eCQM QICore Content Implementation Guide
2024.0.0 - CI Build

eCQM QICore Content Implementation Guide, published by cqframework. This guide is not an authorized publication; it is the continuous build for version 2024.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/cqframework/ecqm-content-qicore-2024/ and changes regularly. See the Directory of published versions

: Chlamydia Screening in WomenFHIR - XML Representation

Draft as of 2024-07-09

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<Measure xmlns="http://hl7.org/fhir">
  <id value="ChlamydiaScreeninginWomenFHIR"/>
  <meta>
    <profile
             value="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/computable-measure-cqfm"/>
    <profile
             value="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/publishable-measure-cqfm"/>
    <profile
             value="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/executable-measure-cqfm"/>
  </meta>
  <text>
    <status value="extensions"/>
    <div xmlns="http://www.w3.org/1999/xhtml">
    <table class="grid dict">
        
            <tr>
                <th scope="row"><b>Title: </b></th>
                <td style="padding-left: 4px;">Chlamydia Screening in WomenFHIR</td>
            </tr>
        

        

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

        
            <tr>
                <th scope="row"><b>Version: </b></th>
                <td style="padding-left: 4px;">0.1.000</td>
            </tr>
        

        
            <tr>
                <th scope="row"><b>Url: </b></th>
                <td style="padding-left: 4px;"><a href="Measure-ChlamydiaScreeninginWomenFHIR.html">Chlamydia Screening in WomenFHIR</a></td>
            </tr>
        

        
            <tr>
                <th scope="row">
                    <b>
                        
                            
                                short-name identifier:
                            
                        
                    </b>
                </th>

                <td style="padding-left: 4px;">
                    
                        <p style="margin-bottom: 5px;">
                            <span>CMS153FHIR</span>
                        </p>
                    
                </td>
            </tr>
        
            <tr>
                <th scope="row">
                    <b>
                        
                            
                                version-independent identifier:
                            
                        
                    </b>
                </th>

                <td style="padding-left: 4px;">
                    
                        <p style="margin-bottom: 5px;">
                            <span>urn:uuid:3443b43b-a2a3-4b91-84aa-6080479d4d9a</span>
                        </p>
                    
                </td>
            </tr>
        
            <tr>
                <th scope="row">
                    <b>
                        
                            
                                version-specific identifier:
                            
                        
                    </b>
                </th>

                <td style="padding-left: 4px;">
                    
                        <p style="margin-bottom: 5px;">
                            <span>urn:uuid:b908fbc3-7514-4196-baf1-f04d49393cc9</span>
                        </p>
                    
                </td>
            </tr>
        
            <tr>
                <th scope="row">
                    <b>
                        
                            
                                publisher (CMS) identifier:
                            
                        
                    </b>
                </th>

                <td style="padding-left: 4px;">
                    
                        <p style="margin-bottom: 5px;">
                            <span>153FHIR</span>
                        </p>
                    
                </td>
            </tr>
        

        
            <tr>
                <th scope="row"><b>Effective Period: </b></th>
                <td style="padding-left: 4px;">2025-01-01..2025-12-31</td>
            </tr>
        

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

        

        
            <tr>
                <th scope="row"><b>Publisher: </b></th>
                <td style="padding-left: 4px;">National Committee for Quality Assurance</td>
            </tr>
        

        
        <tr>
            <th scope="row"><b>Author: </b></th>
            <td style="padding-left: 4px;">National Committee for Quality Assurance</td>
        </tr>
        

        

        
            <tr>
                <th scope="row"><b>Description: </b></th>
                <td style="padding-left: 4px;"><div><p>Percentage of women 16-24 years of age who were identified as sexually active at any time during the measurement period and who had at least one test for chlamydia during the measurement period</p>
</div></td>
            </tr>
        

        

        

        

        

        

        
            <tr>
                <th scope="row"><b>Purpose: </b></th>
                <td style="padding-left: 4px;"><div><p>UNKNOWN</p>
</div></td>
            </tr>
        

        
            <tr>
                <th scope="row"><b>Copyright: </b></th>
                <td style="padding-left: 4px;"><div><p>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 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 can be reproduced and distributed, without modification, for noncommercial purposes (e.g., use by healthcare providers in connection with their practices) without obtaining approval from NCQA. Commercial use is defined as the sale, licensing, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain. All commercial uses or requests for modification must be approved by NCQA and are subject to a license at the discretion of NCQA. (C) 2012-2024 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 2024. 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) (http://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 2004-2024 Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee, and are available at no cost under the license at http://loinc.org/terms-of-use.  This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2023 International Health Terminology Standards Development Organisation.  ICD-10 copyright 2024 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.</p>
</div></td>
            </tr>
        

        
            <tr>
                <th scope="row"><b>Disclaimer: </b></th>
                <td style="padding-left: 4px;"><div><p>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 &quot;AS IS&quot; 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].</p>
</div></td>
            </tr>
        

        

        

        

        

        

        

        

        
        <tr>
            <th scope="row"><b>Rationale: </b></th>
            <td style="padding-left: 4px;"><div><p>Chlamydia trachomatis is the most common sexually transmitted bacterial infection in the U.S., resulting in roughly 1.7 million cases (Centers for Disease Control and Prevention, 2019). Chlamydia infections are often asymptomatic, but, if left untreated, can lead to serious and irreversible complications (U.S. Preventive Services Task Force, 2021; Centers for Disease Control and Prevention, 2019).   Women are particularly vulnerable when infected with chlamydia. Left untreated, chlamydia can cause pelvic inflammatory disease (PID), which can lead to chronic pelvic pain or infertility. Pregnant women may also transmit the infection to their infant, potentially resulting in neonatal pneumonia (Centers for Disease Control and Prevention, 2019).</p>
</div></td>
        </tr>
        

        
        <tr>
            <th scope="row"><b>Clinical recommendation statement: </b></th>
            <td style="padding-left: 4px;"><div><p>U.S. Preventive Services Task Force (2021) recommends screening for chlamydia in all sexually active women aged 24 years or younger and in women 25 years or older who are at increased risk for infection (B recommendation)</p>
</div></td>
        </tr>
        

        

        
            <tr>
                <th scope="row"><b>Guidance (Usage): </b></th>
                <td style="padding-left: 4px;">Codes to identify sexually active women include codes for: pregnancy, sexually transmitted infections, contraceptives or contraceptive devices, and infertility treatments.  The denominator exclusion does not apply to patients who qualify for the initial population (IP) based on services other than the pregnancy test alone. These other services include services for sexually transmitted infections, contraceptives or contraceptive devices and infertility treatments. For example, a patient who has both a pregnancy test and a chlamydia diagnosis, either of which would qualify them for the IP, would not be eligible for this denominator exclusion.  This eCQM is a patient-based measure.  This FHIR-based measure has been derived from the QDM-based measure:  CMS153v13.  Please refer to the HL7 QI-Core Implementation Guide (http://hl7.org/fhir/us/qicore/STU4.1.1/) for more information on QI-Core and mapping recommendations from QDM to QI-Core 4.1.1 (http://hl7.org/fhir/us/qicore/STU4.1.1/qdm-to-qicore.html).</td>
            </tr>
        

        
            
                <tr>
                    <th scope="row"><b>Population Criteria: </b></th>
                    <td style="padding-left: 4px;">
                        
                            <table class="grid-dict">
                                
                                    <tr>
                                        <th><b>654a55d378418140875e358d</b></th>
                                    </tr>
                                
                                
                                    <tr>
                                        <td>Initial Population:</td>

                                        
                                            
                                                <td>Women 16 to 24 years of age by the end of the measurement period who are sexually active and who had a visit in the measurement period</td>
                                            
                                        

                                    </tr>
                                
                                    <tr>
                                        <td>Denominator:</td>

                                        
                                            
                                                <td>Equals Initial Population</td>
                                            
                                        

                                    </tr>
                                
                                    <tr>
                                        <td>Denominator Exclusion:</td>

                                        
                                            
                                                <td>Exclude patients who are in hospice care for any part of the measurement period.  Women who are only eligible for the initial population due to a pregnancy test during the measurement period, and who had an order for an x-ray or for a specified medication on the date of the pregnancy test or the six days after the pregnancy test.</td>
                                            
                                        

                                    </tr>
                                
                                    <tr>
                                        <td>Numerator:</td>

                                        
                                            
                                                <td>Women with at least one chlamydia test during the measurement period</td>
                                            
                                        

                                    </tr>
                                
                                
                                  <tr><b>Stratifier Criteria: </b></tr>
                                    
                                        <tr>
                                            
                                                <td>Stratum:</td>
                                            

                                            
                                                <td>Report a total score, and each of the following strata: Stratum 1: Patients age 16-20 by the end of the measurement period.</td>
                                            
                                        </tr>
                                    
                                        <tr>
                                            
                                                <td>Stratum:</td>
                                            

                                            
                                                <td>Stratum 2: Patients age 21-24 by the end of the measurement period.</td>
                                            
                                        </tr>
                                    
                                
                            </table>
                        
                    </td>
                </tr>
            
        

        

        

        

        
            <tr>
                <th scope="row"><b>Libraries: </b></th>
                <td style="padding-left: 4px;">
                    <table class="grid-dict">
                        
                            <tr>
                                <td><a href="Library-ChlamydiaScreeninginWomenFHIR.html">ChlamydiaScreeninginWomenFHIR</a></td>
                            </tr>
                        
                    </table>
                </td>
            </tr>
        

        

        
            
                <tr>
                    <th scope="row"><b>Terminology and Other Dependencies: </b></th>
                    <td style="padding-left: 4px;">
                        
                            <li><code>Library/Status|1.8.000</code></li>
                        
                            <li><code>Library/FHIRHelpers|4.4.000</code></li>
                        
                            <li><code>Library/QICoreCommon|2.1.000</code></li>
                        
                            <li><code>Library/CumulativeMedicationDuration|4.1.000</code></li>
                        
                            <li><code>Library/Hospice|6.12.000</code></li>
                        
                            <li><a href="http://terminology.hl7.org/5.5.0/CodeSystem-observation-category.html">Observation Category Codes</a></li>
                        
                            <li><a href="http://terminology.hl7.org/5.5.0/CodeSystem-v3-loinc.html">Logical Observation Identifiers, Names and Codes (LOINC)</a></li>
                        
                            <li><a href="http://hl7.org/fhir/R4/codesystem-snomedct.html">SNOMED CT (all versions)</a></li>
                        
                            <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.110.12.1052/expansion">Chlamydia Screening</a></li>
                        
                            <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1001/expansion">Office Visit</a></li>
                        
                            <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1025/expansion">Preventive Care Services - Established Office Visit, 18 and Up</a></li>
                        
                            <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1023/expansion">Preventive Care Services-Initial Office Visit, 18 and Up</a></li>
                        
                            <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1022/expansion">Preventive Care Services, Initial Office Visit, 0 to 17</a></li>
                        
                            <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1024/expansion">Preventive Care, Established Office Visit, 0 to 17</a></li>
                        
                            <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1016/expansion">Home Healthcare Services</a></li>
                        
                            <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1080/expansion">Telephone Visits</a></li>
                        
                            <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1089/expansion">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1089</a></li>
                        
                            <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.111.12.1018/expansion">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.111.12.1018</a></li>
                        
                            <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.120.12.1003/expansion">HIV</a></li>
                        
                            <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.111.12.1012/expansion">Complications of Pregnancy, Childbirth and the Puerperium</a></li>
                        
                            <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.196.12.1080/expansion">Contraceptive Medications</a></li>
                        
                            <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.111.12.1011/expansion">Pregnancy Test</a></li>
                        
                            <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.108.12.1017/expansion">Pap Test</a></li>
                        
                            <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.111.12.1007/expansion">Lab Tests During Pregnancy</a></li>
                        
                            <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.110.12.1051/expansion">Lab Tests for Sexually Transmitted Infections</a></li>
                        
                            <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.111.12.1008/expansion">Diagnostic Studies During Pregnancy</a></li>
                        
                            <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.111.12.1017/expansion">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.111.12.1017</a></li>
                        
                            <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.666.5.307/expansion">Encounter Inpatient</a></li>
                        
                            <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1003/expansion">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1003</a></li>
                        
                            <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1584/expansion">Hospice Care Ambulatory</a></li>
                        
                            <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1165/expansion">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1165</a></li>
                        
                            <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.198.12.1034/expansion">X-Ray Study (all inclusive)</a></li>
                        
                            <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.196.12.1143/expansion">Isotretinoin</a></li>
                        
                    </td>
                </tr>
                <tr>
                    <th scope="row"><b>Parameters:</b></th>
                    <td style="padding-left: 4px;">
                        <table class="grid-dict">
                            <tr>
                                <th><b>name</b></th>
                                <th><b>use</b></th>
                                <th><b>min</b></th>
                                <th><b>max</b></th>
                                <th><b>type</b></th>
                            </tr>
                            
