Outcome

define "Initial Population":
  "Measure Population"

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

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

Outcome

define "Initial Population":
  "Measure Population"

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

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

Outcome

define "Initial Population":
  "Measure Population"

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

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

Outcome

define "Initial Population":
  "Measure Population"

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

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

Outcome

define "Initial Population":
  "Measure Population"

define "Measure 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 Exclusion":
  "Encounter with Discharge for Hospice Care"
    union "Encounter 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 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) })

Outcome

define "Initial Population":
  "Measure Population"

define "Measure 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 Exclusion":
  "Encounter with Discharge for Hospice Care"
    union "Encounter 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 Sex":
  case
    when Patient.gender = 'male' then "M"
    when Patient.gender = 'female' then "F"
    else null
  end

define "SDE Patient sex for quality measurement":
  SDE."SDE Sex"

define "Measure 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 "Encounter with Discharge for Hospice Care":
  ( "Measure Population" QualifyingEncounter
      where QualifyingEncounter.status = 'finished'
        and ( QualifyingEncounter.hospitalization.dischargeDisposition in "Hospice Care Referral or Admission" )
  )

define "Encounter with Hospice during Eligible Encounter":
  from
    "Measure Population" QualifyingEncounter,
    ( ["ServiceRequest": code in "Hospice Status"]
      union ["Procedure": "Hospice Status"] ) HospiceStatus
    where "Hospice Status" contains HospiceStatus.code as Concept
      and HospiceStatus.status in { 'active', 'completed' }
      and Coalesce(start of HospiceStatus.performed.toInterval(), HospiceStatus.authoredOn) during day of QualifyingEncounter."hospitalizationWithObservation" ( )
    return QualifyingEncounter

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

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

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

define "Encounter with Malnutrition Risk Screening":
  from
    "Measure Population" QualifyingEncounter,
    ["Observation": "Malnutrition Risk Screening"] MalnutritionRiskScreening
    where ( "Malnutrition Risk Screening" contains MalnutritionRiskScreening.code as Concept
        and MalnutritionRiskScreening.status in { 'final', 'amended', 'corrected' }
        and MalnutritionRiskScreening.effective.toInterval ( ) during QualifyingEncounter.hospitalizationWithObservation ( )
        and ( "Malnutrition Screening Finding of Not At Risk Result" contains MalnutritionRiskScreening.value as Concept
            or "Malnutrition Screening Finding of At Risk Result" contains MalnutritionRiskScreening.value as Concept
        )
    )
    return QualifyingEncounter

define "Encounter with Dietitian Referral":
  from
    "Measure Population" QualifyingEncounter,
    ["Procedure": "Hospital Dietitian Referral"] HospitalDietitianReferral
    where "Hospital Dietitian Referral" contains HospitalDietitianReferral.code as Concept
      and HospitalDietitianReferral.status in { 'active', 'completed', 'in-progress' }
      and HospitalDietitianReferral.performed.earliest ( ) during day of QualifyingEncounter.hospitalizationWithObservation ( )
    return QualifyingEncounter

define "Encounter with Malnutrition Risk Screening or with Hospital Dietitian Referral":
  from
    "Measure Population" QualifyingEncounter
    where "Encounter with Malnutrition Risk Screening" contains QualifyingEncounter
      or "Encounter with Dietitian Referral" contains QualifyingEncounter
    return QualifyingEncounter

define "Encounter with Malnutrition Risk Screening Not At Risk":
  from
    "Measure Population" QualifyingEncounter,
    ["Observation": "Malnutrition Risk Screening"] MalnutritionRiskScreening
    where "Malnutrition Risk Screening" contains MalnutritionRiskScreening.code as Concept
      and MalnutritionRiskScreening.status in { 'final', 'amended', 'corrected' }
      and MalnutritionRiskScreening.effective.toInterval ( ) during QualifyingEncounter.hospitalizationWithObservation ( )
      and ( "Malnutrition Screening Finding of Not At Risk Result" contains MalnutritionRiskScreening.value as Concept )
    return QualifyingEncounter

define "Encounter with Malnutrition Not At Risk Screening and without Hospital Dietitian Referral":
  from
    "Measure Population" QualifyingEncounter
    where "Encounter with Malnutrition Risk Screening Not At Risk" contains QualifyingEncounter
      and not exists ( "Encounter with Dietitian Referral" )
    return QualifyingEncounter

define "Encounter with Malnutrition Risk Screening At Risk":
  from
    "Measure Population" QualifyingEncounter,
    ["Observation": "Malnutrition Risk Screening"] MalnutritionRiskScreening
    where "Malnutrition Risk Screening" contains MalnutritionRiskScreening.code as Concept
      and MalnutritionRiskScreening.status in { 'final', 'amended', 'corrected' }
      and MalnutritionRiskScreening.effective.toInterval ( ) during QualifyingEncounter.hospitalizationWithObservation ( )
      and ( "Malnutrition Screening Finding of At Risk Result" contains MalnutritionRiskScreening.value as Concept )
    return QualifyingEncounter

define "Encounter with Malnutrition Risk Screening At Risk or with Hospital Dietitian Referral":
  from
    "Measure Population" QualifyingEncounter
    where "Encounter with Malnutrition Risk Screening At Risk" contains QualifyingEncounter
      or "Encounter with Dietitian Referral" contains QualifyingEncounter
    return QualifyingEncounter

