define "Initial Population":
  [Encounter: "Encounter Inpatient"] EncounterInpatient
    where EncounterInpatient.period ends during day of "Measurement Period"
      and AgeInYearsAt(date from start of EncounterInpatient.period) >= 18
      and ( duration in hours of EncounterInpatient.period >= 24 )
      and EncounterInpatient.status = 'finished'

define "Measure Population":
  "Initial Population"

define "Measure Population Exclusion":
  "Encounters with Discharge for Hospice Care"
    union "Encounters with Hospice during Eligible Encounter"

define function "Measure Observation 1"(MalnutritionRiskScreening Encounter):
  if "Encounters with Malnutrition Risk Screening or with Dietitian Referral" contains MalnutritionRiskScreening then 1 
    else 0

define "Initial Population":
  [Encounter: "Encounter Inpatient"] EncounterInpatient
    where EncounterInpatient.period ends during day of "Measurement Period"
      and AgeInYearsAt(date from start of EncounterInpatient.period) >= 18
      and ( duration in hours of EncounterInpatient.period >= 24 )
      and EncounterInpatient.status = 'finished'

define "Measure Population":
  "Initial Population"

define "Measure Population Exclusion":
  "Encounters with Discharge for Hospice Care"
    union "Encounters with Hospice during Eligible Encounter"

define function "Measure Observation 2"(NutritionAssessment Encounter):
  if "Encounters with Malnutrition Not At Risk Screening and without Dietitian Referral" contains NutritionAssessment then 0 
    else if "Encounters with Malnutrition Risk Screening At Risk or with Dietitian Referral" contains NutritionAssessment then if "Encounter With Most Recent Nutrition Assessment And Identified Status" contains NutritionAssessment then 1 
    else 0 
    else 0

define "Initial Population":
  [Encounter: "Encounter Inpatient"] EncounterInpatient
    where EncounterInpatient.period ends during day of "Measurement Period"
      and AgeInYearsAt(date from start of EncounterInpatient.period) >= 18
      and ( duration in hours of EncounterInpatient.period >= 24 )
      and EncounterInpatient.status = 'finished'

define "Measure Population":
  "Initial Population"

define "Measure Population Exclusion":
  "Encounters with Discharge for Hospice Care"
    union "Encounters with Hospice during Eligible Encounter"

define function "Measure Observation 3"(MalnutritionDiagnosis Encounter):
  if "Encounters with Malnutrition Not At Risk Screening and without Dietitian Referral" contains MalnutritionDiagnosis then 0 
    else if "Encounters with Malnutrition Risk Screening At Risk or with Dietitian Referral" contains MalnutritionDiagnosis then if "Encounters with Malnutrition Diagnosis" contains MalnutritionDiagnosis then if "Encounter With Most Recent Nutrition Assessment Status of Not or Mildly Malnourished" contains MalnutritionDiagnosis then 0 
    else if "Encounter With Most Recent Nutrition Assessment Status of Moderately Or Severely Malnourished" contains MalnutritionDiagnosis then 1 
    else 0 
    else 0 
    else 0

define "Initial Population":
  [Encounter: "Encounter Inpatient"] EncounterInpatient
    where EncounterInpatient.period ends during day of "Measurement Period"
      and AgeInYearsAt(date from start of EncounterInpatient.period) >= 18
      and ( duration in hours of EncounterInpatient.period >= 24 )
      and EncounterInpatient.status = 'finished'

define "Measure Population":
  "Initial Population"

define "Measure Population Exclusion":
  "Encounters with Discharge for Hospice Care"
    union "Encounters with Hospice during Eligible Encounter"