                                <tr>
                                    <td>Measurement Period</td>
                                    <td>In</td>
                                    <td>0</td>
                                    <td>1</td>
                                    <td>Period</td>
                                </tr>
                            
                                <tr>
                                    <td>ErrorLevel</td>
                                    <td>In</td>
                                    <td>0</td>
                                    <td>1</td>
                                    <td>string</td>
                                </tr>
                            
                                <tr>
                                    <td>Numerator</td>
                                    <td>Out</td>
                                    <td>0</td>
                                    <td>1</td>
                                    <td>boolean</td>
                                </tr>
                            
                                <tr>
                                    <td>Stratification 2</td>
                                    <td>Out</td>
                                    <td>0</td>
                                    <td>1</td>
                                    <td>boolean</td>
                                </tr>
                            
                                <tr>
                                    <td>Stratification 1</td>
                                    <td>Out</td>
                                    <td>0</td>
                                    <td>1</td>
                                    <td>boolean</td>
                                </tr>
                            
                                <tr>
                                    <td>Denominator</td>
                                    <td>Out</td>
                                    <td>0</td>
                                    <td>1</td>
                                    <td>boolean</td>
                                </tr>
                            
                                <tr>
                                    <td>Initial Population</td>
                                    <td>Out</td>
                                    <td>0</td>
                                    <td>1</td>
                                    <td>boolean</td>
                                </tr>
                            
                                <tr>
                                    <td>Denominator Exclusions</td>
                                    <td>Out</td>
                                    <td>0</td>
                                    <td>1</td>
                                    <td>boolean</td>
                                </tr>
                            
                        </table>
                    </td>
                </tr>

                <tr>
                    <th scope="row"><b>DataRequirements:</b></th>
                    <td style="padding-left: 4px;">
                        <table class="grid-dict">
                            <tr>
                                <th><b>Resource Type</b></th>
                                <th><b>Resource Elements</b></th>
                                <th><b>Valueset Name</b></th>
                                <th><b>Valueset</b></th>
                            </tr>
                            
                                <tr>
                                    <td>Observation(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-observation.html">QICoreObservation</a>)</td>
                                    <td>
                                        
                                            code
                                        
                                            effective
                                        
                                            value
                                        
                                            status
                                        
                                            status.value
                                        
                                            category
                                        
                                    </td>
                                    <td>
                                        
                                            
                                                 Chlamydia Screening
                                            
                                        
                                    </td>
                                    <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.110.12.1052/expansion">Chlamydia Screening</a></td>
                                </tr>
                            
                                <tr>
                                    <td>Observation(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-observation.html">QICoreObservation</a>)</td>
                                    <td>
                                        
                                            code
                                        
                                            value
                                        
                                            effective
                                        
                                            status
                                        
                                            status.value
                                        
                                            category
                                        
                                    </td>
                                    <td>
                                        
                                    </td>
                                    <td/>
                                </tr>
                            
                                <tr>
                                    <td>Observation(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-observation.html">QICoreObservation</a>)</td>
                                    <td>
                                        
                                            code
                                        
                                            value
                                        
                                            effective
                                        
                                            status
                                        
                                            status.value
                                        
                                            category
                                        
                                    </td>
                                    <td>
                                        
                                    </td>
                                    <td/>
                                </tr>
                            
                                <tr>
                                    <td>Patient(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-patient.html">QICorePatient</a>)</td>
                                    <td>
                                        
                                    </td>
                                    <td>
                                        
                                    </td>
                                    <td/>
                                </tr>
                            
                                <tr>
                                    <td>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
                                    <td>
                                        
                                            type
                                        
                                            status
                                        
                                            status.value
                                        
                                            period
                                        
                                    </td>
                                    <td>
                                        
                                            
                                                 Office Visit
                                            
                                        
                                    </td>
                                    <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1001/expansion">Office Visit</a></td>
                                </tr>
                            
                                <tr>
                                    <td>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
                                    <td>
                                        
                                            type
                                        
                                            status
                                        
                                            status.value
                                        
                                            period
                                        
                                    </td>
                                    <td>
                                        
                                            
                                                 Preventive Care Services Established Office Visit, 18 and Up
                                            
                                        
                                    </td>
                                    <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1025/expansion">Preventive Care Services - Established Office Visit, 18 and Up</a></td>
                                </tr>
                            
                                <tr>
                                    <td>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
                                    <td>
                                        
                                            type
                                        
                                            status
                                        
                                            status.value
                                        
                                            period
                                        
                                    </td>
                                    <td>
                                        
                                            
                                                 Preventive Care Services Initial Office Visit, 18 and Up
                                            
                                        
                                    </td>
                                    <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1023/expansion">Preventive Care Services-Initial Office Visit, 18 and Up</a></td>
                                </tr>
                            
                                <tr>
                                    <td>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
                                    <td>
                                        
                                            type
                                        
                                            status
                                        
                                            status.value
                                        
                                            period
                                        
                                    </td>
                                    <td>
                                        
                                            
                                                 Preventive Care Services, Initial Office Visit, 0 to 17
                                            
                                        
                                    </td>
                                    <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1022/expansion">Preventive Care Services, Initial Office Visit, 0 to 17</a></td>
                                </tr>
                            
                                <tr>
                                    <td>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
                                    <td>
                                        
                                            type
                                        
                                            status
                                        
                                            status.value
                                        
                                            period
                                        
                                    </td>
                                    <td>
                                        
                                            
                                                 Preventive Care, Established Office Visit, 0 to 17
                                            
                                        
                                    </td>
                                    <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1024/expansion">Preventive Care, Established Office Visit, 0 to 17</a></td>
                                </tr>
                            
                                <tr>
                                    <td>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
                                    <td>
                                        
                                            type
                                        
                                            status
                                        
                                            status.value
                                        
                                            period
                                        
                                    </td>
                                    <td>
                                        
                                            
                                                 Home Healthcare Services
                                            
                                        
                                    </td>
                                    <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1016/expansion">Home Healthcare Services</a></td>
                                </tr>
                            
                                <tr>
                                    <td>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
                                    <td>
                                        
                                            type
                                        
                                            status
                                        
                                            status.value
                                        
                                            period
                                        
                                    </td>
                                    <td>
                                        
                                            
                                                 Telephone Visits
                                            
                                        
                                    </td>
                                    <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1080/expansion">Telephone Visits</a></td>
                                </tr>
                            
                                <tr>
                                    <td>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
                                    <td>
                                        
                                            type
                                        
                                            status
                                        
                                            status.value
                                        
                                            period
                                        
                                    </td>
                                    <td>
                                        
                                            
                                                 Virtual Encounter
                                            
                                        
                                    </td>
                                    <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1089/expansion">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1089</a></td>
                                </tr>
                            
                                <tr>
                                    <td>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
                                    <td>
                                        
                                            type
                                        
                                            hospitalization
                                        
                                            hospitalization.dischargeDisposition
                                        
                                            period
                                        
                                            status
                                        
                                            status.value
                                        
                                    </td>
                                    <td>
                                        
                                            
                                                 Encounter Inpatient
                                            
                                        
                                    </td>
                                    <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.666.5.307/expansion">Encounter Inpatient</a></td>
                                </tr>
                            
                                <tr>
                                    <td>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
                                    <td>
                                        
                                            type
                                        
                                            period
                                        
                                            status
                                        
                                            status.value
                                        
                                    </td>
                                    <td>
                                        
                                            
                                                 Hospice Encounter
                                            
                                        
                                    </td>
                                    <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1003/expansion">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1003</a></td>
                                </tr>
                            
                                <tr>
                                    <td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
                                    <td>
                                        
                                            code
                                        
                                    </td>
                                    <td>
                                        
                                            
                                                 Diagnoses Used to Indicate Sexual Activity
                                            
                                        
                                    </td>
                                    <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.111.12.1018/expansion">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.111.12.1018</a></td>
                                </tr>
                            
                                <tr>
                                    <td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
                                    <td>
                                        
                                            code
                                        
                                    </td>
                                    <td>
                                        
                                            
                                                 HIV
                                            
                                        
                                    </td>
                                    <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.120.12.1003/expansion">HIV</a></td>
                                </tr>
                            
                                <tr>
                                    <td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
                                    <td>
                                        
                                            code
                                        
                                    </td>
                                    <td>
                                        
                                            
                                                 Complications of Pregnancy, Childbirth and the Puerperium
                                            
                                        
                                    </td>
                                    <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.111.12.1012/expansion">Complications of Pregnancy, Childbirth and the Puerperium</a></td>
                                </tr>
                            
                                <tr>
                                    <td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
                                    <td>
                                        
                                            code
                                        
                                    </td>
                                    <td>
                                        
                                            
                                                 Hospice Diagnosis
                                            
                                        
                                    </td>
                                    <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1165/expansion">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1165</a></td>
                                </tr>
                            
                                <tr>
                                    <td>Medication(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html">QICoreMedication</a>)</td>
                                    <td>
                                        
                                            id
                                        
                                    </td>
                                    <td>
                                        
                                    </td>
                                    <td/>
                                </tr>
                            
                                <tr>
                                    <td>Medication(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html">QICoreMedication</a>)</td>
                                    <td>
                                        
                                            id
                                        
                                    </td>
                                    <td>
                                        
                                    </td>
                                    <td/>
                                </tr>
                            
                                <tr>
                                    <td>Medication(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html">QICoreMedication</a>)</td>
                                    <td>
                                        
                                            id
                                        
                                    </td>
                                    <td>
                                        
                                    </td>
                                    <td/>
                                </tr>
                            
                                <tr>
                                    <td>MedicationRequest(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html">QICoreMedicationRequest</a>)</td>
                                    <td>
                                        
                                            medication
                                        
                                            status
                                        
                                            status.value
                                        
                                            intent
                                        
                                            intent.value
                                        
                                            dosageInstruction
                                        
                                            dispenseRequest
                                        
                                            dispenseRequest.expectedSupplyDuration
                                        
                                            dispenseRequest.quantity
                                        
                                            dispenseRequest.numberOfRepeatsAllowed
                                        
                                            dispenseRequest.numberOfRepeatsAllowed.value
                                        
                                            authoredOn
                                        
                                            authoredOn.value
                                        
                                            dispenseRequest.validityPeriod
                                        
                                    </td>
                                    <td>
                                        
                                            
                                                 Contraceptive Medications
                                            
                                        
                                    </td>
                                    <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.196.12.1080/expansion">Contraceptive Medications</a></td>
                                </tr>
                            
                                <tr>
                                    <td>MedicationRequest(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html">QICoreMedicationRequest</a>)</td>
                                    <td>
                                        
                                            medication.reference
                                        
                                            status
                                        
                                            status.value
                                        
                                            intent
                                        
                                            intent.value
                                        
                                            dosageInstruction
                                        
                                            dispenseRequest
                                        
                                            dispenseRequest.expectedSupplyDuration
                                        
                                            dispenseRequest.quantity
                                        
                                            dispenseRequest.numberOfRepeatsAllowed
                                        
                                            dispenseRequest.numberOfRepeatsAllowed.value
                                        
                                            authoredOn
                                        
                                            authoredOn.value
                                        
                                            dispenseRequest.validityPeriod
                                        
                                    </td>
                                    <td>
                                        
                                    </td>
                                    <td/>
                                </tr>
                            
                                <tr>
                                    <td>MedicationRequest(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html">QICoreMedicationRequest</a>)</td>
                                    <td>
                                        
                                            medication
                                        
                                            status
                                        
                                            status.value
                                        
                                            intent
                                        
                                            intent.value
                                        
                                            dosageInstruction
                                        
                                            dispenseRequest
                                        
                                            dispenseRequest.expectedSupplyDuration
                                        
                                            dispenseRequest.quantity
                                        
                                            dispenseRequest.numberOfRepeatsAllowed
                                        
                                            dispenseRequest.numberOfRepeatsAllowed.value
                                        
                                            authoredOn
                                        
                                            authoredOn.value
                                        
                                            dispenseRequest.validityPeriod
                                        
                                    </td>
                                    <td>
                                        
                                            
                                                 Isotretinoin
                                            
                                        
                                    </td>
                                    <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.196.12.1143/expansion">Isotretinoin</a></td>
                                </tr>
                            
                                <tr>
                                    <td>ServiceRequest(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-servicerequest.html">QICoreServiceRequest</a>)</td>
                                    <td>
                                        
                                            code
                                        
                                            status
                                        
                                            status.value
                                        
                                            intent
                                        
                                            intent.value
                                        
                                            authoredOn
                                        
                                            authoredOn.value
                                        
                                    </td>
                                    <td>
                                        
                                            
                                                 Pap Test
                                            
                                        
                                    </td>
                                    <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.108.12.1017/expansion">Pap Test</a></td>
                                </tr>
                            
