define "Initial Population":
  AgeInYearsAt(date from start of "Measurement Period") >= 12
    and ( Count("Qualifying Visit During Measurement Period") >= 2
        or exists "Preventive Visit During Measurement Period"
    )

define "Denominator 1":
  "Initial Population"

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

define "Numerator 1":
  "Most Recent Tobacco Use Screening Indicates Tobacco Non User" is not null
    or "Most Recent Tobacco Use Screening Indicates Tobacco User" is not null

define "Initial Population":
  AgeInYearsAt(date from start of "Measurement Period") >= 12
    and ( Count("Qualifying Visit During Measurement Period") >= 2
        or exists "Preventive Visit During Measurement Period"
    )

define "Denominator 2":
  "Initial Population"
    and "Most Recent Tobacco Use Screening Indicates Tobacco User" is not null

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

define "Numerator 2":
  exists "Tobacco Cessation Counseling Given"
    or exists "Tobacco Cessation Pharmacotherapy Ordered"
    or exists "Active Pharmacotherapy for Tobacco Cessation"

define "Initial Population":
  AgeInYearsAt(date from start of "Measurement Period") >= 12
    and ( Count("Qualifying Visit During Measurement Period") >= 2
        or exists "Preventive Visit During Measurement Period"
    )

define "Denominator 3":
  "Initial Population"

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

define "Numerator 3":
  "Most Recent Tobacco Use Screening Indicates Tobacco Non User" is not null
    or ( "Most Recent Tobacco Use Screening Indicates Tobacco User" is not null
        and ( exists "Tobacco Cessation Counseling Given"
            or exists "Tobacco Cessation Pharmacotherapy Ordered"
            or exists "Active Pharmacotherapy for Tobacco Cessation"
        )
    )

define "Has Hospice Services":
  exists ((([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 ((([Encounter: "Hospice Encounter"]).isEncounterPerformed()) HospiceEncounter
        where HospiceEncounter.period overlaps day of "Measurement Period"
    )
    or exists ((([ObservationScreeningAssessment: "Hospice care [Minimum Data Set]"]).isAssessmentPerformed()) HospiceAssessment
        where HospiceAssessment.value ~ "Yes (qualifier value)"
          and HospiceAssessment.effective.toInterval() overlaps day of "Measurement Period"
    )
    or exists ((([ServiceRequest: "Hospice Care Ambulatory"]).isInterventionOrder()) HospiceOrder
        where HospiceOrder.authoredOn during day of "Measurement Period"
    )
    or exists ((([Procedure: "Hospice Care Ambulatory"]).isInterventionPerformed()) HospicePerformed
        where HospicePerformed.performed.toInterval() overlaps day of "Measurement Period"
    )
    or exists ((([ConditionProblemsHealthConcerns: "Hospice Diagnosis"]
        union [ConditionEncounterDiagnosis: "Hospice Diagnosis"]).verified()) HospiceCareDiagnosis
        where HospiceCareDiagnosis.prevalenceInterval() overlaps day of "Measurement Period"
    )

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

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

define "SDE Ethnicity":
  Patient.ethnicity E
    return Tuple {
      codes: { E.ombCategory } union E.detailed,
      display: E.text
    }

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

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

define "Qualifying Visit During Measurement Period":
  ( ( ( [Encounter] E
        where exists ( ( E.type ) T
            where T ~ "Health behavior intervention, individual, face-to-face; initial 30 minutes"
        )
    )
      union ( [Encounter] E
          where exists ( ( E.type ) T
              where T ~ "Health behavior assessment, or re-assessment (ie, health-focused clinical interview, behavioral observations, clinical decision making)"
          )
      )
      union [Encounter: "Home Healthcare Services"]
      union [Encounter: "Occupational Therapy Evaluation"]
      union [Encounter: "Office Visit"]
      union [Encounter: "Ophthalmological Services"]
      union [Encounter: "Physical Therapy Evaluation"]
      union [Encounter: "Psych Visit Diagnostic Evaluation"]
      union [Encounter: "Psych Visit Psychotherapy"]
      union [Encounter: "Psychoanalysis"]
      union [Encounter: "Speech and Hearing Evaluation"]
      union [Encounter: "Telephone Visits"]
      union [Encounter: "Virtual Encounter"]
  ).isEncounterPerformed ( ) ) OfficeBasedEncounter
    where OfficeBasedEncounter.period during day of "Measurement Period"

