<Measure xmlns="http://hl7.org/fhir">
   <id value="CMS135FHIRACEIorARBorARNIforHF"></id>
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      <div xmlns="http://www.w3.org/1999/xhtml" class="col-12"> 
         <table class="narrative-table"> 
            <tbody> 
               <tr> 
                  <th colspan="2" scope="row" class="row-header">Metadata</th> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Title</th> 
                  <td class="content-container">Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) or Angiotensin Receptor-Neprilysin Inhibitor (ARNI) Therapy for Left Ventricular Systolic Dysfunction (LVSD)FHIR</td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Version</th> 
                  <td class="content-container">1.0.000</td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Short Name</th> 
                  <td class="content-container">CMS135FHIR</td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">GUID (Version Independent)</th> 
                  <td class="content-container">urn:uuid:86136d6c-dbe1-4b7f-89f3-406cb90f08d5</td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">GUID (Version Specific)</th> 
                  <td class="content-container">urn:uuid:a0aa7f51-9882-4ceb-b4e5-bb94669b62ca</td> 
               </tr>  
               <tr> 
                  <th scope="row" class="row-header">CMS Identifier</th> 
                  <td class="content-container">135FHIR</td> 
               </tr>   
               <tr> 
                  <th scope="row" class="row-header">CMS Consensus Based Entity Identifier</th> 
                  <td class="content-container">0081e</td> 
               </tr>   
               <tr> 
                  <th scope="row" class="row-header">Effective Period</th> 
                  <td class="content-container">2026-01-01 through 2026-12-31</td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Steward (Publisher)</th> 
                  <td class="content-container">American Heart Association</td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Developer</th> 
                  <td class="content-container">American Heart Association</td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Developer</th> 
                  <td class="content-container">American Medical Association (AMA)</td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Description</th> 
                  <td class="content-container">
                     <p>Percentage of patients aged 18 years and older with a diagnosis of heart failure (HF) with a current or prior left ventricular ejection fraction (LVEF) &lt;=40% who were prescribed or already taking ACE inhibitor or ARB or ARNI therapy during the measurement period</p>
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Copyright</th> 
                  <td class="content-container">
                     <p>Copyright 2025 American College of Cardiology and American Heart Association. All Rights Reserved.</p>
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Disclaimer</th> 
                  <td class="content-container">
                     <p>The Measure is not a clinical guideline, does not establish a standard of medical care, and has not been tested for all potential applications.</p> 
                     <p>The Measure, while copyrighted, can be reproduced and distributed, without modification, for noncommercial purposes, e.g., use by health care providers in connection with their practices. Commercial use is defined as the sale, license, 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.</p> 
                     <p>Commercial uses of the Measure require a license agreement between the user and the American College of Cardiology (ACC) or the American Heart Association (AHA). Neither the ACC, nor AHA, nor their members shall be responsible for any use of the Measure.</p> 
                     <p>ACC and AHA encourage use of the Measure by other health care professionals, where appropriate. THE MEASURE AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND.</p> 
                     <p>Limited proprietary coding is contained in the Measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. The ACC and AHA and their members disclaim all liability for use or accuracy of any Current Procedural Terminology (CPT[R]) or other coding contained in the specifications.</p> 
                     <p>CPT(R) contained in the Measure specifications is copyright 2004-20234 American Medical Association. LOINC(R) is copyright 2004-20234 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-20234 International Health Terminology Standards Development Organisation. ICD-10 is copyright 20234 World Health Organization. All Rights Reserved.</p> 
                     <p>The American Medical Association’s and the PCPI(R) Foundation’s significant past efforts and contributions to the performance measure are gratefully acknowledged. Due to technical limitations, registered trademarks are indicated by (R) or [R].</p>
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Rationale</th> 
                  <td class="content-container">
                     <p>Use of ACE inhibitor, ARB, or ARNI therapy has been associated with improved outcomes in patients with reduced LVEF. Long-term therapy with ARBs have also been shown to reduce morbidity and mortality, especially in ACE inhibitor–intolerant patients. More recently, ARNI therapy has also been shown to more significantly improve outcomes, such that the newest guidelines recommend replacement of ACE inhibitors or ARBs with ARNI therapy in eligible patients. However, despite the benefits of these drugs, use of ACE inhibitor, ARB, or ARNI remains suboptimal.</p>
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Clinical Recommendation Statement</th> 
                  <td class="content-container">
                     <p>In patients with Heart Failure with Reduced Ejection Fraction (HFrEF) and New York Heart Association (NYHA) class II to III symptoms, the use of ARNI is recommended to reduce morbidity and mortality (Class I, Level of Evidence A) (Heidenreich et al., 2022). In patients with previous or current symptoms of chronic HFrEF, the use of angiotension-converting enzyme inhibitors (ACEi) is beneficial to reduce morbidity and mortality when the use of ARNI is not feasible (Class I, Level of Evidence A) (Heidenreich et al., 2022). In patients with previous or current symptoms of chronic HFrEF who are intolerant to ACEi because of cough or angioedema and when the use of ARNI is not feasible, the use of ARB is recommended to reduce morbidity and mortality (Class I, Level of Evidence A) (Heidenreich et al., 2022). In patients with chronic symptomatic HFrEF NYHA class II or III who tolerate an ACEi or ARB, replacement by an ARNI is recommended to further reduce morbidity and mortality (Class I, Level of Evidence B-R) (Heidenreich et al., 2022). ARNI should not be administered concomitantly with ACEi or within 36 hours of the last dose of an ACEi (Class II: Harm, Level of Evidence B-R) (Heidenreich et al., 2022). ARNI should not be administered to patients with any history of angioedema (Class III: Harm, Level of Evidence C-LD) (Heidenreich et al., 2022). ACEi should not be administered to patients with any history of angioedema (Class III: Harm, Level of Evidence C-LD) (Heidenreich et al., 2022).</p> 
                     <p>Drugs Commonly Used for Stage C HFrEF (abbreviated to align with focus of measure to include only ACE inhibitors, ARB and ARNI therapy)</p> 
                     <table style="width: 1020px" class="rich-text-table"> 
                        <colgroup> 
                           <col style="width: 203px"></col> 
                           <col style="width: 209px"></col> 
                           <col style="width: 205px"></col> 
