      <valueInteger value="21"/>
    </extension>
  </extension>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
    <extension url="libraryName">
      <valueString value="FHIRHelpers"/>
    </extension>
    <extension url="name">
      <valueString value="ToConcept"/>
    </extension>
    <extension url="statement">
      <valueString
                   value="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
        }"/>
    </extension>
    <extension url="displaySequence">
      <valueInteger value="22"/>
    </extension>
  </extension>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
    <extension url="libraryName">
      <valueString value="FHIRHelpers"/>
    </extension>
    <extension url="name">
      <valueString value="ToCode"/>
    </extension>
    <extension url="statement">
      <valueString
                   value="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
        }"/>
    </extension>
    <extension url="displaySequence">
      <valueInteger value="23"/>
    </extension>
  </extension>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
    <extension url="libraryName">
      <valueString value="WHOCommon"/>
    </extension>
    <extension url="name">
      <valueString value="Only"/>
    </extension>
    <extension url="statement">
      <valueString
                   value="define function Only(observations List&lt;Observation&gt;):
  singleton from observations"/>
    </extension>
    <extension url="displaySequence">
      <valueInteger value="24"/>
    </extension>
  </extension>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
    <extension url="libraryName">
      <valueString value="FHIRHelpers"/>
    </extension>
    <extension url="name">
      <valueString value="ToString"/>
    </extension>
    <extension url="statement">
      <valueString
                   value="define function ToString(value ObservationStatus): value.value"/>
    </extension>
    <extension url="displaySequence">
      <valueInteger value="25"/>
    </extension>
  </extension>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
    <extension url="libraryName">
      <valueString value="FHIRHelpers"/>
    </extension>
    <extension url="name">
      <valueString value="ToBoolean"/>
    </extension>
    <extension url="statement">
      <valueString
                   value="define function ToBoolean(value boolean): value.value"/>
    </extension>
    <extension url="displaySequence">
      <valueInteger value="26"/>
    </extension>
  </extension>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
    <extension url="libraryName">
      <valueString value="WHOCommon"/>
    </extension>
    <extension url="name">
      <valueString value="ModifierExtension"/>
    </extension>
    <extension url="statement">
      <valueString
                   value="/*
@description: Returns the single WHO core modifier extension (if present) on the given resource with the specified id.
@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 function ModifierExtension(domainResource DomainResource, id String):
  singleton from ModifierExtensions(domainResource, id)"/>
    </extension>
    <extension url="displaySequence">
      <valueInteger value="27"/>
    </extension>
  </extension>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
    <extension url="libraryName">
      <valueString value="WHOCommon"/>
    </extension>
    <extension url="name">
      <valueString value="ModifierExtensions"/>
    </extension>
    <extension url="statement">
      <valueString
                   value="/*
@description: Returns any WHO core modifier extensions defined on the given resource with the specified id.
@comment: NOTE: Extensions are not the preferred approach, but are used as a way to access
content that is defined by extensions but not yet surfaced in the
CQL model info.