define "Preventive Visit During Measurement Period":
  ( ( [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: "Preventive Care, Established Office Visit, 0 to 17"]
      union [Encounter: "Preventive Care Services, Initial Office Visit, 0 to 17"]
      union [Encounter: "Preventive Care Services Group Counseling"]
      union [Encounter: "Preventive Care Services Individual Counseling"]
      union ( [Encounter] E
          where exists ( ( E.type ) T
              where T ~ "Unlisted preventive medicine service"
          )
      )
      union ( [Encounter] E
          where exists ( ( E.type ) T
              where T ~ "Postoperative follow-up visit, normally included in the surgical package, to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) related to the original procedure"
          )
      )
      union [Encounter: "Nutrition Services"]
  ).isEncounterPerformed ( ) ) PreventiveEncounter
    where PreventiveEncounter.period during day of "Measurement Period"

define "Initial Population":
  AgeInYearsAt(date from start of "Measurement Period") >= 12
    and ( Count("Qualifying Visit During Measurement Period") >= 2
        or exists "Preventive Visit During Measurement Period"
    )

define "Denominator 3":
  "Initial Population"

define "Most Recent Tobacco Use Screening Indicates Tobacco Non User":
  ( Last((([USCoreSmokingStatusProfile]).isObservationSmokingStatus()) TobaccoUseScreening
      where TobaccoUseScreening.effective.toInterval() during day of "Measurement Period"
      sort by start of effective.toInterval()
  ) ) MostRecentTobaccoUseScreening
    where MostRecentTobaccoUseScreening.value as Concept in "Tobacco Non User"

define "Most Recent Tobacco Use Screening Indicates Tobacco User":
  ( Last((([USCoreSmokingStatusProfile]).isObservationSmokingStatus()) TobaccoUseScreening
      where TobaccoUseScreening.effective.toInterval() during day of "Measurement Period"
      sort by start of effective.toInterval()
  ) ) MostRecentTobaccoUseScreening
    where MostRecentTobaccoUseScreening.value as Concept in "Tobacco User"

define "Tobacco Cessation Counseling Given":
  ( ( ( [Procedure: "Tobacco Use Cessation Counseling"] ).isInterventionPerformed ( ) ) TobaccoCessationCounseling
      where TobaccoCessationCounseling.performed.toInterval ( ) during day of Interval[start of "Measurement Period" - 6 months, end of "Measurement Period"]
  )
    union ( ( ( [ConditionProblemsHealthConcerns: "Tobacco abuse counseling"]
          union [ConditionEncounterDiagnosis: "Tobacco abuse counseling"]
      ).verified ( ) ) TobaccoCounseling
        where TobaccoCounseling.prevalenceInterval ( ) starts during day of Interval[start of "Measurement Period" - 6 months, end of "Measurement Period"]
    )

define "Tobacco Cessation Pharmacotherapy Ordered":
  ( ( [MedicationRequest: "Tobacco Use Cessation Pharmacotherapy"] ).isMedicationOrder ( ) ) CessationPharmacotherapyOrdered
    where CessationPharmacotherapyOrdered.authoredOn during day of Interval[start of "Measurement Period" - 6 months, end of "Measurement Period"]
      and not exists ( [TaskRejected] TaskReject
          where TaskReject.focus.references ( CessationPharmacotherapyOrdered )
            and TaskReject.code ~ "fulfill"
      )

define "Active Pharmacotherapy for Tobacco Cessation":
  ( ( [MedicationRequest: "Tobacco Use Cessation Pharmacotherapy"] ).isMedicationActive ( ) ) TakingCessationPharmacotherapy
    where TakingCessationPharmacotherapy.medicationRequestPeriod ( ) during day of Interval[start of "Measurement Period" - 6 months, end of "Measurement Period"]

define "Numerator 3":
  "Most Recent Tobacco Use Screening Indicates Tobacco Non User" is not null
    or ( "Most Recent Tobacco Use Screening Indicates Tobacco User" is not null
        and ( exists "Tobacco Cessation Counseling Given"
            or exists "Tobacco Cessation Pharmacotherapy Ordered"
            or exists "Active Pharmacotherapy for Tobacco Cessation"
        )
    )

define "Denominator 2":
  "Initial Population"
    and "Most Recent Tobacco Use Screening Indicates Tobacco User" is not null

define "Numerator 1":
  "Most Recent Tobacco Use Screening Indicates Tobacco Non User" is not null
    or "Most Recent Tobacco Use Screening Indicates Tobacco User" is not null

