# Diabetes: Glycemic Status Assessment Greater Than 9%FHIR - Draft dQM CMS Content Implementation Guide v2025.1.0

* [**Table of Contents**](toc.md)
* [**Artifacts Summary**](artifacts.md)
* **Diabetes: Glycemic Status Assessment Greater Than 9%FHIR**

## Measure: Diabetes: Glycemic Status Assessment Greater Than 9%FHIR 

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| *Official URL*:https://madie.cms.gov/Measure/CMS122FHIRDiabetesAssessGT9Pct | *Version*:1.1.000 | |
| Active as of 2026-01-16 | *Responsible:*[National Committee for Quality Assurance](https://www.ncqa.org/) | *Computable Name*:CMS122FHIRDiabetesAssessGT9Pct |
| *Other Identifiers:*Short Name: CMS122FHIR (use: usual, ), UUID:f04ee808-8ece-4936-8b26-fafa462e1594 (use: official, ), UUID:2ea22cb2-9bcc-4ca6-b2f2-68fc964365ad (use: official, ), Publisher: 122FHIR (use: official, ) | | |
| **Copyright/Legal**: This Physician Performance Measure (Measure) and related data specifications are owned and were developed by the National Committee for Quality Assurance (NCQA). NCQA is not responsible for any use of the Measure. NCQA makes no representations, warranties or endorsements about the quality of any product, test or protocol identified as numerator compliant or otherwise identified as meeting the requirements of the measure or specification. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures or specifications. NCQA holds a copyright in the Measure. The Measure may be used for internal, noncommercial purposes (e.g., use by healthcare providers in connection with their practices) without obtaining approval from NCQA. All other uses, including a commercial use (including but not limited to vendors using or embedding the measures and specifications into any product or service to calculate measure results for customers for any purpose), must be approved by NCQA and are subject to a license at the discretion of NCQA. (C) 2012-2025 National Committee for Quality Assurance. All Rights Reserved. Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. NCQA disclaims all liability for use or accuracy of any third-party codes contained in the specifications. CPT(R) codes, descriptions and other data are copyright 2025. American Medical Association. All rights reserved. CPT is a trademark of the American Medical Association. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. Applicable FARS/DFARS restrictions apply to government use. Some measure specifications contain coding from LOINC(R) (https://loinc.org). The LOINC table, LOINC codes, LOINC panels and form file, LOINC linguistic variants file, LOINC/RSNA Radiology Playbook, and LOINC/IEEE Medical Device Code Mapping Table are copyright 2004-2025 Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee, and are available at no cost under the license at https://loinc.org/kb/license/. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2024 International Health Terminology Standards Development Organisation. ICD-10 copyright 2025 World Health Organization. All Rights Reserved. Some measures use RxNorm, a standardized nomenclature and coding for clinical drugs and drug delivery devices, which is made publicly available courtesy of the U.S. National Library of Medicine (NLM), National Institutes of Health, Department of Health and Human Services. NLM is not responsible for the measures and does not endorse or recommend this or any other product. “HL7” is the registered trademark of Health Level Seven International. | | |

 
Percentage of patients 18-75 years of age with diabetes who had a glycemic status assessment (hemoglobin A1c [HbA1c] or glucose management indicator [GMI]) > 9.0% during the measurement period 

* Metadata: Title
  * ?: Diabetes: Glycemic Status Assessment Greater Than 9%FHIR
* Metadata: Version
  * ?: 1.1.000
* Metadata: Short Name
  * ?: CMS122FHIR
* Metadata: GUID (Version Independent)
  * ?: urn:uuid:f04ee808-8ece-4936-8b26-fafa462e1594
* Metadata: GUID (Version Specific)
  * ?: urn:uuid:2ea22cb2-9bcc-4ca6-b2f2-68fc964365ad
* Metadata: CMS Identifier
  * ?: 122FHIR
* Metadata: Effective Period
  * ?: 2026-01-01 through 2026-12-31
* Metadata: Steward (Publisher)
  * ?: National Committee for Quality Assurance
* Metadata: Developer
  * ?: National Committee for Quality Assurance
* Metadata: Description
  * ?: Percentage of patients 18-75 years of age with diabetes who had a glycemic status assessment (hemoglobin A1c [HbA1c] or glucose management indicator [GMI]) > 9.0% during the measurement period
* Metadata: Copyright
  * ?: This Physician Performance Measure (Measure) and related data specifications are owned and were developed by the National Committee for Quality Assurance (NCQA). NCQA is not responsible for any use of the Measure. NCQA makes no representations, warranties or endorsements about the quality of any product, test or protocol identified as numerator compliant or otherwise identified as meeting the requirements of the measure or specification. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures or specifications. NCQA holds a copyright in the Measure. The Measure may be used for internal, noncommercial purposes (e.g., use by healthcare providers in connection with their practices) without obtaining approval from NCQA. All other uses, including a commercial use (including but not limited to vendors using or embedding the measures and specifications into any product or service to calculate measure results for customers for any purpose), must be approved by NCQA and are subject to a license at the discretion of NCQA. (C) 2012-2025 National Committee for Quality Assurance. All Rights Reserved. Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. NCQA disclaims all liability for use or accuracy of any third-party codes contained in the specifications. CPT(R) codes, descriptions and other data are copyright 2025. American Medical Association. All rights reserved. CPT is a trademark of the American Medical Association. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. Applicable FARS/DFARS restrictions apply to government use. Some measure specifications contain coding from LOINC(R) (https://loinc.org). The LOINC table, LOINC codes, LOINC panels and form file, LOINC linguistic variants file, LOINC/RSNA Radiology Playbook, and LOINC/IEEE Medical Device Code Mapping Table are copyright 2004-2025 Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee, and are available at no cost under the license at https://loinc.org/kb/license/. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2024 International Health Terminology Standards Development Organisation. ICD-10 copyright 2025 World Health Organization. All Rights Reserved. Some measures use RxNorm, a standardized nomenclature and coding for clinical drugs and drug delivery devices, which is made publicly available courtesy of the U.S. National Library of Medicine (NLM), National Institutes of Health, Department of Health and Human Services. NLM is not responsible for the measures and does not endorse or recommend this or any other product. “HL7” is the registered trademark of Health Level Seven International.
* Metadata: Disclaimer
  * ?: The performance Measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications. THE MEASURE AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND. Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].
* Metadata: Rationale
  * ?: Diabetes is the seventh leading cause of death in the United States (Centers for Disease Control and Prevention [CDC], 2022a). In 2019, diabetes affected more than 37 million Americans (11.3% of the U.S. population) and killed more than 87,000 people (American Diabetes Association [ADA], 2022a). Diabetes is a long-lasting disease marked by high blood glucose levels, resulting from the body's inability to produce or use insulin properly (CDC, 2022a). People with diabetes are at increased risk of serious health complications including vision loss, heart disease, stroke, kidney damage, amputation of feet or legs, and premature death (CDC, 2022b). In 2017, diabetes cost the U.S. an estimated $327 billion: $237 billion in direct medical costs and $90 billion in reduced productivity. This is a 34% increase from the estimated $245 billion spent on diabetes in 2012 (ADA, 2018). Controlling A1c blood levels helps reduce the risk of microvascular complications (eye, kidney and nerve diseases) (ADA, 2022b).
* Metadata: Clinical Recommendation Statement
  * ?: American Diabetes Association (2023): - Assess glycemic status (A1C or other glycemic measurement such as time in range or glucose management indicator) at least two times a year in patients who are meeting treatment goals (and who have stable glycemic control). (Level of evidence: E) - An A1C goal for many nonpregnant adults of <7% (53 mmol/mol) without significant hypoglycemia is appropriate. (Level of evidence: A) - On the basis of health care professional judgement and patient preference, achievement of lower A1C levels than the goal of 7% may be acceptable and even beneficial if it can be achieved safely without significant hypoglycemia or other adverse effects of treatment. (Level of evidence: B) - Less stringent A1C goals (such as <8% [64 mmol/mol]) may be appropriate for patients with limited life expectancy or where the harms of treatment are greater than the benefits. Health care professionals should consider deintensification of therapy if appropriate to reduce the risk of hypoglycemia in patients with inappropriate stringent A1C targets. (Level of evidence: B) - Standardized, single-page glucose reports from continuous glucose monitoring (CGM) devices with visual cues, such as the ambulatory glucose profile, should be considered as a standard summary for all CGM devices. Level of evidence: E
* Metadata: Citation
  * ?: American Diabetes Association. (2018). Economic Costs of Diabetes in the U.S. in 2017. Diabetes Care, 41, 917-928. Retrieved from http://care.diabetesjournals.org/content/early/2018/03/20/dci18-0007
* Metadata: Citation
  * ?: American Diabetes Association. (2022a). Statistics About Diabetes. Retrieved from https://diabetes.org/about-us/statistics/about-diabetes
* Metadata: Citation
  * ?: Centers for Disease Control and Prevention. (2022a). What is Diabetes? Retrieved from https://www.cdc.gov/diabetes/basics/diabetes.html
* Metadata: Citation
  * ?: Centers for Disease Control and Prevention. (2022b). Diabetes Report Card 2021. US Dept of Health and Human Services. Retrieved from https://archive.cdc.gov/www_cdc_gov/diabetes/library/reports/reportcard.html
* Metadata: Citation
  * ?: ElSayed, N.A., Aleppo, G., Ardoda, V.R., Bannuru, R.B., Brown, F.M., Bruemmer, D.,…Staton, R.C., American Diabetes Association (ADA). (2022). 6. Glycemic Targets: Standards of Care in Diabetes—2023. Diabetes Care 2023,46(Supplement_1):S97–S110. https://doi.org/10.2337/dc23-S006
* Metadata: Guidance (Usage)
  * ?: If the glycemic status assessment (HbA1c or GMI) is in the medical record, the test can be used to determine numerator compliance. Glycemic status assessment (HbA1c or GMI) must be reported as a percentage (%). If multiple glycemic status assessments were recorded for a single date, use the lowest result. This eCQM is a patient-based measure. This FHIR-based measure has been derived from the QDM-based measure: CMS122v14. Please refer to the HL7 QI-Core Implementation Guide (https://hl7.org/fhir/us/qicore/STU6/) for more information on QI-Core and mapping recommendations from QDM to QI-Core STU 6. (https://hl7.org/fhir/us/qicore/STU6/qdm-to-qicore.html).
* Metadata: Measure Group (Rate) (ID: Group_1)
* Metadata: Basis
  * ?: boolean
* Metadata: Scoring
  * ?: Proportion
* Metadata: Improvement Notation
  * ?: Increased score indicates improvement
* Metadata: Type
  * ?: Intermediate Outcome
* Metadata: Rate Aggregation
  * ?: None
* Metadata: Initial Population
  * ?: **ID**: InitialPopulation_1**Description**:Patients 18-75 years of age by the end of the measurement period, with diabetes with a visit during the measurement period**Criteria**:[Initial Population](#Group_1-InitialPopulation_1)
* Metadata: Denominator
  * ?: **ID**: Denominator_1**Description**:Equals Initial Population**Criteria**:[Denominator](#Group_1-Denominator_1)
* Metadata: Denominator Exclusion
  * ?: **ID**: DenominatorExclusion_1**Description**:Exclude patients who are in hospice care for any part of the measurement period. Exclude patients 66 and older by the end of the measurement period who are living long term in a nursing home any time on or before the end of the measurement period. Exclude patients 66 and older by the end of the measurement period with an indication of frailty for any part of the measurement period who also meet any of the following advanced illness criteria: - Advanced illness diagnosis during the measurement period or the year prior - OR taking dementia medications during the measurement period or the year prior Exclude patients receiving palliative care for any part of the measurement period.**Criteria**:[Denominator Exclusions](#Group_1-DenominatorExclusion_1)
* Metadata: Numerator
  * ?: **ID**: Numerator_1**Description**:Patients whose most recent glycemic status assessment (HbA1c or GMI) (performed during the measurement period) is &gt;9.0% or is missing, or was not performed during the measurement period**Criteria**:[Numerator](#Group_1-Numerator_1)
* Metadata: Supplemental Data Guidance Guidance
  * ?: For every patient evaluated by this measure also identify payer, race, ethnicity and sex
* Metadata: Supplemental Data Elements
* Metadata: Supplemental Data Element
  * ?: **ID**: sde-ethnicity**Usage Code**:Supplemental Data**Description**: SDE Ethnicity**Logic Definition**:[SDE Ethnicity](#cms122fhirdiabetesassessgt9pct-sde-ethnicity)
* Metadata: Supplemental Data Element
  * ?: **ID**: sde-payer**Usage Code**:Supplemental Data**Description**: SDE Payer**Logic Definition**:[SDE Payer](#cms122fhirdiabetesassessgt9pct-sde-payer)
* Metadata: Supplemental Data Element
  * ?: **ID**: sde-race**Usage Code**:Supplemental Data**Description**: SDE Race**Logic Definition**:[SDE Race](#cms122fhirdiabetesassessgt9pct-sde-race)
* Metadata: Supplemental Data Element
  * ?: **ID**: sde-sex**Usage Code**:Supplemental Data**Description**: SDE Sex**Logic Definition**:[SDE Sex](#cms122fhirdiabetesassessgt9pct-sde-sex)
* Metadata: Measure Logic
* Metadata: Primary Library
  * ?: [CMS122FHIRDiabetesAssessGT9Pct](Library-CMS122FHIRDiabetesAssessGT9Pct.md)
* Metadata: Contents
  * ?: **[Population Criteria](#population-criteria)****[Logic Definitions](#definitions)****[Terminology](#terminology)****[Dependencies](#dependencies)****[Data Requirements](#data-requirements)****[Parameters](#parameters)**
* Metadata:  Population Criteria
* Metadata: Measure Group (Rate) (ID: Group_1)
* Metadata: Initial Population
* Metadata:  ````define "Initial Population": AgeInYearsAt(date from end of "Measurement Period" ) in Interval[18, 75] and exists "Qualifying Encounters" and exists ( ( ( [ConditionEncounterDiagnosis: "Diabetes"] ).verified ( ) ) DiabetesDiagnosis where DiabetesDiagnosis.prevalenceInterval ( ) overlaps day of "Measurement Period" )````[**Definition**](#cms122fhirdiabetesassessgt9pct-initial-population)
* Metadata: Denominator
* Metadata:  ````define "Denominator": "Initial Population"````[**Definition**](#cms122fhirdiabetesassessgt9pct-denominator)
* Metadata: Denominator Exclusion
* Metadata:  ````define "Denominator Exclusions": Hospice."Has Hospice Services" or AIFrailLTCF."Is Age 66 or Older Living Long Term in a Nursing Home" or AIFrailLTCF."Is Age 66 or Older with Advanced Illness and Frailty" or PalliativeCare."Has Palliative Care in the Measurement Period"````[**Definition**](#cms122fhirdiabetesassessgt9pct-denominator-exclusions)
* Metadata: Numerator
* Metadata:  ````define "Numerator": "Has Most Recent Glycemic Status Assessment Without Result" or "Has Most Recent Elevated Glycemic Status Assessment" or "Has No Record Of Glycemic Status Assessment"````[**Definition**](#cms122fhirdiabetesassessgt9pct-numerator)
* Metadata:  Logic Definitions
* Metadata: Logic Definition
  * ?: **Library Name:**Hospice
* Metadata:  ````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" )````
* Metadata: Logic Definition
  * ?: **Library Name:**AdvancedIllnessandFrailty
* Metadata:  ````define "Is Age 66 or Older Living Long Term in a Nursing Home": AgeInYearsAt(date from end of "Measurement Period") >= 66 and ( ( Last( (([ObservationScreeningAssessment: "Housing status"]).isAssessmentPerformed()) HousingStatus where HousingStatus.effective.toInterval() ends on or before day of end of "Measurement Period" sort by end of effective.toInterval() asc )) LastHousingStatus where LastHousingStatus.value ~ "Lives in nursing home (finding)" ) is not null````
* Metadata: Logic Definition
  * ?: **Library Name:**AdvancedIllnessandFrailty
* Metadata:  ````define "Has Criteria Indicating Frailty": exists ( (([USQualityCore.DeviceRequest: "Frailty Device"]).isDeviceOrderPersonalUseDevices()) FrailtyDeviceOrder where FrailtyDeviceOrder.authoredOn.toInterval() during day of "Measurement Period" ) or exists ( (([ObservationScreeningAssessment: "Medical equipment used"]).isAssessmentPerformed()) EquipmentUsed where EquipmentUsed.value as CodeableConcept in "Frailty Device" and EquipmentUsed.effective.toInterval() ends during day of "Measurement Period" ) // TODO: Consider whether to keep this as the union of problems and encounter diagnoses or exists ( (([FHIR.Condition: "Frailty Diagnosis"]).verified()) FrailtyDiagnosis where FrailtyDiagnosis.prevalenceInterval() overlaps day of "Measurement Period" ) or exists ( (([USQualityCore.Encounter: "Frailty Encounter"]).isEncounterPerformed()) FrailtyEncounter where FrailtyEncounter.period overlaps day of "Measurement Period" ) or exists ( (([USQualityCore.SimpleObservation: "Frailty Symptom"]).isSymptom()) FrailtySymptom where FrailtySymptom.effective.toInterval() overlaps day of "Measurement Period" )````