                                <tr>
                                    <td>ServiceRequest(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-servicerequest.html">QICoreServiceRequest</a>)</td>
                                    <td>
                                        
                                            code
                                        
                                            status
                                        
                                            status.value
                                        
                                            intent
                                        
                                            intent.value
                                        
                                            authoredOn
                                        
                                            authoredOn.value
                                        
                                    </td>
                                    <td>
                                        
                                            
                                                 Lab Tests During Pregnancy
                                            
                                        
                                    </td>
                                    <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.111.12.1007/expansion">Lab Tests During Pregnancy</a></td>
                                </tr>
                            
                                <tr>
                                    <td>ServiceRequest(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-servicerequest.html">QICoreServiceRequest</a>)</td>
                                    <td>
                                        
                                            code
                                        
                                            status
                                        
                                            status.value
                                        
                                            intent
                                        
                                            intent.value
                                        
                                            authoredOn
                                        
                                            authoredOn.value
                                        
                                    </td>
                                    <td>
                                        
                                            
                                                 Lab Tests for Sexually Transmitted Infections
                                            
                                        
                                    </td>
                                    <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.110.12.1051/expansion">Lab Tests for Sexually Transmitted Infections</a></td>
                                </tr>
                            
                                <tr>
                                    <td>ServiceRequest(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-servicerequest.html">QICoreServiceRequest</a>)</td>
                                    <td>
                                        
                                            code
                                        
                                            authoredOn
                                        
                                            authoredOn.value
                                        
                                            status
                                        
                                            status.value
                                        
                                            intent
                                        
                                            intent.value
                                        
                                    </td>
                                    <td>
                                        
                                            
                                                 Diagnostic Studies During Pregnancy
                                            
                                        
                                    </td>
                                    <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.111.12.1008/expansion">Diagnostic Studies During Pregnancy</a></td>
                                </tr>
                            
                                <tr>
                                    <td>ServiceRequest(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-servicerequest.html">QICoreServiceRequest</a>)</td>
                                    <td>
                                        
                                            code
                                        
                                            authoredOn
                                        
                                            authoredOn.value
                                        
                                            status
                                        
                                            status.value
                                        
                                            intent
                                        
                                            intent.value
                                        
                                    </td>
                                    <td>
                                        
                                            
                                                 Hospice Care Ambulatory
                                            
                                        
                                    </td>
                                    <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1584/expansion">Hospice Care Ambulatory</a></td>
                                </tr>
                            
                                <tr>
                                    <td>ServiceRequest(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-servicerequest.html">QICoreServiceRequest</a>)</td>
                                    <td>
                                        
                                            code
                                        
                                            authoredOn
                                        
                                            authoredOn.value
                                        
                                            status
                                        
                                            status.value
                                        
                                            intent
                                        
                                            intent.value
                                        
                                    </td>
                                    <td>
                                        
                                            
                                                 XRay Study
                                            
                                        
                                    </td>
                                    <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.198.12.1034/expansion">X-Ray Study (all inclusive)</a></td>
                                </tr>
                            
                                <tr>
                                    <td>ServiceRequest(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-servicerequest.html">QICoreServiceRequest</a>)</td>
                                    <td>
                                        
                                            code
                                        
                                            authoredOn
                                        
                                            authoredOn.value
                                        
                                            status
                                        
                                            status.value
                                        
                                            intent
                                        
                                            intent.value
                                        
                                    </td>
                                    <td>
                                        
                                            
                                                 Pregnancy Test
                                            
                                        
                                    </td>
                                    <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.111.12.1011/expansion">Pregnancy Test</a></td>
                                </tr>
                            
                                <tr>
                                    <td>Procedure(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-procedure.html">QICoreProcedure</a>)</td>
                                    <td>
                                        
                                            code
                                        
                                            performed
                                        
                                            status
                                        
                                            status.value
                                        
                                    </td>
                                    <td>
                                        
                                            
                                                 Procedures Used to Indicate Sexual Activity
                                            
                                        
                                    </td>
                                    <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.111.12.1017/expansion">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.111.12.1017</a></td>
                                </tr>
                            
                                <tr>
                                    <td>Procedure(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-procedure.html">QICoreProcedure</a>)</td>
                                    <td>
                                        
                                            code
                                        
                                            performed
                                        
                                            status
                                        
                                            status.value
                                        
                                    </td>
                                    <td>
                                        
                                            
                                                 Hospice Care Ambulatory
                                            
                                        
                                    </td>
                                    <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1584/expansion">Hospice Care Ambulatory</a></td>
                                </tr>
                            
                        </table>
                    </td>
                </tr>

                
                    <tr>
                        <th scope="row"><b>Direct Reference Codes:</b></th>
                        <td style="padding-left: 4px;">
                            <table class="grid-dict">
                                <tr>
                                    <th><b>display</b></th>
                                    <th><b>code</b></th>
                                    <th><b>system</b></th>
                                </tr>
                                
                                    <tr>
                                        <td>laboratory</td>
                                        <td>laboratory</td>
                                        <td><a href="http://hl7.org/fhir/R4/codesystem-observation-category.html">http://terminology.hl7.org/CodeSystem/observation-category</a></td>
                                    </tr>
                                
                                    <tr>
                                        <td>survey</td>
                                        <td>survey</td>
                                        <td><a href="http://hl7.org/fhir/R4/codesystem-observation-category.html">http://terminology.hl7.org/CodeSystem/observation-category</a></td>
                                    </tr>
                                
                                    <tr>
                                        <td>Have you ever had vaginal intercourse [PhenX]</td>
                                        <td>64728-9</td>
                                        <td><a href="http://terminology.hl7.org/5.5.0/CodeSystem-v3-loinc.html">http://loinc.org</a></td>
                                    </tr>
                                
                                    <tr>
                                        <td>Yes (qualifier value)</td>
                                        <td>373066001</td>
                                        <td><a href="http://hl7.org/fhir/R4/codesystem-snomedct.html">http://snomed.info/sct</a></td>
                                    </tr>
                                
                                    <tr>
                                        <td>Discharge to home for hospice care (procedure)</td>
                                        <td>428361000124107</td>
                                        <td><a href="http://hl7.org/fhir/R4/codesystem-snomedct.html">http://snomed.info/sct</a></td>
                                    </tr>
                                
                                    <tr>
                                        <td>Discharge to healthcare facility for hospice care (procedure)</td>
                                        <td>428371000124100</td>
                                        <td><a href="http://hl7.org/fhir/R4/codesystem-snomedct.html">http://snomed.info/sct</a></td>
                                    </tr>
                                
                                    <tr>
                                        <td>Hospice care [Minimum Data Set]</td>
                                        <td>45755-6</td>
                                        <td><a href="http://terminology.hl7.org/5.5.0/CodeSystem-v3-loinc.html">http://loinc.org</a></td>
                                    </tr>
                                
                            </table>
                        </td>
                    </tr>
                

                
                <tr>
                    <th scope="row"><b>Logic Definitions:</b></th>
                    <td style="padding-left: 4px;">
                        
                        <table class="grid-dict">
                            <tr>
                                <th><b>Group</b></th>
                                <th><b>Scoring</b></th>
                                <th><b>Population Criteria</b></th>
                                <th><b>Expression</b></th>
                            </tr>
                            <tr>
                                
                                <td> 654a55d378418140875e358d </td>
                                <td colspan="3" style="padding-left: 4px;">
                                    
                                        <b>Group scoring:</b>
                                        
                                            <span>  proportion </span>
                                        
                                    

                                    

                                    

                                    

                                    
                                        <tr>
                                        
                                            <th scope="row"><b>Type: </b></th>
                                            <td style="padding-left: 4px;">
                                                
                                                    
                                                        <p style="margin-bottom: 5px;">
                                                            <span>Process </span>
                                                        </p>
                                                    
                                                
                                                
                                            </td>
                                        
                                        </tr>
                                    

                                    

                                    
                                    <tr>
                                        <th scope="row"><b>Rate Aggregation: </b></th>
                                        <td colspan="3" style="padding-left: 4px;">None</td>
                                    </tr>
                                    

                                    
                                        <tr>
                                            <th scope="row"><b>Improvement Notation: </b></th>
                                            <td style="padding-left: 4px;">
                                            
                                                
                                                    
                                                        <p style="margin-bottom: 5px;">
                                                            <span>increase </span>
                                                        </p>
                                                    
                                                
                                                
                                            
                                            </td>
                                        </tr>
                                    

                                    

                                </td>
                                
                                <tr>
                                    <td/>
                                    <td/>
                                    <td>Initial Population</td>
                                    <td>
                                        
                                            <pre><code class="language-cql">define &quot;Initial Population&quot;:
  AgeInYearsAt(date from 
    end of &quot;Measurement Period&quot;
  ) in Interval[16, 24]
    and Patient.gender = 'female'
    and exists ( &quot;Qualifying Encounters&quot; )
    and ( ( &quot;Has Assessments Identifying Sexual Activity&quot; )
        or ( &quot;Has Diagnoses Identifying Sexual Activity&quot; )
        or ( &quot;Has Active Contraceptive Medications&quot; )
        or ( &quot;Has Ordered Contraceptive Medications&quot; )
        or ( &quot;Has Laboratory Tests Identifying Sexual Activity&quot; )
        or ( &quot;Has Diagnostic Studies Identifying Sexual Activity&quot; )
        or ( &quot;Has Procedures Identifying Sexual Activity&quot; )
    )</code></pre>
                                        
                                    </td>
                                </tr>
                                
                                <tr>
                                    <td/>
                                    <td/>
                                    <td>Denominator</td>
                                    <td>
                                        
                                            <pre><code class="language-cql">define &quot;Denominator&quot;:
  &quot;Initial Population&quot;</code></pre>
                                        
                                    </td>
                                </tr>
                                
                                <tr>
                                    <td/>
                                    <td/>
                                    <td>Denominator Exclusion</td>
                                    <td>
                                        
                                            <pre><code class="language-cql">define &quot;Denominator Exclusions&quot;:
  Hospice.&quot;Has Hospice Services&quot;
    or ( ( &quot;Has Pregnancy Test Exclusion&quot; )
        and not ( &quot;Has Assessments Identifying Sexual Activity&quot; )
        and not ( &quot;Has Diagnoses Identifying Sexual Activity&quot; )
        and not ( &quot;Has Active Contraceptive Medications&quot; )
        and not ( &quot;Has Ordered Contraceptive Medications&quot; )
        and not ( &quot;Has Laboratory Tests Identifying Sexual Activity But Not Pregnancy&quot; )
        and not ( &quot;Has Diagnostic Studies Identifying Sexual Activity&quot; )
        and not ( &quot;Has Procedures Identifying Sexual Activity&quot; )
    )</code></pre>
                                        
                                    </td>
                                </tr>
                                
                                <tr>
                                    <td/>
                                    <td/>
                                    <td>Numerator</td>
                                    <td>
                                        
                                            <pre><code class="language-cql">define &quot;Numerator&quot;:
  exists ( ( ( [Observation: &quot;Chlamydia Screening&quot;] ).isLaboratoryTestPerformed ( ) ) ChlamydiaTest
      where ChlamydiaTest.effective.latest ( ) during day of &quot;Measurement Period&quot;
        and ChlamydiaTest.value is not null
  )</code></pre>
                                        
                                    </td>
                                </tr>
                                
                                
                                <tr>
                                    <td/>
                                    <td/>
                                    <td/>
                                    <td>
                                        
                                            <pre><code class="language-cql"/></pre>
                                        
                                    </td>
                                </tr>
                                
                                <tr>
                                    <td/>
                                    <td/>
                                    <td/>
                                    <td>
                                        
                                            <pre><code class="language-cql"/></pre>
                                        
                                    </td>
                                </tr>
                                
                            
                            </tr>
                        </table>
                

                <table class="grid-dict">
                    
                        <tr>
                            <th><b>Library Name</b></th>
                            <th><b>Name</b></th>
                        </tr>
                        <tr>
                            
                                <td>ChlamydiaScreeninginWomenFHIR</td>
                            
                            
                                <td>Numerator</td>
                            
                        </tr>
                        <tr>
                            
                                <td/>
                                <td>
                                    <pre class="highlight language-cql"><code class="language-cql">define &quot;Numerator&quot;:
  exists ( ( ( [Observation: &quot;Chlamydia Screening&quot;] ).isLaboratoryTestPerformed ( ) ) ChlamydiaTest
      where ChlamydiaTest.effective.latest ( ) during day of &quot;Measurement Period&quot;
        and ChlamydiaTest.value is not null
  )</code></pre>
                                </td>
                            
                        </tr>
                    
                        <tr>
                            <th><b>Library Name</b></th>
                            <th><b>Name</b></th>
                        </tr>
                        <tr>
                            
