define "Has Hospice Services":
  exists ( ( ( [Encounter: "Encounter Inpatient"] ).isEncounterPerformed() ) InpatientEncounter
      where FHIRHelpers.ToConcept(InpatientEncounter.hospitalization.dischargeDisposition) ~ "Hospice (HL7 discharge)"
        and FHIRHelpers.ToInterval(InpatientEncounter.period as FHIR.Period) ends during day of "Measurement Period"
  )
    or exists ( ( ( [Encounter: "Hospice Encounter"] ).isEncounterPerformed() ) HospiceEncounter
        where FHIRHelpers.ToInterval(HospiceEncounter.period as FHIR.Period) overlaps day of "Measurement Period"
    )
    or exists ( ( ( [ObservationGeneralAssessment: "Hospice care [Minimum Data Set]"] ).isAssessmentPerformed() ) HospiceAssessment
        where FHIRHelpers.ToConcept(HospiceAssessment.value as FHIR.CodeableConcept) ~ "Yes (qualifier value)"
          and HospiceAssessment.effective.toObservationEffectiveInterval() overlaps day of "Measurement Period"
    )
    or exists ( ( ( [ServiceRequest: "Hospice Care Ambulatory"] ).isInterventionOrder() ) HospiceOrder
        where FHIRHelpers.ToDateTime(HospiceOrder.authoredOn) during day of "Measurement Period"
    )
    or exists ( ( ( [Procedure: "Hospice Care Ambulatory"] ).isInterventionPerformed() ) HospicePerformed
        where HospicePerformed.performed.toPerformedInterval() overlaps day of "Measurement Period"
    )
    or exists ( ( (
        [ConditionProblemsHealthConcerns: "Hospice Diagnosis"]
          union [ConditionEncounterDiagnosis: "Hospice Diagnosis"]
    ).verified() ) HospiceCareDiagnosis
        where HospiceCareDiagnosis.prevalenceInterval() overlaps day of "Measurement Period"
    )

define "Has Palliative Care in the Measurement Period":
  exists (
    [ObservationGeneralAssessment: "Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)"] PalliativeAssessment
      where PalliativeAssessment.status in { 'final', 'amended', 'corrected' }
        and PalliativeAssessment.effective.toObservationEffectiveInterval() overlaps day of "Measurement Period"
  )
    or exists (
      [ConditionProblemsHealthConcerns: "Palliative Care Diagnosis"] PalliativeProblem
        where (
          PalliativeProblem.verificationStatus is null
            or FHIRHelpers.ToConcept(PalliativeProblem.verificationStatus) ~ "confirmed"
            or FHIRHelpers.ToConcept(PalliativeProblem.verificationStatus) ~ "unconfirmed"
            or FHIRHelpers.ToConcept(PalliativeProblem.verificationStatus) ~ "provisional"
            or FHIRHelpers.ToConcept(PalliativeProblem.verificationStatus) ~ "differential"
        )
          and PalliativeProblem.prevalenceInterval() overlaps day of "Measurement Period"
    )
    or exists (
      [ConditionEncounterDiagnosis: "Palliative Care Diagnosis"] PalliativeEncounterDiagnosis
        where (
          PalliativeEncounterDiagnosis.verificationStatus is null
            or FHIRHelpers.ToConcept(PalliativeEncounterDiagnosis.verificationStatus) ~ "confirmed"
            or FHIRHelpers.ToConcept(PalliativeEncounterDiagnosis.verificationStatus) ~ "unconfirmed"
            or FHIRHelpers.ToConcept(PalliativeEncounterDiagnosis.verificationStatus) ~ "provisional"
            or FHIRHelpers.ToConcept(PalliativeEncounterDiagnosis.verificationStatus) ~ "differential"
        )
          and PalliativeEncounterDiagnosis.prevalenceInterval() overlaps day of "Measurement Period"
    )
    or exists (
      [Encounter: "Palliative Care Encounter"] PalliativeEncounter
        where PalliativeEncounter.status = 'finished'
          and FHIRHelpers.ToInterval(PalliativeEncounter.period as FHIR.Period) overlaps day of "Measurement Period"
    )
    or exists (
      [Procedure: "Palliative Care Intervention"] PalliativeIntervention
        where PalliativeIntervention.status = 'completed'
          and PalliativeIntervention.performed.toPerformedInterval() overlaps day of "Measurement Period"
    )

define "Cervical Cytology Within 3 Years":
  ( [Observation: "Pap Test"] ) CervicalCytology
    where CervicalCytology.status in { 'final', 'amended', 'corrected' }
      and CervicalCytology.effective.toObservationEffectiveInterval ( ) during day of Interval[start of "Measurement Period" - 2 years, end of "Measurement Period"]
      and CervicalCytology.value is not null

define "HPV Test Within 5 Years for Women Age 30 and Older":
  ( [Observation: "HPV Test"] ) HPVTest
    where HPVTest.status in { 'final', 'amended', 'corrected' }
      and AgeInYearsAt(date from end of HPVTest.effective.toObservationEffectiveInterval()) >= 30
      and HPVTest.effective.toObservationEffectiveInterval ( ) during day of Interval[start of "Measurement Period" - 4 years, end of "Measurement Period"]
      and HPVTest.value is not null