* Metadata: Logic Definition
  * ?: **Library Name:**AdvancedIllnessandFrailty
* Metadata:  ````define "Has Advanced Illness in Year Before or During Measurement Period": // TODO: Consider whether to keep this as the union of problems and encounter diagnoses exists ((([Condition: "Advanced Illness"]).verified()) AdvancedIllnessDiagnosis where AdvancedIllnessDiagnosis.prevalenceInterval() starts during day of Interval[start of "Measurement Period" - 1 year, end of "Measurement Period"])````
* Metadata: Logic Definition
  * ?: **Library Name:**AdvancedIllnessandFrailty
* Metadata:  ````define "Has Dementia Medications in Year Before or During Measurement Period": exists (( ([FHIR.MedicationRequest: "Dementia Medications"]).isMedicationActive()) DementiaMedication where DementiaMedication.medicationRequestPeriod() overlaps day of Interval[start of "Measurement Period" - 1 year, end of "Measurement Period"] )````
* Metadata: Logic Definition
  * ?: **Library Name:**AdvancedIllnessandFrailty
* Metadata:  ````define "Is Age 66 or Older with Advanced Illness and Frailty": AgeInYearsAt(date from end of "Measurement Period") >= 66 and "Has Criteria Indicating Frailty" and ( "Has Advanced Illness in Year Before or During Measurement Period" or "Has Dementia Medications in Year Before or During Measurement Period" )````
* Metadata: Logic Definition
  * ?: **Library Name:**PalliativeCare
* Metadata:  ````define "Has Palliative Care in the Measurement Period": // TODO: Shouldn't need to specify a code path here (see https://jira.hl7.org/browse/FHIR-53941) exists ((([USQualityCore.ObservationScreeningAssessment: code ~ "Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)"]).isAssessmentPerformed()) PalliativeAssessment where PalliativeAssessment.effective.toInterval() overlaps day of "Measurement Period" ) // TODO: Consider whether to keep this as the union of the problems and encounter diagnosis list? Anything enforced by the profiles that is expected but isn't stated here? or exists ((([FHIR.Condition: "Palliative Care Diagnosis"]).verified()) PalliativeDiagnosis where PalliativeDiagnosis.prevalenceInterval() overlaps day of "Measurement Period" ) or exists ((([USQualityCore.Encounter: "Palliative Care Encounter"]).isEncounterPerformed()) PalliativeEncounter where PalliativeEncounter.period overlaps day of "Measurement Period" ) or exists ((([USQualityCore.Procedure: "Palliative Care Intervention"]).isInterventionPerformed()) PalliativeIntervention where PalliativeIntervention.performed.toInterval() overlaps day of "Measurement Period" )````
* Metadata: Logic Definition
  * ?: **Library Name:**SupplementalDataElements
* Metadata:  ````define "SDE Sex": case when Patient.sex() = '248153007' then "Male (finding)" when Patient.sex() = '248152002' then "Female (finding)" else null end````
* Metadata: Logic Definition
  * ?: **Library Name:**SupplementalDataElements
* Metadata:  ````define "SDE Payer": [USQualityCore.Coverage: type in "Payer Type"] Payer return { code: Payer.type, period: Payer.period }````
* Metadata: Logic Definition
  * ?: **Library Name:**SupplementalDataElements
* Metadata:  ````define "SDE Ethnicity": (Patient.ethnicity()) E return Tuple { codes: { E.ombCategory } union E.detailed, display: E.text }````
* Metadata: Logic Definition
  * ?: **Library Name:**SupplementalDataElements
* Metadata:  ````define "SDE Race": (Patient.race()) R return Tuple { codes: R.ombCategory union R.detailed, display: R.text }````
* Metadata: Logic Definition
  * ?: **Library Name:**CMS122FHIRDiabetesAssessGT9Pct
* Metadata:  ````define "SDE Sex": SDE."SDE Sex"````
* Metadata: Logic Definition
  * ?: **Library Name:**CMS122FHIRDiabetesAssessGT9Pct
* Metadata:  ````define "Glycemic Status Assessment": ( ( [LaboratoryResultObservation: "HbA1c Laboratory Test"] union [LaboratoryResultObservation: "Glucose management indicator"] ).isLaboratoryTestPerformed ( ) ) GlycemicStatus where GlycemicStatus.effective.latest ( ) during day of "Measurement Period"````
* Metadata: Logic Definition
  * ?: **Library Name:**CMS122FHIRDiabetesAssessGT9Pct
* Metadata:  ````define "Most Recent Glycemic Status Date": Last(("Glycemic Status Assessment" QualifyingGlycemicStatus return date from QualifyingGlycemicStatus.effective.latest()) QualifyingGlycemicStatus sort asc )````
* Metadata: Logic Definition
  * ?: **Library Name:**CMS122FHIRDiabetesAssessGT9Pct
* Metadata:  ````define "Lowest Glycemic Status Assessment Reading on Most Recent Day": First("Glycemic Status Assessment" QualifyingGlycemicStatus where QualifyingGlycemicStatus.effective.latest() same day as "Most Recent Glycemic Status Date" return { QualifyingGlycemicStatusValue: QualifyingGlycemicStatus.value as Quantity, QualifyingGlycemicStatus: QualifyingGlycemicStatus } sort by QualifyingGlycemicStatusValue ).QualifyingGlycemicStatus````
* Metadata: Logic Definition
  * ?: **Library Name:**CMS122FHIRDiabetesAssessGT9Pct
* Metadata:  ````define "Has Most Recent Glycemic Status Assessment Without Result": "Lowest Glycemic Status Assessment Reading on Most Recent Day" is not null and "Lowest Glycemic Status Assessment Reading on Most Recent Day".value is null````
* Metadata: Logic Definition
  * ?: **Library Name:**CMS122FHIRDiabetesAssessGT9Pct
* Metadata:  ````define "Has Most Recent Elevated Glycemic Status Assessment": "Lowest Glycemic Status Assessment Reading on Most Recent Day".value > 9 '%'````
* Metadata: Logic Definition
  * ?: **Library Name:**CMS122FHIRDiabetesAssessGT9Pct
* Metadata:  ````define "Has No Record Of Glycemic Status Assessment": not exists "Glycemic Status Assessment"````
* Metadata: Logic Definition
  * ?: **Library Name:**CMS122FHIRDiabetesAssessGT9Pct
* Metadata:  ````define "Numerator": "Has Most Recent Glycemic Status Assessment Without Result" or "Has Most Recent Elevated Glycemic Status Assessment" or "Has No Record Of Glycemic Status Assessment"````
* Metadata: Logic Definition
  * ?: **Library Name:**CMS122FHIRDiabetesAssessGT9Pct
* Metadata:  ````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: "Nutrition Services"] union ( [Encounter] E where exists ( ( E.type ) T where T ~ "Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes" ) ) union ( [Encounter] E where exists ( ( E.type ) T where T ~ "Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes" ) ) union ( [Encounter] E where exists ( ( E.type ) T where T ~ "Medical nutrition therapy; group (2 or more individual(s)), each 30 minutes" ) ) union ( [Encounter] E where exists ( ( E.type ) T where T ~ "Medical nutrition therapy; reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition or treatment regimen (including additional hours needed for renal disease), individual, face to face with the patient, each 15 minutes" ) ) union ( [Encounter] E where exists ( ( E.type ) T where T ~ "Medical nutrition therapy, reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition, or treatment regimen (including additional hours needed for renal disease), group (2 or more individuals), each 30 minutes" ) ) union [Encounter: "Telephone Visits"] ).isEncounterPerformed ( ) ) ValidEncounters where ValidEncounters.period during day of "Measurement Period"````
* Metadata: Logic Definition
  * ?: **Library Name:**CMS122FHIRDiabetesAssessGT9Pct
* Metadata:  ````define "Initial Population": AgeInYearsAt(date from end of "Measurement Period" ) in Interval[18, 75] and exists "Qualifying Encounters" and exists ( ( ( [ConditionEncounterDiagnosis: "Diabetes"] ).verified ( ) ) DiabetesDiagnosis where DiabetesDiagnosis.prevalenceInterval ( ) overlaps day of "Measurement Period" )````
* Metadata: Logic Definition
  * ?: **Library Name:**CMS122FHIRDiabetesAssessGT9Pct
* Metadata:  ````define "Denominator": "Initial Population"````
* Metadata: Logic Definition
  * ?: **Library Name:**CMS122FHIRDiabetesAssessGT9Pct
* Metadata:  ````define "SDE Payer": SDE."SDE Payer"````
* Metadata: Logic Definition
  * ?: **Library Name:**CMS122FHIRDiabetesAssessGT9Pct
* Metadata:  ````define "SDE Ethnicity": SDE."SDE Ethnicity"````
* Metadata: Logic Definition
  * ?: **Library Name:**CMS122FHIRDiabetesAssessGT9Pct
* Metadata:  ````define "Denominator Exclusions": Hospice."Has Hospice Services" or AIFrailLTCF."Is Age 66 or Older Living Long Term in a Nursing Home" or AIFrailLTCF."Is Age 66 or Older with Advanced Illness and Frailty" or PalliativeCare."Has Palliative Care in the Measurement Period"````
* Metadata: Logic Definition
  * ?: **Library Name:**CMS122FHIRDiabetesAssessGT9Pct
* Metadata:  ````define "SDE Race": SDE."SDE Race"````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRCommon
* Metadata:  ````/* @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)````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRCommon
* Metadata:  ````/* @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````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRCommon
* Metadata:  ````/* @description: Given an interval, returns the ending point if the interval has an ending boundary specified, otherwise, returns the starting point */ define fluent function latest(choice Choice<FHIR.dateTime, FHIR.Period, FHIR.Age, FHIR.Range>): (choice.toInterval()) period return if (period.hasEnd()) then end of period else start of period````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRCommon
* Metadata:  ````/* @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````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRCommon
* Metadata:  ````/* @description: Given an interval, returns true if the interval has an ending boundary specified (i.e. the end of the interval is not null and not the maximum DateTime value) */ define fluent function hasEnd(period Interval<DateTime>): not ( end of period is null or end of period = maximum DateTime )````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRCommon
* Metadata:  ````/* @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" )````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRCommon
* Metadata:  ````/* @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]````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRCommon
* Metadata:  ````/* @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````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRCommon
* Metadata:  ````/* @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)````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRCommon
* Metadata:  ````/* @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````
* Metadata: Logic Definition
  * ?: **Library Name:**Status
* Metadata:  ````//Laboratory Test, Performed define fluent function isLaboratoryTestPerformed(Obs List<LaboratoryResultObservation>): Obs O where O.status in { 'final', 'amended', 'corrected' }````
* Metadata: Logic Definition
  * ?: **Library Name:**Status
* Metadata:  ````//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'````
* Metadata: Logic Definition
  * ?: **Library Name:**Status
* Metadata:  ````//Assessment, Performed define fluent function isAssessmentPerformed(Obs List<ObservationScreeningAssessment>): Obs O where O.status in { 'final', 'amended', 'corrected' }````
* Metadata: Logic Definition
  * ?: **Library Name:**Status
* Metadata:  ````//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'}````
* Metadata: Logic Definition
  * ?: **Library Name:**Status
* Metadata:  ````//Intervention, Performed define fluent function isInterventionPerformed(Proc List<FHIR.Procedure>): Proc P where P.status ~ 'completed'````
* Metadata: Logic Definition
  * ?: **Library Name:**Status
* Metadata:  ````//Device, Order - Personal Use Devices define fluent function isDeviceOrderPersonalUseDevices(DeviceRequest List<FHIR.DeviceRequest>): DeviceRequest D where D.status in { 'active', 'completed' } and D.intent in {'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order'}````
* Metadata: Logic Definition
  * ?: **Library Name:**Status
* Metadata:  ````//Symptom define fluent function isSymptom(Obs List<SimpleObservation>): Obs O where O.status in { 'preliminary', 'final', 'amended', 'corrected' }````
* Metadata: Logic Definition
  * ?: **Library Name:**Status
* Metadata:  ````//Medication, Active define fluent function isMedicationActive(MedicationRequest List<FHIR.MedicationRequest>): MedicationRequest M where M.status = 'active' and M.intent in {'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order'}````
* Metadata: Logic Definition
  * ?: **Library Name:**CumulativeMedicationDuration
* Metadata:  ````/* Calculates the Medication Period for a single MedicationRequest. MedicationRequest instances provided to this function are expected to conform to the [MMEMedicationRequest](http://build.fhir.org/ig/cqframework/opioid-mme-r4/StructureDefinition-mmemedicationrequest.html) profile, which expects: * 1 and only 1 dosageInstruction, multiple dosageInstruction elements will result in an error * 1 and only 1 doseAndRate, multiple doseAndRate elements will result in an error * 1 timing with 1 repeat, missing timing or repeat elements will result in a null * frequency, frequencyMax, defaulting to 1 * period, periodUnit, defaulting to 1 'd' * timeOfDay * doseQuantity or doseRange, missing doseQuantity and doseRange will result in a null Note that MedicationRequest status is not considered by this calculation, as the list of MedicationRequest instances provided to this function should already have considered appropriate statuses, depending on the use case, typically `completed`. NOTE: Updated return to use "date from end of boundsPeriod" to ensure result is Interval<Date> */ define fluent function medicationRequestPeriod(Request MedicationRequest): Request R let dosage: singleton from R.dosageInstruction, doseAndRate: singleton from dosage.doseAndRate, timing: dosage.timing, frequency: Coalesce(timing.repeat.frequencyMax, timing.repeat.frequency), period: Quantity(timing.repeat.period, timing.repeat.periodUnit), doseRange: doseAndRate.dose as FHIR.Range, doseQuantity: doseAndRate.dose as FHIR.SimpleQuantity, dose: Coalesce(end of doseRange, doseQuantity), dosesPerDay: Coalesce(ToDaily(frequency, period), Count(timing.repeat.timeOfDay), 1.0), boundsPeriod: timing.repeat.bounds as Period, // TODO: this isn't working as expected, convert results in null //daysSupply: (convert(R.dispenseRequest.expectedSupplyDuration) to days).value, daysSupply: (R.dispenseRequest.expectedSupplyDuration).value, quantity: R.dispenseRequest.quantity, refills: Coalesce(R.dispenseRequest.numberOfRepeatsAllowed, 0), startDate: Coalesce( date from start of boundsPeriod, date from R.authoredOn, date from start of R.dispenseRequest.validityPeriod ), totalDaysSupplied: Coalesce(daysSupply, quantity.value / (dose.value * dosesPerDay)) * (1 + refills) return if startDate is not null and totalDaysSupplied is not null then Interval[startDate, startDate + Quantity(totalDaysSupplied - 1, 'day') ] else if startDate is not null and boundsPeriod."end" is not null then Interval[startDate, date from end of boundsPeriod] else null````
* Metadata: Logic Definition
  * ?: **Library Name:**CumulativeMedicationDuration
* Metadata:  ````/**********************************************************************/ /* Functions in this region are copied from opioid-mme-r4 */ /**********************************************************************/ define function Quantity(value Decimal, unit String): if value is not null then System.Quantity { value: value, unit: unit } else null````
* Metadata: Logic Definition
  * ?: **Library Name:**CumulativeMedicationDuration
* Metadata:  ````/* Goal is to get to number of days Two broad approaches to the calculation: 1) Based on supply and frequency, calculate the number of expected days the medication will cover/has covered 2) Based on relevant period, determine a covered interval and calculate the length of that interval in days This topic covers several use cases and illustrates how to calculate Cumulative Medication Duration for each type of medication resource using the supply and frequency approach. */ /* For the first approach, we need to get from frequency to a frequency/day So we define ToDaily */ /* Calculates daily frequency given frequency within a period */ define function ToDaily(frequency System.Integer, period System.Quantity): case period.unit when 'h' then frequency * (24.0 / period.value) when 'min' then frequency * (24.0 / period.value) * 60 when 's' then frequency * (24.0 / period.value) * 60 * 60 when 'd' then frequency * (24.0 / period.value) / 24 when 'wk' then frequency * (24.0 / period.value) / (24 * 7) when 'mo' then frequency * (24.0 / period.value) / (24 * 30) /* assuming 30 days in month */ when 'a' then frequency * (24.0 / period.value) / (24 * 365) /* assuming 365 days in year */ when 'hour' then frequency * (24.0 / period.value) when 'minute' then frequency * (24.0 / period.value) * 60 when 'second' then frequency * (24.0 / period.value) * 60 * 60 when 'day' then frequency * (24.0 / period.value) / 24 when 'week' then frequency * (24.0 / period.value) / (24 * 7) when 'month' then frequency * (24.0 / period.value) / (24 * 30) /* assuming 30 days in month */ when 'year' then frequency * (24.0 / period.value) / (24 * 365) /* assuming 365 days in year */ when 'hours' then frequency * (24.0 / period.value) when 'minutes' then frequency * (24.0 / period.value) * 60 when 'seconds' then frequency * (24.0 / period.value) * 60 * 60 when 'days' then frequency * (24.0 / period.value) / 24 when 'weeks' then frequency * (24.0 / period.value) / (24 * 7) when 'months' then frequency * (24.0 / period.value) / (24 * 30) /* assuming 30 days in month */ when 'years' then frequency * (24.0 / period.value) / (24 * 365) /* assuming 365 days in year */ else Message(null, true, 'CMDLogic.ToDaily.UnknownUnit', ErrorLevel, 'Unknown unit ' & period.unit) end````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRHelpers
* Metadata:  ````define function ToString(value string): value.value````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRHelpers
* Metadata:  ````define function ToString(value uri): value.value````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRHelpers
* Metadata:  ````define function ToString(value ObservationStatus): value.value````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRHelpers
* Metadata:  ````define function ToDateTime(value dateTime): value.value````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRHelpers
* Metadata:  ````/* @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]````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRHelpers
* Metadata:  ````define function ToDateTime(value instant): value.value````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRHelpers
* Metadata:  ````define function ToDate(value date): value.value````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRHelpers
* Metadata:  ````/* @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````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRHelpers
* Metadata:  ````/* @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````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRHelpers
* Metadata:  ````define function ToString(value EncounterStatus): value.value````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRHelpers
* Metadata:  ````/* @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 }````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRHelpers
* Metadata:  ````/* @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 }````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRHelpers
* Metadata:  ````define function ToString(value ServiceRequestStatus): value.value````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRHelpers
* Metadata:  ````define function ToString(value ServiceRequestIntent): value.value````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRHelpers
* Metadata:  ````define function ToString(value ProcedureStatus): value.value````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRHelpers
* Metadata:  ````define function ToString(value DeviceRequestStatus): value.value````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRHelpers
* Metadata:  ````define function ToString(value RequestIntent): value.value````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRHelpers
* Metadata:  ````define function ToString(value MedicationRequestStatus): value.value````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRHelpers
* Metadata:  ````define function ToString(value MedicationRequestIntent): value.value````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRHelpers
* Metadata:  ````define function ToDecimal(value decimal): value.value````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRHelpers
* Metadata:  ````define function ToString(value UnitsOfTime): value.value````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRHelpers
* Metadata:  ````/* @description: Converts the given FHIR [Range](https://hl7.org/fhir/datatypes.html#Range) value to a CQL Interval of Quantity */ define function ToInterval(range FHIR.Range): if range is null then null else Interval[ToQuantity(range.low), ToQuantity(range.high)]````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRHelpers
* Metadata:  ````define function ToInteger(value integer): value.value````
* Metadata: Logic Definition
  * ?: **Library Name:**USCoreCommon
* Metadata:  ````/* @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````
* Metadata: Logic Definition
  * ?: **Library Name:**USCoreCommon
* Metadata:  ````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 }````
* Metadata: Logic Definition
  * ?: **Library Name:**USCoreCommon
* Metadata:  ````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 }````
* Metadata:  Terminology
* Metadata: Code System
  * ?: **Description**: Code system SNOMEDCT**Resource**:[SNOMED CT (all versions)](http://hl7.org/fhir/R4/codesystem-snomedct.html)**Canonical URL**:http://snomed.info/sct
* Metadata: Code System
  * ?: **Description**: Code system LOINC**Resource**:[Logical Observation Identifiers, Names and Codes (LOINC)](http://terminology.hl7.org/6.5.0/CodeSystem-v3-loinc.html)**Canonical URL**:http://loinc.org
* Metadata: Code System
  * ?: **Description**: Code system CPT**Resource**:[Current Procedural Terminology (CPT®)](http://terminology.hl7.org/6.5.0/CodeSystem-CPT.html)**Canonical URL**:http://www.ama-assn.org/go/cpt
* Metadata: Code System
  * ?: **Description**: Code system HCPCS**Resource**:[Healthcare Common Procedure Coding System (HCPCS) level II alphanumeric codes](http://terminology.hl7.org/6.5.0/CodeSystem-hcpcs-Level-II.html)**Canonical URL**:http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets
* Metadata: Code System
  * ?: **Description**: Code system ConditionVerificationStatusCodes**Resource**:[ConditionVerificationStatus](http://terminology.hl7.org/7.1.0/CodeSystem-condition-ver-status.html)**Canonical URL**:http://terminology.hl7.org/CodeSystem/condition-ver-status
* Metadata: Code System
  * ?: **Description**: Code system ConditionClinicalStatusCodes**Resource**:[Condition Clinical Status Codes](http://terminology.hl7.org/7.1.0/CodeSystem-condition-clinical.html)**Canonical URL**:http://terminology.hl7.org/CodeSystem/condition-clinical
* Metadata: Value Set
  * ?: **Description**: Value set HbA1c Laboratory Test**Resource**:[HbA1c Laboratory Test](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.198.12.1013/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1013
* Metadata: Value Set
  * ?: **Description**: Value set Office Visit**Resource**:[Office Visit](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1001/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001
* Metadata: Value Set
  * ?: **Description**: Value set Annual Wellness Visit**Resource**:[Annual Wellness Visit](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1240/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1240
* Metadata: Value Set
  * ?: **Description**: Value set Preventive Care Services Established Office Visit, 18 and Up**Resource**:[Preventive Care Services Established Office Visit, 18 and Up](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1025/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1025
* Metadata: Value Set
  * ?: **Description**: Value set Preventive Care Services Initial Office Visit, 18 and Up**Resource**:[Preventive Care Services Initial Office Visit, 18 and Up](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1023/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1023
* Metadata: Value Set
  * ?: **Description**: Value set Home Healthcare Services**Resource**:[Home Healthcare Services](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1016/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016
* Metadata: Value Set
  * ?: **Description**: Value set Nutrition Services**Resource**:[Nutrition Services](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1006/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1006
* Metadata: Value Set
  * ?: **Description**: Value set Telephone Visits**Resource**:[Telephone Visits](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1080/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1080
* Metadata: Value Set
  * ?: **Description**: Value set Diabetes**Resource**:[Diabetes](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.103.12.1001/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.103.12.1001
* Metadata: Value Set
  * ?: **Description**: Value set Payer Type**Resource**:[Payer Type](https://vsac.nlm.nih.gov/valueset/2.16.840.1.114222.4.11.3591/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591
* Metadata: Value Set
  * ?: **Description**: Value set Encounter Inpatient**Resource**:[Encounter Inpatient](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.666.5.307/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307
* Metadata: Value Set
  * ?: **Description**: Value set Hospice Encounter**Resource**:[Hospice Encounter](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1003/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1003
* Metadata: Value Set
  * ?: **Description**: Value set Hospice Care Ambulatory**Resource**:[Hospice Care Ambulatory](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1584/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1584
* Metadata: Value Set
  * ?: **Description**: Value set Hospice Diagnosis**Resource**:[Hospice Diagnosis](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1165/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1165
* Metadata: Value Set
  * ?: **Description**: Value set Frailty Device**Resource**:[Frailty Device](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.118.12.1300/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.118.12.1300
* Metadata: Value Set
  * ?: **Description**: Value set Frailty Diagnosis**Resource**:[Frailty Diagnosis](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.113.12.1074/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.113.12.1074
* Metadata: Value Set
  * ?: **Description**: Value set Frailty Encounter**Resource**:[Frailty Encounter](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1088/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1088
* Metadata: Value Set
  * ?: **Description**: Value set Frailty Symptom**Resource**:[Frailty Symptom](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.113.12.1075/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.113.12.1075
* Metadata: Value Set
  * ?: **Description**: Value set Advanced Illness**Resource**:[Advanced Illness](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.110.12.1082/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.110.12.1082
* Metadata: Value Set
  * ?: **Description**: Value set Dementia Medications**Resource**:[Dementia Medications](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.196.12.1510/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.196.12.1510
* Metadata: Value Set
  * ?: **Description**: Value set Palliative Care Diagnosis**Resource**:[Palliative Care Diagnosis](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1167/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1167
* Metadata: Value Set
  * ?: **Description**: Value set Palliative Care Encounter**Resource**:[Palliative Care Encounter](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1090/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1090
* Metadata: Value Set
  * ?: **Description**: Value set Palliative Care Intervention**Resource**:[Palliative Care Intervention](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.198.12.1135/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1135
* Metadata: Direct Reference Code
  * ?: **Display**: Male (finding)**Code**: 248153007**System**:http://snomed.info/sct
* Metadata: Direct Reference Code
  * ?: **Display**: Female (finding)**Code**: 248152002**System**:http://snomed.info/sct
* Metadata: Direct Reference Code
  * ?: **Display**: Glucose management indicator**Code**: 97506-0**System**:http://loinc.org
* Metadata: Direct Reference Code
  * ?: **Display**: Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes**Code**: 97802**System**:http://www.ama-assn.org/go/cpt
* Metadata: Direct Reference Code
  * ?: **Display**: Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes**Code**: 97803**System**:http://www.ama-assn.org/go/cpt
* Metadata: Direct Reference Code
  * ?: **Display**: Medical nutrition therapy; group (2 or more individual(s)), each 30 minutes**Code**: 97804**System**:http://www.ama-assn.org/go/cpt
* Metadata: Direct Reference Code
  * ?: **Display**: Medical nutrition therapy; reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition or treatment regimen (including additional hours needed for renal disease), individual, face to face with the patient, each 15 minutes**Code**: G0270**System**:http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets
* Metadata: Direct Reference Code
  * ?: **Display**: Medical nutrition therapy, reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition, or treatment regimen (including additional hours needed for renal disease), group (2 or more individuals), each 30 minutes**Code**: G0271**System**:http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets
* Metadata: Direct Reference Code
  * ?: **Code**: confirmed**System**:http://terminology.hl7.org/CodeSystem/condition-ver-status
* Metadata: Direct Reference Code
  * ?: **Code**: unconfirmed**System**:http://terminology.hl7.org/CodeSystem/condition-ver-status
* Metadata: Direct Reference Code
  * ?: **Code**: provisional**System**:http://terminology.hl7.org/CodeSystem/condition-ver-status
* Metadata: Direct Reference Code
  * ?: **Code**: differential**System**:http://terminology.hl7.org/CodeSystem/condition-ver-status
* Metadata: Direct Reference Code
  * ?: **Code**: active**System**:http://terminology.hl7.org/CodeSystem/condition-clinical
* Metadata: Direct Reference Code
  * ?: **Code**: recurrence**System**:http://terminology.hl7.org/CodeSystem/condition-clinical
* Metadata: Direct Reference Code
  * ?: **Code**: relapse**System**:http://terminology.hl7.org/CodeSystem/condition-clinical
* Metadata: Direct Reference Code
  * ?: **Display**: Discharge to home for hospice care (procedure)**Code**: 428361000124107**System**:http://snomed.info/sct
* Metadata: Direct Reference Code
  * ?: **Display**: Discharge to healthcare facility for hospice care (procedure)**Code**: 428371000124100**System**:http://snomed.info/sct
* Metadata: Direct Reference Code
  * ?: **Display**: Hospice care [Minimum Data Set]**Code**: 45755-6**System**:http://loinc.org
* Metadata: Direct Reference Code
  * ?: **Display**: Yes (qualifier value)**Code**: 373066001**System**:http://snomed.info/sct
* Metadata: Direct Reference Code
  * ?: **Display**: Housing status**Code**: 71802-3**System**:http://loinc.org
* Metadata: Direct Reference Code
  * ?: **Display**: Lives in nursing home (finding)**Code**: 160734000**System**:http://snomed.info/sct
* Metadata: Direct Reference Code
  * ?: **Display**: Medical equipment used**Code**: 98181-1**System**:http://loinc.org
* Metadata: Direct Reference Code
  * ?: **Display**: Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)**Code**: 71007-9**System**:http://loinc.org
* Metadata:  Dependencies
* Metadata: Dependency
  * ?: **Description**: USQualityCore model information**Resource**:`https://madie.cms.gov/Library/USQualityCore-ModelInfo|0.1.0-cibuild`**Canonical URL**:https://madie.cms.gov/Library/USQualityCore-ModelInfo|0.1.0-cibuild
* Metadata: Dependency
  * ?: **Description**: USCore model information**Resource**:[http://hl7.org/fhir/us/cql/Library/USCore-ModelInfo|6.1.0-derived](https://build.fhir.org/ig/HL7/us-cql-ig/Library-USCore-ModelInfo.html)**Canonical URL**:http://hl7.org/fhir/us/cql/Library/USCore-ModelInfo|6.1.0-derived
* Metadata: Dependency
  * ?: **Description**: FHIR model information**Resource**:[http://hl7.org/fhir/uv/cql/Library/FHIR-ModelInfo|4.0.1](http://hl7.org/fhir/uv/cql/STU2/Library-FHIR-ModelInfo.html)**Canonical URL**:http://hl7.org/fhir/uv/cql/Library/FHIR-ModelInfo|4.0.1
* Metadata: Dependency
  * ?: **Description**: Library SDE**Resource**:[SupplementalDataElementsversion: null6.1.000)](Library-SupplementalDataElements.md)**Canonical URL**:https://madie.cms.gov/Library/SupplementalDataElements|6.1.000
* Metadata: Dependency
  * ?: **Description**: Library FHIRHelpers**Resource**:[http://hl7.org/fhir/uv/cql/Library/FHIRHelpers|4.0.1](http://hl7.org/fhir/uv/cql/STU2/Library-FHIRHelpers.html)**Canonical URL**:http://hl7.org/fhir/uv/cql/Library/FHIRHelpers|4.0.1
* Metadata: Dependency
  * ?: **Description**: Library USCommon**Resource**:[http://hl7.org/fhir/us/cql/Library/USCoreCommon|2.0.0-ballot](https://build.fhir.org/ig/HL7/us-cql-ig/Library-USCoreCommon.html)**Canonical URL**:http://hl7.org/fhir/us/cql/Library/USCoreCommon|2.0.0-ballot
* Metadata: Dependency
  * ?: **Description**: Library FHIRCommon**Resource**:[http://hl7.org/fhir/uv/cql/Library/FHIRCommon|2.0.0](http://hl7.org/fhir/uv/cql/STU2/Library-FHIRCommon.html)**Canonical URL**:http://hl7.org/fhir/uv/cql/Library/FHIRCommon|2.0.0
* Metadata: Dependency
  * ?: **Description**: Library Status**Resource**:[Statusversion: null2.1.000)](Library-Status.md)**Canonical URL**:https://madie.cms.gov/Library/Status|2.1.000
* Metadata: Dependency
  * ?: **Description**: Library Hospice**Resource**:[Hospiceversion: null7.1.000)](Library-Hospice.md)**Canonical URL**:https://madie.cms.gov/Library/Hospice|7.1.000
* Metadata: Dependency
  * ?: **Description**: Library AIFrailLTCF**Resource**:[AdvancedIllnessandFrailtyversion: null2.1.000)](Library-AdvancedIllnessandFrailty.md)**Canonical URL**:https://madie.cms.gov/Library/AdvancedIllnessandFrailty|2.1.000
* Metadata: Dependency
  * ?: **Description**: Library CMD**Resource**:[http://hl7.org/fhir/us/cql/Library/CumulativeMedicationDuration|2.0.0-ballot](https://build.fhir.org/ig/HL7/us-cql-ig/Library-CumulativeMedicationDuration.html)**Canonical URL**:http://hl7.org/fhir/us/cql/Library/CumulativeMedicationDuration|2.0.0-ballot
* Metadata: Dependency
  * ?: **Description**: Library PalliativeCare**Resource**:[PalliativeCareversion: null2.1.000)](Library-PalliativeCare.md)**Canonical URL**:https://madie.cms.gov/Library/PalliativeCare|2.1.000
* Metadata:  Data Requirements
* Metadata: Data Requirement
  * ?: **Type**: Patient**Profile(s)**:`http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-patient`**Must Support Elements**: ombCategory, detailed, text
* Metadata: Data Requirement
  * ?: **Type**: Patient**Profile(s)**:[Patient](http://hl7.org/fhir/R4/patient.html)**Must Support Elements**: birthDate
* Metadata: Data Requirement