                           <col style="width: 403px"></col> 
                        </colgroup> 
                        <tbody> 
                           <tr> 
                              <th colspan="1" rowspan="1" colwidth="203">
                                 <p>Drug</p>
                              </th> 
                              <th colspan="1" rowspan="1" colwidth="209">
                                 <p>Initial Daily Dose(s)</p>
                              </th> 
                              <th colspan="1" rowspan="1" colwidth="205">
                                 <p>Target Dose(s)</p>
                              </th> 
                              <th colspan="1" rowspan="1" colwidth="403">
                                 <p>Mean Doses Achieved in Clinical Trials</p>
                              </th> 
                           </tr> 
                           <tr> 
                              <td colspan="1" rowspan="1" colwidth="203">
                                 <p>
                                    <em> ACEi </em>
                                 </p>
                              </td> 
                              <td colspan="1" rowspan="1" colwidth="209">
                                 <p></p>
                              </td> 
                              <td colspan="1" rowspan="1" colwidth="205">
                                 <p></p>
                              </td> 
                              <td colspan="1" rowspan="1" colwidth="403">
                                 <p></p>
                              </td> 
                           </tr> 
                           <tr> 
                              <td colspan="1" rowspan="1" colwidth="203">
                                 <p>Captopril</p>
                              </td> 
                              <td colspan="1" rowspan="1" colwidth="209">
                                 <p>6.25 mg 3 times</p>
                              </td> 
                              <td colspan="1" rowspan="1" colwidth="205">
                                 <p>50 mg 3 times</p>
                              </td> 
                              <td colspan="1" rowspan="1" colwidth="403">
                                 <p>122.7 mg total daily</p>
                              </td> 
                           </tr> 
                           <tr> 
                              <td colspan="1" rowspan="1" colwidth="203">
                                 <p>Enalapril</p>
                              </td> 
                              <td colspan="1" rowspan="1" colwidth="209">
                                 <p>2.5 mg twice</p>
                              </td> 
                              <td colspan="1" rowspan="1" colwidth="205">
                                 <p>10 to 20 mg twice</p>
                              </td> 
                              <td colspan="1" rowspan="1" colwidth="403">
                                 <p>16.6 mg total daily</p>
                              </td> 
                           </tr> 
                           <tr> 
                              <td colspan="1" rowspan="1" colwidth="203">
                                 <p>Fosinopril</p>
                              </td> 
                              <td colspan="1" rowspan="1" colwidth="209">
                                 <p>5 to 10 mg once</p>
                              </td> 
                              <td colspan="1" rowspan="1" colwidth="205">
                                 <p>40 mg once</p>
                              </td> 
                              <td colspan="1" rowspan="1" colwidth="403">
                                 <p>N/A</p>
                              </td> 
                           </tr> 
                           <tr> 
                              <td colspan="1" rowspan="1" colwidth="203">
                                 <p>Lisinopril</p>
                              </td> 
                              <td colspan="1" rowspan="1" colwidth="209">
                                 <p>2.5 to 5 mg once</p>
                              </td> 
                              <td colspan="1" rowspan="1" colwidth="205">
                                 <p>20 to 40 mg once</p>
                              </td> 
                              <td colspan="1" rowspan="1" colwidth="403">
                                 <p>32.5 to 35.0 mg total daily</p>
                              </td> 
                           </tr> 
                           <tr> 
                              <td colspan="1" rowspan="1" colwidth="203">
                                 <p>Perindopril</p>
                              </td> 
                              <td colspan="1" rowspan="1" colwidth="209">
                                 <p>2 mg once</p>
                              </td> 
                              <td colspan="1" rowspan="1" colwidth="205">
                                 <p>8 to 16 mg once</p>
                              </td> 
                              <td colspan="1" rowspan="1" colwidth="403">
                                 <p>N/A</p>
                              </td> 
                           </tr> 
                           <tr> 
                              <td colspan="1" rowspan="1" colwidth="203">
                                 <p>Quinapril</p>
                              </td> 
                              <td colspan="1" rowspan="1" colwidth="209">
                                 <p>5 mg twice</p>
                              </td> 
                              <td colspan="1" rowspan="1" colwidth="205">
                                 <p>20 mg twice</p>
                              </td> 
                              <td colspan="1" rowspan="1" colwidth="403">
                                 <p>N/A</p>
                              </td> 
                           </tr> 
                           <tr> 
                              <td colspan="1" rowspan="1" colwidth="203">
                                 <p>Ramipril</p>
                              </td> 
                              <td colspan="1" rowspan="1" colwidth="209">
                                 <p>1.25 to 2.5 mg once</p>
                              </td> 
                              <td colspan="1" rowspan="1" colwidth="205">
                                 <p>10 mg once</p>
                              </td> 
                              <td colspan="1" rowspan="1" colwidth="403">
                                 <p>N/A</p>
                              </td> 
                           </tr> 
                           <tr> 
                              <td colspan="1" rowspan="1" colwidth="203">
                                 <p>Trandolapril</p>
                              </td> 
                              <td colspan="1" rowspan="1" colwidth="209">
                                 <p>1 mg once</p>
                              </td> 
                              <td colspan="1" rowspan="1" colwidth="205">
                                 <p>4 mg once</p>
                              </td> 
                              <td colspan="1" rowspan="1" colwidth="403">
                                 <p>N/A</p>
                              </td> 
                           </tr> 
                           <tr> 
                              <td colspan="1" rowspan="1" colwidth="203">
                                 <p>
                                    <em> ARB</em>
                                 </p>
                              </td> 
                              <td colspan="1" rowspan="1" colwidth="209">
                                 <p></p>
                              </td> 