                                <td>ChlamydiaScreeninginWomenFHIR</td>
                            
                            
                                <td>Stratification 2</td>
                            
                        </tr>
                        <tr>
                            
                                <td/>
                                <td>
                                    <pre class="highlight language-cql"><code class="language-cql">define &quot;Stratification 2&quot;:
  AgeInYearsAt(date from 
    end of &quot;Measurement Period&quot;
  ) in Interval[21, 24]</code></pre>
                                </td>
                            
                        </tr>
                    
                        <tr>
                            <th><b>Library Name</b></th>
                            <th><b>Name</b></th>
                        </tr>
                        <tr>
                            
                                <td>ChlamydiaScreeninginWomenFHIR</td>
                            
                            
                                <td>Stratification 1</td>
                            
                        </tr>
                        <tr>
                            
                                <td/>
                                <td>
                                    <pre class="highlight language-cql"><code class="language-cql">define &quot;Stratification 1&quot;:
  AgeInYearsAt(date from 
    end of &quot;Measurement Period&quot;
  ) in Interval[16, 20]</code></pre>
                                </td>
                            
                        </tr>
                    
                        <tr>
                            <th><b>Library Name</b></th>
                            <th><b>Name</b></th>
                        </tr>
                        <tr>
                            
                                <td>ChlamydiaScreeninginWomenFHIR</td>
                            
                            
                                <td>Qualifying Encounters</td>
                            
                        </tr>
                        <tr>
                            
                                <td/>
                                <td>
                                    <pre class="highlight language-cql"><code class="language-cql">define &quot;Qualifying Encounters&quot;:
  ( ( [Encounter: &quot;Office Visit&quot;]
      union [Encounter: &quot;Preventive Care Services Established Office Visit, 18 and Up&quot;]
      union [Encounter: &quot;Preventive Care Services Initial Office Visit, 18 and Up&quot;]
      union [Encounter: &quot;Preventive Care Services, Initial Office Visit, 0 to 17&quot;]
      union [Encounter: &quot;Preventive Care, Established Office Visit, 0 to 17&quot;]
      union [Encounter: &quot;Home Healthcare Services&quot;]
      union [Encounter: &quot;Telephone Visits&quot;]
      union [Encounter: &quot;Virtual Encounter&quot;]
  ).isEncounterPerformed ( ) ) ValidEncounters
    where ValidEncounters.period.toInterval ( ) during day of &quot;Measurement Period&quot;</code></pre>
                                </td>
                            
                        </tr>
                    
                        <tr>
                            <th><b>Library Name</b></th>
                            <th><b>Name</b></th>
                        </tr>
                        <tr>
                            
                                <td>ChlamydiaScreeninginWomenFHIR</td>
                            
                            
                                <td>Has Assessments Identifying Sexual Activity</td>
                            
                        </tr>
                        <tr>
                            
                                <td/>
                                <td>
                                    <pre class="highlight language-cql"><code class="language-cql">define &quot;Has Assessments Identifying Sexual Activity&quot;:
  exists ( ( ( [Observation: &quot;Have you ever had vaginal intercourse [PhenX]&quot;] ).isAssessmentPerformed ( ) ) SexualActivityAssessment
      where SexualActivityAssessment.value ~ &quot;Yes (qualifier value)&quot;
        and SexualActivityAssessment.effective.toInterval ( ) on or before end of &quot;Measurement Period&quot;
  )</code></pre>
                                </td>
                            
                        </tr>
                    
                        <tr>
                            <th><b>Library Name</b></th>
                            <th><b>Name</b></th>
                        </tr>
                        <tr>
                            
                                <td>ChlamydiaScreeninginWomenFHIR</td>
                            
                            
                                <td>Has Diagnoses Identifying Sexual Activity</td>
                            
                        </tr>
                        <tr>
                            
                                <td/>
                                <td>
                                    <pre class="highlight language-cql"><code class="language-cql">define &quot;Has Diagnoses Identifying Sexual Activity&quot;:
  exists ( ( [Condition: &quot;Diagnoses Used to Indicate Sexual Activity&quot;]
      union [Condition: &quot;HIV&quot;]
      union [Condition: &quot;Complications of Pregnancy, Childbirth and the Puerperium&quot;] ) SexualActivityDiagnosis
      where SexualActivityDiagnosis.prevalenceInterval ( ) overlaps &quot;Measurement Period&quot;
  )</code></pre>
                                </td>
                            
                        </tr>
                    
                        <tr>
                            <th><b>Library Name</b></th>
                            <th><b>Name</b></th>
                        </tr>
                        <tr>
                            
                                <td>ChlamydiaScreeninginWomenFHIR</td>
                            
                            
                                <td>Has Active Contraceptive Medications</td>
                            
                        </tr>
                        <tr>
                            
                                <td/>
                                <td>
                                    <pre class="highlight language-cql"><code class="language-cql">define &quot;Has Active Contraceptive Medications&quot;:
  exists ( ( [MedicationRequest: &quot;Contraceptive Medications&quot;] ).isMedicationActive ( ) ) ActiveContraceptives
    where ActiveContraceptives.medicationRequestPeriod ( ) overlaps &quot;Measurement Period&quot;</code></pre>
                                </td>
                            
                        </tr>
                    
                        <tr>
                            <th><b>Library Name</b></th>
                            <th><b>Name</b></th>
                        </tr>
                        <tr>
                            
                                <td>ChlamydiaScreeninginWomenFHIR</td>
                            
                            
                                <td>Has Ordered Contraceptive Medications</td>
                            
                        </tr>
                        <tr>
                            
                                <td/>
                                <td>
                                    <pre class="highlight language-cql"><code class="language-cql">define &quot;Has Ordered Contraceptive Medications&quot;:
  exists ( ( [MedicationRequest: &quot;Contraceptive Medications&quot;] ).isMedicationOrder ( ) ) OrderedContraceptives
    where OrderedContraceptives.authoredOn.toInterval ( ) during day of &quot;Measurement Period&quot;</code></pre>
                                </td>
                            
                        </tr>
                    
                        <tr>
                            <th><b>Library Name</b></th>
                            <th><b>Name</b></th>
                        </tr>
                        <tr>
                            
                                <td>ChlamydiaScreeninginWomenFHIR</td>
                            
                            
                                <td>Has Laboratory Tests Identifying Sexual Activity But Not Pregnancy</td>
                            
                        </tr>
                        <tr>
                            
                                <td/>
                                <td>
                                    <pre class="highlight language-cql"><code class="language-cql">define &quot;Has Laboratory Tests Identifying Sexual Activity But Not Pregnancy&quot;:
  exists ( ( [ServiceRequest: &quot;Pap Test&quot;]
      union [ServiceRequest: &quot;Lab Tests During Pregnancy&quot;]
      union [ServiceRequest: &quot;Lab Tests for Sexually Transmitted Infections&quot;]
  ).isLaboratoryTestOrder ( ) ) LabOrders
    where LabOrders.authoredOn.toInterval ( ) during day of &quot;Measurement Period&quot;</code></pre>
                                </td>
                            
                        </tr>
                    
                        <tr>
                            <th><b>Library Name</b></th>
                            <th><b>Name</b></th>
                        </tr>
                        <tr>
                            
                                <td>ChlamydiaScreeninginWomenFHIR</td>
                            
                            
                                <td>Has Laboratory Tests Identifying Sexual Activity</td>
                            
                        </tr>
                        <tr>
                            
                                <td/>
                                <td>
                                    <pre class="highlight language-cql"><code class="language-cql">//   and LabOrders.doNotPerform is not true
            //   https://oncprojectracking.healthit.gov/support/browse/CQLIT-447



define &quot;Has Laboratory Tests Identifying Sexual Activity&quot;:
  exists ( ( ( [ServiceRequest: &quot;Pregnancy Test&quot;] ).isLaboratoryTestOrder ( ) ) PregnancyTest
      where PregnancyTest.authoredOn.toInterval ( ) during day of &quot;Measurement Period&quot;
    //   and PregnancyTest.doNotPerform is not true
    //   https://oncprojectracking.healthit.gov/support/browse/CQLIT-447
  
  
  )
    or &quot;Has Laboratory Tests Identifying Sexual Activity But Not Pregnancy&quot;</code></pre>
                                </td>
                            
                        </tr>
                    
                        <tr>
                            <th><b>Library Name</b></th>
                            <th><b>Name</b></th>
                        </tr>
                        <tr>
                            
                                <td>ChlamydiaScreeninginWomenFHIR</td>
                            
                            
                                <td>Has Diagnostic Studies Identifying Sexual Activity</td>
                            
                        </tr>
                        <tr>
                            
                                <td/>
                                <td>
                                    <pre class="highlight language-cql"><code class="language-cql">define &quot;Has Diagnostic Studies Identifying Sexual Activity&quot;:
  exists ( ( [ServiceRequest: &quot;Diagnostic Studies During Pregnancy&quot;] ).isDiagnosticStudyOrder ( ) ) SexualActivityDiagnostics
    where SexualActivityDiagnostics.authoredOn.toInterval ( ) during day of &quot;Measurement Period&quot;</code></pre>
                                </td>
                            
                        </tr>
                    
                        <tr>
                            <th><b>Library Name</b></th>
                            <th><b>Name</b></th>
                        </tr>
                        <tr>
                            
                                <td>ChlamydiaScreeninginWomenFHIR</td>
                            
                            
                                <td>Has Procedures Identifying Sexual Activity</td>
                            
                        </tr>
                        <tr>
                            
                                <td/>
                                <td>
                                    <pre class="highlight language-cql"><code class="language-cql">//   and SexualActivityDiagnostics.doNotPerform is not true
            //   https://oncprojectracking.healthit.gov/support/browse/CQLIT-447   



define &quot;Has Procedures Identifying Sexual Activity&quot;:
  exists ( ( [Procedure: &quot;Procedures Used to Indicate Sexual Activity&quot;] ).isProcedurePerformed ( ) ) ProceduresForSexualActivity
    where ProceduresForSexualActivity.performed.toInterval ( ) during day of &quot;Measurement Period&quot;</code></pre>
                                </td>
                            
                        </tr>
                    
                        <tr>
                            <th><b>Library Name</b></th>
                            <th><b>Name</b></th>
                        </tr>
                        <tr>
                            
                                <td>ChlamydiaScreeninginWomenFHIR</td>
                            
                            
                                <td>Initial Population</td>
                            
                        </tr>
                        <tr>
                            
                                <td/>
                                <td>
                                    <pre class="highlight language-cql"><code class="language-cql">define &quot;Initial Population&quot;:
  AgeInYearsAt(date from 
    end of &quot;Measurement Period&quot;
  ) in Interval[16, 24]
    and Patient.gender = 'female'
    and exists ( &quot;Qualifying Encounters&quot; )
    and ( ( &quot;Has Assessments Identifying Sexual Activity&quot; )
        or ( &quot;Has Diagnoses Identifying Sexual Activity&quot; )
        or ( &quot;Has Active Contraceptive Medications&quot; )
        or ( &quot;Has Ordered Contraceptive Medications&quot; )
        or ( &quot;Has Laboratory Tests Identifying Sexual Activity&quot; )
        or ( &quot;Has Diagnostic Studies Identifying Sexual Activity&quot; )
        or ( &quot;Has Procedures Identifying Sexual Activity&quot; )
    )</code></pre>
                                </td>
                            
                        </tr>
                    
                        <tr>
                            <th><b>Library Name</b></th>
                            <th><b>Name</b></th>
                        </tr>
                        <tr>
                            
                                <td>ChlamydiaScreeninginWomenFHIR</td>
                            
                            
                                <td>Denominator</td>
                            
                        </tr>
                        <tr>
                            
                                <td/>
                                <td>
                                    <pre class="highlight language-cql"><code class="language-cql">define &quot;Denominator&quot;:
  &quot;Initial Population&quot;</code></pre>
                                </td>
                            
                        </tr>
                    
                        <tr>
                            <th><b>Library Name</b></th>
                            <th><b>Name</b></th>
                        </tr>
                        <tr>
                            