  * ?: **Type**: Observation**Profile(s)**:`http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-observation-lab`**Must Support Elements**: code, status, effective, value**Code Filter(s)**:**Path**: code**ValueSet**:[HbA1c Laboratory Test](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.198.12.1013/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Observation**Profile(s)**:`http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-observation-lab`**Must Support Elements**: code, status, effective, value**Code Filter(s)**:**Path**: code**Code(s)**: [LOINC: 97506-0](https://loinc.org/97506-0) (Glucose management indicator) 
* Metadata: Data Requirement
  * ?: **Type**: Observation**Profile(s)**:`http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-observation-lab`**Must Support Elements**: value, status, effective
* Metadata: Data Requirement
  * ?: **Type**: Encounter**Profile(s)**:[Encounter](http://hl7.org/fhir/R4/encounter.html)**Must Support Elements**: type, status, period
* Metadata: Data Requirement
  * ?: **Type**: Encounter**Profile(s)**:[Encounter](http://hl7.org/fhir/R4/encounter.html)**Must Support Elements**: type, status, period**Code Filter(s)**:**Path**: type**ValueSet**:[Office Visit](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1001/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Encounter**Profile(s)**:[Encounter](http://hl7.org/fhir/R4/encounter.html)**Must Support Elements**: type, status, period**Code Filter(s)**:**Path**: type**ValueSet**:[Annual Wellness Visit](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1240/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Encounter**Profile(s)**:[Encounter](http://hl7.org/fhir/R4/encounter.html)**Must Support Elements**: type, status, period**Code Filter(s)**:**Path**: type**ValueSet**:[Preventive Care Services Established Office Visit, 18 and Up](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1025/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Encounter**Profile(s)**:[Encounter](http://hl7.org/fhir/R4/encounter.html)**Must Support Elements**: type, status, period**Code Filter(s)**:**Path**: type**ValueSet**:[Preventive Care Services Initial Office Visit, 18 and Up](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1023/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Encounter**Profile(s)**:[Encounter](http://hl7.org/fhir/R4/encounter.html)**Must Support Elements**: type, status, period**Code Filter(s)**:**Path**: type**ValueSet**:[Home Healthcare Services](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1016/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Encounter**Profile(s)**:[Encounter](http://hl7.org/fhir/R4/encounter.html)**Must Support Elements**: type, status, period**Code Filter(s)**:**Path**: type**ValueSet**:[Nutrition Services](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1006/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Encounter**Profile(s)**:[Encounter](http://hl7.org/fhir/R4/encounter.html)**Must Support Elements**: type, status, period**Code Filter(s)**:**Path**: type**ValueSet**:[Telephone Visits](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1080/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Condition**Profile(s)**:[Condition](http://hl7.org/fhir/R4/condition.html)**Must Support Elements**: abatement, verificationStatus, onset, recordedDate, clinicalStatus
* Metadata: Data Requirement
  * ?: **Type**: Condition**Profile(s)**:[Condition](http://hl7.org/fhir/R4/condition.html)**Must Support Elements**: code, verificationStatus**Code Filter(s)**:**Path**: code**ValueSet**:[Hospice Diagnosis](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1165/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Condition**Profile(s)**:[Condition](http://hl7.org/fhir/R4/condition.html)**Must Support Elements**: code, verificationStatus**Code Filter(s)**:**Path**: code**ValueSet**:[Frailty Diagnosis](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.113.12.1074/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Condition**Profile(s)**:[Condition](http://hl7.org/fhir/R4/condition.html)**Must Support Elements**: code, verificationStatus**Code Filter(s)**:**Path**: code**ValueSet**:[Advanced Illness](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.110.12.1082/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Condition**Profile(s)**:[Condition](http://hl7.org/fhir/R4/condition.html)**Must Support Elements**: code, verificationStatus**Code Filter(s)**:**Path**: code**ValueSet**:[Palliative Care Diagnosis](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1167/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Condition**Profile(s)**:`http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-condition-encounter-diagnosis`**Must Support Elements**: code**Code Filter(s)**:**Path**: code**ValueSet**:[Diabetes](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.103.12.1001/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Coverage**Profile(s)**:`http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-coverage`**Must Support Elements**: type, period**Code Filter(s)**:**Path**: type**ValueSet**:[Payer Type](https://vsac.nlm.nih.gov/valueset/2.16.840.1.114222.4.11.3591/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Encounter**Profile(s)**:`http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-encounter`**Must Support Elements**: type, hospitalization, hospitalization.dischargeDisposition, period**Code Filter(s)**:**Path**: type**ValueSet**:[Encounter Inpatient](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.666.5.307/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Encounter**Profile(s)**:`http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-encounter`**Must Support Elements**: type, period**Code Filter(s)**:**Path**: type**ValueSet**:[Hospice Encounter](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1003/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Encounter**Profile(s)**:`http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-encounter`**Must Support Elements**: type, period**Code Filter(s)**:**Path**: type**ValueSet**:[Frailty Encounter](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1088/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Encounter**Profile(s)**:`http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-encounter`**Must Support Elements**: type, period**Code Filter(s)**:**Path**: type**ValueSet**:[Palliative Care Encounter](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1090/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Observation**Profile(s)**:`http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-observation-screening-assessment`**Must Support Elements**: code, value, effective, status**Code Filter(s)**:**Path**: code**Code(s)**: [LOINC: 45755-6](https://loinc.org/45755-6) (Hospice care [Minimum Data Set]) **Path**: value
* Metadata: Data Requirement
  * ?: **Type**: Observation**Profile(s)**:`http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-observation-screening-assessment`**Must Support Elements**: code, effective, status**Code Filter(s)**:**Path**: code**Code(s)**: [LOINC: 71802-3](https://loinc.org/71802-3) (Housing status) 
* Metadata: Data Requirement
  * ?: **Type**: Observation**Profile(s)**:`http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-observation-screening-assessment`**Must Support Elements**: code, effective, value, status**Code Filter(s)**:**Path**: code**Code(s)**: [LOINC: 71802-3](https://loinc.org/71802-3) (Housing status) **Path**: value
* Metadata: Data Requirement
  * ?: **Type**: Observation**Profile(s)**:`http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-observation-screening-assessment`**Must Support Elements**: code, value, effective, status**Code Filter(s)**:**Path**: code**Code(s)**: [LOINC: 98181-1](https://loinc.org/98181-1) (Medical equipment used) **Path**: value**ValueSet**:[Frailty Device](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.118.12.1300/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Observation**Profile(s)**:`http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-observation-screening-assessment`**Must Support Elements**: code, effective, status**Code Filter(s)**:**Path**: code**Code(s)**: [LOINC: 71007-9](https://loinc.org/71007-9) (Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)) 
* Metadata: Data Requirement
  * ?: **Type**: ServiceRequest**Profile(s)**:`http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-servicerequest`**Must Support Elements**: code, authoredOn**Code Filter(s)**:**Path**: code**ValueSet**:[Hospice Care Ambulatory](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1584/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Procedure**Profile(s)**:`http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-procedure`**Must Support Elements**: code, performed**Code Filter(s)**:**Path**: code**ValueSet**:[Hospice Care Ambulatory](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1584/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Procedure**Profile(s)**:`http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-procedure`**Must Support Elements**: code, performed**Code Filter(s)**:**Path**: code**ValueSet**:[Palliative Care Intervention](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.198.12.1135/expansion)
* Metadata: Data Requirement
  * ?: **Type**: DeviceRequest**Profile(s)**:`http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-devicerequest`**Must Support Elements**: code, authoredOn**Code Filter(s)**:**Path**: code**ValueSet**:[Frailty Device](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.118.12.1300/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Observation**Profile(s)**:`http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-simple-observation`**Must Support Elements**: code, effective, status**Code Filter(s)**:**Path**: code**ValueSet**:[Frailty Symptom](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.113.12.1075/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Medication**Profile(s)**:[Medication](http://hl7.org/fhir/R4/medication.html)**Must Support Elements**: id, code**Code Filter(s)**:**Path**: code**ValueSet**:[Dementia Medications](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.196.12.1510/expansion)
* Metadata: Data Requirement
  * ?: **Type**: MedicationRequest**Profile(s)**:[MedicationRequest](http://hl7.org/fhir/R4/medicationrequest.html)**Must Support Elements**: medication.reference, status, intent, dosageInstruction, dispenseRequest, dispenseRequest.expectedSupplyDuration, dispenseRequest.expectedSupplyDuration.value, dispenseRequest.quantity, dispenseRequest.numberOfRepeatsAllowed, authoredOn, dispenseRequest.validityPeriod
* Metadata: Data Requirement
  * ?: **Type**: MedicationRequest**Profile(s)**:[MedicationRequest](http://hl7.org/fhir/R4/medicationrequest.html)**Must Support Elements**: medication, status, intent, dosageInstruction, dispenseRequest, dispenseRequest.expectedSupplyDuration, dispenseRequest.expectedSupplyDuration.value, dispenseRequest.quantity, dispenseRequest.numberOfRepeatsAllowed, authoredOn, dispenseRequest.validityPeriod**Code Filter(s)**:**Path**: medication**ValueSet**:[Dementia Medications](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.196.12.1510/expansion)
* Metadata:  Parameters
* Metadata: 
  * ?: 
| | | | | |
| :--- | :--- | :--- | :--- | :--- |
| **Name** | **Use** | **Card.** | **Type** | **Documentation** |
| Measurement Period | In | 0..1 | Period |  |
| ErrorLevel | In | 0..1 | string |  |
| SDE Sex | Out | 0..1 | Coding |  |
| Numerator | Out | 0..1 | boolean |  |
| Denominator | Out | 0..1 | boolean |  |
| SDE Payer | Out | 0..* | Resource |  |
| Initial Population | Out | 0..1 | boolean |  |
| SDE Ethnicity | Out | 0..1 | Resource |  |
| Denominator Exclusions | Out | 0..1 | boolean |  |
| SDE Race | Out | 0..1 | Resource |  |

* Metadata: Generated using version 0.5.4 of the sample-content-ig Liquid templates



## Resource Content

```json
{
  "resourceType" : "Measure",
  "id" : "CMS122FHIRDiabetesAssessGT9Pct",
  "meta" : {
    "profile" : ["http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-shareablemeasure",
    "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/computable-measure-cqfm",
    "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/publishable-measure-cqfm",
    "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/executable-measure-cqfm",
    "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cql-measure-cqfm",
    "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/elm-measure-cqfm",
    "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/proportion-measure-cqfm"]
  },
  "contained" : [{
    "resourceType" : "Library",
    "id" : "effective-data-requirements",
    "extension" : [{
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
      "valueCoding" : {
        "system" : "http://snomed.info/sct",
        "code" : "248153007",
        "display" : "Male (finding)"
      }
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
      "valueCoding" : {
        "system" : "http://snomed.info/sct",
        "code" : "248152002",
        "display" : "Female (finding)"
      }
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
      "valueCoding" : {
        "system" : "http://loinc.org",
        "code" : "97506-0",
        "display" : "Glucose management indicator"
      }
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
      "valueCoding" : {
        "system" : "http://www.ama-assn.org/go/cpt",
        "code" : "97802",
        "display" : "Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes"
      }
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
      "valueCoding" : {
        "system" : "http://www.ama-assn.org/go/cpt",
        "code" : "97803",
        "display" : "Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes"
      }
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
      "valueCoding" : {
        "system" : "http://www.ama-assn.org/go/cpt",
        "code" : "97804",
        "display" : "Medical nutrition therapy; group (2 or more individual(s)), each 30 minutes"
      }
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
      "valueCoding" : {
        "system" : "http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets",
        "code" : "G0270",
        "display" : "Medical nutrition therapy; reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition or treatment regimen (including additional hours needed for renal disease), individual, face to face with the patient, each 15 minutes"
      }
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
      "valueCoding" : {
        "system" : "http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets",
        "code" : "G0271",
        "display" : "Medical nutrition therapy, reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition, or treatment regimen (including additional hours needed for renal disease), group (2 or more individuals), each 30 minutes"
      }
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
      "valueCoding" : {
        "system" : "http://terminology.hl7.org/CodeSystem/condition-ver-status",
        "code" : "confirmed"
      }
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
      "valueCoding" : {
        "system" : "http://terminology.hl7.org/CodeSystem/condition-ver-status",
        "code" : "unconfirmed"
      }
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
      "valueCoding" : {
        "system" : "http://terminology.hl7.org/CodeSystem/condition-ver-status",
        "code" : "provisional"
      }
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
      "valueCoding" : {
        "system" : "http://terminology.hl7.org/CodeSystem/condition-ver-status",
        "code" : "differential"
      }
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
      "valueCoding" : {
        "system" : "http://terminology.hl7.org/CodeSystem/condition-clinical",
        "code" : "active"
      }
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
      "valueCoding" : {
        "system" : "http://terminology.hl7.org/CodeSystem/condition-clinical",
        "code" : "recurrence"
      }
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
      "valueCoding" : {
        "system" : "http://terminology.hl7.org/CodeSystem/condition-clinical",
        "code" : "relapse"
      }
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
      "valueCoding" : {
        "system" : "http://snomed.info/sct",
        "code" : "428361000124107",
        "display" : "Discharge to home for hospice care (procedure)"
      }
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
      "valueCoding" : {
        "system" : "http://snomed.info/sct",
        "code" : "428371000124100",
        "display" : "Discharge to healthcare facility for hospice care (procedure)"
      }
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
      "valueCoding" : {
        "system" : "http://loinc.org",
        "code" : "45755-6",
        "display" : "Hospice care [Minimum Data Set]"
      }
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
      "valueCoding" : {
        "system" : "http://snomed.info/sct",
        "code" : "373066001",
        "display" : "Yes (qualifier value)"
      }
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
      "valueCoding" : {
        "system" : "http://loinc.org",
        "code" : "71802-3",
        "display" : "Housing status"
      }
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
      "valueCoding" : {
        "system" : "http://snomed.info/sct",
        "code" : "160734000",
        "display" : "Lives in nursing home (finding)"
      }
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
      "valueCoding" : {
        "system" : "http://loinc.org",
        "code" : "98181-1",
        "display" : "Medical equipment used"
      }
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
      "valueCoding" : {
        "system" : "http://loinc.org",
        "code" : "71007-9",
        "display" : "Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)"
      }