define function "Measure Observation 4"(NutritionCarePlan Encounter):
  if "Encounters with Malnutrition Not At Risk Screening and without Dietitian Referral" contains NutritionCarePlan then 0 
    else if "Encounters with Malnutrition Risk Screening At Risk or with Dietitian Referral" contains NutritionCarePlan then if "Encounters with Nutrition Care Plan" contains NutritionCarePlan then if "Encounter With Most Recent Nutrition Assessment Status of Not or Mildly Malnourished" contains NutritionCarePlan then 0 
    else if "Encounter With Most Recent Nutrition Assessment Status of Moderately Or Severely Malnourished" contains NutritionCarePlan then 1 
    else 0 
    else 0 
    else 0

define "Initial Population":
  [Encounter: "Encounter Inpatient"] EncounterInpatient
    where EncounterInpatient.period ends during day of "Measurement Period"
      and AgeInYearsAt(date from start of EncounterInpatient.period) >= 18
      and ( duration in hours of EncounterInpatient.period >= 24 )
      and EncounterInpatient.status = 'finished'

define "Measure Population":
  "Initial Population"

define "Measure Population Exclusion":
  "Encounters with Discharge for Hospice Care"
    union "Encounters with Hospice during Eligible Encounter"

define function "Measure Observation Total Malnutrition Components Score"(QualifyingEncounter Encounter):
  Sum({ "Measure Observation 1"(QualifyingEncounter), "Measure Observation 2"(QualifyingEncounter), "Measure Observation 3"(QualifyingEncounter), "Measure Observation 4"(QualifyingEncounter) })

define "Initial Population":
  [Encounter: "Encounter Inpatient"] EncounterInpatient
    where EncounterInpatient.period ends during day of "Measurement Period"
      and AgeInYearsAt(date from start of EncounterInpatient.period) >= 18
      and ( duration in hours of EncounterInpatient.period >= 24 )
      and EncounterInpatient.status = 'finished'

define "Measure Population":
  "Initial Population"

define "Measure Population Exclusion":
  "Encounters with Discharge for Hospice Care"
    union "Encounters with Hospice during Eligible Encounter"

define function "Measure Observation Total Malnutrition Care Score as Percentage"(QualifyingEncounter Encounter):
  100 * ( "Measure Observation Total Malnutrition Components Score"(QualifyingEncounter) / "Total Malnutrition Care Score Eligible Occurrences"(QualifyingEncounter) )

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

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
    }

/*
@description: Converts the given [Period](https://hl7.org/fhir/datatypes.html#Period)
value to a CQL DateTime Interval
@comment: If the start value of the given period is unspecified, the starting
boundary of the resulting interval will be open (meaning the start of the interval
is unknown, as opposed to interpreted as the beginning of time).
*/
define function ToInterval(period FHIR.Period):
    if period is null then
        null
    else
        if period."start" is null then
            Interval(period."start".value, period."end".value]
        else
            Interval[period."start".value, period."end".value]

define function ToString(value uri): value.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 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
        }

//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"
      )

/*
@description: Hospitalization with Observation returns the total interval from the start of any immediately prior emergency department visit through the observation visit to the discharge of the given encounter
*/
define fluent function hospitalizationWithObservation(TheEncounter Encounter ):
  TheEncounter Visit
  		let ObsVisit: Last([Encounter: "Observation Services"] LastObs
  				where LastObs.status = 'finished'
            and LastObs.period ends 1 hour or less on or before start of Visit.period
  				sort by end of period
  			),
  			VisitStart: Coalesce(start of ObsVisit.period, start of Visit.period),
  			EDVisit: Last([Encounter: "Emergency Department Visit"] LastED
  				where LastED.status = 'finished'
            and LastED.period ends 1 hour or less on or before VisitStart
  				sort by end of period
  			)
  		return Interval[Coalesce(start of EDVisit.period, VisitStart), end of Visit.period]

/*  
@description: Returns the Condition resources referenced by the diagnosis element of the Encounter  
*/
define fluent function encounterDiagnosis(Encounter Encounter ):
  Encounter.reasonReference D
    return singleton from (([ConditionEncounterDiagnosis] union [ConditionProblemsHealthConcerns]) C where D.references(C.id))

/*
@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: 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<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>> ):
  (choice.toInterval()) period
    return
      if (period."hasEnd"()) then end of period
      else start of period