                                <td>Hospice</td>
                            
                            
                                <td>Has Hospice Services</td>
                            
                        </tr>
                        <tr>
                            
                                <td/>
                                <td>
                                    <pre class="highlight language-cql"><code class="language-cql">define &quot;Has Hospice Services&quot;:
  exists ((([Encounter: &quot;Encounter Inpatient&quot;]).isEncounterPerformed()) InpatientEncounter
      where (InpatientEncounter.hospitalization.dischargeDisposition ~ &quot;Discharge to home for hospice care (procedure)&quot;
          or InpatientEncounter.hospitalization.dischargeDisposition ~ &quot;Discharge to healthcare facility for hospice care (procedure)&quot;
      )
        and InpatientEncounter.period.toInterval() ends during day of &quot;Measurement Period&quot;
  )
    or exists ((([Encounter: &quot;Hospice Encounter&quot;]).isEncounterPerformed()) HospiceEncounter
        where HospiceEncounter.period.toInterval() overlaps day of &quot;Measurement Period&quot;
    )
    or exists ((([Observation: &quot;Hospice care [Minimum Data Set]&quot;]).isAssessmentPerformed()) HospiceAssessment
        where HospiceAssessment.value ~ &quot;Yes (qualifier value)&quot;
          and HospiceAssessment.effective.toInterval() overlaps day of &quot;Measurement Period&quot;
    )
    or exists ((([ServiceRequest: &quot;Hospice Care Ambulatory&quot;]).isInterventionOrder()) HospiceOrder
        where HospiceOrder.authoredOn.toInterval() during day of &quot;Measurement Period&quot;
        // and HospiceOrder.doNotPerform is not true
        // https://oncprojectracking.healthit.gov/support/browse/CQLIT-447
    )
    or exists ((([Procedure: &quot;Hospice Care Ambulatory&quot;]).isInterventionPerformed()) HospicePerformed
        where HospicePerformed.performed.toInterval() overlaps day of &quot;Measurement Period&quot;
    )
    or exists (([Condition: &quot;Hospice Diagnosis&quot;]) HospiceCareDiagnosis
        where HospiceCareDiagnosis.prevalenceInterval() overlaps day of &quot;Measurement Period&quot;
    )</code></pre>
                                </td>
                            
                        </tr>
                    
                        <tr>
                            <th><b>Library Name</b></th>
                            <th><b>Name</b></th>
                        </tr>
                        <tr>
                            
                                <td>ChlamydiaScreeninginWomenFHIR</td>
                            
                            
                                <td>Has Pregnancy Test Exclusion</td>
                            
                        </tr>
                        <tr>
                            
                                <td/>
                                <td>
                                    <pre class="highlight language-cql"><code class="language-cql">define &quot;Has Pregnancy Test Exclusion&quot;:
  exists ( ( ( ( [ServiceRequest: &quot;Pregnancy Test&quot;] ).isLaboratoryTestOrder ( ) ) PregnancyTest
        with ( ( [ServiceRequest: &quot;XRay Study&quot;] ).isDiagnosticStudyOrder ( ) ) XrayOrder
          such that XrayOrder.authoredOn.toInterval ( ) occurs 6 days or less on or after day of PregnancyTest.authoredOn.toInterval ( )
        where PregnancyTest.authoredOn.toInterval ( ) during &quot;Measurement Period&quot;
        //   and PregnancyTest.doNotPerform is not true
        //   https://oncprojectracking.healthit.gov/support/browse/CQLIT-447
    
    
    )
      union ( ( ( [ServiceRequest: &quot;Pregnancy Test&quot;] ).isLaboratoryTestOrder ( ) ) PregnancyTestOrder
          with ( ( [MedicationRequest: &quot;Isotretinoin&quot;] ).isMedicationOrder ( ) ) AccutaneOrder
            such that AccutaneOrder.authoredOn.toInterval ( ) occurs 6 days or less on or after day of PregnancyTestOrder.authoredOn.toInterval ( )
          where PregnancyTestOrder.authoredOn.toInterval ( ) during &quot;Measurement Period&quot;
            //   and PregnancyTestOrder.doNotPerform is not true
            //   https://oncprojectracking.healthit.gov/support/browse/CQLIT-447 
      
      
      )
  )</code></pre>
                                </td>
                            
                        </tr>
                    
                        <tr>
                            <th><b>Library Name</b></th>
                            <th><b>Name</b></th>
                        </tr>
                        <tr>
                            
                                <td>ChlamydiaScreeninginWomenFHIR</td>
                            
                            
                                <td>Denominator Exclusions</td>
                            
                        </tr>
                        <tr>
                            
                                <td/>
                                <td>
                                    <pre class="highlight language-cql"><code class="language-cql">define &quot;Denominator Exclusions&quot;:
  Hospice.&quot;Has Hospice Services&quot;
    or ( ( &quot;Has Pregnancy Test Exclusion&quot; )
        and not ( &quot;Has Assessments Identifying Sexual Activity&quot; )
        and not ( &quot;Has Diagnoses Identifying Sexual Activity&quot; )
        and not ( &quot;Has Active Contraceptive Medications&quot; )
        and not ( &quot;Has Ordered Contraceptive Medications&quot; )
        and not ( &quot;Has Laboratory Tests Identifying Sexual Activity But Not Pregnancy&quot; )
        and not ( &quot;Has Diagnostic Studies Identifying Sexual Activity&quot; )
        and not ( &quot;Has Procedures Identifying Sexual Activity&quot; )
    )</code></pre>
                                </td>
                            
                        </tr>
                    
                        <tr>
                            <th><b>Library Name</b></th>
                            <th><b>Name</b></th>
                        </tr>
                        <tr>
                            
                                <td>Status</td>
                            
                            
                                <td>isLaboratoryTestPerformed</td>
                            
                        </tr>
                        <tr>
                            
                                <td/>
                                <td>
                                    <pre class="highlight language-cql"><code class="language-cql">//Laboratory Test, Performed
define fluent function isLaboratoryTestPerformed(Obs List&lt;Observation&gt;):
  Obs O
    where O.status in { 'final', 'amended', 'corrected' }
      and exists ( O.category ObservationCategory
          where ( ObservationCategory ) ~ &quot;laboratory&quot;
      )</code></pre>
                                </td>
                            
                        </tr>
                    
                        <tr>
                            <th><b>Library Name</b></th>
                            <th><b>Name</b></th>
                        </tr>
                        <tr>
                            
                                <td>FHIRHelpers</td>
                            
                            
                                <td>ToConcept</td>
                            
                        </tr>
                        <tr>
                            
                                <td/>
                                <td>
                                    <pre class="highlight language-cql"><code class="language-cql">/*
@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
        }</code></pre>
                                </td>
                            
                        </tr>
                    
                        <tr>
                            <th><b>Library Name</b></th>
                            <th><b>Name</b></th>
                        </tr>
                        <tr>
                            
                                <td>QICoreCommon</td>
                            
                            
                                <td>latest</td>
                            
                        </tr>
                        <tr>
                            
                                <td/>
                                <td>
                                    <pre class="highlight language-cql"><code class="language-cql">/*
@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&lt;DateTime, Quantity, Interval&lt;DateTime&gt;, Interval&lt;Quantity&gt;&gt; ):
  (choice.toInterval()) period
    return
      if (period.&quot;hasEnd&quot;()) then end of period
      else start of period</code></pre>
                                </td>
                            
                        </tr>
                    
                        <tr>
                            <th><b>Library Name</b></th>
                            <th><b>Name</b></th>
                        </tr>
                        <tr>
                            
                                <td>Status</td>
                            
                            
                                <td>isEncounterPerformed</td>
                            
                        </tr>
                        <tr>
                            
                                <td/>
                                <td>
                                    <pre class="highlight language-cql"><code class="language-cql">//Encounter, Performed
//General usage unless required otherwise by measure intent (e.g., follow-up encounters)
define fluent function isEncounterPerformed(Enc List&lt;Encounter&gt;):
  Enc E
    where E.status in {'finished', 'arrived', 'triaged', 'in-progress', 'onleave'}</code></pre>
                                </td>
                            
                        </tr>
                    
                        <tr>
                            <th><b>Library Name</b></th>
                            <th><b>Name</b></th>
                        </tr>
                        <tr>
                            
                                <td>QICoreCommon</td>
                            
                            
                                <td>toInterval</td>
                            
                        </tr>
                        <tr>
                            
                                <td/>
                                <td>
                                    <pre class="highlight language-cql"><code class="language-cql">/*
@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&lt;DateTime&gt;, or Interval&lt;Quantity&gt; 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&lt;DateTime&gt; or Interval&lt;Quantity&gt;.
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&lt;DateTime, Quantity, Interval&lt;DateTime&gt;, Interval&lt;Quantity&gt;, Timing&gt;):
  case
	  when choice is DateTime then
    	Interval[choice as DateTime, choice as DateTime]
		when choice is Interval&lt;DateTime&gt; then
  		choice as Interval&lt;DateTime&gt;
		when choice is Quantity then
		  Interval[Patient.birthDate + (choice as Quantity),
			  Patient.birthDate + (choice as Quantity) + 1 year)
		when choice is Interval&lt;Quantity&gt; 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&lt;DateTime&gt;
		else
			null as Interval&lt;DateTime&gt;
	end</code></pre>
                                </td>
                            
                        </tr>
                    
                        <tr>
                            <th><b>Library Name</b></th>
                            <th><b>Name</b></th>
                        </tr>
                        <tr>
                            
                                <td>Status</td>
                            
                            
                                <td>isAssessmentPerformed</td>
                            
                        </tr>
                        <tr>
                            
                                <td/>
                                <td>
                                    <pre class="highlight language-cql"><code class="language-cql">//This library contains functions that are based on QDM 5.6 to QICore 4.1.1 March 2023 (https://github.com/cqframework/CQL-Formatting-and-Usage-Wiki/wiki/Authoring-Patterns---QICore-v4.1.1). The functions may appear similar to some QICoreCommon functions but different in that they have constraints that are relevant for measures authored by NCQA.

//Assessment, Performed
define fluent function isAssessmentPerformed(Obs List&lt;Observation&gt;):
  Obs O
    where O.status in { 'final', 'amended', 'corrected' }
          and exists ( O.category ObservationCategory
          where ( ObservationCategory ) ~ &quot;survey&quot;
      )</code></pre>
                                </td>
                            
                        </tr>
                    
                        <tr>
                            <th><b>Library Name</b></th>
                            <th><b>Name</b></th>
                        </tr>
                        <tr>
                            
                                <td>QICoreCommon</td>
                            
                            
                                <td>prevalenceInterval</td>
                            
                        </tr>
                        <tr>
                            
                                <td/>
                                <td>
                                    <pre class="highlight language-cql"><code class="language-cql">/*
@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 ~ &quot;active&quot;
  or condition.clinicalStatus ~ &quot;recurrence&quot;
  or condition.clinicalStatus ~ &quot;relapse&quot; 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]</code></pre>
                                </td>
                            
                        </tr>
                    
                        <tr>
                            <th><b>Library Name</b></th>
                            <th><b>Name</b></th>
                        </tr>
                        <tr>
                            
                                <td>Status</td>
                            
                            
                                <td>isMedicationActive</td>
                            
                        </tr>
                        <tr>
                            
                                <td/>
                                <td>
                                    <pre class="highlight language-cql"><code class="language-cql">//Medication, Active
define fluent function isMedicationActive(MedicationRequest List&lt;MedicationRequest&gt;):
  MedicationRequest M
    where M.status = 'active'
      and M.intent = 'order'</code></pre>
                                </td>
                            
                        </tr>
                    
                        <tr>
                            <th><b>Library Name</b></th>
                            <th><b>Name</b></th>
                        </tr>
                        <tr>
                            
                                <td>CumulativeMedicationDuration</td>
                            
                            
                                <td>medicationRequestPeriod</td>
                            
                        </tr>
                        <tr>
                            
                                <td/>
                                <td>
                                    <pre class="highlight language-cql"><code class="language-cql">define fluent function medicationRequestPeriod(Request &quot;MedicationRequest&quot;):
  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&lt;DateTime&gt;,
      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.&quot;high&quot; is not null then
        Interval[startDate, date from end of boundsPeriod]
      else
        null</code></pre>
                                </td>
                            
                        </tr>
                    
                        <tr>
                            <th><b>Library Name</b></th>
                            <th><b>Name</b></th>
                        </tr>
                        <tr>
                            
                                <td>CumulativeMedicationDuration</td>
                            
                            
                                <td>Quantity</td>
                            
                        </tr>
                        <tr>
                            
                                <td/>
                                <td>
                                    <pre class="highlight language-cql"><code class="language-cql">/**********************************************************************/
/* 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</code></pre>
                                </td>
                            
                        </tr>
                    
                        <tr>
                            <th><b>Library Name</b></th>
                            <th><b>Name</b></th>
                        </tr>
                        <tr>
                            
                                <td>CumulativeMedicationDuration</td>
                            
                            
                                <td>ToDaily</td>
                            
                        </tr>
                        <tr>
                            
                                <td/>
                                <td>
                                    <pre class="highlight language-cql"><code class="language-cql">/*
 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 ' &amp; period.unit)
  end</code></pre>
                                </td>
                            
                        </tr>
                    
                        <tr>
                            <th><b>Library Name</b></th>
                            <th><b>Name</b></th>
                        </tr>
                        <tr>
                            
                                <td>Status</td>
                            
                            
                                <td>isMedicationOrder</td>
                            
                        </tr>
                        <tr>
                            
                                <td/>
                                <td>
                                    <pre class="highlight language-cql"><code class="language-cql">//Medication, Order: active and completed only
define fluent function isMedicationOrder(MedicationRequest List&lt;MedicationRequest&gt;):
  MedicationRequest M
    where M.status in { 'active', 'completed' }
      and M.intent = 'order'</code></pre>
                                </td>
                            