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "SupplementalDataElements"
      },
      {
        "url" : "name",
        "valueString" : "SDE Sex"
      },
      {
        "url" : "statement",
        "valueString" : "define \"SDE Sex\":\n  case\n    when Patient.sex() = '248153007' then \"Male (finding)\"\n    when Patient.sex() = '248152002' then \"Female (finding)\"\n    else null\n  end"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 0
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "CMS122FHIRDiabetesAssessGT9Pct"
      },
      {
        "url" : "name",
        "valueString" : "SDE Sex"
      },
      {
        "url" : "statement",
        "valueString" : "define \"SDE Sex\":\n  SDE.\"SDE Sex\""
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 1
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "CMS122FHIRDiabetesAssessGT9Pct"
      },
      {
        "url" : "name",
        "valueString" : "Glycemic Status Assessment"
      },
      {
        "url" : "statement",
        "valueString" : "define \"Glycemic Status Assessment\":\n  ( ( [LaboratoryResultObservation: \"HbA1c Laboratory Test\"]\n      union [LaboratoryResultObservation: \"Glucose management indicator\"]\n  ).isLaboratoryTestPerformed ( ) ) GlycemicStatus\n    where GlycemicStatus.effective.latest ( ) during day of \"Measurement Period\""
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 2
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "CMS122FHIRDiabetesAssessGT9Pct"
      },
      {
        "url" : "name",
        "valueString" : "Most Recent Glycemic Status Date"
      },
      {
        "url" : "statement",
        "valueString" : "define \"Most Recent Glycemic Status Date\":\n  Last((\"Glycemic Status Assessment\" QualifyingGlycemicStatus\n      return date from QualifyingGlycemicStatus.effective.latest()) QualifyingGlycemicStatus\n      sort asc\n  )"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 3
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "CMS122FHIRDiabetesAssessGT9Pct"
      },
      {
        "url" : "name",
        "valueString" : "Lowest Glycemic Status Assessment Reading on Most Recent Day"
      },
      {
        "url" : "statement",
        "valueString" : "define \"Lowest Glycemic Status Assessment Reading on Most Recent Day\":\n  First(\"Glycemic Status Assessment\" QualifyingGlycemicStatus\n      where QualifyingGlycemicStatus.effective.latest() same day as \"Most Recent Glycemic Status Date\"\n      return {\n        QualifyingGlycemicStatusValue: QualifyingGlycemicStatus.value as Quantity,\n        QualifyingGlycemicStatus: QualifyingGlycemicStatus\n      }\n      sort by QualifyingGlycemicStatusValue\n  ).QualifyingGlycemicStatus"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 4
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "CMS122FHIRDiabetesAssessGT9Pct"
      },
      {
        "url" : "name",
        "valueString" : "Has Most Recent Glycemic Status Assessment Without Result"
      },
      {
        "url" : "statement",
        "valueString" : "define \"Has Most Recent Glycemic Status Assessment Without Result\":\n  \"Lowest Glycemic Status Assessment Reading on Most Recent Day\" is not null\n    and \"Lowest Glycemic Status Assessment Reading on Most Recent Day\".value is null"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 5
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "CMS122FHIRDiabetesAssessGT9Pct"
      },
      {
        "url" : "name",
        "valueString" : "Has Most Recent Elevated Glycemic Status Assessment"
      },
      {
        "url" : "statement",
        "valueString" : "define \"Has Most Recent Elevated Glycemic Status Assessment\":\n  \"Lowest Glycemic Status Assessment Reading on Most Recent Day\".value > 9 '%'"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 6
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "CMS122FHIRDiabetesAssessGT9Pct"
      },
      {
        "url" : "name",
        "valueString" : "Has No Record Of Glycemic Status Assessment"
      },
      {
        "url" : "statement",
        "valueString" : "define \"Has No Record Of Glycemic Status Assessment\":\n  not exists \"Glycemic Status Assessment\""
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 7
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "CMS122FHIRDiabetesAssessGT9Pct"
      },
      {
        "url" : "name",
        "valueString" : "Numerator"
      },
      {
        "url" : "statement",
        "valueString" : "define \"Numerator\":\n  \"Has Most Recent Glycemic Status Assessment Without Result\"\n    or \"Has Most Recent Elevated Glycemic Status Assessment\"\n    or \"Has No Record Of Glycemic Status Assessment\""
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 8
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "CMS122FHIRDiabetesAssessGT9Pct"
      },
      {
        "url" : "name",
        "valueString" : "Qualifying Encounters"
      },
      {
        "url" : "statement",
        "valueString" : "define \"Qualifying Encounters\":\n  ( ( [Encounter: \"Office Visit\"]\n      union [Encounter: \"Annual Wellness Visit\"]\n      union [Encounter: \"Preventive Care Services Established Office Visit, 18 and Up\"]\n      union [Encounter: \"Preventive Care Services Initial Office Visit, 18 and Up\"]\n      union [Encounter: \"Home Healthcare Services\"]\n      union [Encounter: \"Nutrition Services\"]\n      union ( [Encounter] E\n          where exists ( ( E.type ) T\n              where T ~ \"Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes\"\n          )\n      )\n      union ( [Encounter] E\n          where exists ( ( E.type ) T\n              where T ~ \"Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes\"\n          )\n      )\n      union ( [Encounter] E\n          where exists ( ( E.type ) T\n              where T ~ \"Medical nutrition therapy; group (2 or more individual(s)), each 30 minutes\"\n          )\n      )\n      union ( [Encounter] E\n          where exists ( ( E.type ) T\n              where T ~ \"Medical nutrition therapy; reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition or treatment regimen (including additional hours needed for renal disease), individual, face to face with the patient, each 15 minutes\"\n          )\n      )\n      union ( [Encounter] E\n          where exists ( ( E.type ) T\n              where T ~ \"Medical nutrition therapy, reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition, or treatment regimen (including additional hours needed for renal disease), group (2 or more individuals), each 30 minutes\"\n          )\n      )\n      union [Encounter: \"Telephone Visits\"]\n  ).isEncounterPerformed ( ) ) ValidEncounters\n    where ValidEncounters.period during day of \"Measurement Period\""
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 9
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "CMS122FHIRDiabetesAssessGT9Pct"
      },
      {
        "url" : "name",
        "valueString" : "Initial Population"
      },
      {
        "url" : "statement",
        "valueString" : "define \"Initial Population\":\n  AgeInYearsAt(date from \n    end of \"Measurement Period\"\n  ) in Interval[18, 75]\n    and exists \"Qualifying Encounters\"\n    and exists ( ( ( [ConditionEncounterDiagnosis: \"Diabetes\"] ).verified ( ) ) DiabetesDiagnosis\n        where DiabetesDiagnosis.prevalenceInterval ( ) overlaps day of \"Measurement Period\"\n    )"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 10
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "CMS122FHIRDiabetesAssessGT9Pct"
      },
      {
        "url" : "name",
        "valueString" : "Denominator"
      },
      {
        "url" : "statement",
        "valueString" : "define \"Denominator\":\n  \"Initial Population\""
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 11
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "SupplementalDataElements"
      },
      {
        "url" : "name",
        "valueString" : "SDE Payer"
      },
      {
        "url" : "statement",
        "valueString" : "define \"SDE Payer\":\n  [USQualityCore.Coverage: type in \"Payer Type\"] Payer\n    return {\n      code: Payer.type,\n      period: Payer.period\n    }"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 12
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "CMS122FHIRDiabetesAssessGT9Pct"
      },
      {
        "url" : "name",
        "valueString" : "SDE Payer"
      },
      {
        "url" : "statement",
        "valueString" : "define \"SDE Payer\":\n  SDE.\"SDE Payer\""
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 13
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "SupplementalDataElements"
      },
      {
        "url" : "name",
        "valueString" : "SDE Ethnicity"
      },
      {
        "url" : "statement",
        "valueString" : "define \"SDE Ethnicity\":\n  (Patient.ethnicity()) E\n    return Tuple {\n      codes: { E.ombCategory } union E.detailed,\n      display: E.text\n    }"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 14
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "CMS122FHIRDiabetesAssessGT9Pct"
      },
      {
        "url" : "name",
        "valueString" : "SDE Ethnicity"
      },
      {
        "url" : "statement",
        "valueString" : "define \"SDE Ethnicity\":\n  SDE.\"SDE Ethnicity\""
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 15
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "Hospice"
      },
      {
        "url" : "name",
        "valueString" : "Has Hospice Services"
      },
      {
        "url" : "statement",
        "valueString" : "define \"Has Hospice Services\":\n  exists ((([USQualityCore.Encounter: \"Encounter Inpatient\"]).isEncounterPerformed()) InpatientEncounter\n      where (InpatientEncounter.hospitalization.dischargeDisposition ~ \"Discharge to home for hospice care (procedure)\"\n          or InpatientEncounter.hospitalization.dischargeDisposition ~ \"Discharge to healthcare facility for hospice care (procedure)\"\n      )\n        and InpatientEncounter.period ends during day of \"Measurement Period\"\n  )\n    or exists ((([USQualityCore.Encounter: \"Hospice Encounter\"]).isEncounterPerformed()) HospiceEncounter\n        where HospiceEncounter.period overlaps day of \"Measurement Period\"\n    )\n    // TODO: Shouldn't need to specify a code path here (see https://jira.hl7.org/browse/FHIR-53941)\n    or exists ((([USQualityCore.ObservationScreeningAssessment: code ~ \"Hospice care [Minimum Data Set]\"]).isAssessmentPerformed()) HospiceAssessment\n        where HospiceAssessment.value ~ \"Yes (qualifier value)\"\n          and HospiceAssessment.effective.toInterval() overlaps day of \"Measurement Period\"\n    )\n    or exists ((([USQualityCore.ServiceRequest: \"Hospice Care Ambulatory\"]).isInterventionOrder()) HospiceOrder\n        where HospiceOrder.authoredOn during day of \"Measurement Period\"\n    )\n    or exists ((([USQualityCore.Procedure: \"Hospice Care Ambulatory\"]).isInterventionPerformed()) HospicePerformed\n        where HospicePerformed.performed.toInterval() overlaps day of \"Measurement Period\"\n    )\n    // TODO: Consider whether to keep this as the union of Problems and EncounterDiagnosis\n    or exists ((([FHIR.Condition: \"Hospice Diagnosis\"]).verified()) HospiceCareDiagnosis\n        where HospiceCareDiagnosis.prevalenceInterval() overlaps day of \"Measurement Period\"\n    )"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 16
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "AdvancedIllnessandFrailty"
      },
      {
        "url" : "name",
        "valueString" : "Is Age 66 or Older Living Long Term in a Nursing Home"
      },
      {
        "url" : "statement",
        "valueString" : "define \"Is Age 66 or Older Living Long Term in a Nursing Home\":\n  AgeInYearsAt(date from end of \"Measurement Period\") >= 66\n    and ( ( Last( (([ObservationScreeningAssessment: \"Housing status\"]).isAssessmentPerformed()) HousingStatus    \n          where HousingStatus.effective.toInterval() ends on or before \n          day of end of \"Measurement Period\"\n          sort by \n          end of effective.toInterval() asc\n      )) LastHousingStatus\n        where LastHousingStatus.value ~ \"Lives in nursing home (finding)\"\n    ) is not null"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 17
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "AdvancedIllnessandFrailty"
      },
      {
        "url" : "name",
        "valueString" : "Has Criteria Indicating Frailty"
      },
      {
        "url" : "statement",
        "valueString" : "define \"Has Criteria Indicating Frailty\":\n  exists ( (([USQualityCore.DeviceRequest: \"Frailty Device\"]).isDeviceOrderPersonalUseDevices()) FrailtyDeviceOrder\n      where FrailtyDeviceOrder.authoredOn.toInterval() during day of \"Measurement Period\"\n  )\n    or exists ( (([ObservationScreeningAssessment: \"Medical equipment used\"]).isAssessmentPerformed()) EquipmentUsed\n        where EquipmentUsed.value as CodeableConcept in \"Frailty Device\" \n        and EquipmentUsed.effective.toInterval() ends during day of \"Measurement Period\"\n    )\n    // TODO: Consider whether to keep this as the union of problems and encounter diagnoses\n    or exists ( (([FHIR.Condition: \"Frailty Diagnosis\"]).verified()) FrailtyDiagnosis\n        where FrailtyDiagnosis.prevalenceInterval() overlaps day of \"Measurement Period\"\n    )\n    or exists ( (([USQualityCore.Encounter: \"Frailty Encounter\"]).isEncounterPerformed()) FrailtyEncounter\n        where FrailtyEncounter.period overlaps day of \"Measurement Period\"\n    )\n    or exists ( (([USQualityCore.SimpleObservation: \"Frailty Symptom\"]).isSymptom()) FrailtySymptom\n        where FrailtySymptom.effective.toInterval() overlaps day of \"Measurement Period\"\n    )"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 18
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "AdvancedIllnessandFrailty"
      },
      {
        "url" : "name",
        "valueString" : "Has Advanced Illness in Year Before or During Measurement Period"
      },
      {
        "url" : "statement",
        "valueString" : "define \"Has Advanced Illness in Year Before or During Measurement Period\":\n// TODO: Consider whether to keep this as the union of problems and encounter diagnoses\nexists ((([Condition: \"Advanced Illness\"]).verified()) AdvancedIllnessDiagnosis\nwhere AdvancedIllnessDiagnosis.prevalenceInterval() starts during day of Interval[start of \"Measurement Period\" - 1 year, end of \"Measurement Period\"])"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 19
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "AdvancedIllnessandFrailty"
      },
      {
        "url" : "name",
        "valueString" : "Has Dementia Medications in Year Before or During Measurement Period"
      },
      {
        "url" : "statement",
        "valueString" : "define \"Has Dementia Medications in Year Before or During Measurement Period\":\n  exists (( ([FHIR.MedicationRequest: \"Dementia Medications\"]).isMedicationActive()) DementiaMedication\n      where DementiaMedication.medicationRequestPeriod() overlaps day of Interval[start of \"Measurement Period\" - 1 year, \n        end of \"Measurement Period\"]\n  )"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 20
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "AdvancedIllnessandFrailty"
      },
      {
        "url" : "name",
        "valueString" : "Is Age 66 or Older with Advanced Illness and Frailty"
      },
      {
        "url" : "statement",
        "valueString" : "define \"Is Age 66 or Older with Advanced Illness and Frailty\":\n   AgeInYearsAt(date from end of \"Measurement Period\") >= 66\n    and \"Has Criteria Indicating Frailty\"\n    and ( \"Has Advanced Illness in Year Before or During Measurement Period\"\n        or \"Has Dementia Medications in Year Before or During Measurement Period\"\n    )"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 21
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "PalliativeCare"
      },
      {
        "url" : "name",
        "valueString" : "Has Palliative Care in the Measurement Period"
      },
      {
        "url" : "statement",
        "valueString" : "define \"Has Palliative Care in the Measurement Period\":\n  // TODO: Shouldn't need to specify a code path here (see https://jira.hl7.org/browse/FHIR-53941)\n  exists ((([USQualityCore.ObservationScreeningAssessment: code ~ \"Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)\"]).isAssessmentPerformed()) PalliativeAssessment\n      where PalliativeAssessment.effective.toInterval() overlaps day of \"Measurement Period\"\n  )\n    // TODO: Consider whether to keep this as the union of the problems and encounter diagnosis list? Anything enforced by the profiles that is expected but isn't stated here?\n    or exists ((([FHIR.Condition: \"Palliative Care Diagnosis\"]).verified()) PalliativeDiagnosis\n        where PalliativeDiagnosis.prevalenceInterval() overlaps day of \"Measurement Period\"\n    )\n    or exists ((([USQualityCore.Encounter: \"Palliative Care Encounter\"]).isEncounterPerformed()) PalliativeEncounter\n        where PalliativeEncounter.period overlaps day of \"Measurement Period\"\n    )\n    or exists ((([USQualityCore.Procedure: \"Palliative Care Intervention\"]).isInterventionPerformed()) PalliativeIntervention\n        where PalliativeIntervention.performed.toInterval() overlaps day of \"Measurement Period\"\n    )"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 22
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "CMS122FHIRDiabetesAssessGT9Pct"
      },
      {
        "url" : "name",
        "valueString" : "Denominator Exclusions"
      },
      {
        "url" : "statement",
        "valueString" : "define \"Denominator Exclusions\":\n  Hospice.\"Has Hospice Services\"\n    or AIFrailLTCF.\"Is Age 66 or Older Living Long Term in a Nursing Home\"\n    or AIFrailLTCF.\"Is Age 66 or Older with Advanced Illness and Frailty\"\n    or PalliativeCare.\"Has Palliative Care in the Measurement Period\""