/*
@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
  )

/*
@description: Returns an interval representing the normalized prevalence period of a given Condition.
@comment: Uses the ToInterval and ToAbatementInterval functions to determine the widest potential interval from
onset to abatement as specified in the given Condition. If the condition is active, or has an abatement date the resulting 
interval will have a closed ending boundary. Otherwise, the resulting interval will have an open ending boundary.
*/
define fluent function prevalenceInterval(condition Choice<"ConditionEncounterDiagnosis", "ConditionProblemsHealthConcerns">):
if condition.clinicalStatus ~ "active"
  or condition.clinicalStatus ~ "recurrence"
  or condition.clinicalStatus ~ "relapse" then
  Interval[start of condition.onset.toInterval(), end of condition.abatementInterval()]
else
    (end of condition.abatementInterval()) abatementDate
    return if abatementDate is null then
      Interval[start of condition.onset.toInterval(), abatementDate)
    else
      Interval[start of condition.onset.toInterval(), abatementDate]

/*
@description: Returns an interval representing the normalized abatement of a given Condition.
@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.
*/
define fluent function abatementInterval(condition Choice<"ConditionEncounterDiagnosis", "ConditionProblemsHealthConcerns">):
	if condition.abatement is DateTime then
	  Interval[condition.abatement as DateTime, condition.abatement as DateTime]
	else if condition.abatement is Quantity then
		Interval[Patient.birthDate + (condition.abatement as Quantity),
			Patient.birthDate + (condition.abatement as Quantity) + 1 year)
	else if condition.abatement is Interval<Quantity> then
	  Interval[Patient.birthDate + (condition.abatement.low as Quantity),
		  Patient.birthDate + (condition.abatement.high as Quantity) + 1 year)
	else if condition.abatement is Interval<DateTime> then
	  Interval[condition.abatement.low, condition.abatement.high)
	else null as Interval<DateTime>

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

/*
@description: Given an interval, return the starting point if the interval has a starting boundary specified,
otherwise, return the ending point
*/
define fluent function earliest(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>> ):
  (choice.toInterval()) period
    return
      if (period."hasStart"()) then start of period
      else end of period

/*
@description: Given an interval, return true if the interval has a starting boundary specified
(i.e. the start of the interval is not null and not the minimum DateTime value)
*/
define fluent function hasStart(period Interval<DateTime> ):
  not ( start of period is null
      or start of period = minimum DateTime
  )

define "Initial Population":
  [Encounter: "Encounter Inpatient"] EncounterInpatient
    where EncounterInpatient.period ends during day of "Measurement Period"
      and AgeInYearsAt(date from start of EncounterInpatient.period) >= 18
      and ( duration in hours of EncounterInpatient.period >= 24 )
      and EncounterInpatient.status = 'finished'

define "Measure Population":
  "Initial Population"

define "Encounters with Discharge for Hospice Care":
  "Measure Population" QualifyingEncounter
    where QualifyingEncounter.hospitalization.dischargeDisposition in "Hospice Care Referral or Admission"

define "Intervention Hospice Care":
  ( ["ServiceRequest": "Hospice Status"] HospiceStatusOrder
      where HospiceStatusOrder.status in { 'active', 'completed', 'on-hold' }
        and HospiceStatusOrder.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
  )
    union ( ["Procedure": "Hospice Status"] HospiceStatusPerformed
        where HospiceStatusPerformed.status in { 'completed', 'in-progress' }
    )

define "Encounters with Hospice during Eligible Encounter":
  "Measure Population" QualifyingEncounter
    with "Intervention Hospice Care" HospiceStatus
      such that Coalesce(start of HospiceStatus.performed.toInterval(), HospiceStatus.authoredOn) during day of QualifyingEncounter.hospitalizationWithObservation ( )

define "Measure Population Exclusion":
  "Encounters with Discharge for Hospice Care"
    union "Encounters with Hospice during Eligible Encounter"