define "Nutrition Assessment Performed":
  from
    "Measure Population" QualifyingEncounter,
    ["Observation": "Nutrition Assessment"] NutritionAssessment
    let NAssessLatest: NutritionAssessment.effective.latest ( )
    where "Nutrition Assessment" contains NutritionAssessment.code as Concept
      and NutritionAssessment.status in { 'final', 'amended', 'corrected' }
      and NutritionAssessment.effective.toInterval ( ) during QualifyingEncounter.hospitalizationWithObservation ( )
      and NutritionAssessment.value is not null
    return Tuple {
      HospEncId: QualifyingEncounter.id,
      HospitalizationPeriod: QualifyingEncounter.hospitalizationWithObservation ( ),
      NutrAssessCode: NutritionAssessment.code as Concept,
      NutrAssessId: NutritionAssessment.id,
      NutrAssessResult: NutritionAssessment.value,
      NutrAssessTimingEff: NutritionAssessment.effective,
      NutrAssessTimingInt: NutritionAssessment.effective.toInterval ( ),
      NutrAssessTimingLatest: NAssessLatest
    }
    sort by NutrAssessTimingLatest asc

define "Most Recent Encounter with Nutrition Assessment and Identified Status":
  from
    "Measure Population" QualifyingEncounter,
    ["Observation": "Nutrition Assessment"] NutritionAssessment
    where ( "Nutrition Assessment" contains NutritionAssessment.code as Concept
        and NutritionAssessment.status in { 'final', 'amended', 'corrected' }
        and NutritionAssessment.effective.toInterval ( ) during QualifyingEncounter.hospitalizationWithObservation ( )
        and ( "Nutrition Assessment Status Finding of Well Nourished or Not Malnourished or Mildly Malnourished" contains NutritionAssessment.value as Concept
            or ( "Nutrition Assessment Status Finding of Moderately Malnourished" contains NutritionAssessment.value as Concept )
            or ( "Nutrition Assessment Status Finding of Severely Malnourished" contains NutritionAssessment.value as Concept )
        )
        and ( exists ( "Encounter with Malnutrition Risk Screening At Risk" )
            or exists ( "Encounter with Dietitian Referral" )
        )
        and NutritionAssessment.effective.latest ( ) same day as "Last Nutrition Assessment Day During Encounter"(QualifyingEncounter)
    )
    return QualifyingEncounter

define "Encounter with Malnutrition Diagnosis":
  from
    "Measure Population" QualifyingEncounter,
    ["Condition": "Malnutrition Diagnosis"] MalnutritionDiagnosis
    where "Malnutrition Diagnosis" contains MalnutritionDiagnosis.code as Concept
      and MalnutritionDiagnosis.prevalenceInterval ( ) overlaps QualifyingEncounter.hospitalizationWithObservation ( )
    return QualifyingEncounter

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

define "Encounter with Nutrition Assessment Status Moderately Or Severely Malnourished":
  from
    "Measure Population" QualifyingEncounter,
    ["Observation": "Nutrition Assessment"] NutritionAssessment
    where ( "Nutrition Assessment" contains NutritionAssessment.code as Concept
        and NutritionAssessment.status in { 'final', 'amended', 'corrected' }
        and NutritionAssessment.effective.toInterval ( ) during QualifyingEncounter.hospitalizationWithObservation ( )
        and ( "Nutrition Assessment Status Finding of Moderately Malnourished" contains NutritionAssessment.value as Concept
            or "Nutrition Assessment Status Finding of Severely Malnourished" contains NutritionAssessment.value as Concept
        )
        and NutritionAssessment.effective.latest ( ) same day as "Last Nutrition Assessment Day During Encounter"(QualifyingEncounter)
    )
    return QualifyingEncounter

define "Encounter with Nutrition Care Plan":
  from
    "Measure Population" QualifyingEncounter,
    ["Procedure": "Nutrition Care Plan"] NutritionCarePlan
    where "Nutrition Care Plan" contains NutritionCarePlan.code as Concept
      and NutritionCarePlan.status in { 'completed', 'in-progress' }
      and NutritionCarePlan.performed.earliest ( ) during QualifyingEncounter.hospitalizationWithObservation ( )
    return QualifyingEncounter

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

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

define "Initial Population":
  "Measure Population"

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

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

/*
@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: 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]

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
        }

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

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

/*
@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
  )

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

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

/*
@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 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]

/*
@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 Condition):
	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>

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

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

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

define function "Measure Observation 4"(NutritionCarePlan Encounter):
  if "Encounter with Malnutrition Not At Risk Screening and without Hospital Dietitian Referral" contains NutritionCarePlan then 0 
    else if "Encounter with Malnutrition Risk Screening At Risk or with Hospital Dietitian Referral" contains NutritionCarePlan then if "Encounter with Nutrition Care Plan" contains NutritionCarePlan then if "Encounter with Nutrition Assessment Not or Mildly Malnourished" contains NutritionCarePlan then 0 
    else if "Encounter with Nutrition Assessment Status 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 "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 "Total Malnutrition Care Score Eligible Occurrences"(QualifyingEncounter Encounter):
  if ( ( "Encounter with Malnutrition Risk Screening or with Hospital Dietitian Referral" contains QualifyingEncounter )
      and ( "Encounter with Malnutrition Risk Screening Not At Risk" contains QualifyingEncounter )
  )
    and not ( "Encounter with Dietitian Referral" contains QualifyingEncounter ) then 1 
    else if ( ( ( "Encounter with Malnutrition Risk Screening or with Hospital Dietitian Referral" contains QualifyingEncounter )
        and ( "Encounter with Malnutrition Risk Screening At Risk" contains QualifyingEncounter )
    )
      or ( "Encounter with Dietitian Referral" contains QualifyingEncounter )
  )
    and ( "Encounter with Nutrition Assessment Not or Mildly Malnourished" contains QualifyingEncounter )
    or not ( "Most Recent Encounter with Nutrition Assessment and Identified Status" contains QualifyingEncounter ) then 2 
    else 4