                              <td colspan="1" rowspan="1" colwidth="205">
                                 <p></p>
                              </td> 
                              <td colspan="1" rowspan="1" colwidth="403">
                                 <p></p>
                              </td> 
                           </tr> 
                           <tr> 
                              <td colspan="1" rowspan="1" colwidth="203">
                                 <p>Candesartan</p>
                              </td> 
                              <td colspan="1" rowspan="1" colwidth="209">
                                 <p>4 to 8 mg once</p>
                              </td> 
                              <td colspan="1" rowspan="1" colwidth="205">
                                 <p>32 mg once</p>
                              </td> 
                              <td colspan="1" rowspan="1" colwidth="403">
                                 <p>24 mg total daily</p>
                              </td> 
                           </tr> 
                           <tr> 
                              <td colspan="1" rowspan="1" colwidth="203">
                                 <p>Losartan</p>
                              </td> 
                              <td colspan="1" rowspan="1" colwidth="209">
                                 <p>25 to 50 mg once</p>
                              </td> 
                              <td colspan="1" rowspan="1" colwidth="205">
                                 <p>50 to 150 mg once</p>
                              </td> 
                              <td colspan="1" rowspan="1" colwidth="403">
                                 <p>129 mg total daily</p>
                              </td> 
                           </tr> 
                           <tr> 
                              <td colspan="1" rowspan="1" colwidth="203">
                                 <p>Valsartan</p>
                              </td> 
                              <td colspan="1" rowspan="1" colwidth="209">
                                 <p>20 to 40 mg twice</p>
                              </td> 
                              <td colspan="1" rowspan="1" colwidth="205">
                                 <p>160 mg twice</p>
                              </td> 
                              <td colspan="1" rowspan="1" colwidth="403">
                                 <p>254 mg total daily</p>
                              </td> 
                           </tr> 
                           <tr> 
                              <td colspan="1" rowspan="1" colwidth="203">
                                 <p>
                                    <em> ARNI</em>
                                 </p>
                              </td> 
                              <td colspan="1" rowspan="1" colwidth="209">
                                 <p></p>
                              </td> 
                              <td colspan="1" rowspan="1" colwidth="205">
                                 <p></p>
                              </td> 
                              <td colspan="1" rowspan="1" colwidth="403">
                                 <p></p>
                              </td> 
                           </tr> 
                           <tr> 
                              <td colspan="1" rowspan="1" colwidth="203">
                                 <p>Sacubitril-valsartan</p>
                              </td> 
                              <td colspan="1" rowspan="1" colwidth="209">
                                 <p>49/51 mg twice (sacubitril/valsartan)</p>
                              </td> 
                              <td colspan="1" rowspan="1" colwidth="205">
                                 <p>97/103 mg twice (sacubitril/valsartan)</p>
                              </td> 
                              <td colspan="1" rowspan="1" colwidth="403">
                                 <p>182/193 mg (sacubitril/valsartan) total daily</p>
                                 <p>(therapy may be initiated at 24/26 mg twice)</p>
                              </td> 
                           </tr> 
                        </tbody> 
                     </table>
                  </td> 
               </tr> 
               <tr>   
                  <th scope="row" class="row-header">Citation</th>  
                  <td class="content-container">  
                     <p>Heidenreich, P.A., Bozkurt, B, Aguilar, D., ... Allen, L. A. (2022). 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 145(18), e895-e1032. doi: 10.1161/CIR.0000000000001063</p>   
                  </td> 
               </tr>  
               <tr> 
                  <th scope="row" class="row-header">Definition</th> 
                  <td class="content-container">Moderate or Severe LVSD: 
                     <p>LVEF &lt;=40% corresponds to qualitative documentation of moderate dysfunction or severe dysfunction (LVSD). The LVSD may be determined by quantitative or qualitative assessment, which may be current or historical. Examples of a quantitative or qualitative assessment may include an echocardiogram:</p> 
                     <ol> 
                        <li>
                           <p>that provides a numerical value of LVSD or</p>
                        </li> 
                        <li>
                           <p>that uses descriptive terms such as moderately or severely depressed left ventricular systolic function. Any current or prior ejection fraction study documenting LVSD can be used to identify patients.</p>
                        </li> 
                     </ol>
                  </td> 
               </tr>  
               <tr> 
                  <th scope="row" class="row-header">Definition</th> 
                  <td class="content-container">Prescribed: 
                     <p>Denotes that a prescription has been given to the patient for ACE inhibitor or ARB or ARNI therapy at one or more visits in the measurement period OR that the patient is already taking an ACE inhibitor or ARB or ARNI therapy as documented in their current medication list</p>
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Guidance (Usage)</th> 
                  <td class="content-container">
                     <p>This eCQM is to be reported as patient-based. To satisfy this measure, it must be reported for all heart failure patients at least once during the measurement period.</p> 
                     <p>The requirement of two or more visits is used to establish that the eligible clinician has an existing relationship with the patient.</p> 
                     <p>A range value should satisfy the logic requirement for 'Ejection Fraction' as long as the ranged observation value clearly meets the less than or equal to 40% threshold noted in the denominator logic. A range that is greater than 40% would not meet the measure requirement.</p> 
                     <p>In order for the Ejection Fraction result pathway to be recognized as below 40%, the result must be reported as a number with unit of %. A text string of "below 40%" or "ejection fraction between 35 and 40%" will not be recognized through electronic data capture. Although, this criteria can also be met using the Diagnosis pathway if specified as "Moderate or Severe."</p> 
                     <p>Eligible clinicians who have given a prescription for or whose patient is already taking an Angiotensin-Converting Enzyme Inhibitor (ACEI) or Angiotensin Receptor Blocker (ARB) would meet performance for this measure. Other combination therapies that consist of an ACEI plus diuretic, ARB + neprilysin inhibitor (ARNI), ARB plus diuretic, ACEI plus calcium channel blocker, ARB plus calcium channel blocker, or ARB plus calcium channel blocker plus diuretic would also meet performance for this measure.</p> 