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

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

define "Encounters with Malnutrition Risk Screening Not At Risk":
  "Measure Population" QualifyingEncounter
    with ["ObservationScreeningAssessment": "Malnutrition Risk Screening"] MalnutritionRiskScreening
      such that MalnutritionRiskScreening.status in { 'final', 'amended', 'corrected' }
        and MalnutritionRiskScreening.effective.toInterval ( ) during QualifyingEncounter.hospitalizationWithObservation ( )
        and ( MalnutritionRiskScreening.value as Concept in "Malnutrition Screening Finding of Not At Risk Result" )

define "Encounters with Malnutrition Risk Screening At Risk":
  "Measure Population" QualifyingEncounter
    with ["ObservationScreeningAssessment": "Malnutrition Risk Screening"] MalnutritionRiskScreening
      such that MalnutritionRiskScreening.status in { 'final', 'amended', 'corrected' }
        and MalnutritionRiskScreening.effective.toInterval ( ) during QualifyingEncounter.hospitalizationWithObservation ( )
        and ( MalnutritionRiskScreening.value as Concept in "Malnutrition Screening Finding of At Risk Result" )

define "Encounters with Malnutrition Risk Screening":
  "Encounters with Malnutrition Risk Screening Not At Risk"
    union "Encounters with Malnutrition Risk Screening At Risk"

define "Intervention Dietitian Referral":
  ( ["ServiceRequest": "Dietitian Referral"] DietitianReferralOrder
      where DietitianReferralOrder.status in { 'active', 'completed', 'on-hold' }
        and DietitianReferralOrder.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
  )
    union ( ["Procedure": "Dietitian Referral"] DietitianReferralPerformed
        where DietitianReferralPerformed.status in { 'completed', 'in-progress' }
    )

define "Encounters with Dietitian Referral":
  "Measure Population" QualifyingEncounter
    with "Intervention Dietitian Referral" DietitianReferral
      such that Coalesce(start of DietitianReferral.performed.toInterval(), DietitianReferral.authoredOn) during day of QualifyingEncounter.hospitalizationWithObservation ( )

define "Encounters with Malnutrition Risk Screening or with Dietitian Referral":
  "Encounters with Malnutrition Risk Screening"
    union "Encounters with Dietitian Referral"

define "Encounters with Malnutrition Not At Risk Screening and without Dietitian Referral":
  "Encounters with Malnutrition Risk Screening Not At Risk"
    except "Encounters with Dietitian Referral"

define "Encounters with Malnutrition Risk Screening At Risk or with Dietitian Referral":
  "Encounters with Malnutrition Risk Screening At Risk"
    union "Encounters with Dietitian Referral"

define "Nutrition Assessment Performed":
  from
    "Measure Population" QualifyingEncounter,
    ["ObservationScreeningAssessment": "Nutrition Assessment"] NutritionAssessment
    where NutritionAssessment.status in { 'final', 'amended', 'corrected' }
      and NutritionAssessment.effective.toInterval ( ) during QualifyingEncounter.hospitalizationWithObservation ( )
      and NutritionAssessment.value is not null
    return Tuple {
      HospEncId: QualifyingEncounter.id,
      NutrAssessTimingLatest: NutritionAssessment.effective.latest ( )
    }

define "Encounter With Most Recent Nutrition Assessment And Identified Status":
  "Encounters with Malnutrition Risk Screening At Risk or with Dietitian Referral" QualifyingEncounter
    with ["ObservationScreeningAssessment": "Nutrition Assessment"] NutritionAssessment
      such that ( NutritionAssessment.status in { 'final', 'amended', 'corrected' }
          and NutritionAssessment.effective.toInterval ( ) during QualifyingEncounter.hospitalizationWithObservation ( )
          and ( NutritionAssessment.value as Concept in "Nutrition Assessment Status Finding of Well Nourished or Not Malnourished or Mildly Malnourished"
              or ( NutritionAssessment.value as Concept in "Nutrition Assessment Status Finding of Moderately Malnourished" )
              or ( NutritionAssessment.value as Concept in "Nutrition Assessment Status Finding of Severely Malnourished" )
          )
          and NutritionAssessment.effective.latest ( ) same day as "Last Nutrition Assessment Day During Encounter"(QualifyingEncounter)
      )