                        </tr>
                    
                        <tr>
                            <th><b>Library Name</b></th>
                            <th><b>Name</b></th>
                        </tr>
                        <tr>
                            
                                <td>Status</td>
                            
                            
                                <td>isLaboratoryTestOrder</td>
                            
                        </tr>
                        <tr>
                            
                                <td/>
                                <td>
                                    <pre class="highlight language-cql"><code class="language-cql">//Laboratory Test, Order: active and completed only
define fluent function isLaboratoryTestOrder(ServiceRequest List&lt;ServiceRequest&gt;):
  ServiceRequest S
    where S.status in { 'active', 'completed' }
      and S.intent = 'order'</code></pre>
                                </td>
                            
                        </tr>
                    
                        <tr>
                            <th><b>Library Name</b></th>
                            <th><b>Name</b></th>
                        </tr>
                        <tr>
                            
                                <td>Status</td>
                            
                            
                                <td>isDiagnosticStudyOrder</td>
                            
                        </tr>
                        <tr>
                            
                                <td/>
                                <td>
                                    <pre class="highlight language-cql"><code class="language-cql">//Diagnostic Study, Order: active and completed only
define fluent function isDiagnosticStudyOrder(ServiceRequest List&lt;ServiceRequest&gt;):
  ServiceRequest S
    where S.status in { 'active', 'completed' }
      and S.intent = 'order'</code></pre>
                                </td>
                            
                        </tr>
                    
                        <tr>
                            <th><b>Library Name</b></th>
                            <th><b>Name</b></th>
                        </tr>
                        <tr>
                            
                                <td>Status</td>
                            
                            
                                <td>isProcedurePerformed</td>
                            
                        </tr>
                        <tr>
                            
                                <td/>
                                <td>
                                    <pre class="highlight language-cql"><code class="language-cql">//Procedure, Performed
define fluent function isProcedurePerformed(Proc List&lt;Procedure&gt;):
  Proc P
    where P.status ~ 'completed'</code></pre>
                                </td>
                            
                        </tr>
                    
                        <tr>
                            <th><b>Library Name</b></th>
                            <th><b>Name</b></th>
                        </tr>
                        <tr>
                            
                                <td>Status</td>
                            
                            
                                <td>isInterventionOrder</td>
                            
                        </tr>
                        <tr>
                            
                                <td/>
                                <td>
                                    <pre class="highlight language-cql"><code class="language-cql">//Intervention, Order: active and completed only    
define fluent function isInterventionOrder(ServiceRequest List&lt;ServiceRequest&gt;):
  ServiceRequest S
    where S.status in { 'active', 'completed' }
      and S.intent = 'order'</code></pre>
                                </td>
                            
                        </tr>
                    
                        <tr>
                            <th><b>Library Name</b></th>
                            <th><b>Name</b></th>
                        </tr>
                        <tr>
                            
                                <td>Status</td>
                            
                            
                                <td>isInterventionPerformed</td>
                            
                        </tr>
                        <tr>
                            
                                <td/>
                                <td>
                                    <pre class="highlight language-cql"><code class="language-cql">//Intervention, Performed
define fluent function isInterventionPerformed(Proc List&lt;Procedure&gt;):
  Proc P
    where P.status ~ 'completed'</code></pre>
                                </td>
                            
                        </tr>
                    
                    </table>
                </td>
            </tr>
            
        
    

    </table>
</div>
  </text>
  <contained>
    <Library>
      <id value="effective-data-requirements"/>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
        <valueCoding>
          <system
                  value="http://terminology.hl7.org/CodeSystem/observation-category"/>
          <code value="laboratory"/>
          <display value="laboratory"/>
        </valueCoding>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
        <valueCoding>
          <system
                  value="http://terminology.hl7.org/CodeSystem/observation-category"/>
          <code value="survey"/>
          <display value="survey"/>
        </valueCoding>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
        <valueCoding>
          <system value="http://loinc.org"/>
          <code value="64728-9"/>
          <display value="Have you ever had vaginal intercourse [PhenX]"/>
        </valueCoding>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
        <valueCoding>
          <system value="http://snomed.info/sct"/>
          <code value="373066001"/>
          <display value="Yes (qualifier value)"/>
        </valueCoding>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
        <valueCoding>
          <system value="http://snomed.info/sct"/>
          <code value="428361000124107"/>
          <display value="Discharge to home for hospice care (procedure)"/>
        </valueCoding>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
        <valueCoding>
          <system value="http://snomed.info/sct"/>
          <code value="428371000124100"/>
          <display
                   value="Discharge to healthcare facility for hospice care (procedure)"/>
        </valueCoding>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
        <valueCoding>
          <system value="http://loinc.org"/>
          <code value="45755-6"/>
          <display value="Hospice care [Minimum Data Set]"/>
        </valueCoding>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
        <extension url="libraryName">
          <valueString value="ChlamydiaScreeninginWomenFHIR"/>
        </extension>
        <extension url="name">
          <valueString value="Numerator"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define &quot;Numerator&quot;:
  exists ( ( ( [Observation: &quot;Chlamydia Screening&quot;] ).isLaboratoryTestPerformed ( ) ) ChlamydiaTest
      where ChlamydiaTest.effective.latest ( ) during day of &quot;Measurement Period&quot;
        and ChlamydiaTest.value is not null
  )"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="0"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
        <extension url="libraryName">
          <valueString value="ChlamydiaScreeninginWomenFHIR"/>
        </extension>
        <extension url="name">
          <valueString value="Stratification 2"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define &quot;Stratification 2&quot;:
  AgeInYearsAt(date from 
    end of &quot;Measurement Period&quot;
  ) in Interval[21, 24]"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="1"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
        <extension url="libraryName">
          <valueString value="ChlamydiaScreeninginWomenFHIR"/>
        </extension>
        <extension url="name">
          <valueString value="Stratification 1"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define &quot;Stratification 1&quot;:
  AgeInYearsAt(date from 
    end of &quot;Measurement Period&quot;
  ) in Interval[16, 20]"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="2"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
        <extension url="libraryName">
          <valueString value="ChlamydiaScreeninginWomenFHIR"/>
        </extension>
        <extension url="name">
          <valueString value="Qualifying Encounters"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define &quot;Qualifying Encounters&quot;:
  ( ( [Encounter: &quot;Office Visit&quot;]
      union [Encounter: &quot;Preventive Care Services Established Office Visit, 18 and Up&quot;]
      union [Encounter: &quot;Preventive Care Services Initial Office Visit, 18 and Up&quot;]
      union [Encounter: &quot;Preventive Care Services, Initial Office Visit, 0 to 17&quot;]
      union [Encounter: &quot;Preventive Care, Established Office Visit, 0 to 17&quot;]
      union [Encounter: &quot;Home Healthcare Services&quot;]
      union [Encounter: &quot;Telephone Visits&quot;]
      union [Encounter: &quot;Virtual Encounter&quot;]
  ).isEncounterPerformed ( ) ) ValidEncounters
    where ValidEncounters.period.toInterval ( ) during day of &quot;Measurement Period&quot;"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="3"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
        <extension url="libraryName">
          <valueString value="ChlamydiaScreeninginWomenFHIR"/>
        </extension>
        <extension url="name">
          <valueString value="Has Assessments Identifying Sexual Activity"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define &quot;Has Assessments Identifying Sexual Activity&quot;:
  exists ( ( ( [Observation: &quot;Have you ever had vaginal intercourse [PhenX]&quot;] ).isAssessmentPerformed ( ) ) SexualActivityAssessment
      where SexualActivityAssessment.value ~ &quot;Yes (qualifier value)&quot;
        and SexualActivityAssessment.effective.toInterval ( ) on or before end of &quot;Measurement Period&quot;
  )"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="4"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
        <extension url="libraryName">
          <valueString value="ChlamydiaScreeninginWomenFHIR"/>
        </extension>
        <extension url="name">
          <valueString value="Has Diagnoses Identifying Sexual Activity"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define &quot;Has Diagnoses Identifying Sexual Activity&quot;:
  exists ( ( [Condition: &quot;Diagnoses Used to Indicate Sexual Activity&quot;]
      union [Condition: &quot;HIV&quot;]
      union [Condition: &quot;Complications of Pregnancy, Childbirth and the Puerperium&quot;] ) SexualActivityDiagnosis
      where SexualActivityDiagnosis.prevalenceInterval ( ) overlaps &quot;Measurement Period&quot;
  )"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="5"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
        <extension url="libraryName">
          <valueString value="ChlamydiaScreeninginWomenFHIR"/>
        </extension>
        <extension url="name">
          <valueString value="Has Active Contraceptive Medications"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define &quot;Has Active Contraceptive Medications&quot;:
  exists ( ( [MedicationRequest: &quot;Contraceptive Medications&quot;] ).isMedicationActive ( ) ) ActiveContraceptives
    where ActiveContraceptives.medicationRequestPeriod ( ) overlaps &quot;Measurement Period&quot;"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="6"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
        <extension url="libraryName">
          <valueString value="ChlamydiaScreeninginWomenFHIR"/>
        </extension>
        <extension url="name">
          <valueString value="Has Ordered Contraceptive Medications"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define &quot;Has Ordered Contraceptive Medications&quot;:
  exists ( ( [MedicationRequest: &quot;Contraceptive Medications&quot;] ).isMedicationOrder ( ) ) OrderedContraceptives
    where OrderedContraceptives.authoredOn.toInterval ( ) during day of &quot;Measurement Period&quot;"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="7"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
        <extension url="libraryName">
          <valueString value="ChlamydiaScreeninginWomenFHIR"/>
        </extension>
        <extension url="name">
          <valueString
                       value="Has Laboratory Tests Identifying Sexual Activity But Not Pregnancy"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define &quot;Has Laboratory Tests Identifying Sexual Activity But Not Pregnancy&quot;:
  exists ( ( [ServiceRequest: &quot;Pap Test&quot;]
      union [ServiceRequest: &quot;Lab Tests During Pregnancy&quot;]
      union [ServiceRequest: &quot;Lab Tests for Sexually Transmitted Infections&quot;]
  ).isLaboratoryTestOrder ( ) ) LabOrders
    where LabOrders.authoredOn.toInterval ( ) during day of &quot;Measurement Period&quot;"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="8"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
        <extension url="libraryName">
          <valueString value="ChlamydiaScreeninginWomenFHIR"/>
        </extension>
        <extension url="name">
          <valueString
                       value="Has Laboratory Tests Identifying Sexual Activity"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="//   and LabOrders.doNotPerform is not true
            //   https://oncprojectracking.healthit.gov/support/browse/CQLIT-447



define &quot;Has Laboratory Tests Identifying Sexual Activity&quot;:
  exists ( ( ( [ServiceRequest: &quot;Pregnancy Test&quot;] ).isLaboratoryTestOrder ( ) ) PregnancyTest
      where PregnancyTest.authoredOn.toInterval ( ) during day of &quot;Measurement Period&quot;
    //   and PregnancyTest.doNotPerform is not true
    //   https://oncprojectracking.healthit.gov/support/browse/CQLIT-447
  