                     <p>This FHIR-based measure has been derived from the QDM-based measure CMS135v14. Please refer to the HL7 QI-Core Implementation Guide (https://hl7.org/fhir/us/qicore/STU6/) for more information on QI-Core and mapping recommendations from QDM to QI-Core STU 6 (https://hl7.org/fhir/us/qicore/STU6/qdm-to-qicore.html).</p>
                  </td> 
               </tr>  
               <tr> 
                  <th colspan="2" scope="row" class="row-header">Measure Group (Rate) (ID: Group_1)</th> 
               </tr>   
               <tr> 
                  <th scope="row" class="row-header">Basis</th> 
                  <td class="content-container">boolean</td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Scoring</th> 
                  <td class="content-container">[http://terminology.hl7.org/CodeSystem/measure-scoring#proportion: 'Proportion']</td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Type</th> 
                  <td class="content-container">[http://terminology.hl7.org/CodeSystem/measure-type#process: 'Process']</td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Improvement Notation</th> 
                  <td class="content-container">[http://terminology.hl7.org/CodeSystem/measure-improvement-notation#increase: 'Increased score indicates improvement']</td> 
               </tr>  
               <tr>  
                  <th scope="row" class="row-header">Initial Population</th> 
                  <td class="content-container"> 
                     <em>ID</em>: InitialPopulation_1 
                     <br></br>  
                     <em>Description</em>: 
                     <p style="white-space: pre-line" class="tab-one">
                        <p>All patients aged 18 years and older with two qualifying encounters during the measurement period and a diagnosis of heart failure on or before at least one qualifying encounter</p>
                     </p>   
                     <em>Logic Definition</em>: 
                     <a href="#primary-cms135fhiraceiorarborarniforhf-initial-population">Initial Population</a>  
                  </td> 
               </tr>  
               <tr>  
                  <th scope="row" class="row-header">Denominator</th> 
                  <td class="content-container"> 
                     <em>ID</em>: Denominator_1 
                     <br></br>  
                     <em>Description</em>: 
                     <p style="white-space: pre-line" class="tab-one">
                        <p>Equals Initial Population with a current or prior LVEF &lt;= 40%</p>
                     </p>   
                     <em>Logic Definition</em>: 
                     <a href="#primary-cms135fhiraceiorarborarniforhf-denominator">Denominator</a>  
                  </td> 
               </tr>  
               <tr>  
                  <th scope="row" class="row-header">Denominator Exclusion</th> 
                  <td class="content-container"> 
                     <em>ID</em>: DenominatorExclusion_1 
                     <br></br>  
                     <em>Description</em>: 
                     <p style="white-space: pre-line" class="tab-one">
                        <p>Patients with a history of heart transplant or with a Left Ventricular Assist Device (LVAD) prior to the end of the outpatient encounter with Moderate or Severe LVSD</p>
                     </p>   
                     <em>Logic Definition</em>: 
                     <a href="#primary-cms135fhiraceiorarborarniforhf-denominator-exclusions">Denominator Exclusions</a>  
                  </td> 
               </tr>  
               <tr>  
                  <th scope="row" class="row-header">Numerator</th> 
                  <td class="content-container"> 
                     <em>ID</em>: Numerator_1 
                     <br></br>  
                     <em>Description</em>: 
                     <p style="white-space: pre-line" class="tab-one">
                        <p>Patients who were prescribed or already taking ACE inhibitor or ARB or ARNI therapy during the measurement period</p>
                     </p>   
                     <em>Logic Definition</em>: 
                     <a href="#primary-cms135fhiraceiorarborarniforhf-numerator">Numerator</a>  
                  </td> 
               </tr>  
               <tr>  
                  <th scope="row" class="row-header">Denominator Exception</th> 
                  <td class="content-container"> 
                     <em>ID</em>: DenominatorException_1 
                     <br></br>  
                     <em>Description</em>: 
                     <p style="white-space: pre-line" class="tab-one">
                        <ul> 
                           <li>
                              <p>Documentation of medical reason(s) for not prescribing ACE inhibitor or ARB or ARNI therapy (e.g., pregnancy, renal failure due to ACEI, allergy, intolerance, other medical reasons).</p>
                           </li> 
                           <li>
                              <p>Documentation of patient reason(s) for not prescribing ACE inhibitor or ARB or ARNI therapy (e.g., patient declined, other patient reasons).</p>
                           </li> 
                        </ul>
                     </p>   
                     <em>Logic Definition</em>: 
                     <a href="#primary-cms135fhiraceiorarborarniforhf-denominator-exceptions">Denominator Exceptions</a>  
                  </td> 
               </tr>   
               <tr> 
                  <th scope="row" class="row-header">Supplemental Data Guidance</th> 
                  <td class="content-container">
                     <p>For every patient evaluated by this measure also identify payer, race, ethnicity and sex</p>
                  </td> 
               </tr> 
               <tr> 
                  <th colspan="2" scope="row" class="row-header">Supplemental Data Elements</th> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Supplemental Data Element</th> 
                  <td class="content-container"> 
                     <em>ID</em>: sde-ethnicity  
                     <br></br>   
                     <em>Usage Code</em>: [http://terminology.hl7.org/CodeSystem/measure-data-usage#supplemental-data]  
                     <br></br>  
                     <em>Description</em>: SDE Ethnicity   
                     <br></br> 
                     <em>Logic Definition</em>: 
                     <a href="#cms135fhiraceiorarborarniforhf-sde-ethnicity">SDE Ethnicity</a>  
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Supplemental Data Element</th> 
                  <td class="content-container"> 
                     <em>ID</em>: sde-payer  
                     <br></br>   
                     <em>Usage Code</em>: [http://terminology.hl7.org/CodeSystem/measure-data-usage#supplemental-data]  
                     <br></br>  
                     <em>Description</em>: SDE Payer   
                     <br></br> 
                     <em>Logic Definition</em>: 
                     <a href="#cms135fhiraceiorarborarniforhf-sde-payer">SDE Payer</a>  
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Supplemental Data Element</th> 
                  <td class="content-container"> 
                     <em>ID</em>: sde-race  
                     <br></br>   
                     <em>Usage Code</em>: [http://terminology.hl7.org/CodeSystem/measure-data-usage#supplemental-data]  
                     <br></br>  
                     <em>Description</em>: SDE Race   
                     <br></br> 
                     <em>Logic Definition</em>: 
                     <a href="#cms135fhiraceiorarborarniforhf-sde-race">SDE Race</a>  
