{ "resourceType" : "PlanDefinition", "id" : "CXCAD2DTScreeningEligibility", "meta" : { "profile" : ["http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-recommendationdefinition"] }, "text" : { "status" : "extensions", "div" : "
\n
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Id: CXCAD2DTScreeningEligibility
Url: CXCA.D2.DT — Cervical Cancer Screening Eligibility
Version: 0.0.1
Title: CXCA.D2.DT — Cervical Cancer Screening Eligibility
Status: draft
Type: \n \n \n \n

\n system: http://terminology.hl7.org/CodeSystem/plan-definition-type\n

\n \n \n

\n code: eca-rule\n

\n \n \n \n \n \n
Date: 2026-05-14 00:50:23+0000
Publisher: Dan Heslinga (independent contributor)
Description:

Decision support recommendation for cervical cancer screening eligibility (CXCA.D2). Evaluates the rules from Mongolia MOH Order A/641 (2020) section 2.2 via the CXCAD2DTScreeningEligibilityLogic CQL library; when the client is due, recommends instantiating the CXCAD2HPVScreeningServiceRequest ActivityDefinition.

\n
Libraries: \n \n \n \n \n \n \n
CXCAD2DTScreeningEligibilityLogic
\n
Actions: \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n
\n \n Recommend HPV high-risk DNA screening (client is due): Client is at the binding target age (35 or 45 per A/641 section 2.2), has not had a hysterectomy, and has not been screened in the current cycle. Create a proposed ServiceRequest for HPV high-risk DNA testing.\n \n
\n \n \n If:\n \n Applicability:\n \n (Client is due for HPV screening (legal binding))\n
\n \n \n \n \n Then: Definition: CXCAD2 — HPV Screening Service Request
\n \n \n \n
\n \n Defer screening — client already screened in current cycle: Client is at a binding target age but has had a recent valid HPV screening result. Per A/641 section 2.2 they are not due for re-screening at this encounter. Inform the client of their next due date.\n \n
\n \n \n If:\n \n Applicability:\n \n (Client not due — already screened in current cycle (legal binding))\n
\n \n \n \n \n \n
\n \n Defer screening — client outside binding target age range: Client is not at a binding target age (35 or 45 per A/641 section 2.2 for HPV-test-capable facilities). Note: cytology-only facilities follow a different age cycle (30, 33, 36, ..., 60 every 3 years per A/641 section 2.2 cytology pathway) — see the separate cytology-pathway PlanDefinition (deferred to a future Phase 5 chunk).\n \n
\n \n \n If:\n \n Applicability:\n \n (Client excluded — outside target age range (legal binding))\n
\n \n \n \n \n \n
\n \n Exclude from screening — prior hysterectomy: Client has had a hysterectomy. Per A/641 section 2.2, women who have had a hysterectomy for non-cervical-cancer indication and who have a documented negative post-operative vaginal-smear cytology are exempt from cervical cancer screening. Verify the indication and the post-operative cytology status before fully excluding.\n \n
\n \n \n If:\n \n Applicability:\n \n (Client excluded — prior hysterectomy (legal binding))\n
\n \n \n \n \n \n
\n
\n
\n
" }, "contained" : [{ "resourceType" : "Library", "id" : "effective-data-requirements", "extension" : [{ "extension" : [{ "url" : "libraryName", "valueString" : "CXCAD2DTScreeningEligibilityLogic" }, { "url" : "name", "valueString" : "Client age" }, { "url" : "statement", "valueString" : "// =============================================================================\n// Helper definitions\n// =============================================================================\n\n/*\n * Client age in years at the encounter date.\n */\ndefine \"Client age\":\n AgeInYearsAt(Today)" }, { "url" : "displaySequence", "valueInteger" : 0 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "CXCAD2DTScreeningEligibilityLogic" }, { "url" : "name", "valueString" : "Client is at binding target age (35 or 45)" }, { "url" : "statement", "valueString" : "/*\n * The client is at one of the binding target ages per A/641 section 2.2\n * (HPV-test-capable facilities: ages 35 and 45 only).\n */\ndefine \"Client is at binding target age (35 or 45)\":\n \"Client age\" = 35 or \"Client age\" = 45" }, { "url" : "displaySequence", "valueInteger" : 1 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "CXCAElements" }, { "url" : "name", "valueString" : "Hysterectomy Procedures" }, { "url" : "statement", "valueString" : "// =============================================================================\n// Hysterectomy history\n// =============================================================================\n\n/*\n * @internal: All recorded hysterectomy procedures for this patient,\n * filtered to status = completed.\n */\ndefine \"Hysterectomy Procedures\":\n [Procedure] P\n where P.status = 'completed'\n and exists (P.code.coding C where C.code = 'DE45'\n and C.system = 'http://smart.who.int/cxca/CodeSystem/CXCA.D')" }, { "url" : "displaySequence", "valueInteger" : 2 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "CXCAElements" }, { "url" : "name", "valueString" : "Has Had Hysterectomy" }, { "url" : "statement", "valueString" : "/*\n * The patient has a documented completed hysterectomy.