*/
define function ModifierExtensions(domainResource DomainResource, id String):
  domainResource.modifierExtension E
	  where E.url = ('http://fhir.org/guides/who/core/StructureDefinition/' + id)
		return E"/>
    </extension>
    <extension url="displaySequence">
      <valueInteger value="28"/>
    </extension>
  </extension>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
    <extension url="libraryName">
      <valueString value="FHIRHelpers"/>
    </extension>
    <extension url="name">
      <valueString value="ToString"/>
    </extension>
    <extension url="statement">
      <valueString value="define function ToString(value uri): value.value"/>
    </extension>
    <extension url="displaySequence">
      <valueInteger value="29"/>
    </extension>
  </extension>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
    <extension url="libraryName">
      <valueString value="FHIRHelpers"/>
    </extension>
    <extension url="name">
      <valueString value="ToString"/>
    </extension>
    <extension url="statement">
      <valueString
                   value="define function ToString(value string): value.value"/>
    </extension>
    <extension url="displaySequence">
      <valueInteger value="30"/>
    </extension>
  </extension>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
    <extension url="libraryName">
      <valueString value="FHIRHelpers"/>
    </extension>
    <extension url="name">
      <valueString value="ToQuantity"/>
    </extension>
    <extension url="statement">
      <valueString
                   value="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: ' &amp; quantity.unit.value &amp; ' (' &amp; quantity.system.value &amp; '|' &amp; quantity.code.value &amp; ')')
    end"/>
    </extension>
    <extension url="displaySequence">
      <valueInteger value="31"/>
    </extension>
  </extension>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
    <extension url="libraryName">
      <valueString value="FHIRHelpers"/>
    </extension>
    <extension url="name">
      <valueString value="ToCalendarUnit"/>
    </extension>
    <extension url="statement">
      <valueString
                   value="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"/>
    </extension>
    <extension url="displaySequence">
      <valueInteger value="32"/>
    </extension>
  </extension>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
    <extension url="libraryName">
      <valueString value="WHOCommon"/>
    </extension>
    <extension url="name">
      <valueString value="MostRecent"/>
    </extension>
    <extension url="statement">
      <valueString
                   value="define function MostRecent(observations List&lt;Observation&gt;):
  Last(
    observations O
      sort by issued
  )"/>
    </extension>
    <extension url="displaySequence">
      <valueInteger value="33"/>
    </extension>
  </extension>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
    <extension url="libraryName">
      <valueString value="WHOCommon"/>
    </extension>
    <extension url="name">
      <valueString value="Earliest"/>
    </extension>
    <extension url="statement">
      <valueString
                   value="define function Earliest(observations List&lt;Observation&gt;):
  First(
    observations O
      sort by issued
  )"/>
    </extension>
    <extension url="displaySequence">
      <valueInteger value="34"/>
    </extension>
  </extension>
  <extension
             url="http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-effectiveDataRequirements" id="effective-data-requirements">
    <valueCanonical value="#effective-data-requirements"/>
  </extension>
  <extension
             url="http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-softwaresystem">
    <valueReference>🔗 
      <reference value="Device/cqf-tooling"/>
    </valueReference>
  </extension>
  <url value="http://smart.who.int/anc/PlanDefinition/ANCDT06"/>
  <identifier>
    <use value="official"/>
    <value value="ANC.DT.06"/>
  </identifier>
  <version value="0.3.0"/>
  <name value="ANCDT06"/>
  <title
         value="ANC.DT.06 Physical symptoms and exam results requiring referral"/>
  <type>
    <coding>
      <system
              value="http://terminology.hl7.org/CodeSystem/plan-definition-type"/>
      <code value="eca-rule"/>
    </coding>
  </type>
  <status value="active"/>
  <experimental value="false"/>
  <date value="2025-06-24T13:58:48-06:00"/>
  <publisher value="World Health Organization (WHO)"/>
  <contact>
    <telecom>
      <system value="url"/>
      <value value="https://www.who.int"/>
    </telecom>
  </contact>
  <description
               value="If the woman has any of the following physical exam results, refer to the hospital"/>
  <useContext>
    <code>
      <system
              value="http://terminology.hl7.org/CodeSystem/usage-context-type"/>
      <code value="task"/>
      <display value="Workflow Task"/>
    </code>
    <valueCodeableConcept>
      <coding>
        <system value="http://smart.who.int/anc/CodeSystem/activity-codes"/>
        <code value="ANC.B8."/>
        <display value="Conduct physical exam"/>
      </coding>
    </valueCodeableConcept>
  </useContext>
  <jurisdiction>
    <coding>
      <system value="http://unstats.un.org/unsd/methods/m49/m49.htm"/>
      <code value="001"/>
    </coding>
  </jurisdiction>
  <library value="http://smart.who.int/anc/Library/ANCDT06"/>
  <action>
    <title
           value="ANC.DT.06 Physical symptoms and exam results requiring referral"/>
    <trigger>
      <type value="named-event"/>
      <name value="ANC.B8. Conduct physical exam"/>
    </trigger>
    <action id="1">
      <title
             value="Conduct further investigation and, if necessary, refer urgently if treatment not available at your facility "/>
      <description
                   value="Conduct further investigation and, if necessary, refer urgently if treatment not available at your facility "/>
      <textEquivalent
                      value="Woman has a fever – provide treatment and refer urgently to hospital!