  
  )
    or &quot;Has Laboratory Tests Identifying Sexual Activity But Not Pregnancy&quot;"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="9"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
        <extension url="libraryName">
          <valueString value="ChlamydiaScreeninginWomenFHIR"/>
        </extension>
        <extension url="name">
          <valueString
                       value="Has Diagnostic Studies Identifying Sexual Activity"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define &quot;Has Diagnostic Studies Identifying Sexual Activity&quot;:
  exists ( ( [ServiceRequest: &quot;Diagnostic Studies During Pregnancy&quot;] ).isDiagnosticStudyOrder ( ) ) SexualActivityDiagnostics
    where SexualActivityDiagnostics.authoredOn.toInterval ( ) during day of &quot;Measurement Period&quot;"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="10"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
        <extension url="libraryName">
          <valueString value="ChlamydiaScreeninginWomenFHIR"/>
        </extension>
        <extension url="name">
          <valueString value="Has Procedures Identifying Sexual Activity"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="//   and SexualActivityDiagnostics.doNotPerform is not true
            //   https://oncprojectracking.healthit.gov/support/browse/CQLIT-447   



define &quot;Has Procedures Identifying Sexual Activity&quot;:
  exists ( ( [Procedure: &quot;Procedures Used to Indicate Sexual Activity&quot;] ).isProcedurePerformed ( ) ) ProceduresForSexualActivity
    where ProceduresForSexualActivity.performed.toInterval ( ) during day of &quot;Measurement Period&quot;"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="11"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
        <extension url="libraryName">
          <valueString value="ChlamydiaScreeninginWomenFHIR"/>
        </extension>
        <extension url="name">
          <valueString value="Initial Population"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define &quot;Initial Population&quot;:
  AgeInYearsAt(date from 
    end of &quot;Measurement Period&quot;
  ) in Interval[16, 24]
    and Patient.gender = 'female'
    and exists ( &quot;Qualifying Encounters&quot; )
    and ( ( &quot;Has Assessments Identifying Sexual Activity&quot; )
        or ( &quot;Has Diagnoses Identifying Sexual Activity&quot; )
        or ( &quot;Has Active Contraceptive Medications&quot; )
        or ( &quot;Has Ordered Contraceptive Medications&quot; )
        or ( &quot;Has Laboratory Tests Identifying Sexual Activity&quot; )
        or ( &quot;Has Diagnostic Studies Identifying Sexual Activity&quot; )
        or ( &quot;Has Procedures Identifying Sexual Activity&quot; )
    )"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="12"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
        <extension url="libraryName">
          <valueString value="ChlamydiaScreeninginWomenFHIR"/>
        </extension>
        <extension url="name">
          <valueString value="Denominator"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define &quot;Denominator&quot;:
  &quot;Initial Population&quot;"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="13"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
        <extension url="libraryName">
          <valueString value="Hospice"/>
        </extension>
        <extension url="name">
          <valueString value="Has Hospice Services"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define &quot;Has Hospice Services&quot;:
  exists ((([Encounter: &quot;Encounter Inpatient&quot;]).isEncounterPerformed()) InpatientEncounter
      where (InpatientEncounter.hospitalization.dischargeDisposition ~ &quot;Discharge to home for hospice care (procedure)&quot;
          or InpatientEncounter.hospitalization.dischargeDisposition ~ &quot;Discharge to healthcare facility for hospice care (procedure)&quot;
      )
        and InpatientEncounter.period.toInterval() ends during day of &quot;Measurement Period&quot;
  )
    or exists ((([Encounter: &quot;Hospice Encounter&quot;]).isEncounterPerformed()) HospiceEncounter
        where HospiceEncounter.period.toInterval() overlaps day of &quot;Measurement Period&quot;
    )
    or exists ((([Observation: &quot;Hospice care [Minimum Data Set]&quot;]).isAssessmentPerformed()) HospiceAssessment
        where HospiceAssessment.value ~ &quot;Yes (qualifier value)&quot;
          and HospiceAssessment.effective.toInterval() overlaps day of &quot;Measurement Period&quot;
    )
    or exists ((([ServiceRequest: &quot;Hospice Care Ambulatory&quot;]).isInterventionOrder()) HospiceOrder
        where HospiceOrder.authoredOn.toInterval() during day of &quot;Measurement Period&quot;
        // and HospiceOrder.doNotPerform is not true
        // https://oncprojectracking.healthit.gov/support/browse/CQLIT-447
    )
    or exists ((([Procedure: &quot;Hospice Care Ambulatory&quot;]).isInterventionPerformed()) HospicePerformed
        where HospicePerformed.performed.toInterval() overlaps day of &quot;Measurement Period&quot;
    )
    or exists (([Condition: &quot;Hospice Diagnosis&quot;]) HospiceCareDiagnosis
        where HospiceCareDiagnosis.prevalenceInterval() overlaps day of &quot;Measurement Period&quot;
    )"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="14"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
        <extension url="libraryName">
          <valueString value="ChlamydiaScreeninginWomenFHIR"/>
        </extension>
        <extension url="name">
          <valueString value="Has Pregnancy Test Exclusion"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define &quot;Has Pregnancy Test Exclusion&quot;:
  exists ( ( ( ( [ServiceRequest: &quot;Pregnancy Test&quot;] ).isLaboratoryTestOrder ( ) ) PregnancyTest
        with ( ( [ServiceRequest: &quot;XRay Study&quot;] ).isDiagnosticStudyOrder ( ) ) XrayOrder
          such that XrayOrder.authoredOn.toInterval ( ) occurs 6 days or less on or after day of PregnancyTest.authoredOn.toInterval ( )
        where PregnancyTest.authoredOn.toInterval ( ) during &quot;Measurement Period&quot;
        //   and PregnancyTest.doNotPerform is not true
        //   https://oncprojectracking.healthit.gov/support/browse/CQLIT-447
    
    
    )
      union ( ( ( [ServiceRequest: &quot;Pregnancy Test&quot;] ).isLaboratoryTestOrder ( ) ) PregnancyTestOrder
          with ( ( [MedicationRequest: &quot;Isotretinoin&quot;] ).isMedicationOrder ( ) ) AccutaneOrder
            such that AccutaneOrder.authoredOn.toInterval ( ) occurs 6 days or less on or after day of PregnancyTestOrder.authoredOn.toInterval ( )
          where PregnancyTestOrder.authoredOn.toInterval ( ) during &quot;Measurement Period&quot;
            //   and PregnancyTestOrder.doNotPerform is not true
            //   https://oncprojectracking.healthit.gov/support/browse/CQLIT-447 
      
      
      )
  )"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="15"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
        <extension url="libraryName">
          <valueString value="ChlamydiaScreeninginWomenFHIR"/>
        </extension>
        <extension url="name">
          <valueString value="Denominator Exclusions"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define &quot;Denominator Exclusions&quot;:
  Hospice.&quot;Has Hospice Services&quot;
    or ( ( &quot;Has Pregnancy Test Exclusion&quot; )
        and not ( &quot;Has Assessments Identifying Sexual Activity&quot; )
        and not ( &quot;Has Diagnoses Identifying Sexual Activity&quot; )
        and not ( &quot;Has Active Contraceptive Medications&quot; )
        and not ( &quot;Has Ordered Contraceptive Medications&quot; )
        and not ( &quot;Has Laboratory Tests Identifying Sexual Activity But Not Pregnancy&quot; )
        and not ( &quot;Has Diagnostic Studies Identifying Sexual Activity&quot; )
        and not ( &quot;Has Procedures Identifying Sexual Activity&quot; )
    )"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="16"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
        <extension url="libraryName">
          <valueString value="Status"/>
        </extension>
        <extension url="name">
          <valueString value="isLaboratoryTestPerformed"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="//Laboratory Test, Performed
define fluent function isLaboratoryTestPerformed(Obs List&lt;Observation&gt;):
  Obs O
    where O.status in { 'final', 'amended', 'corrected' }
      and exists ( O.category ObservationCategory
          where ( ObservationCategory ) ~ &quot;laboratory&quot;
      )"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="17"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
        <extension url="libraryName">
          <valueString value="FHIRHelpers"/>
        </extension>
        <extension url="name">
          <valueString value="ToConcept"/>
        </extension>
        <extension url="statement">
          <valueString
                       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
        }"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="18"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
        <extension url="libraryName">
          <valueString value="QICoreCommon"/>
        </extension>
        <extension url="name">
          <valueString value="latest"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="/*
@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&lt;DateTime, Quantity, Interval&lt;DateTime&gt;, Interval&lt;Quantity&gt;&gt; ):
  (choice.toInterval()) period
    return
      if (period.&quot;hasEnd&quot;()) then end of period
      else start of period"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="19"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
        <extension url="libraryName">
          <valueString value="Status"/>
        </extension>
        <extension url="name">
          <valueString value="isEncounterPerformed"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="//Encounter, Performed
//General usage unless required otherwise by measure intent (e.g., follow-up encounters)
define fluent function isEncounterPerformed(Enc List&lt;Encounter&gt;):
  Enc E
    where E.status in {'finished', 'arrived', 'triaged', 'in-progress', 'onleave'}"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="20"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
        <extension url="libraryName">
          <valueString value="QICoreCommon"/>
        </extension>
        <extension url="name">
          <valueString value="toInterval"/>
        </extension>
        <extension url="statement">
          <valueString
                       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&lt;DateTime&gt;, or Interval&lt;Quantity&gt; 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&lt;DateTime&gt; or Interval&lt;Quantity&gt;.
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&lt;DateTime, Quantity, Interval&lt;DateTime&gt;, Interval&lt;Quantity&gt;, Timing&gt;):
  case
	  when choice is DateTime then
    	Interval[choice as DateTime, choice as DateTime]
		when choice is Interval&lt;DateTime&gt; then
  		choice as Interval&lt;DateTime&gt;
		when choice is Quantity then
		  Interval[Patient.birthDate + (choice as Quantity),
			  Patient.birthDate + (choice as Quantity) + 1 year)
		when choice is Interval&lt;Quantity&gt; 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&lt;DateTime&gt;
		else
			null as Interval&lt;DateTime&gt;
	end"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="21"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
        <extension url="libraryName">
          <valueString value="Status"/>
        </extension>
        <extension url="name">
          <valueString value="isAssessmentPerformed"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="//This library contains functions that are based on QDM 5.6 to QICore 4.1.1 March 2023 (https://github.com/cqframework/CQL-Formatting-and-Usage-Wiki/wiki/Authoring-Patterns---QICore-v4.1.1). The functions may appear similar to some QICoreCommon functions but different in that they have constraints that are relevant for measures authored by NCQA.