define "Numerator":
  exists "Cervical Cytology Within 3 Years"
    or exists "HPV Test Within 5 Years for Women Age 30 and Older"

define "Qualifying Encounters":
  ( ( [Encounter: "Office Visit"]
      union [Encounter: "Preventive Care Services Established Office Visit, 18 and Up"]
      union [Encounter: "Preventive Care Services Initial Office Visit, 18 and Up"]
      union [Encounter: "Home Healthcare Services"]
      union [Encounter: "Telephone Visits"]
      union [Encounter: "Virtual Encounter"]
  ).isEncounterPerformed ( ) ) ValidEncounters
    where ValidEncounters.period during day of "Measurement Period"

define "Initial Population":
  AgeInYearsAt(date from
    end of "Measurement Period"
  ) in Interval[24, 64]
    and Patient.gender = 'female'
    and exists "Qualifying Encounters"

define "Denominator":
  "Initial Population"

define "Absence of Cervix":
  ( ( ( [Procedure: "Hysterectomy with No Residual Cervix"] ).isProcedurePerformed ( ) ) NoCervixProcedure
      where NoCervixProcedure.performed.toPerformedInterval ( ) ends on or before end of "Measurement Period"
  )
    union ( ( ( [ConditionProblemsHealthConcerns: "Congenital or Acquired Absence of Cervix"]
          union [ConditionEncounterDiagnosis: "Congenital or Acquired Absence of Cervix"]
      ).verified ( ) ) NoCervixDiagnosis
        where NoCervixDiagnosis.prevalenceInterval ( ) starts on or before end of "Measurement Period"
    )

define "Denominator Exclusions":
  Hospice."Has Hospice Services"
    or exists "Absence of Cervix"
    or PalliativeCare."Has Palliative Care in the Measurement Period"

define function ToString(value ObservationStatus): value.value

define function ToString(value AdministrativeGender): value.value

define function ToString(value EncounterStatus): value.value

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

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

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

define function ToString(value ServiceRequestStatus): value.value

define function ToString(value ServiceRequestIntent): value.value

define function ToDateTime(value dateTime): value.value

define function ToString(value ProcedureStatus): value.value

define fluent function toObservationEffectiveInterval(choice Choice<FHIR.dateTime, FHIR.Period, FHIR.Timing, FHIR.instant>):
  choice.toInterval()

define fluent function toPerformedInterval(performed Choice<FHIR.dateTime, FHIR.Period, FHIR.string, FHIR.Age, FHIR.Range>):
  performed.toInterval()

/*
@description: Returns an interval representing the normalized prevalence period of a given Condition.
*/
define fluent function prevalenceInterval(condition Choice<ConditionEncounterDiagnosis, ConditionProblemsHealthConcerns>):
  if condition.isActive() then
    Interval[start of condition.onset.toConditionTimingInterval(), end of condition.abatementInterval()]
  else
    (end of condition.abatementInterval()) abatementDate
      return if abatementDate is null then
        Interval[start of condition.onset.toConditionTimingInterval(), abatementDate)
      else
        Interval[start of condition.onset.toConditionTimingInterval(), abatementDate]

/*
@description: Returns true if the given condition has a clinical status of active, recurrence, or relapse
*/
define fluent function isActive(condition Choice<ConditionEncounterDiagnosis, ConditionProblemsHealthConcerns>):
  FHIRHelpers.ToConcept(condition.clinicalStatus) ~ "active"
    or FHIRHelpers.ToConcept(condition.clinicalStatus) ~ "recurrence"
    or FHIRHelpers.ToConcept(condition.clinicalStatus) ~ "relapse"

define fluent function toConditionTimingInterval(choice Choice<FHIR.dateTime, FHIR.Age, FHIR.Period, FHIR.Range, FHIR.string>):
  choice.toInterval()

/*
@description: Returns an interval representing the normalized abatement of a given Condition.
*/
define fluent function abatementInterval(condition Choice<ConditionEncounterDiagnosis, ConditionProblemsHealthConcerns>):
  condition.abatement.toConditionTimingInterval()

define fluent function isEncounterPerformed(Enc List<Encounter>):
  Enc E
    where E.status = 'finished'

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

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

define fluent function isInterventionPerformed(Proc List<Procedure>):
  Proc P
    where P.status = 'completed'

define fluent function verified(
  conditions List<Choice<ConditionEncounterDiagnosis, ConditionProblemsHealthConcerns>>
):
  conditions C
    where C.verificationStatus is not null implies (
      FHIRHelpers.ToConcept(C.verificationStatus) ~ "confirmed"
        or FHIRHelpers.ToConcept(C.verificationStatus) ~ "unconfirmed"
        or FHIRHelpers.ToConcept(C.verificationStatus) ~ "provisional"
        or FHIRHelpers.ToConcept(C.verificationStatus) ~ "differential"
    )

define fluent function isProcedurePerformed(Proc List<Procedure>):
  Proc P
    where P.status = 'completed'