Procedure:
– Insert an IV line
– Give fluids slowly"/>
      <documentation>
        <type value="citation"/>
        <label
               value="Managing complications guide (IMPAC) (2017): Section S-113 (5)"/>
      </documentation>
      <condition>
        <kind value="applicability"/>
        <expression>
          <description
                       value="(&quot;Body temperature&quot; ≥ 38°C)
  AND (&quot;Second body temperature&quot; ≥ 38°C)"/>
          <language value="text/cql-identifier"/>
          <expression
                      value="Should Conduct further investigation and, if necessary, refer urgently if treatment not available at your facility "/>
        </expression>
      </condition>
    </action>
    <action id="2">
      <title value="Refer to a hospital"/>
      <description value="Refer to a hospital"/>
      <textEquivalent
                      value="Abnormal pulse rate – refer for further investigation
Procedure:
– Check for fever, infection, respiratory distress, arrhythmia
– Refer for further investigation"/>
      <documentation>
        <type value="citation"/>
        <label
               value="Managing complications guide (IMPAC) (2017): Section S-1 (5)"/>
      </documentation>
      <condition>
        <kind value="applicability"/>
        <expression>
          <description
                       value="60 bpm &gt; &quot;Second pulse rate&quot; &gt; 100 bpm"/>
          <language value="text/cql-identifier"/>
          <expression value="Should Refer to a hospital"/>
        </expression>
      </condition>
    </action>
    <action id="3">
      <title value="Refer urgently to a hospital"/>
      <description value="Refer urgently to a hospital"/>
      <textEquivalent
                      value="Woman has respiratory distress – refer urgently to the hospital!"/>
      <documentation>
        <type value="citation"/>
        <label
               value="Managing complications in pregnancy and childbirth guide (IMPAC) (2017): Section S-149 (5)"/>
      </documentation>
      <condition>
        <kind value="applicability"/>
        <expression>
          <description
                       value="((((((&quot;Respiratory exam result&quot; = &quot;Dyspnoea&quot;)
  OR (&quot;Respiratory exam result&quot; = &quot;Cough&quot;))
  OR (&quot;Respiratory exam result&quot; = &quot;Rapid breathing&quot;))
  OR (&quot;Respiratory exam result&quot; = &quot;Slow breathing&quot;))
  OR (&quot;Respiratory exam result&quot; = &quot;Wheezing&quot;))
  OR (&quot;Respiratory exam result&quot; = &quot;Rales&quot;))
  OR (&quot;Respiratory exam result&quot; = &quot;Other abnormal respiratory exam result (specify)&quot;)"/>
          <language value="text/cql-identifier"/>
          <expression value="Should Refer urgently to a hospital"/>
        </expression>
      </condition>
    </action>
    <action id="4">
      <title value="Refer urgently to a hospital"/>
      <description value="Refer urgently to a hospital 2"/>
      <textEquivalent
                      value="Woman has low oximetry (&lt;92%) – she should be referred urgently to the hospital"/>
      <documentation>
        <type value="citation"/>
        <label
               value="Managing complications in pregnancy and childbirth guide (IMPAC) (2017): Section S-58 (5)"/>
      </documentation>
      <condition>
        <kind value="applicability"/>
        <expression>
          <description value="&quot;Oximetry&quot; &lt; 92%"/>
          <language value="text/cql-identifier"/>
          <expression value="Should Refer urgently to a hospital 2"/>
        </expression>
      </condition>
    </action>
    <action id="5">
      <title value="Refer urgently to a hospital"/>
      <description value="Refer urgently to a hospital 3"/>
      <textEquivalent
                      value="Woman's cardiac condition is abnormal and she should be referred urgently to the hospital"/>