define "Has Malnutrition Diagnosis":
  [ConditionProblemsHealthConcerns: "Malnutrition Diagnosis"] MalnutritionDiagnosis
    where MalnutritionDiagnosis.prevalenceInterval ( ) overlaps "Measurement Period"
      and MalnutritionDiagnosis.isVerified ( )

define "Encounters With Encounter Diagnosis Of Malnutrition Diagnosis":
  "Measure Population" QualifyingEncounter
    where QualifyingEncounter.reasonCode in "Malnutrition Diagnosis"
      or QualifyingEncounter.encounterDiagnosis ( ).verified ( ).code in "Malnutrition Diagnosis"

define "Encounters with Malnutrition Diagnosis":
  ( "Measure Population" QualifyingEncounter
      where exists ( "Has Malnutrition Diagnosis" MalnutritionDiagnosis
          where MalnutritionDiagnosis.prevalenceInterval ( ) overlaps day of QualifyingEncounter.hospitalizationWithObservation ( )
      )
  )
    union "Encounters With Encounter Diagnosis Of Malnutrition Diagnosis"

define "Encounter With Most Recent Nutrition Assessment Status of Not or Mildly Malnourished":
  "Measure Population" QualifyingEncounter
    with ["ObservationScreeningAssessment": "Nutrition Assessment"] NutritionAssessment
      such that ( NutritionAssessment.status in { 'final', 'amended', 'corrected' }
          and NutritionAssessment.effective.toInterval ( ) during QualifyingEncounter.hospitalizationWithObservation ( )
          and ( NutritionAssessment.value as Concept in "Nutrition Assessment Status Finding of Well Nourished or Not Malnourished or Mildly Malnourished" )
          and NutritionAssessment.effective.latest ( ) same day as "Last Nutrition Assessment Day During Encounter"(QualifyingEncounter)
      )

define "Encounter With Most Recent Nutrition Assessment Status of Moderately Or Severely Malnourished":
  "Measure Population" QualifyingEncounter
    with ["ObservationScreeningAssessment": "Nutrition Assessment"] NutritionAssessment
      such that NutritionAssessment.status in { 'final', 'amended', 'corrected' }
        and NutritionAssessment.effective.toInterval ( ) during QualifyingEncounter.hospitalizationWithObservation ( )
        and ( NutritionAssessment.value as Concept in "Nutrition Assessment Status Finding of Moderately Malnourished"
            or NutritionAssessment.value as Concept in "Nutrition Assessment Status Finding of Severely Malnourished"
        )
        and NutritionAssessment.effective.latest ( ) same day as "Last Nutrition Assessment Day During Encounter"(QualifyingEncounter)

define "Encounters with Nutrition Care Plan":
  "Measure Population" QualifyingEncounter
    with ["Procedure": "Nutrition Care Plan"] NutritionCarePlan
      such that NutritionCarePlan.status in { 'completed', 'in-progress' }
        and NutritionCarePlan.performed.earliest ( ) during QualifyingEncounter.hospitalizationWithObservation ( )