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Supplemental Data Element</th> 
                  <td class="content-container"> 
                     <em>ID</em>: sde-sex  
                     <br></br>   
                     <em>Usage Code</em>: [http://terminology.hl7.org/CodeSystem/measure-data-usage#supplemental-data]  
                     <br></br>  
                     <em>Description</em>: SDE Sex   
                     <br></br> 
                     <em>Logic Definition</em>: 
                     <a href="#cms135fhiraceiorarborarniforhf-sde-sex">SDE Sex</a>  
                  </td> 
               </tr> 
               <tr> 
                  <th colspan="2" scope="row" class="row-header">Measure Logic</th> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Primary Library</th> 
                  <td class="content-container">https://madie.cms.gov/Library/CMS135FHIRACEIorARBorARNIforHF</td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Contents</th> 
                  <td class="content-container"> 
                     <em>
                        <a href="#population-criteria">Population Criteria</a>
                     </em> 
                     <br></br> 
                     <em>
                        <a href="#definitions">Logic Definitions</a>
                     </em> 
                     <br></br> 
                     <em>
                        <a href="#terminology">Terminology</a>
                     </em> 
                     <br></br> 
                     <em>
                        <a href="#dependencies">Dependencies</a>
                     </em> 
                     <br></br> 
                     <em>
                        <a href="#data-requirements">Data Requirements</a>
                     </em> 
                     <br></br> 
                  </td> 
               </tr> 
               <tr> 
                  <th colspan="2" scope="row" class="row-header">
                     <a name="population-criteria"> </a>Population Criteria
                  </th> 
               </tr>   
               <tr> 
                  <th colspan="2" scope="row" class="row-header">Measure Group (Rate) (ID: Group_1)</th> 
               </tr>                  
               <tr> 
                  <th scope="row" rowspan="2" class="row-header">  
                     <a name="primary-cms135fhiraceiorarborarniforhf-initial-population"> </a>  Initial Population  
                  </th> 
               </tr> 
               <tr> 
                  <td> 
                     <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Initial Population":
  AHA."Is Adult With Two Qualifying Outpatient Encounters and One Heart Failure Outpatient Encounter During the Measurement Period"</code></pre> 
                  </td> 
               </tr>                                                        
               <tr> 
                  <th scope="row" rowspan="2" class="row-header">  
                     <a name="primary-cms135fhiraceiorarborarniforhf-denominator"> </a>  Denominator  
                  </th> 
               </tr> 
               <tr> 
                  <td> 
                     <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Denominator":
  "Initial Population"
    and exists AHA."Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD"</code></pre> 
                  </td> 
               </tr>                                                               
               <tr> 
                  <th scope="row" rowspan="2" class="row-header">  
                     <a name="primary-cms135fhiraceiorarborarniforhf-denominator-exclusions"> </a>  Denominator Exclusion  
                  </th> 
               </tr> 
               <tr> 
                  <td> 
                     <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Denominator Exclusions":
  AHA."Has Heart Transplant"
    or AHA."Has Heart Transplant Complications"
    or AHA."Has Left Ventricular Assist Device"
    or AHA."Has Left Ventricular Assist Device Complications"</code></pre> 
                  </td> 
               </tr>                                        
               <tr> 
                  <th scope="row" rowspan="2" class="row-header">  
                     <a name="primary-cms135fhiraceiorarborarniforhf-numerator"> </a>  Numerator  
                  </th> 
               </tr> 
               <tr> 
                  <td> 
                     <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Numerator":
  "Has ACEI or ARB or ARNI Ordered"
    or "Is Currently Taking ACEI or ARB or ARNI"</code></pre> 
                  </td> 
               </tr>                                                                            
               <tr> 
                  <th scope="row" rowspan="2" class="row-header">  
                     <a name="primary-cms135fhiraceiorarborarniforhf-denominator-exceptions"> </a>  Denominator Exception  
                  </th> 
               </tr> 
               <tr> 
                  <td> 
                     <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Denominator Exceptions":
  "Has Medical or Patient Reason for Not Ordering ACEI or ARB or ARNI"
    or "Has Allergy or Intolerance to ACEI or ARB or ARNI Ingredient"
    or "Has Diagnosis of Allergy or Intolerance to ACEI or ARB"
    or "Has Diagnosis of Pregnancy"
    or "Has Diagnosis of Renal Failure Due to ACEI"</code></pre> 
                  </td> 
               </tr>                      
               <tr> 
                  <th colspan="2" scope="row" class="row-header">
                     <a name="definitions"> </a>Logic Definitions
                  </th> 
               </tr>   
               <tr> 
                  <th scope="row" rowspan="2" class="row-header">  
                     <a name="supplementaldataelements-sde-sex"> </a> Logic Definition 
                  </th> 
                  <td class="content-container">
                     <em>Library Name:</em> SupplementalDataElements
                  </td> 
               </tr> 
               <tr> 
                  <td> 
                     <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "SDE Sex":
  case
    when Patient.sex = '248153007' then "Male (finding)"
    when Patient.sex = '248152002' then "Female (finding)"
    else null
  end</code></pre> 
                  </td> 
               </tr>        
               <tr> 
                  <th scope="row" rowspan="2" class="row-header">  
                     <a name="supplementaldataelements-sde-payer"> </a> Logic Definition 
                  </th> 
                  <td class="content-container">
                     <em>Library Name:</em> SupplementalDataElements
                  </td> 
               </tr> 
               <tr> 
                  <td> 
                     <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "SDE Payer":
  [Coverage: type in "Payer Type"] Payer
    return {
      code: Payer.type,
      period: Payer.period
    }</code></pre> 
                  </td> 
               </tr>  
               <tr> 
                  <th scope="row" rowspan="2" class="row-header">  
                     <a name="supplementaldataelements-sde-ethnicity"> </a> Logic Definition 
                  </th> 
                  <td class="content-container">
                     <em>Library Name:</em> SupplementalDataElements
                  </td> 
               </tr> 
               <tr> 
                  <td> 
                     <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "SDE Ethnicity":
  Patient.ethnicity E
    return Tuple {
      codes: { E.ombCategory } union E.detailed,
      display: E.text
    }</code></pre> 
                  </td> 
               </tr>    
               <tr> 
                  <th scope="row" rowspan="2" class="row-header">  