      <documentation>
        <type value="citation"/>
        <label
               value="Managing complications in pregnancy and childbirth guide (IMPAC) (2017): Section S-150 (5)"/>
      </documentation>
      <condition>
        <kind value="applicability"/>
        <expression>
          <description
                       value="(((((((&quot;Cardiac exam result&quot; = &quot;Heart murmur&quot;)
  OR (&quot;Cardiac exam result&quot; = &quot;Weak pulse&quot;))
  OR (&quot;Cardiac exam result&quot; = &quot;Tachycardia&quot;))
  OR (&quot;Cardiac exam result&quot; = &quot;Bradycardia&quot;))
  OR (&quot;Cardiac exam result&quot; = &quot;Arrhythmia&quot;))
  OR (&quot;Cardiac exam result&quot; = &quot;Cyanosis&quot;))
  OR (&quot;Cardiac exam result&quot; = &quot;Cold sweats&quot;))
  OR (&quot;Cardiac exam result&quot; = &quot;Other abnormal cardiac exam result (specify)&quot;)"/>
          <language value="text/cql-identifier"/>
          <expression value="Should Refer urgently to a hospital 3"/>
        </expression>
      </condition>
    </action>
    <action id="6">
      <title
             value="Conduct further investigation and, if necessary, refer urgently to a hospital"/>
      <description
                   value="Conduct further investigation and, if necessary, refer urgently to a hospital"/>
      <textEquivalent
                      value="Woman's breast exam was abnormal and she should be referred to hospital for further investigation"/>
      <documentation>
        <type value="citation"/>
      </documentation>
      <condition>
        <kind value="applicability"/>
        <expression>
          <description
                       value="((((((&quot;Breast exam result&quot; = &quot;Nodule&quot;)
  OR (&quot;Breast exam result&quot; = &quot;Discharge&quot;))
  OR (&quot;Breast exam result&quot; = &quot;Flushing&quot;))
  OR (&quot;Breast exam result&quot; = &quot;Local pain&quot;))
  OR (&quot;Breast exam result&quot; = &quot;Bleeding&quot;))
  OR (&quot;Breast exam result&quot; = &quot;Increased temperature&quot;))
  OR (&quot;Breast exam result&quot; = &quot;Other breast exam result (specify)&quot;)"/>
          <language value="text/cql-identifier"/>
          <expression
                      value="Should Conduct further investigation and, if necessary, refer urgently to a hospital"/>
        </expression>
      </condition>
    </action>
    <action id="7">
      <title value="Refer to a hospital"/>
      <description value="Refer to a hospital 2"/>
      <textEquivalent
                      value="Woman's abdominal exam was abnormal and she should be referred or further evaluated"/>
      <documentation>
        <type value="citation"/>
        <label
               value="WHO ANC recommendations (2016): B2.2 (2)
Managing complications in pregnancy and childbirth guide (IMPAC) (2017): Section S-139 (5)"/>
      </documentation>
      <condition>
        <kind value="applicability"/>
        <expression>
          <description
                       value="(((((((((((((((((&quot;Abdominal exam result&quot; = &quot;Mass/tumour&quot;)
  OR (&quot;Abdominal exam result&quot; = &quot;Pain on superficial palpation&quot;))
  OR (&quot;Abdominal exam result&quot; = &quot;Pain on deep palpation&quot;))
  OR (&quot;Abdominal exam result&quot; = &quot;Painful decompression&quot;))
  OR (&quot;Abdominal exam result&quot; = &quot;Other abnormal abdominal exam result (specify)&quot;))
  OR (&quot;Pelvic exam result (visual)&quot; = &quot;Abnormal vaginal discharge&quot;))
  OR (&quot;Pelvic exam result (visual)&quot; = &quot;Evidence of amniotic fluid&quot;))
  OR (&quot;Pelvic exam result (visual)&quot; = &quot;Foul-smelling vaginal discharge&quot;))
  OR (&quot;Pelvic exam result (visual)&quot; = &quot;Clusters of erythematous papules&quot;))