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

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

define function "Measure Observation 1"(MalnutritionRiskScreening Encounter):
  if "Encounters with Malnutrition Risk Screening or with Dietitian Referral" contains MalnutritionRiskScreening then 1 
    else 0

define function "Measure Observation Total Malnutrition Components Score"(QualifyingEncounter Encounter):
  Sum({ "Measure Observation 1"(QualifyingEncounter), "Measure Observation 2"(QualifyingEncounter), "Measure Observation 3"(QualifyingEncounter), "Measure Observation 4"(QualifyingEncounter) })

define function "Measure Observation 2"(NutritionAssessment Encounter):
  if "Encounters with Malnutrition Not At Risk Screening and without Dietitian Referral" contains NutritionAssessment then 0 
    else if "Encounters with Malnutrition Risk Screening At Risk or with Dietitian Referral" contains NutritionAssessment then if "Encounter With Most Recent Nutrition Assessment And Identified Status" contains NutritionAssessment then 1 
    else 0 
    else 0

define function "Last Nutrition Assessment Day During Encounter"(QualifyingEncounter Encounter):
  Max("Nutrition Assessment Performed" NutritionAssessmentTuple
      where NutritionAssessmentTuple.HospEncId = QualifyingEncounter.id
      return NutritionAssessmentTuple.NutrAssessTimingLatest
  )

define function "Measure Observation 3"(MalnutritionDiagnosis Encounter):
  if "Encounters with Malnutrition Not At Risk Screening and without Dietitian Referral" contains MalnutritionDiagnosis then 0 
    else if "Encounters with Malnutrition Risk Screening At Risk or with Dietitian Referral" contains MalnutritionDiagnosis then if "Encounters with Malnutrition Diagnosis" contains MalnutritionDiagnosis then if "Encounter With Most Recent Nutrition Assessment Status of Not or Mildly Malnourished" contains MalnutritionDiagnosis then 0 
    else if "Encounter With Most Recent Nutrition Assessment Status of Moderately Or Severely Malnourished" contains MalnutritionDiagnosis then 1 
    else 0 
    else 0 
    else 0

define fluent function isVerified(condition Choice<QICore.ConditionProblemsHealthConcerns, QICore.ConditionEncounterDiagnosis>):
  condition.verificationStatus is not null implies ( condition.verificationStatus ~ QICoreCommon."confirmed"
      or condition.verificationStatus ~ QICoreCommon."unconfirmed"
      or condition.verificationStatus ~ QICoreCommon."provisional"
      or condition.verificationStatus ~ QICoreCommon."differential"
  )

define function "Measure Observation 4"(NutritionCarePlan Encounter):
  if "Encounters with Malnutrition Not At Risk Screening and without Dietitian Referral" contains NutritionCarePlan then 0 
    else if "Encounters with Malnutrition Risk Screening At Risk or with Dietitian Referral" contains NutritionCarePlan then if "Encounters with Nutrition Care Plan" contains NutritionCarePlan then if "Encounter With Most Recent Nutrition Assessment Status of Not or Mildly Malnourished" contains NutritionCarePlan then 0 
    else if "Encounter With Most Recent Nutrition Assessment Status of Moderately Or Severely Malnourished" contains NutritionCarePlan then 1 
    else 0 
    else 0 
    else 0

define function "Measure Observation Total Malnutrition Care Score as Percentage"(QualifyingEncounter Encounter):
  100 * ( "Measure Observation Total Malnutrition Components Score"(QualifyingEncounter) / "Total Malnutrition Care Score Eligible Occurrences"(QualifyingEncounter) )

define function "Total Malnutrition Care Score Eligible Occurrences"(QualifyingEncounter Encounter):
  if "Encounters with Malnutrition Risk Screening or with Dietitian Referral" contains QualifyingEncounter
    and "Encounters with Malnutrition Risk Screening Not At Risk" contains QualifyingEncounter
    and not ( "Encounters with Dietitian Referral" contains QualifyingEncounter ) then 1 
    else if ( "Encounters with Malnutrition Risk Screening or with Dietitian Referral" contains QualifyingEncounter
      and "Encounters with Malnutrition Risk Screening At Risk" contains QualifyingEncounter
      or "Encounters with Dietitian Referral" contains QualifyingEncounter
  )
    and "Encounter With Most Recent Nutrition Assessment Status of Not or Mildly Malnourished" contains QualifyingEncounter
    or not ( "Encounter With Most Recent Nutrition Assessment And Identified Status" contains QualifyingEncounter ) then 2 
    else 4