                     <a name="supplementaldataelements-sde-race"> </a> Logic Definition 
                  </th> 
                  <td class="content-container">
                     <em>Library Name:</em> SupplementalDataElements
                  </td> 
               </tr> 
               <tr> 
                  <td> 
                     <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "SDE Race":
  Patient.race R
    return Tuple {
      codes: R.ombCategory union R.detailed,
      display: R.text
    }</code></pre> 
                  </td> 
               </tr>              
               <tr> 
                  <th scope="row" rowspan="2" class="row-header">  
                     <a name="cms135fhiraceiorarborarniforhf-sde-sex"> </a> Logic Definition 
                  </th> 
                  <td class="content-container">
                     <em>Library Name:</em> CMS135FHIRACEIorARBorARNIforHF
                  </td> 
               </tr> 
               <tr> 
                  <td> 
                     <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "SDE Sex":
  SDE."SDE Sex"</code></pre> 
                  </td> 
               </tr>   
               <tr> 
                  <th scope="row" rowspan="2" class="row-header">  
                     <a name="cms135fhiraceiorarborarniforhf-has-acei-or-arb-or-arni-ordered"> </a> Logic Definition 
                  </th> 
                  <td class="content-container">
                     <em>Library Name:</em> CMS135FHIRACEIorARBorARNIforHF
                  </td> 
               </tr> 
               <tr> 
                  <td> 
                     <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Has ACEI or ARB or ARNI Ordered":
  exists ( [MedicationRequest: medication in "ACE Inhibitor or ARB or ARNI"] ACEIOrARBOrARNIOrdered
      where ACEIOrARBOrARNIOrdered.isOrderedDuringHeartFailureOutpatientEncounter ( )
  )</code></pre> 
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" rowspan="2" class="row-header">  
                     <a name="cms135fhiraceiorarborarniforhf-is-currently-taking-acei-or-arb-or-arni"> </a> Logic Definition 
                  </th> 
                  <td class="content-container">
                     <em>Library Name:</em> CMS135FHIRACEIorARBorARNIforHF
                  </td> 
               </tr> 
               <tr> 
                  <td> 
                     <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Is Currently Taking ACEI or ARB or ARNI":
  exists ( [MedicationRequest: medication in "ACE Inhibitor or ARB or ARNI"] ActiveACEIOrARBOrARNI
      where ActiveACEIOrARBOrARNI.overlapsAfterHeartFailureOutpatientEncounter ( )
  )</code></pre> 
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" rowspan="2" class="row-header">  
                     <a name="cms135fhiraceiorarborarniforhf-numerator"> </a> Logic Definition 
                  </th> 
                  <td class="content-container">
                     <em>Library Name:</em> CMS135FHIRACEIorARBorARNIforHF
                  </td> 
               </tr> 
               <tr> 
                  <td> 
                     <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Numerator":
  "Has ACEI or ARB or ARNI Ordered"
    or "Is Currently Taking ACEI or ARB or ARNI"</code></pre> 
                  </td> 
               </tr>   
               <tr> 
                  <th scope="row" rowspan="2" class="row-header">  
                     <a name="cms135fhiraceiorarborarniforhf-initial-population"> </a> Logic Definition 
                  </th> 
                  <td class="content-container">
                     <em>Library Name:</em> CMS135FHIRACEIorARBorARNIforHF
                  </td> 
               </tr> 
               <tr> 
                  <td> 
                     <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Initial Population":
  AHA."Is Adult With Two Qualifying Outpatient Encounters and One Heart Failure Outpatient Encounter During the Measurement Period"</code></pre> 
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" rowspan="2" class="row-header">  
                     <a name="cms135fhiraceiorarborarniforhf-denominator"> </a> Logic Definition 
                  </th> 
                  <td class="content-container">
                     <em>Library Name:</em> CMS135FHIRACEIorARBorARNIforHF
                  </td> 
               </tr> 
               <tr> 
                  <td> 
                     <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Denominator":
  "Initial Population"
    and exists AHA."Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD"</code></pre> 
                  </td> 
               </tr>  
               <tr> 
                  <th scope="row" rowspan="2" class="row-header">  
                     <a name="cms135fhiraceiorarborarniforhf-sde-payer"> </a> Logic Definition 
                  </th> 
                  <td class="content-container">
                     <em>Library Name:</em> CMS135FHIRACEIorARBorARNIforHF
                  </td> 
               </tr> 
               <tr> 
                  <td> 
                     <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "SDE Payer":
  SDE."SDE Payer"</code></pre> 
                  </td> 
               </tr>  
               <tr> 
                  <th scope="row" rowspan="2" class="row-header">  
                     <a name="cms135fhiraceiorarborarniforhf-sde-ethnicity"> </a> Logic Definition 
                  </th> 
                  <td class="content-container">
                     <em>Library Name:</em> CMS135FHIRACEIorARBorARNIforHF
                  </td> 
               </tr> 
               <tr> 
                  <td> 
                     <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "SDE Ethnicity":
  SDE."SDE Ethnicity"</code></pre> 
                  </td> 
               </tr>   
               <tr> 
                  <th scope="row" rowspan="2" class="row-header">  
                     <a name="cms135fhiraceiorarborarniforhf-denominator-exclusions"> </a> Logic Definition 
                  </th> 
                  <td class="content-container">
                     <em>Library Name:</em> CMS135FHIRACEIorARBorARNIforHF
                  </td> 
               </tr> 
               <tr> 
                  <td> 
                     <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Denominator Exclusions":
  AHA."Has Heart Transplant"
    or AHA."Has Heart Transplant Complications"
    or AHA."Has Left Ventricular Assist Device"
    or AHA."Has Left Ventricular Assist Device Complications"</code></pre> 
                  </td> 
               </tr>  
               <tr> 
                  <th scope="row" rowspan="2" class="row-header">  
                     <a name="cms135fhiraceiorarborarniforhf-sde-race"> </a> Logic Definition 
                  </th> 
                  <td class="content-container">
                     <em>Library Name:</em> CMS135FHIRACEIorARBorARNIforHF
                  </td> 
               </tr> 
               <tr> 
                  <td> 
                     <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "SDE Race":
  SDE."SDE Race"</code></pre> 
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" rowspan="2" class="row-header">  
                     <a name="cms135fhiraceiorarborarniforhf-has-medical-or-patient-reason-for-not-ordering-acei-or-arb-or-arni"> </a> Logic Definition 
                  </th> 
                  <td class="content-container">
                     <em>Library Name:</em> CMS135FHIRACEIorARBorARNIforHF
                  </td> 
               </tr> 
               <tr> 
                  <td> 
                     <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Has Medical or Patient Reason for Not Ordering ACEI or ARB or ARNI":