  OR (&quot;Pelvic exam result (visual)&quot; = &quot;Vesicles&quot;))
  OR (&quot;Pelvic exam result (visual)&quot; = &quot;Genital ulcer&quot;))
  OR (&quot;Pelvic exam result (visual)&quot; = &quot;Genital pain&quot;))
  OR (&quot;Pelvic exam result (visual)&quot; = &quot;Tender bilateral inguinal and femoral lymphadenopathy&quot;))
  OR (&quot;Pelvic exam result (visual)&quot; = &quot;Cervical friability&quot;))
  OR (&quot;Pelvic exam result (visual)&quot; = &quot;Mucopurulent cervicitis&quot;))
  OR (&quot;Pelvic exam result (visual)&quot; = &quot;Tender unilateral lymphadenopathy&quot;))
  OR (&quot;Pelvic exam result (visual)&quot; = &quot;Curd-like vaginal discharge&quot;))
  OR (&quot;Pelvic exam result (visual)&quot; = &quot;Other abnormal pelvic exam (visual) result (specify)&quot;)"/>
          <language value="text/cql-identifier"/>
          <expression value="Should Refer to a hospital 2"/>
        </expression>
      </condition>
    </action>
    <action id="8">
      <title value="Refer urgently to a hospital"/>
      <description value="Refer urgently to a hospital 4"/>
      <textEquivalent
                      value="Woman should be referred urgently if there is evidence of amniotic fluid, which could indicate the start of labour"/>
      <documentation>
        <type value="citation"/>
        <label
               value="Managing complications in pregnancy and childbirth guide (IMPAC) (2017): Sections S-51, C-91 (5)"/>
      </documentation>
      <condition>
        <kind value="applicability"/>
        <expression>
          <description
                       value="(&quot;Pelvic exam result (visual)&quot; = &quot;Evidence of amniotic fluid&quot;)
  AND (&quot;Gestational age&quot; &lt; 37 weeks)"/>
          <language value="text/cql-identifier"/>
          <expression value="Should Refer urgently to a hospital 4"/>
        </expression>
      </condition>
    </action>
    <action id="9">
      <title value="Refer to a hospital"/>
      <description value="Refer to a hospital 3"/>
      <textEquivalent
                      value="If no fetal heartbeat is observed, inform the woman that there might be a problem and that she needs to be referred to the hospital for further examination and next steps.

Procedure:
– Inform the woman that you cannot find the heartbeat and need to refer her to check if there's a problem
– Refer to hospital"/>
      <documentation>
        <type value="citation"/>
        <label
               value="Pregnancy, childbirth, postpartum and newborn care guide (IMPAC) (2015): C7 (1)"/>
      </documentation>
      <condition>
        <kind value="applicability"/>
        <expression>
          <description
                       value="(&quot;Fetal heartbeat present&quot; = FALSE)
  AND (&quot;Gestational age&quot; ≥ 20 weeks)"/>
          <language value="text/cql-identifier"/>
          <expression value="Should Refer to a hospital 3"/>
        </expression>
      </condition>
    </action>
    <action id="10">
      <title value="Refer to a hospital"/>
      <description value="Refer to a hospital 4"/>
      <textEquivalent
                      value="Fetal heart rate is abnormal after two readings: the woman should be referred to hospital"/>
      <documentation>
        <type value="citation"/>
        <label
               value="Pregnancy, childbirth, postpartum and newborn care guide (IMPAC) (2015): C7 (1)"/>
      </documentation>
      <condition>
        <kind value="applicability"/>
        <expression>
          <description
                       value="(100 bpm &gt; &quot;Second fetal heart rate&quot; &gt; 180 bpm)
  AND (&quot;Gestational age&quot; ≥ 20 weeks)"/>
          <language value="text/cql-identifier"/>
          <expression value="Should Refer to a hospital 4"/>
        </expression>
      </condition>
    </action>
  </action>
</PlanDefinition>