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

define "Numerator 2":
  exists "Tobacco Cessation Counseling Given"
    or exists "Tobacco Cessation Pharmacotherapy Ordered"
    or exists "Active Pharmacotherapy for Tobacco Cessation"

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

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

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

define "Denominator 1":
  "Initial Population"

define function ToString(value uri): value.value

/*
@description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept.
*/
define function ToConcept(concept FHIR.CodeableConcept):
    if concept is null then
        null
    else
        System.Concept {
            codes: concept.coding C return ToCode(C),
            display: concept.text.value
        }

/*
@description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code.
*/
define function ToCode(coding FHIR.Coding):
    if coding is null then
        null
    else
        System.Code {
          code: coding.code.value,
          system: coding.system.value,
          version: coding.version.value,
          display: coding.display.value
        }

/*
@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]

/*
@description: Normalizes a value that is a choice of timing-valued types to an equivalent interval
@comment: Normalizes a choice type of DateTime, Quanitty, Interval<DateTime>, or Interval<Quantity> 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 QICore, allowing this function to be used across any resource.
The input can be provided as a DateTime, Quantity, Interval<DateTime> or Interval<Quantity>.
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 Quantity, the quantity is expected to be a calendar-duration interpreted as an Age,
and the result is a DateTime Interval beginning on the Date the patient turned that age and ending immediately before one year later.
If the input is a DateTime Interval, the result is the input.
If the input is a Quantity Interval, the quantities are expected to be calendar-durations interpreted as an Age, and the result
is a DateTime Interval beginning on the date the patient turned the age given as the start of the quantity interval, and ending
immediately before one year later than the date the patient turned the age given as the end of the quantity interval.
If the input is a Timing, an error will be thrown indicating that Timing calculations are not implemented. Any other input will reslt in a null DateTime Interval
*/
define fluent function toInterval(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>, Timing>):
  case
	  when choice is DateTime then
    	Interval[choice as DateTime, choice as DateTime]
		when choice is Interval<DateTime> then
  		choice as Interval<DateTime>
		when choice is Quantity then
		  Interval[Patient.birthDate + (choice as Quantity),
			  Patient.birthDate + (choice as Quantity) + 1 year)
		when choice is Interval<Quantity> then
		  Interval[Patient.birthDate + (choice.low as Quantity),
			  Patient.birthDate + (choice.high as Quantity) + 1 year)
		when choice is Timing then
      Message(null, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a Timing value is not supported') as Interval<DateTime>
		else
			null as Interval<DateTime>
	end

/*
@description: Returns true if the given reference is to the given resource
@comment: Returns true if the `id` element of the given resource exactly equals the tail of the given reference.
NOTE: This function assumes resources from the same source server.
*/
define fluent function references(reference Reference, resource Resource):
  resource.id = Last(Split(reference.reference, '/'))

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,
      doseQuantity: doseAndRate.dose,
      dose: Coalesce(end of doseRange, doseQuantity),
      dosesPerDay: Coalesce(ToDaily(frequency, period), Count(timing.repeat.timeOfDay), 1.0),
      boundsPeriod: timing.repeat.bounds as Interval<DateTime>,
      daysSupply: (convert R.dispenseRequest.expectedSupplyDuration to days).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."high" is not null then
        Interval[startDate, date from end of boundsPeriod]
      else
        null

/**********************************************************************/
/* 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

/*
 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

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

//Observation Smoking Status
define fluent function isObservationSmokingStatus(Obs List<USCoreSmokingStatusProfile>):
  Obs O
    where O.status = 'final'

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

//This library contains functions used to constrain FHIR resource elements for measures authored by NCQA, based on QICore 6.0.0 resources including IG and authoring patterns. The functions may appear similar to some QICoreCommon functions but differ in that they have constraints that are relevant for measures authored by NCQA.

//Condition
//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<Choice<ConditionProblemsHealthConcerns, ConditionEncounterDiagnosis>>):
  conditions C
    where C.verificationStatus is not null implies
      (C.verificationStatus ~ "confirmed"
        or C.verificationStatus ~ "unconfirmed"
        or C.verificationStatus ~ "provisional"
        or C.verificationStatus ~ "differential"
      )

//Medication, Order
define fluent function isMedicationOrder(MedicationRequest List<MedicationRequest>):
  MedicationRequest M
    where M.status in { 'active', 'completed' }
    and M.intent in {'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order'}

//Medication, Active
define fluent function isMedicationActive(MedicationRequest List<MedicationRequest>):
  MedicationRequest M
    where M.status = 'active'
      and M.intent in {'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order'}

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

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