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 23
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "SupplementalDataElements"
      },
      {
        "url" : "name",
        "valueString" : "SDE Race"
      },
      {
        "url" : "statement",
        "valueString" : "define \"SDE Race\":\n  (Patient.race()) R\n    return Tuple {\n      codes: R.ombCategory union R.detailed,\n      display: R.text\n    }"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 24
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "CMS122FHIRDiabetesAssessGT9Pct"
      },
      {
        "url" : "name",
        "valueString" : "SDE Race"
      },
      {
        "url" : "statement",
        "valueString" : "define \"SDE Race\":\n  SDE.\"SDE Race\""
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 25
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRHelpers"
      },
      {
        "url" : "name",
        "valueString" : "ToString"
      },
      {
        "url" : "statement",
        "valueString" : "define function ToString(value string): value.value"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 26
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "USCoreCommon"
      },
      {
        "url" : "name",
        "valueString" : "sex"
      },
      {
        "url" : "statement",
        "valueString" : "/*\n@description: Returns the sex element as defined for the USCore patient profile\n*/\ndefine fluent function sex(patient Patient):\n  patient.ext('http://hl7.org/fhir/us/core/StructureDefinition/us-core-sex').value as FHIR.code"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 27
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRCommon"
      },
      {
        "url" : "name",
        "valueString" : "ext"
      },
      {
        "url" : "statement",
        "valueString" : "/*\n@description: Returns the single extension (if present) on the given resource with the specified url.\n@comment: This function uses singleton from to ensure that a run-time exception is thrown if there\nis more than one extension on the given resource with the specified url.\n*/\ndefine fluent function ext(domainResource DomainResource, url String):\n  singleton from domainResource.exts(url)"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 28
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRCommon"
      },
      {
        "url" : "name",
        "valueString" : "exts"
      },
      {
        "url" : "statement",
        "valueString" : "/*\n@description: Returns any extensions defined on the given resource with the specified url\n*/\ndefine fluent function exts(domainResource DomainResource, url String):\n  domainResource.extension E\n    where E.url = url\n    return E"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 29
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRHelpers"
      },
      {
        "url" : "name",
        "valueString" : "ToString"
      },
      {
        "url" : "statement",
        "valueString" : "define function ToString(value uri): value.value"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 30
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "Status"
      },
      {
        "url" : "name",
        "valueString" : "isLaboratoryTestPerformed"
      },
      {
        "url" : "statement",
        "valueString" : "//Laboratory Test, Performed\ndefine fluent function isLaboratoryTestPerformed(Obs List<LaboratoryResultObservation>):\n  Obs O\n    where O.status in { 'final', 'amended', 'corrected' }"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 31
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRHelpers"
      },
      {
        "url" : "name",
        "valueString" : "ToString"
      },
      {
        "url" : "statement",
        "valueString" : "define function ToString(value ObservationStatus): value.value"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 32
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRCommon"
      },
      {
        "url" : "name",
        "valueString" : "latest"
      },
      {
        "url" : "statement",
        "valueString" : "/*\n@description: Given an interval, returns the ending point if the interval has an ending boundary specified,\notherwise, returns the starting point\n*/\ndefine fluent function latest(choice Choice<FHIR.dateTime, FHIR.Period, FHIR.Age, FHIR.Range>):\n  (choice.toInterval()) period\n    return\n      if (period.hasEnd()) then end of period\n      else start of period"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 33
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRCommon"
      },
      {
        "url" : "name",
        "valueString" : "toInterval"
      },
      {
        "url" : "statement",
        "valueString" : "/*\n@description: Normalizes a value that is a choice of timing-valued types to an equivalent interval\n@comment: Normalizes a choice type of FHIR.dateTime, FHIR.Period, FHIR.Timing, FHIR.instance, FHIR.string, FHIR.Age, or FHIR.Range types\nto an equivalent interval. This selection of choice types is a superset of the majority of choice types that are used as possible\nrepresentations for timing-valued elements in FHIR, allowing this function to be used across any resource.\n\nThe input can be provided as a dateTime, Period, Timing, instant, string, Age, or Range.\nThe intent of this function is to provide a clear and concise mechanism to treat single\nelements that have multiple possible representations as intervals so that logic doesn't have to account\nfor the variability. More complex calculations (such as medication request period or dispense period\ncalculation) need specific guidance and consideration. That guidance may make use of this function, but\nthe focus of this function is on single element calculations where the semantics are unambiguous.\nIf the input is a dateTime, the result a DateTime Interval beginning and ending on that dateTime.\nIf the input is a Period, the result is a DateTime Interval.\nIf the input is a Timing, an error is raised indicating a single interval cannot be computed from a Timing.\nIf the input is an instant, the result is a DateTime Interval beginning and ending on that instant.\nIf the input is a string, an error is raised indicating a single interval cannot be computed from a string.\nIf the input is an Age, the result is a DateTime Interval beginning when the patient was the given Age,\nand ending immediately prior to when the patient was the given Age plus one year.\nIf the input is a Range, the result is a DateTime Interval beginning when the patient was the Age given\nby the low end of the Range, and ending immediately prior to when the patient was the Age given by the\nhigh end of the Range plus one year.\n\nNOTE: Due to the\ncomplexity of determining a single interval from a Timing or String type, this function will throw a run-time exception if it is used\nwith a Timing or String.\n*/\ndefine fluent function toInterval(choice Choice<FHIR.dateTime, FHIR.Period, FHIR.Timing, FHIR.instant, FHIR.string, FHIR.Age, FHIR.Range>):\n  case\n    when choice is FHIR.dateTime then\n      Interval[FHIRHelpers.ToDateTime(choice as FHIR.dateTime), FHIRHelpers.ToDateTime(choice as FHIR.dateTime)]\n    when choice is FHIR.Period then\n      FHIRHelpers.ToInterval(choice as FHIR.Period)\n    when choice is FHIR.instant then\n      Interval[FHIRHelpers.ToDateTime(choice as FHIR.instant), FHIRHelpers.ToDateTime(choice as FHIR.instant)]\n    when choice is FHIR.Age then\n      Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(choice as FHIR.Age),\n        FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(choice as FHIR.Age) + 1 year)\n    when choice is FHIR.Range then\n      Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((choice as FHIR.Range).low),\n        FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((choice as FHIR.Range).high) + 1 year)\n    when choice is FHIR.Timing then\n      Message(null as Interval<DateTime>, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a Timing value is not supported')\n    when choice is FHIR.string then\n      Message(null as Interval<DateTime>, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a String value is not supported')\n    else\n      null as Interval<DateTime>\n  end"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 34
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRHelpers"
      },
      {
        "url" : "name",
        "valueString" : "ToDateTime"
      },
      {
        "url" : "statement",
        "valueString" : "define function ToDateTime(value dateTime): value.value"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 35
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRHelpers"
      },
      {
        "url" : "name",
        "valueString" : "ToInterval"
      },
      {
        "url" : "statement",
        "valueString" : "/*\n@description: Converts the given [Period](https://hl7.org/fhir/datatypes.html#Period)\nvalue to a CQL DateTime Interval\n@comment: If the start value of the given period is unspecified, the starting\nboundary of the resulting interval will be open (meaning the start of the interval\nis unknown, as opposed to interpreted as the beginning of time).\n*/\ndefine function ToInterval(period FHIR.Period):\n    if period is null then\n        null\n    else\n        if period.\"start\" is null then\n            Interval(period.\"start\".value, period.\"end\".value]\n        else\n            Interval[period.\"start\".value, period.\"end\".value]"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 36
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRHelpers"
      },
      {
        "url" : "name",
        "valueString" : "ToDateTime"
      },
      {
        "url" : "statement",
        "valueString" : "define function ToDateTime(value instant): value.value"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 37
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRHelpers"
      },
      {
        "url" : "name",
        "valueString" : "ToDate"
      },
      {
        "url" : "statement",
        "valueString" : "define function ToDate(value date): value.value"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 38
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRHelpers"
      },
      {
        "url" : "name",
        "valueString" : "ToQuantity"
      },
      {
        "url" : "statement",
        "valueString" : "/*\n@description: Converts the given FHIR [Quantity](https://hl7.org/fhir/datatypes.html#Quantity) \nvalue to a CQL Quantity\n@comment: If the given quantity has a comparator specified, a runtime error is raised. If the given quantity\nhas a system other than UCUM (i.e. `http://unitsofmeasure.org`) or CQL calendar units (i.e. `http://hl7.org/fhirpath/CodeSystem/calendar-units`)\nan error is raised. For UCUM to calendar units, the `ToCalendarUnit` function is used.\n@seealso: ToCalendarUnit\n*/\ndefine function ToQuantity(quantity FHIR.Quantity):\n    case\n        when quantity is null then null\n        when quantity.value is null then null\n        when quantity.comparator is not null then\n            Message(null, true, 'FHIRHelpers.ToQuantity.ComparatorQuantityNotSupported', 'Error', 'FHIR Quantity value has a comparator and cannot be converted to a System.Quantity value.')\n        when quantity.system is null or quantity.system.value = 'http://unitsofmeasure.org'\n              or quantity.system.value = 'http://hl7.org/fhirpath/CodeSystem/calendar-units' then\n            System.Quantity { value: quantity.value.value, unit: ToCalendarUnit(Coalesce(quantity.code.value, quantity.unit.value, '1')) }\n        else\n            Message(null, true, 'FHIRHelpers.ToQuantity.InvalidFHIRQuantity', 'Error', 'Invalid FHIR Quantity code: ' & quantity.unit.value & ' (' & quantity.system.value & '|' & quantity.code.value & ')')\n    end"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 39
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRHelpers"
      },
      {
        "url" : "name",
        "valueString" : "ToCalendarUnit"
      },
      {
        "url" : "statement",
        "valueString" : "/*\n@description: Converts a UCUM definite duration unit to a CQL calendar duration\nunit using conversions specified in the [quantities](https://cql.hl7.org/02-authorsguide.html#quantities) \ntopic of the CQL specification.\n@comment: Note that for durations above days (or weeks), the conversion is understood to be approximate\n*/\ndefine function ToCalendarUnit(unit System.String):\n    case unit\n        when 'ms' then 'millisecond'\n        when 's' then 'second'\n        when 'min' then 'minute'\n        when 'h' then 'hour'\n        when 'd' then 'day'\n        when 'wk' then 'week'\n        when 'mo' then 'month'\n        when 'a' then 'year'\n        else unit\n    end"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 40
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRCommon"
      },
      {
        "url" : "name",
        "valueString" : "hasEnd"
      },
      {
        "url" : "statement",
        "valueString" : "/*\n@description: Given an interval, returns true if the interval has an ending boundary specified\n(i.e. the end of the interval is not null and not the maximum DateTime value)\n*/\ndefine fluent function hasEnd(period Interval<DateTime>):\n  not (\n    end of period is null\n      or end of period = maximum DateTime\n  )"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 41
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "Status"
      },
      {
        "url" : "name",
        "valueString" : "isEncounterPerformed"
      },
      {
        "url" : "statement",
        "valueString" : "//Encounter, Performed\n//General usage unless required otherwise by measure intent (e.g., follow-up encounters)\ndefine fluent function isEncounterPerformed(Enc List<FHIR.Encounter>):\n  Enc E\n    where E.status = 'finished'"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 42
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRHelpers"
      },
      {
        "url" : "name",
        "valueString" : "ToString"
      },
      {
        "url" : "statement",
        "valueString" : "define function ToString(value EncounterStatus): value.value"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 43
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRHelpers"
      },
      {
        "url" : "name",
        "valueString" : "ToConcept"
      },
      {
        "url" : "statement",
        "valueString" : "/*\n@description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept.\n*/\ndefine function ToConcept(concept FHIR.CodeableConcept):\n    if concept is null then\n        null\n    else\n        System.Concept {\n            codes: concept.coding C return ToCode(C),\n            display: concept.text.value\n        }"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 44
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRHelpers"
      },
      {
        "url" : "name",
        "valueString" : "ToCode"
      },
      {
        "url" : "statement",
        "valueString" : "/*\n@description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code.\n*/\ndefine function ToCode(coding FHIR.Coding):\n    if coding is null then\n        null\n    else\n        System.Code {\n          code: coding.code.value,\n          system: coding.system.value,\n          version: coding.version.value,\n          display: coding.display.value\n        }"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 45
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRCommon"
      },
      {
        "url" : "name",
        "valueString" : "verified"
      },
      {
        "url" : "statement",
        "valueString" : "/*\n@description: Returns conditions in the given list that either have no verification status or have a verification status of confirmed, unconfirmed, provisional, or differential\n*/\ndefine fluent function verified(conditions List<FHIR.Condition>):\n  conditions C\n    where C.verificationStatus is not null implies\n      (C.verificationStatus ~ \"confirmed\"\n        or C.verificationStatus ~ \"unconfirmed\"\n        or C.verificationStatus ~ \"provisional\"\n        or C.verificationStatus ~ \"differential\"\n      )"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 46
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRCommon"
      },
      {
        "url" : "name",
        "valueString" : "prevalenceInterval"
      },
      {
        "url" : "statement",
        "valueString" : "/*\n@description: Returns an interval representing the normalized prevalence period of a given Condition resource.\n@comment: Uses the toInterval and toAbatementInterval functions to determine the widest potential interval from\nonset to abatement as specified in the given Condition.\n*/\ndefine fluent function prevalenceInterval(condition Condition):\nif condition.clinicalStatus ~ \"active\"\n  or condition.clinicalStatus ~ \"recurrence\"\n  or condition.clinicalStatus ~ \"relapse\" then\n  Interval[start of condition.onset.toInterval(), end of condition.abatementInterval()]\nelse\n  (end of condition.abatementInterval()) abatementDate\n    return \n\t  if abatementDate is null then\n        Interval[start of condition.onset.toInterval(), abatementDate)\n      else\n        Interval[start of condition.onset.toInterval(), abatementDate]"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 47
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRCommon"
      },
      {
        "url" : "name",
        "valueString" : "abatementInterval"
      },
      {
        "url" : "statement",