  exists ( [MedicationNotRequested: medication in "ACE Inhibitor or ARB or ARNI"] NoACEIOrARBOrARNIOrdered
      where NoACEIOrARBOrARNIOrdered.isMedicationNotRequestedOrderedDuringHeartFailureOutpatientEncounter ( )
        and ( NoACEIOrARBOrARNIOrdered.reasonCode in "Medical Reason"
            or NoACEIOrARBOrARNIOrdered.reasonCode in "Patient Reason"
            or NoACEIOrARBOrARNIOrdered.reasonCode in "Patient Reason for ACE Inhibitor or ARB Decline"
        )
  )</code></pre> 
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" rowspan="2" class="row-header">  
                     <a name="cms135fhiraceiorarborarniforhf-has-allergy-or-intolerance-to-acei-or-arb-or-arni-ingredient"> </a> Logic Definition 
                  </th> 
                  <td class="content-container">
                     <em>Library Name:</em> CMS135FHIRACEIorARBorARNIforHF
                  </td> 
               </tr> 
               <tr> 
                  <td> 
                     <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Has Allergy or Intolerance to ACEI or ARB or ARNI Ingredient":
  exists ( ( [AllergyIntolerance: "ACE Inhibitor or ARB or ARNI Ingredient"]
      union [AllergyIntolerance: "Substance with angiotensin-converting enzyme inhibitor mechanism of action (substance)"]
      union [AllergyIntolerance: "Substance with angiotensin II receptor antagonist mechanism of action (substance)"]
      union [AllergyIntolerance: "Substance with neprilysin inhibitor mechanism of action (substance)"] ) ACEIOrARBOrARNIAllergyIntolerance
      where ACEIOrARBOrARNIAllergyIntolerance.overlapsAfterHeartFailureOutpatientEncounter ( )
  )</code></pre> 
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" rowspan="2" class="row-header">  
                     <a name="cms135fhiraceiorarborarniforhf-has-diagnosis-of-allergy-or-intolerance-to-acei-or-arb"> </a> Logic Definition 
                  </th> 
                  <td class="content-container">
                     <em>Library Name:</em> CMS135FHIRACEIorARBorARNIforHF
                  </td> 
               </tr> 
               <tr> 
                  <td> 
                     <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Has Diagnosis of Allergy or Intolerance to ACEI or ARB":
  exists ( ( ( ["ConditionProblemsHealthConcerns": "Allergy to ACE Inhibitor or ARB"]
        union ["ConditionEncounterDiagnosis": "Allergy to ACE Inhibitor or ARB"]
    )
      union ( ["ConditionProblemsHealthConcerns": "Intolerance to ACE Inhibitor or ARB"] )
      union ["ConditionEncounterDiagnosis": "Intolerance to ACE Inhibitor or ARB"] ) ACEIOrARBAllergyOrIntoleranceDiagnosis
      where ACEIOrARBAllergyOrIntoleranceDiagnosis.overlapsAfterHeartFailureOutpatientEncounter ( )
  )</code></pre> 
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" rowspan="2" class="row-header">  
                     <a name="cms135fhiraceiorarborarniforhf-has-diagnosis-of-pregnancy"> </a> Logic Definition 
                  </th> 
                  <td class="content-container">
                     <em>Library Name:</em> CMS135FHIRACEIorARBorARNIforHF
                  </td> 
               </tr> 
               <tr> 
                  <td> 
                     <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Has Diagnosis of Pregnancy":
  exists ( ( [ConditionProblemsHealthConcerns: "Pregnancy"]
      union ["ConditionEncounterDiagnosis": "Pregnancy"] ) PregnancyDiagnosis
      with AHA."Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter
        such that PregnancyDiagnosis.prevalenceInterval ( ) starts 9 months or less before or on start of ModerateOrSevereLVSDHFOutpatientEncounter.period
          and PregnancyDiagnosis.isVerified ( )
  )
    or exists ( [USCoreObservationPregnancyStatusProfile] PregnantObservation
        with AHA."Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter
          such that PregnantObservation.effective.toInterval ( ) starts 9 months or less before or on start of ModerateOrSevereLVSDHFOutpatientEncounter.period
            and ( PregnantObservation.value in "Pregnancy"
                and PregnantObservation.status in { 'final', 'amended', 'corrected' }
            )
    )</code></pre> 
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" rowspan="2" class="row-header">  
                     <a name="cms135fhiraceiorarborarniforhf-has-diagnosis-of-renal-failure-due-to-acei"> </a> Logic Definition 
                  </th> 
                  <td class="content-container">
                     <em>Library Name:</em> CMS135FHIRACEIorARBorARNIforHF
                  </td> 
               </tr> 
               <tr> 
                  <td> 
                     <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Has Diagnosis of Renal Failure Due to ACEI":
  exists ( ( [ConditionProblemsHealthConcerns: "Acute renal failure caused by angiotensin-converting-enzyme inhibitor (disorder)"]
      union [ConditionEncounterDiagnosis: "Acute renal failure caused by angiotensin-converting-enzyme inhibitor (disorder)"] ) RenalFailureDueToACEI
      where RenalFailureDueToACEI.overlapsHeartFailureOutpatientEncounter ( )
  )</code></pre> 
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" rowspan="2" class="row-header">  
                     <a name="cms135fhiraceiorarborarniforhf-denominator-exceptions"> </a> Logic Definition 
                  </th> 
                  <td class="content-container">
                     <em>Library Name:</em> CMS135FHIRACEIorARBorARNIforHF
                  </td> 
               </tr> 
               <tr> 
                  <td> 
                     <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Denominator Exceptions":
  "Has Medical or Patient Reason for Not Ordering ACEI or ARB or ARNI"
    or "Has Allergy or Intolerance to ACEI or ARB or ARNI Ingredient"
    or "Has Diagnosis of Allergy or Intolerance to ACEI or ARB"
    or "Has Diagnosis of Pregnancy"
    or "Has Diagnosis of Renal Failure Due to ACEI"</code></pre> 
                  </td> 
               </tr>                            
               <tr> 
                  <th scope="row" rowspan="2" class="row-header">  
                     <a name="qicorecommon-prevalenceinterval"> </a> Logic Definition 
                  </th> 
                  <td class="content-container">
                     <em>Library Name:</em> QICoreCommon
                  </td> 
               </tr> 
               <tr> 
                  <td> 
                     <pre style="border: none;" class="content-container 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 Choice&lt;"ConditionEncounterDiagnosis", "ConditionProblemsHealthConcerns"&gt;):
if condition.clinicalStatus ~ "active"
  or condition.clinicalStatus ~ "recurrence"
  or condition.clinicalStatus ~ "relapse" then
  Interval[start of condition.onset.toInterval(), end of condition.abatementInterval()]
else
    (end of condition.abatementInterval()) abatementDate
    return if abatementDate is null then
      Interval[start of condition.onset.toInterval(), abatementDate)
    else
      Interval[start of condition.onset.toInterval(), abatementDate]</code></pre> 
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" rowspan="2" class="row-header">  
                     <a name="qicorecommon-abatementinterval"> </a> Logic Definition 
                  </th> 
                  <td class="content-container">
                     <em>Library Name:</em> QICoreCommon
                  </td> 
               </tr> 
               <tr> 
                  <td> 
                     <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">/*
@description: Returns an interval representing the normalized abatement of a given Condition.