\n *\n * NOTE: A/641 section 2.2 only excludes hysterectomy for non-cervical-cancer indication\n * with a documented negative post-op vaginal-smear cytology. This define\n * captures only the hysterectomy fact; the indication and post-op cytology\n * checks live in higher-layer logic that combines this define with others.\n */\ndefine \"Has Had Hysterectomy\":\n exists \"Hysterectomy Procedures\"" }, { "url" : "displaySequence", "valueInteger" : 3 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "CXCAD2DTScreeningEligibilityLogic" }, { "url" : "name", "valueString" : "Client is due for HPV screening (legal binding)" }, { "url" : "statement", "valueString" : "// =============================================================================\n// Legal-binding eligibility tree — A/641 section 2.2 (HPV at ages 35 and 45)\n// Bindingness: legal\n// =============================================================================\n\n/*\n * @output: CXCA.D#DE4 \"Due for HPV screening\"\n * @bindingness: legal\n * Client is due if at a binding target age, has not had a hysterectomy,\n * and has not been screened in the current cycle.\n */\ndefine \"Client is due for HPV screening (legal binding)\":\n \"Client is at binding target age (35 or 45)\"\n and not Elements.\"Has Had Hysterectomy\"\n and not \"HasRecentHPVScreening\"" }, { "url" : "displaySequence", "valueInteger" : 4 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "CXCAD2DTScreeningEligibilityLogic" }, { "url" : "name", "valueString" : "Client excluded — prior hysterectomy (legal binding)" }, { "url" : "statement", "valueString" : "/*\n * @output: CXCA.D#DE7 \"Excluded — prior hysterectomy\"\n * @bindingness: legal\n * Client has had a hysterectomy for non-cervical-cancer indication and is\n * therefore exempt from cervical cancer screening per A/641 section 2.2.\n */\ndefine \"Client excluded — prior hysterectomy (legal binding)\":\n Elements.\"Has Had Hysterectomy\"" }, { "url" : "displaySequence", "valueInteger" : 5 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "CXCAD2DTScreeningEligibilityLogic" }, { "url" : "name", "valueString" : "Client excluded — outside target age range (legal binding)" }, { "url" : "statement", "valueString" : "/*\n * @output: CXCA.D#DE6 \"Excluded — outside target age range\"\n * @bindingness: legal\n * Client is not at a binding target age (35 or 45 only for HPV-capable facilities).\n */\ndefine \"Client excluded — outside target age range (legal binding)\":\n not \"Client is at binding target age (35 or 45)\"\n and not Elements.\"Has Had Hysterectomy\"" }, { "url" : "displaySequence", "valueInteger" : 6 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "CXCAD2DTScreeningEligibilityLogic" }, { "url" : "name", "valueString" : "Client not due — already screened in current cycle (legal binding)" }, { "url" : "statement", "valueString" : "/*\n * @output: CXCA.D#DE5 \"Not due — already screened in current cycle\"\n * @bindingness: legal\n * Client is at a target age but has had a recent valid HPV screening result.\n */\ndefine \"Client not due — already screened in current cycle (legal binding)\":\n \"Client is at binding target age (35 or 45)\"\n and \"HasRecentHPVScreening\"\n and not Elements.\"Has Had Hysterectomy\"" }, { "url" : "displaySequence", "valueInteger" : 7 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "FHIRHelpers" }, { "url" : "name", "valueString" : "ToString" }, { "url" : "statement", "valueString" : "define function ToString(value ProcedureStatus): value.value" }, { "url" : "displaySequence", "valueInteger" : 8 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "FHIRHelpers" }, { "url" : "name", "valueString" : "ToString" }, { "url" : "statement", "valueString" : "define function ToString(value string): value.value" }, { "url" : "displaySequence", "valueInteger" : 9 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "FHIRHelpers" }, { "url" : "name", "valueString" : "ToString" }, { "url" : "statement", "valueString" : "define function ToString(value uri): value.value" }, { "url" : "displaySequence", "valueInteger" : 10 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }], "name" : "EffectiveDataRequirements", "status" : "active", "type" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/library-type", "code" : "module-definition" }] }, "relatedArtifact" : [{ "type" : "depends-on", "display" : "FHIR model information", "resource" : "http://fhir.org/guides/cqf/common/Library/FHIR-ModelInfo|4.0.1" }, { "type" : "depends-on", "display" : "Library Elements", "resource" : "http://smart.who.int/cxca/Library/CXCAElements" }, { "type" : "depends-on", "display" : "Library FHIRHelpers", "resource" : "http://fhir.org/guides/cqf/common/Library/FHIRHelpers|4.0.1" }], "parameter" : [{ "name" : "Today", "use" : "in", "min" : 0, "max" : "1", "type" : "date" }, { "name" : "HasRecentHPVScreening", "use" : "in", "min" : 0, "max" : "1", "type" : "boolean" }, { "name" : "Client is due for HPV screening (legal binding)", "use" : "out", "min" : 0, "max" : "1", "type" : "boolean" }, { "name" : "Client excluded — prior hysterectomy (legal binding)", "use" : "out", "min" : 0, "max" : "1", "type" : "boolean" }, { "name" : "Client excluded — outside target age range (legal binding)", "use" : "out", "min" : 0, "max" : "1", "type" : "boolean" }, { "name" : "Client not due — already screened in current cycle (legal binding)", "use" : "out", "min" : 0, "max" : "1", "type" : "boolean" }], "dataRequirement" : [{ "type" : "Patient", "profile" : ["http://hl7.org/fhir/StructureDefinition/Patient"] }, { "type" : "Procedure", "profile" : ["http://hl7.org/fhir/StructureDefinition/Procedure"], "mustSupport" : ["status", "code", "code.coding"] }, { "type" : "Procedure", "profile" : ["http://hl7.org/fhir/StructureDefinition/Procedure"], "mustSupport" : ["status", "code", "code.coding"] }, { "type" : "Procedure", "profile" : ["http://hl7.org/fhir/StructureDefinition/Procedure"], "mustSupport" : ["status", "code", "code.coding"] }] }], "extension" : [{ "url" : "http://smart.who.int/cxca/StructureDefinition/cxca-bindingness", "valueCoding" : { "system" : "http://smart.who.int/cxca/CodeSystem/CXCA.Bindingness", "code" : "legal", "display" : "Legal — binding regulatory instrument" } }, { "url" : "http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-effectiveDataRequirements", "valueCanonical" : "#effective-data-requirements" }], "url" : "http://smart.who.int/cxca/PlanDefinition/CXCAD2DTScreeningEligibility", "version" : "0.0.1", "name" : "CXCAD2DTScreeningEligibility", "title" : "CXCA.D2.DT — Cervical Cancer Screening Eligibility", "type" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/plan-definition-type", "code" : "eca-rule" }] }, "status" : "draft", "experimental" : false, "date" : "2026-05-14T00:50:23+00:00", "publisher" : "Dan Heslinga (independent contributor)", "contact" : [{ "name" : "Dan Heslinga (independent contributor)", "telecom" : [{ "system" : "url", "value" : "https://github.com/dhes" }] }], "description" : "Decision support recommendation for cervical cancer screening eligibility (CXCA.D2). Evaluates the rules from Mongolia MOH Order A/641 (2020) section 2.2 via the CXCAD2DTScreeningEligibilityLogic CQL library; when the client is due, recommends instantiating the CXCAD2HPVScreeningServiceRequest ActivityDefinition.", "library" : ["http://smart.who.int/cxca/Library/CXCAD2DTScreeningEligibilityLogic"], "action" : [{ "title" : "Recommend HPV high-risk DNA screening (client is due)", "description" : "Client is at the binding target age (35 or 45 per A/641 section 2.2), has not had a hysterectomy, and has not been screened in the current cycle. Create a proposed ServiceRequest for HPV high-risk DNA testing.", "condition" : [{ "kind" : "applicability", "expression" : { "language" : "text/cql-identifier", "expression" : "Client is due for HPV screening (legal binding)" } }], "definitionCanonical" : "http://smart.who.int/cxca/ActivityDefinition/CXCAD2HPVScreeningServiceRequest" }, { "title" : "Defer screening — client already screened in current cycle", "description" : "Client is at a binding target age but has had a recent valid HPV screening result. Per A/641 section 2.2 they are not due for re-screening at this encounter. Inform the client of their next due date.", "condition" : [{ "kind" : "applicability", "expression" : { "language" : "text/cql-identifier", "expression" : "Client not due — already screened in current cycle (legal binding)" } }] }, { "title" : "Defer screening — client outside binding target age range", "description" : "Client is not at a binding target age (35 or 45 per A/641 section 2.2 for HPV-test-capable facilities). Note: cytology-only facilities follow a different age cycle (30, 33, 36, ..., 60 every 3 years per A/641 section 2.2 cytology pathway) — see the separate cytology-pathway PlanDefinition (deferred to a future Phase 5 chunk).", "condition" : [{ "kind" : "applicability", "expression" : { "language" : "text/cql-identifier", "expression" : "Client excluded — outside target age range (legal binding)" } }] }, { "title" : "Exclude from screening — prior hysterectomy", "description" : "Client has had a hysterectomy. Per A/641 section 2.2, women who have had a hysterectomy for non-cervical-cancer indication and who have a documented negative post-operative vaginal-smear cytology are exempt from cervical cancer screening. Verify the indication and the post-operative cytology status before fully excluding.", "condition" : [{ "kind" : "applicability", "expression" : { "language" : "text/cql-identifier", "expression" : "Client excluded — prior hysterectomy (legal binding)" } }] }] }