//Assessment, Performed
define fluent function isAssessmentPerformed(Obs List&lt;Observation&gt;):
  Obs O
    where O.status in { 'final', 'amended', 'corrected' }
          and exists ( O.category ObservationCategory
          where ( ObservationCategory ) ~ &quot;survey&quot;
      )"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="22"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
        <extension url="libraryName">
          <valueString value="QICoreCommon"/>
        </extension>
        <extension url="name">
          <valueString value="prevalenceInterval"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="/*
@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 ~ &quot;active&quot;
  or condition.clinicalStatus ~ &quot;recurrence&quot;
  or condition.clinicalStatus ~ &quot;relapse&quot; 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]"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="23"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
        <extension url="libraryName">
          <valueString value="Status"/>
        </extension>
        <extension url="name">
          <valueString value="isMedicationActive"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="//Medication, Active
define fluent function isMedicationActive(MedicationRequest List&lt;MedicationRequest&gt;):
  MedicationRequest M
    where M.status = 'active'
      and M.intent = 'order'"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="24"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
        <extension url="libraryName">
          <valueString value="CumulativeMedicationDuration"/>
        </extension>
        <extension url="name">
          <valueString value="medicationRequestPeriod"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define fluent function medicationRequestPeriod(Request &quot;MedicationRequest&quot;):
  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&lt;DateTime&gt;,
      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.&quot;high&quot; is not null then
        Interval[startDate, date from end of boundsPeriod]
      else
        null"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="25"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
        <extension url="libraryName">
          <valueString value="CumulativeMedicationDuration"/>
        </extension>
        <extension url="name">
          <valueString value="Quantity"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="/**********************************************************************/
/* 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"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="26"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
        <extension url="libraryName">
          <valueString value="CumulativeMedicationDuration"/>
        </extension>
        <extension url="name">
          <valueString value="ToDaily"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="/*
 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 ' &amp; period.unit)
  end"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="27"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
        <extension url="libraryName">
          <valueString value="Status"/>
        </extension>
        <extension url="name">
          <valueString value="isMedicationOrder"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="//Medication, Order: active and completed only
define fluent function isMedicationOrder(MedicationRequest List&lt;MedicationRequest&gt;):
  MedicationRequest M
    where M.status in { 'active', 'completed' }
      and M.intent = 'order'"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="28"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
        <extension url="libraryName">
          <valueString value="Status"/>
        </extension>
        <extension url="name">
          <valueString value="isLaboratoryTestOrder"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="//Laboratory Test, Order: active and completed only
define fluent function isLaboratoryTestOrder(ServiceRequest List&lt;ServiceRequest&gt;):
  ServiceRequest S
    where S.status in { 'active', 'completed' }
      and S.intent = 'order'"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="29"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
        <extension url="libraryName">
          <valueString value="Status"/>
        </extension>
        <extension url="name">
          <valueString value="isDiagnosticStudyOrder"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="//Diagnostic Study, Order: active and completed only
define fluent function isDiagnosticStudyOrder(ServiceRequest List&lt;ServiceRequest&gt;):
  ServiceRequest S
    where S.status in { 'active', 'completed' }
      and S.intent = 'order'"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="30"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
        <extension url="libraryName">
          <valueString value="Status"/>
        </extension>
        <extension url="name">
          <valueString value="isProcedurePerformed"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="//Procedure, Performed
define fluent function isProcedurePerformed(Proc List&lt;Procedure&gt;):
  Proc P
    where P.status ~ 'completed'"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="31"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
        <extension url="libraryName">
          <valueString value="Status"/>
        </extension>
        <extension url="name">
          <valueString value="isInterventionOrder"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="//Intervention, Order: active and completed only    
define fluent function isInterventionOrder(ServiceRequest List&lt;ServiceRequest&gt;):
  ServiceRequest S
    where S.status in { 'active', 'completed' }
      and S.intent = 'order'"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="32"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
        <extension url="libraryName">
          <valueString value="Status"/>
        </extension>
        <extension url="name">
          <valueString value="isInterventionPerformed"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="//Intervention, Performed
define fluent function isInterventionPerformed(Proc List&lt;Procedure&gt;):
  Proc P
    where P.status ~ 'completed'"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="33"/>
        </extension>
      </extension>
      <name value="EffectiveDataRequirements"/>
      <status value="active"/>
      <type>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/library-type"/>
          <code value="module-definition"/>
        </coding>
      </type>
      <relatedArtifact>
        <type value="depends-on"/>
        <display value="Library Status"/>
        <resource value="Library/Status|1.8.000"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display value="Library FHIRHelpers"/>
        <resource value="Library/FHIRHelpers|4.4.000"/>
      </relatedArtifact>
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                    value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.110.12.1051"/>
        </codeFilter>
      </dataRequirement>
      <dataRequirement>
        <type value="ServiceRequest"/>
        <profile
                 value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-servicerequest"/>
        <mustSupport value="code"/>
        <mustSupport value="authoredOn"/>
        <mustSupport value="authoredOn.value"/>
        <mustSupport value="status"/>
        <mustSupport value="status.value"/>
        <mustSupport value="intent"/>
        <mustSupport value="intent.value"/>
        <codeFilter>
          <path value="code"/>
          <valueSet
                    value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.111.12.1008"/>
        </codeFilter>
      </dataRequirement>
      <dataRequirement>
        <type value="ServiceRequest"/>
        <profile
                 value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-servicerequest"/>
        <mustSupport value="code"/>
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        <mustSupport value="status"/>
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        <mustSupport value="intent"/>
        <mustSupport value="intent.value"/>
        <codeFilter>
          <path value="code"/>
          <valueSet
                    value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1584"/>
        </codeFilter>
      </dataRequirement>
      <dataRequirement>
        <type value="ServiceRequest"/>
        <profile
                 value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-servicerequest"/>
        <mustSupport value="code"/>
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                    value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1034"/>
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      </dataRequirement>
      <dataRequirement>
        <type value="ServiceRequest"/>
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                 value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-servicerequest"/>
        <mustSupport value="code"/>
        <mustSupport value="authoredOn"/>
        <mustSupport value="authoredOn.value"/>
        <mustSupport value="status"/>
        <mustSupport value="status.value"/>
        <mustSupport value="intent"/>
        <mustSupport value="intent.value"/>
        <codeFilter>
          <path value="code"/>
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                    value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.111.12.1011"/>
        </codeFilter>
      </dataRequirement>
      <dataRequirement>
        <type value="Procedure"/>
        <profile
                 value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure"/>
        <mustSupport value="code"/>
        <mustSupport value="performed"/>
        <mustSupport value="status"/>
        <mustSupport value="status.value"/>
        <codeFilter>
          <path value="code"/>
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                    value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.111.12.1017"/>
        </codeFilter>
      </dataRequirement>
      <dataRequirement>
        <type value="Procedure"/>
        <profile
                 value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure"/>
        <mustSupport value="code"/>
        <mustSupport value="performed"/>
        <mustSupport value="status"/>
        <mustSupport value="status.value"/>
        <codeFilter>
          <path value="code"/>
          <valueSet
                    value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1584"/>
        </codeFilter>
      </dataRequirement>
    </Library>
  </contained>
  <extension
             url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-effectiveDataRequirements" id="effective-data-requirements">
    <valueReference>
      <reference value="#effective-data-requirements"/>
    </valueReference>
  </extension>
  <extension
             url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-softwaresystem">
    <valueReference>
      <reference value="Device/cqf-tooling"/>
    </valueReference>
  </extension>
  <url value="https://madie.cms.gov/Measure/ChlamydiaScreeninginWomenFHIR"/>
  <identifier>
    <use value="usual"/>
    <type>
      <coding>
        <system
                value="http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type"/>
        <code value="short-name"/>
      </coding>
    </type>
    <system value="https://madie.cms.gov/measure/shortName"/>
    <value value="CMS153FHIR"/>
  </identifier>
  <identifier>
    <use value="official"/>
    <type>
      <coding>
        <system
                value="http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type"/>
        <code value="version-independent"/>
      </coding>
    </type>
    <system value="urn:ietf:rfc:3986"/>
    <value value="urn:uuid:3443b43b-a2a3-4b91-84aa-6080479d4d9a"/>
  </identifier>
  <identifier>
    <use value="official"/>
    <type>
      <coding>
        <system
                value="http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type"/>
        <code value="version-specific"/>
      </coding>
    </type>
    <system value="urn:ietf:rfc:3986"/>
    <value value="urn:uuid:b908fbc3-7514-4196-baf1-f04d49393cc9"/>
  </identifier>
  <identifier>
    <use value="official"/>
    <type>
      <coding>
        <system
                value="http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type"/>
        <code value="publisher"/>
      </coding>
    </type>
    <system value="https://madie.cms.gov/measure/cmsId"/>
    <value value="153FHIR"/>
    <assigner>
      <display value="CMS"/>
    </assigner>
  </identifier>
  <version value="0.1.000"/>
  <name value="ChlamydiaScreeninginWomenFHIR"/>
  <title value="Chlamydia Screening in WomenFHIR"/>
  <status value="draft"/>
  <experimental value="false"/>
  <date value="2024-07-09T14:53:54+00:00"/>
  <publisher value="National Committee for Quality Assurance"/>
  <contact>
    <telecom>
      <system value="url"/>
      <value value="https://www.ncqa.org/"/>
    </telecom>
  </contact>
  <description
               value="Percentage of women 16-24 years of age who were identified as sexually active at any time during the measurement period and who had at least one test for chlamydia during the measurement period"/>
  <purpose value="UNKNOWN"/>
  <usage
         value="Codes to identify sexually active women include codes for: pregnancy, sexually transmitted infections, contraceptives or contraceptive devices, and infertility treatments.  The denominator exclusion does not apply to patients who qualify for the initial population (IP) based on services other than the pregnancy test alone. These other services include services for sexually transmitted infections, contraceptives or contraceptive devices and infertility treatments. For example, a patient who has both a pregnancy test and a chlamydia diagnosis, either of which would qualify them for the IP, would not be eligible for this denominator exclusion.  This eCQM is a patient-based measure.  This FHIR-based measure has been derived from the QDM-based measure:  CMS153v13.  Please refer to the HL7 QI-Core Implementation Guide (http://hl7.org/fhir/us/qicore/STU4.1.1/) for more information on QI-Core and mapping recommendations from QDM to QI-Core 4.1.1 (http://hl7.org/fhir/us/qicore/STU4.1.1/qdm-to-qicore.html)."/>
  <copyright
             value="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 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 can be reproduced and distributed, without modification, for noncommercial purposes (e.g., use by healthcare providers in connection with their practices) without obtaining approval from NCQA. Commercial use is defined as the sale, licensing, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain. All commercial uses or requests for modification must be approved by NCQA and are subject to a license at the discretion of NCQA. (C) 2012-2024 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 2024. 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) (http://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 2004-2024 Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee, and are available at no cost under the license at http://loinc.org/terms-of-use.  This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2023 International Health Terminology Standards Development Organisation.  ICD-10 copyright 2024 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 value="2025-01-01"/>
    <end value="2025-12-31"/>
  </effectivePeriod>
  <author>
    <name value="National Committee for Quality Assurance"/>
    <telecom>
      <system value="url"/>
      <value value="https://www.ncqa.org/"/>
    </telecom>
  </author>
  <library
           value="https://madie.cms.gov/Library/ChlamydiaScreeninginWomenFHIR"/>
  <disclaimer
              value="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 &quot;AS IS&quot; 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
             value="Chlamydia trachomatis is the most common sexually transmitted bacterial infection in the U.S., resulting in roughly 1.7 million cases (Centers for Disease Control and Prevention, 2019). Chlamydia infections are often asymptomatic, but, if left untreated, can lead to serious and irreversible complications (U.S. Preventive Services Task Force, 2021; Centers for Disease Control and Prevention, 2019).   Women are particularly vulnerable when infected with chlamydia. Left untreated, chlamydia can cause pelvic inflammatory disease (PID), which can lead to chronic pelvic pain or infertility. Pregnant women may also transmit the infection to their infant, potentially resulting in neonatal pneumonia (Centers for Disease Control and Prevention, 2019)."/>
  <clinicalRecommendationStatement
                                   value="U.S. Preventive Services Task Force (2021) recommends screening for chlamydia in all sexually active women aged 24 years or younger and in women 25 years or older who are at increased risk for infection (B recommendation)"/>
  <group id="654a55d378418140875e358d">
    <extension
               url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring">
      <valueCodeableConcept>
        <coding>
          <system
                  value="http://terminology.hl7.org/CodeSystem/measure-scoring"/>
          <code value="proportion"/>
          <display value="Proportion"/>
        </coding>
      </valueCodeableConcept>
    </extension>
    <extension
               url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis">
      <valueCode value="boolean"/>
    </extension>
    <extension
               url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-type">
      <valueCodeableConcept>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/measure-type"/>
          <code value="process"/>
          <display value="Process"/>
        </coding>
      </valueCodeableConcept>
    </extension>
    <extension
               url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-rateAggregation">
      <valueCode value="None"/>
    </extension>
    <extension
               url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-improvementNotation">
      <valueCodeableConcept>
        <coding>
          <system
                  value="http://terminology.hl7.org/CodeSystem/measure-improvement-notation"/>
          <code value="decrease"/>
          <display value="increase"/>
        </coding>
      </valueCodeableConcept>
    </extension>
    <population id="10136A25-C04A-4802-A435-CB3A3182ACFA">
      <code>
        <coding>
          <system
                  value="http://terminology.hl7.org/CodeSystem/measure-population"/>
          <code value="initial-population"/>
          <display value="Initial Population"/>
        </coding>
      </code>
      <description
                   value="Women 16 to 24 years of age by the end of the measurement period who are sexually active and who had a visit in the measurement period"/>
      <criteria>
        <language value="text/cql-identifier"/>
        <expression value="Initial Population"/>
      </criteria>
    </population>
    <population id="F0DF1754-6096-41C0-9C42-F01D9427E0DD">
      <code>
        <coding>
          <system
                  value="http://terminology.hl7.org/CodeSystem/measure-population"/>
          <code value="denominator"/>
          <display value="Denominator"/>
        </coding>
      </code>
      <description value="Equals Initial Population"/>
      <criteria>
        <language value="text/cql-identifier"/>
        <expression value="Denominator"/>
      </criteria>
    </population>
    <population id="762B2E31-9A3E-4F06-9952-1AC8961A9AD6">
      <code>
        <coding>
          <system
                  value="http://terminology.hl7.org/CodeSystem/measure-population"/>
          <code value="denominator-exclusion"/>
          <display value="Denominator Exclusion"/>
        </coding>
      </code>
      <description
                   value="Exclude patients who are in hospice care for any part of the measurement period.  Women who are only eligible for the initial population due to a pregnancy test during the measurement period, and who had an order for an x-ray or for a specified medication on the date of the pregnancy test or the six days after the pregnancy test."/>
      <criteria>
        <language value="text/cql-identifier"/>
        <expression value="Denominator Exclusions"/>
      </criteria>
    </population>
    <population id="01195E79-8C6F-4ED5-B5D0-AA77777870CD">
      <code>
        <coding>
          <system
                  value="http://terminology.hl7.org/CodeSystem/measure-population"/>
          <code value="numerator"/>
          <display value="Numerator"/>
        </coding>
      </code>
      <description
                   value="Women with at least one chlamydia test during the measurement period"/>
      <criteria>
        <language value="text/cql-identifier"/>
        <expression value="Numerator"/>
      </criteria>
    </population>
    <stratifier id="fd1b6c30-f3d6-422e-9063-5db3590db24c">
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-appliesTo">
        <valueCodeableConcept>
          <coding>
            <system
                    value="http://terminology.hl7.org/CodeSystem/measure-population"/>
            <code value="initial-population"/>
            <display value="Initial Population"/>
          </coding>
        </valueCodeableConcept>
      </extension>
      <description
                   value="Report a total score, and each of the following strata: Stratum 1: Patients age 16-20 by the end of the measurement period."/>
      <criteria>
        <language value="text/cql-identifier"/>
        <expression value="Stratification 1"/>
      </criteria>
    </stratifier>
    <stratifier id="90321b13-ef34-437a-a79e-0bf9e24e87f8">
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-appliesTo">
        <valueCodeableConcept>
          <coding>
            <system
                    value="http://terminology.hl7.org/CodeSystem/measure-population"/>
            <code value="initial-population"/>
            <display value="Initial Population"/>
          </coding>
        </valueCodeableConcept>
      </extension>
      <description
                   value="Stratum 2: Patients age 21-24 by the end of the measurement period."/>
      <criteria>
        <language value="text/cql-identifier"/>
        <expression value="Stratification 2"/>
      </criteria>
    </stratifier>
  </group>
</Measure>