        "valueString" : "/*\n@description: Returns an interval representing the normalized Abatement of a given Condition resource.\n@comment: @comment: If the abatement element of the Condition is represented as a DateTime, the result\nis an interval beginning and ending on that DateTime.\nIf 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\nresult is an interval from the date the patient turned that age to immediately before one year later.\nIf the abatement is represented as a Quantity Interval, the quantities are expected to be calendar-durations and are interpreted as an age range during\nwhich the abatement occurred. The result is an interval from the date the patient turned the starting age of the quantity interval, and ending immediately\nbefore one year later than the date the patient turned the ending age of the quantity interval.\n\nNOTE: Due to the complexity of determining an interval from a String, this function will throw\na run-time exception if used with a Condition instance that has a String as the abatement value.\n*/\ndefine fluent function abatementInterval(condition Condition):\n  if condition.abatement is FHIR.dateTime then\n    Interval[FHIRHelpers.ToDateTime(condition.abatement as FHIR.dateTime), FHIRHelpers.ToDateTime(condition.abatement as FHIR.dateTime)]\n  else if condition.abatement is FHIR.Period then\n    FHIRHelpers.ToInterval(condition.abatement as FHIR.Period)\n  else if condition.abatement is FHIR.string then\n    Message(null as Interval<DateTime>, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a String value is not supported')\n  else if condition.abatement is FHIR.Age then\n    Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(condition.abatement as FHIR.Age),\n      FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(condition.abatement as FHIR.Age) + 1 year)\n  else if condition.abatement is FHIR.Range then\n    Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((condition.abatement as FHIR.Range).low),\n      FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((condition.abatement as FHIR.Range).high) + 1 year)\n  else if condition.abatement is FHIR.boolean then\n    Interval[end of condition.onset.toInterval(), condition.recordedDate)\n  else \n    null"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 48
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "USCoreCommon"
      },
      {
        "url" : "name",
        "valueString" : "ethnicity"
      },
      {
        "url" : "statement",
        "valueString" : "define fluent function ethnicity(patient Patient):\n  (patient.ext('http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity')) E\n    return {\n      ombCategory: E.ext('ombCategory').value as FHIR.Coding,\n      detailed: (E.exts('detailed')) d return d.value as FHIR.Coding,\n      text: E.ext('text').value as FHIR.string\n    }"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 49
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRCommon"
      },
      {
        "url" : "name",
        "valueString" : "ext"
      },
      {
        "url" : "statement",
        "valueString" : "/*\n@description: Returns the single extension (if present) on the given element with the specified url.\n@comment: This function uses singleton from to ensure that a run-time exception is thrown if there\nis more than one extension on the given element with the specified url.\n*/\ndefine fluent function ext(element Element, url String):\n  singleton from element.exts(url)"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 50
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRCommon"
      },
      {
        "url" : "name",
        "valueString" : "exts"
      },
      {
        "url" : "statement",
        "valueString" : "/*\n@description: Returns any extensions defined on the given element with the specified url.\n*/\ndefine fluent function exts(element Element, url String):\n  element.extension E\n    where E.url = url\n    return E"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 51
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "Status"
      },
      {
        "url" : "name",
        "valueString" : "isAssessmentPerformed"
      },
      {
        "url" : "statement",
        "valueString" : "//Assessment, Performed\ndefine fluent function isAssessmentPerformed(Obs List<ObservationScreeningAssessment>):\n  Obs O\n    where O.status in { 'final', 'amended', 'corrected' }"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 52
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "Status"
      },
      {
        "url" : "name",
        "valueString" : "isInterventionOrder"
      },
      {
        "url" : "statement",
        "valueString" : "//Intervention, Order\ndefine fluent function isInterventionOrder(ServiceRequest List<FHIR.ServiceRequest>):\n  ServiceRequest S\n    where S.status in { 'active', 'completed' }\n      and S.intent in {'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order'}"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 53
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRHelpers"
      },
      {
        "url" : "name",
        "valueString" : "ToString"
      },
      {
        "url" : "statement",
        "valueString" : "define function ToString(value ServiceRequestStatus): value.value"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 54
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRHelpers"
      },
      {
        "url" : "name",
        "valueString" : "ToString"
      },
      {
        "url" : "statement",
        "valueString" : "define function ToString(value ServiceRequestIntent): value.value"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 55
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "Status"
      },
      {
        "url" : "name",
        "valueString" : "isInterventionPerformed"
      },
      {
        "url" : "statement",
        "valueString" : "//Intervention, Performed\ndefine fluent function isInterventionPerformed(Proc List<FHIR.Procedure>):\n  Proc P\n    where P.status ~ 'completed'"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 56
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRHelpers"
      },
      {
        "url" : "name",
        "valueString" : "ToString"
      },
      {
        "url" : "statement",
        "valueString" : "define function ToString(value ProcedureStatus): value.value"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 57
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "Status"
      },
      {
        "url" : "name",
        "valueString" : "isDeviceOrderPersonalUseDevices"
      },
      {
        "url" : "statement",
        "valueString" : "//Device, Order - Personal Use Devices\ndefine fluent function isDeviceOrderPersonalUseDevices(DeviceRequest List<FHIR.DeviceRequest>):\n  DeviceRequest D\n    where D.status in { 'active', 'completed' }\n      and D.intent in {'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order'}"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 58
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRHelpers"
      },
      {
        "url" : "name",
        "valueString" : "ToString"
      },
      {
        "url" : "statement",
        "valueString" : "define function ToString(value DeviceRequestStatus): value.value"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 59
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRHelpers"
      },
      {
        "url" : "name",
        "valueString" : "ToString"
      },
      {
        "url" : "statement",
        "valueString" : "define function ToString(value RequestIntent): value.value"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 60
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "Status"
      },
      {
        "url" : "name",
        "valueString" : "isSymptom"
      },
      {
        "url" : "statement",
        "valueString" : "//Symptom\ndefine fluent function isSymptom(Obs List<SimpleObservation>):\n  Obs O\n    where O.status in { 'preliminary', 'final', 'amended', 'corrected' }"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 61
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "Status"
      },
      {
        "url" : "name",
        "valueString" : "isMedicationActive"
      },
      {
        "url" : "statement",
        "valueString" : "//Medication, Active\ndefine fluent function isMedicationActive(MedicationRequest List<FHIR.MedicationRequest>):\n  MedicationRequest M\n    where M.status = 'active'\n      and M.intent in {'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order'}"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 62
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRHelpers"
      },
      {
        "url" : "name",
        "valueString" : "ToString"
      },
      {
        "url" : "statement",
        "valueString" : "define function ToString(value MedicationRequestStatus): value.value"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 63
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRHelpers"
      },
      {
        "url" : "name",
        "valueString" : "ToString"
      },
      {
        "url" : "statement",
        "valueString" : "define function ToString(value MedicationRequestIntent): value.value"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 64
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "CumulativeMedicationDuration"
      },
      {
        "url" : "name",
        "valueString" : "medicationRequestPeriod"
      },
      {
        "url" : "statement",
        "valueString" : "/*\nCalculates the Medication Period for a single MedicationRequest.\nMedicationRequest instances provided to this function are expected\nto conform to the [MMEMedicationRequest](http://build.fhir.org/ig/cqframework/opioid-mme-r4/StructureDefinition-mmemedicationrequest.html)\nprofile, which expects:\n* 1 and only 1 dosageInstruction, multiple dosageInstruction elements will result in an error\n* 1 and only 1 doseAndRate, multiple doseAndRate elements will result in an error\n* 1 timing with 1 repeat, missing timing or repeat elements will result in a null\n* frequency, frequencyMax, defaulting to 1\n* period, periodUnit, defaulting to 1 'd'\n* timeOfDay\n* doseQuantity or doseRange, missing doseQuantity and doseRange will result in a null\nNote that MedicationRequest status is not considered by this calculation, as the\nlist of MedicationRequest instances provided to this function should already have\nconsidered appropriate statuses, depending on the use case, typically `completed`.\n\nNOTE: Updated return to use \"date from end of boundsPeriod\" to ensure result is Interval<Date>\n*/\ndefine fluent function medicationRequestPeriod(Request MedicationRequest):\n  Request R\n    let\n      dosage: singleton from R.dosageInstruction,\n      doseAndRate: singleton from dosage.doseAndRate,\n      timing: dosage.timing,\n      frequency: Coalesce(timing.repeat.frequencyMax, timing.repeat.frequency),\n      period: Quantity(timing.repeat.period, timing.repeat.periodUnit),\n      doseRange: doseAndRate.dose as FHIR.Range,\n      doseQuantity: doseAndRate.dose as FHIR.SimpleQuantity,\n\n      dose: Coalesce(end of doseRange, doseQuantity),\n      dosesPerDay: Coalesce(ToDaily(frequency, period), Count(timing.repeat.timeOfDay), 1.0),\n      boundsPeriod: timing.repeat.bounds as Period,\n      // TODO: this isn't working as expected, convert results in null\n      //daysSupply: (convert(R.dispenseRequest.expectedSupplyDuration) to days).value,\n      daysSupply: (R.dispenseRequest.expectedSupplyDuration).value,\n      quantity: R.dispenseRequest.quantity,\n      refills: Coalesce(R.dispenseRequest.numberOfRepeatsAllowed, 0),\n      startDate:\n        Coalesce(\n          date from start of boundsPeriod,\n          date from R.authoredOn,\n          date from start of R.dispenseRequest.validityPeriod\n        ),\n      totalDaysSupplied: Coalesce(daysSupply, quantity.value / (dose.value * dosesPerDay)) * (1 + refills)\n    return\n      if startDate is not null and totalDaysSupplied is not null then\n        Interval[startDate, startDate + Quantity(totalDaysSupplied - 1, 'day') ]\n      else if startDate is not null and boundsPeriod.\"end\" is not null then\n        Interval[startDate, date from end of boundsPeriod]\n      else\n        null"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 65
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "CumulativeMedicationDuration"
      },
      {
        "url" : "name",
        "valueString" : "Quantity"
      },
      {
        "url" : "statement",
        "valueString" : "/**********************************************************************/\n/* Functions in this region are copied from opioid-mme-r4             */\n/**********************************************************************/\n\ndefine function Quantity(value Decimal, unit String):\n  if value is not null then\n    System.Quantity { value: value, unit: unit }\n  else\n    null"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 66
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRHelpers"
      },
      {
        "url" : "name",
        "valueString" : "ToDecimal"
      },
      {
        "url" : "statement",
        "valueString" : "define function ToDecimal(value decimal): value.value"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 67
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRHelpers"
      },
      {
        "url" : "name",
        "valueString" : "ToString"
      },
      {
        "url" : "statement",
        "valueString" : "define function ToString(value UnitsOfTime): value.value"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 68
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRHelpers"
      },
      {
        "url" : "name",
        "valueString" : "ToInterval"
      },
      {
        "url" : "statement",
        "valueString" : "/*\n@description: Converts the given FHIR [Range](https://hl7.org/fhir/datatypes.html#Range) value to a CQL Interval of Quantity\n*/\ndefine function ToInterval(range FHIR.Range):\n    if range is null then\n        null\n    else\n        Interval[ToQuantity(range.low), ToQuantity(range.high)]"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 69
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "CumulativeMedicationDuration"
      },
      {
        "url" : "name",
        "valueString" : "ToDaily"
      },
      {
        "url" : "statement",
        "valueString" : "/*\n Goal is to get to number of days\n Two broad approaches to the calculation:\n  1) Based on supply and frequency, calculate the number of expected days the medication will cover/has covered\n  2) Based on relevant period, determine a covered interval and calculate the length of that interval in days\n\nThis topic covers several use cases and illustrates how to calculate Cumulative\nMedication Duration for each type of medication resource using the supply and\nfrequency approach.\n*/\n\n/*\n  For the first approach, we need to get from frequency to a frequency/day\n  So we define ToDaily\n*/\n\n/*\n  Calculates daily frequency given frequency within a period\n*/\ndefine function ToDaily(frequency System.Integer, period System.Quantity):\n  case period.unit\n    when 'h' then frequency * (24.0 / period.value)\n    when 'min' then frequency * (24.0 / period.value) * 60\n    when 's' then frequency * (24.0 / period.value) * 60 * 60\n    when 'd' then frequency * (24.0 / period.value) / 24\n    when 'wk' then frequency * (24.0 / period.value) / (24 * 7)\n    when 'mo' then frequency * (24.0 / period.value) / (24 * 30) /* assuming 30 days in month */\n    when 'a' then frequency * (24.0 / period.value) / (24 * 365) /* assuming 365 days in year */\n    when 'hour' then frequency * (24.0 / period.value)\n    when 'minute' then frequency * (24.0 / period.value) * 60\n    when 'second' then frequency * (24.0 / period.value) * 60 * 60\n    when 'day' then frequency * (24.0 / period.value) / 24\n    when 'week' then frequency * (24.0 / period.value) / (24 * 7)\n    when 'month' then frequency * (24.0 / period.value) / (24 * 30) /* assuming 30 days in month */\n    when 'year' then frequency * (24.0 / period.value) / (24 * 365) /* assuming 365 days in year */\n    when 'hours' then frequency * (24.0 / period.value)\n    when 'minutes' then frequency * (24.0 / period.value) * 60\n    when 'seconds' then frequency * (24.0 / period.value) * 60 * 60\n    when 'days' then frequency * (24.0 / period.value) / 24\n    when 'weeks' then frequency * (24.0 / period.value) / (24 * 7)\n    when 'months' then frequency * (24.0 / period.value) / (24 * 30) /* assuming 30 days in month */\n    when 'years' then frequency * (24.0 / period.value) / (24 * 365) /* assuming 365 days in year */\n    else Message(null, true, 'CMDLogic.ToDaily.UnknownUnit', ErrorLevel, 'Unknown unit ' & period.unit)\n  end"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 70
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRHelpers"
      },
      {
        "url" : "name",
        "valueString" : "ToInteger"
      },
      {
        "url" : "statement",
        "valueString" : "define function ToInteger(value integer): value.value"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 71
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "USCoreCommon"
      },
      {
        "url" : "name",
        "valueString" : "race"
      },
      {
        "url" : "statement",
        "valueString" : "define fluent function race(patient Patient):\n  (patient.ext('http://hl7.org/fhir/us/core/StructureDefinition/us-core-race')) E\n    return {\n      ombCategory: (E.exts('ombCategory')) o return o.value as FHIR.Coding,\n      detailed: (E.exts('detailed')) d return d.value as FHIR.Coding,\n      text: E.ext('text').value as FHIR.string\n    }"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 72
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    }],
    "name" : "EffectiveDataRequirements",
    "status" : "active",
    "type" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/library-type",
        "code" : "module-definition"
      }]
    },
    "relatedArtifact" : [{
      "type" : "depends-on",
      "display" : "USQualityCore model information",
      "resource" : "https://madie.cms.gov/Library/USQualityCore-ModelInfo|0.1.0-cibuild"
    },
    {
      "type" : "depends-on",
      "display" : "USCore model information",
      "resource" : "http://hl7.org/fhir/us/cql/Library/USCore-ModelInfo|6.1.0-derived"
    },
    {
      "type" : "depends-on",
      "display" : "FHIR model information",
      "resource" : "http://hl7.org/fhir/uv/cql/Library/FHIR-ModelInfo|4.0.1"
    },
    {
      "type" : "depends-on",
      "display" : "Library SDE",
      "resource" : "https://madie.cms.gov/Library/SupplementalDataElements|6.1.000"
    },
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        "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.118.12.1300"
      }]
    },
    {
      "type" : "Observation",
      "profile" : ["http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-simple-observation"],
      "mustSupport" : ["code", "effective", "status"],
      "codeFilter" : [{
        "path" : "code",
        "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.113.12.1075"
      }]
    },
    {
      "extension" : [{
        "extension" : [{
          "url" : "targetId",
          "valueString" : "730"
        },
        {
          "url" : "targetProperty",
          "valueString" : "medication"
        }],
        "url" : "http://hl7.org/fhir/StructureDefinition/cqf-relatedRequirement"
      }],
      "type" : "Medication",
      "profile" : ["http://hl7.org/fhir/StructureDefinition/Medication"],
      "mustSupport" : ["id", "code"],
      "codeFilter" : [{
        "path" : "code",
        "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.196.12.1510"
      }]
    },
    {
      "id" : "730",
      "type" : "MedicationRequest",
      "profile" : ["http://hl7.org/fhir/StructureDefinition/MedicationRequest"],
      "mustSupport" : ["medication.reference",
      "status",
      "intent",
      "dosageInstruction",
      "dispenseRequest",
      "dispenseRequest.expectedSupplyDuration",
      "dispenseRequest.expectedSupplyDuration.value",
      "dispenseRequest.quantity",
      "dispenseRequest.numberOfRepeatsAllowed",
      "authoredOn",
      "dispenseRequest.validityPeriod"]
    },
    {
      "type" : "MedicationRequest",
      "profile" : ["http://hl7.org/fhir/StructureDefinition/MedicationRequest"],
      "mustSupport" : ["medication",
      "status",
      "intent",
      "dosageInstruction",
      "dispenseRequest",
      "dispenseRequest.expectedSupplyDuration",
      "dispenseRequest.expectedSupplyDuration.value",
      "dispenseRequest.quantity",
      "dispenseRequest.numberOfRepeatsAllowed",
      "authoredOn",
      "dispenseRequest.validityPeriod"],
      "codeFilter" : [{
        "path" : "medication",
        "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.196.12.1510"
      }]
    }]
  }],
  "extension" : [{
    "id" : "supplementalDataGuidance",
    "extension" : [{
      "url" : "guidance",
      "valueString" : "For every patient evaluated by this measure also identify payer, race, ethnicity and sex"
    },
    {
      "url" : "usage",
      "valueCodeableConcept" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/measure-data-usage",
          "code" : "supplemental-data",
          "display" : "Supplemental Data"
        }],
        "text" : "Supplemental Data Guidance"
      }
    }],
    "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-supplementalDataGuidance"
  },
  {
    "url" : "http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-effectiveDataRequirements",
    "valueCanonical" : "#effective-data-requirements"
  }],
  "url" : "https://madie.cms.gov/Measure/CMS122FHIRDiabetesAssessGT9Pct",
  "identifier" : [{
    "use" : "usual",
    "type" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/artifact-identifier-type",
        "code" : "short-name",
        "display" : "Short Name"
      }]
    },
    "system" : "https://madie.cms.gov/measure/shortName",
    "value" : "CMS122FHIR"
  },
  {
    "use" : "official",
    "type" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/artifact-identifier-type",
        "code" : "version-independent",
        "display" : "Version Independent"
      }]
    },
    "system" : "urn:ietf:rfc:3986",
    "value" : "urn:uuid:f04ee808-8ece-4936-8b26-fafa462e1594"
  },
  {
    "use" : "official",
    "type" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/artifact-identifier-type",
        "code" : "version-specific",
        "display" : "Version Specific"
      }]
    },
    "system" : "urn:ietf:rfc:3986",
    "value" : "urn:uuid:2ea22cb2-9bcc-4ca6-b2f2-68fc964365ad"
  },
  {
    "use" : "official",
    "type" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/artifact-identifier-type",
        "code" : "publisher",
        "display" : "Publisher"
      }]
    },
    "system" : "https://madie.cms.gov/measure/cmsId",
    "value" : "122FHIR",
    "assigner" : {
      "display" : "CMS"
    }
  }],
  "version" : "1.1.000",
  "name" : "CMS122FHIRDiabetesAssessGT9Pct",
  "title" : "Diabetes: Glycemic Status Assessment Greater Than 9%FHIR",
  "status" : "active",
  "experimental" : false,
  "date" : "2026-01-16T18:18:12+00:00",
  "publisher" : "National Committee for Quality Assurance",
  "contact" : [{
    "telecom" : [{
      "system" : "url",
      "value" : "https://www.ncqa.org/"
    }]
  }],
  "description" : "Percentage of patients 18-75 years of age with diabetes who had a glycemic status assessment (hemoglobin A1c [HbA1c] or glucose management indicator [GMI]) &gt; 9.0% during the measurement period",
  "usage" : "If the glycemic status assessment (HbA1c or GMI) is in the medical record, the test can be used to determine numerator compliance. Glycemic status assessment (HbA1c or GMI) must be reported as a percentage (%). If multiple glycemic status assessments were recorded for a single date, use the lowest result. This eCQM is a patient-based measure. This FHIR-based measure has been derived from the QDM-based measure: CMS122v14. Please refer to the HL7 QI-Core Implementation Guide (https://hl7.org/fhir/us/qicore/STU6/) for more information on QI-Core and mapping recommendations from QDM to QI-Core STU 6. (https://hl7.org/fhir/us/qicore/STU6/qdm-to-qicore.html).",
  "copyright" : "This Physician Performance Measure (Measure) and related data specifications are owned and were developed by the National Committee for Quality Assurance (NCQA). NCQA is not responsible for any use of the Measure. NCQA makes no representations, warranties or endorsements about the quality of any product, test or protocol identified as numerator compliant or otherwise identified as meeting the requirements of the measure or specification. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures or specifications. NCQA holds a copyright in the Measure. The Measure may be used for internal, noncommercial purposes (e.g., use by healthcare providers in connection with their practices) without obtaining approval from NCQA. All other uses, including a commercial use (including but not limited to vendors using or embedding the measures and specifications into any product or service to calculate measure results for customers for any purpose), must be approved by NCQA and are subject to a license at the discretion of NCQA. (C) 2012-2025 National Committee for Quality Assurance. All Rights Reserved. Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. NCQA disclaims all liability for use or accuracy of any third-party codes contained in the specifications. CPT(R) codes, descriptions and other data are copyright 2025. American Medical Association. All rights reserved. CPT is a trademark of the American Medical Association. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. Applicable FARS/DFARS restrictions apply to government use. Some measure specifications contain coding from LOINC(R) (https://loinc.org). The LOINC table, LOINC codes, LOINC panels and form file, LOINC linguistic variants file, LOINC/RSNA Radiology Playbook, and LOINC/IEEE Medical Device Code Mapping Table are copyright 2004-2025 Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee, and are available at no cost under the license at https://loinc.org/kb/license/. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2024 International Health Terminology Standards Development Organisation. ICD-10 copyright 2025 World Health Organization. All Rights Reserved. Some measures use RxNorm, a standardized nomenclature and coding for clinical drugs and drug delivery devices, which is made publicly available courtesy of the U.S. National Library of Medicine (NLM), National Institutes of Health, Department of Health and Human Services. NLM is not responsible for the measures and does not endorse or recommend this or any other product. “HL7” is the registered trademark of Health Level Seven International.",
  "effectivePeriod" : {
    "start" : "2026-01-01",
    "end" : "2026-12-31"
  },
  "author" : [{
    "name" : "National Committee for Quality Assurance",
    "telecom" : [{
      "system" : "url",
      "value" : "https://www.ncqa.org/"
    }]
  }],
  "relatedArtifact" : [{
    "type" : "citation",
    "citation" : "American Diabetes Association. (2018). Economic Costs of Diabetes in the U.S. in 2017. Diabetes Care, 41, 917-928. Retrieved from http://care.diabetesjournals.org/content/early/2018/03/20/dci18-0007"
  },
  {
    "type" : "citation",
    "citation" : "American Diabetes Association. (2022a). Statistics About Diabetes. Retrieved from https://diabetes.org/about-us/statistics/about-diabetes"
  },
  {
    "type" : "citation",
    "citation" : "Centers for Disease Control and Prevention. (2022a). What is Diabetes? Retrieved from https://www.cdc.gov/diabetes/basics/diabetes.html"
  },
  {
    "type" : "citation",
    "citation" : "Centers for Disease Control and Prevention. (2022b). Diabetes Report Card 2021. US Dept of Health and Human Services. Retrieved from https://archive.cdc.gov/www_cdc_gov/diabetes/library/reports/reportcard.html"
  },
  {
    "type" : "citation",
    "citation" : "ElSayed, N.A., Aleppo, G., Ardoda, V.R., Bannuru, R.B., Brown, F.M., Bruemmer, D.,…Staton, R.C., American Diabetes Association (ADA). (2022). 6. Glycemic Targets: Standards of Care in Diabetes—2023. Diabetes Care 2023,46(Supplement_1):S97–S110. https://doi.org/10.2337/dc23-S006"
  }],
  "library" : ["https://madie.cms.gov/Library/CMS122FHIRDiabetesAssessGT9Pct"],
  "disclaimer" : "The performance Measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications. THE MEASURE AND SPECIFICATIONS ARE PROVIDED \"AS IS\" WITHOUT WARRANTY OF ANY KIND. Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].",
  "rationale" : "Diabetes is the seventh leading cause of death in the United States (Centers for Disease Control and Prevention [CDC], 2022a). In 2019, diabetes affected more than 37 million Americans (11.3% of the U.S. population) and killed more than 87,000 people (American Diabetes Association [ADA], 2022a). Diabetes is a long-lasting disease marked by high blood glucose levels, resulting from the body's inability to produce or use insulin properly (CDC, 2022a). People with diabetes are at increased risk of serious health complications including vision loss, heart disease, stroke, kidney damage, amputation of feet or legs, and premature death (CDC, 2022b). In 2017, diabetes cost the U.S. an estimated $327 billion: $237 billion in direct medical costs and $90 billion in reduced productivity. This is a 34% increase from the estimated $245 billion spent on diabetes in 2012 (ADA, 2018). Controlling A1c blood levels helps reduce the risk of microvascular complications (eye, kidney and nerve diseases) (ADA, 2022b).",
  "clinicalRecommendationStatement" : "American Diabetes Association (2023): - Assess glycemic status (A1C or other glycemic measurement such as time in range or glucose management indicator) at least two times a year in patients who are meeting treatment goals (and who have stable glycemic control). (Level of evidence: E) - An A1C goal for many nonpregnant adults of &lt;7% (53 mmol/mol) without significant hypoglycemia is appropriate. (Level of evidence: A) - On the basis of health care professional judgement and patient preference, achievement of lower A1C levels than the goal of 7% may be acceptable and even beneficial if it can be achieved safely without significant hypoglycemia or other adverse effects of treatment. (Level of evidence: B) - Less stringent A1C goals (such as &lt;8% [64 mmol/mol]) may be appropriate for patients with limited life expectancy or where the harms of treatment are greater than the benefits. Health care professionals should consider deintensification of therapy if appropriate to reduce the risk of hypoglycemia in patients with inappropriate stringent A1C targets. (Level of evidence: B) - Standardized, single-page glucose reports from continuous glucose monitoring (CGM) devices with visual cues, such as the ambulatory glucose profile, should be considered as a standard summary for all CGM devices. Level of evidence: E",
  "group" : [{
    "id" : "Group_1",
    "extension" : [{
      "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring",
      "valueCodeableConcept" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/measure-scoring",
          "code" : "proportion",
          "display" : "Proportion"
        }]
      }
    },
    {
      "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis",
      "valueCode" : "boolean"
    },
    {
      "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-type",
      "valueCodeableConcept" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/measure-type",
          "code" : "intermediate-outcome",
          "display" : "Intermediate Outcome"
        }]
      }
    },
    {
      "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-rateAggregation",
      "valueCode" : "None"
    },
    {
      "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-improvementNotation",
      "valueCodeableConcept" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/measure-improvement-notation",
          "code" : "increase",
          "display" : "Increased score indicates improvement"
        }]
      }
    }],
    "population" : [{
      "id" : "InitialPopulation_1",
      "code" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
          "code" : "initial-population",
          "display" : "Initial Population"
        }]
      },
      "description" : "Patients 18-75 years of age by the end of the measurement period, with diabetes with a visit during the measurement period",
      "criteria" : {
        "language" : "text/cql-identifier",
        "expression" : "Initial Population"
      }
    },
    {
      "id" : "Denominator_1",
      "code" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
          "code" : "denominator",
          "display" : "Denominator"
        }]
      },
      "description" : "Equals Initial Population",
      "criteria" : {
        "language" : "text/cql-identifier",
        "expression" : "Denominator"
      }
    },
    {
      "id" : "DenominatorExclusion_1",
      "code" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
          "code" : "denominator-exclusion",
          "display" : "Denominator Exclusion"
        }]
      },
      "description" : "Exclude patients who are in hospice care for any part of the measurement period. Exclude patients 66 and older by the end of the measurement period who are living long term in a nursing home any time on or before the end of the measurement period. Exclude patients 66 and older by the end of the measurement period with an indication of frailty for any part of the measurement period who also meet any of the following advanced illness criteria: - Advanced illness diagnosis during the measurement period or the year prior - OR taking dementia medications during the measurement period or the year prior Exclude patients receiving palliative care for any part of the measurement period.",
      "criteria" : {
        "language" : "text/cql-identifier",
        "expression" : "Denominator Exclusions"
      }
    },
    {
      "id" : "Numerator_1",
      "code" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
          "code" : "numerator",
          "display" : "Numerator"
        }]
      },
      "description" : "Patients whose most recent glycemic status assessment (HbA1c or GMI) (performed during the measurement period) is &gt;9.0% or is missing, or was not performed during the measurement period",
      "criteria" : {
        "language" : "text/cql-identifier",
        "expression" : "Numerator"
      }
    }]
  }],
  "supplementalData" : [{
    "id" : "sde-ethnicity",
    "usage" : [{
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/measure-data-usage",
        "code" : "supplemental-data"
      }]
    }],
    "description" : "SDE Ethnicity",
    "criteria" : {
      "language" : "text/cql-identifier",
      "expression" : "SDE Ethnicity"
    }
  },
  {
    "id" : "sde-payer",
    "usage" : [{
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/measure-data-usage",
        "code" : "supplemental-data"
      }]
    }],
    "description" : "SDE Payer",
    "criteria" : {
      "language" : "text/cql-identifier",
      "expression" : "SDE Payer"
    }
  },
  {
    "id" : "sde-race",
    "usage" : [{
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/measure-data-usage",
        "code" : "supplemental-data"
      }]
    }],
    "description" : "SDE Race",
    "criteria" : {
      "language" : "text/cql-identifier",
      "expression" : "SDE Race"
    }
  },
  {
    "id" : "sde-sex",
    "usage" : [{
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/measure-data-usage",
        "code" : "supplemental-data"
      }]
    }],
    "description" : "SDE Sex",
    "criteria" : {
      "language" : "text/cql-identifier",
      "expression" : "SDE Sex"
    }
  }]
}

```