@comment: If the abatement element of the Condition is represented as a DateTime, the result
is an interval beginning and ending on that DateTime.
If the abatement is represented as a Quantity, the quantity is expected to be a calendar-duration and is interpreted as the age of the patient. The
result is an interval from the date the patient turned that age to immediately before one year later.
If the abatement is represented as a Quantity Interval, the quantities are expected to be calendar-durations and are interpreted as an age range during
which the abatement occurred. The result is an interval from the date the patient turned the starting age of the quantity interval, and ending immediately
before one year later than the date the patient turned the ending age of the quantity interval.
*/
define fluent function abatementInterval(condition Choice&lt;"ConditionEncounterDiagnosis", "ConditionProblemsHealthConcerns"&gt;):
	if condition.abatement is DateTime then
	  Interval[condition.abatement as DateTime, condition.abatement as DateTime]
	else if condition.abatement is Quantity then
		Interval[Patient.birthDate + (condition.abatement as Quantity),
			Patient.birthDate + (condition.abatement as Quantity) + 1 year)
	else if condition.abatement is Interval&lt;Quantity&gt; then
	  Interval[Patient.birthDate + (condition.abatement.low as Quantity),
		  Patient.birthDate + (condition.abatement.high as Quantity) + 1 year)
	else if condition.abatement is Interval&lt;DateTime&gt; then
	  Interval[condition.abatement.low, condition.abatement.high)
	else null as Interval&lt;DateTime&gt;</code></pre> 
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" rowspan="2" class="row-header">  
                     <a name="qicorecommon-references"> </a> Logic Definition 
                  </th> 
                  <td class="content-container">
                     <em>Library Name:</em> QICoreCommon
                  </td> 
               </tr> 
               <tr> 
                  <td> 
                     <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">/*
@description: Returns true if the given reference is to the given resource
@comment: Returns true if the `id` element of the given resource exactly equals the tail of the given reference.
NOTE: This function assumes resources from the same source server.
*/
define fluent function references(reference Reference, resource Resource):
  resource.id = Last(Split(reference.reference, '/'))</code></pre> 
                  </td> 
               </tr>   
               <tr> 
                  <th scope="row" rowspan="2" class="row-header">  
                     <a name="qicorecommon-tointerval"> </a> Logic Definition 
                  </th> 
                  <td class="content-container">
                     <em>Library Name:</em> QICoreCommon
                  </td> 
               </tr> 
               <tr> 
                  <td> 
                     <pre style="border: none;" class="content-container 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 scope="row" rowspan="2" class="row-header">  
                     <a name="fhirhelpers-tostring"> </a> Logic Definition 
                  </th> 
                  <td class="content-container">
                     <em>Library Name:</em> FHIRHelpers
                  </td> 
               </tr> 
               <tr> 
                  <td> 
                     <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define function ToString(value uri): value.value</code></pre> 
                  </td> 
               </tr>  
               <tr> 
                  <th scope="row" rowspan="2" class="row-header">  
                     <a name="fhirhelpers-tointerval"> </a> Logic Definition 
                  </th> 
                  <td class="content-container">
                     <em>Library Name:</em> FHIRHelpers
                  </td> 
               </tr> 
               <tr> 
                  <td> 
                     <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">/*
@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]</code></pre> 
                  </td> 
               </tr>     
               <tr> 
                  <th scope="row" rowspan="2" class="row-header">  
                     <a name="fhirhelpers-tocode"> </a> Logic Definition 
                  </th> 
                  <td class="content-container">
                     <em>Library Name:</em> FHIRHelpers
                  </td> 
               </tr> 
               <tr> 
                  <td> 
                     <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">/*
@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
        }</code></pre> 
                  </td> 
               </tr>  
               <tr> 
                  <th scope="row" rowspan="2" class="row-header">  
                     <a name="fhirhelpers-toconcept"> </a> Logic Definition 
                  </th> 
                  <td class="content-container">
                     <em>Library Name:</em> FHIRHelpers
                  </td> 
               </tr> 
               <tr> 
                  <td> 
                     <pre style="border: none;" class="content-container 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 scope="row" rowspan="2" class="row-header">  
                     <a name="ahaoverall-outpatient-encounter"> </a> Logic Definition 
                  </th> 
                  <td class="content-container">
                     <em>Library Name:</em> AHAOverall
                  </td> 
               </tr> 
               <tr> 
                  <td> 
                     <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Outpatient Encounter":
  ( [Encounter: "Care Services in Long Term Residential Facility"]
      union [Encounter: "Home Healthcare Services"]
      union [Encounter: "Nursing Facility Visit"]
      union [Encounter: "Office Visit"]
      union [Encounter: "Outpatient Consultation"]
  )</code></pre> 
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" rowspan="2" class="row-header">  
                     <a name="ahaoverall-heart-failure-outpatient-encounter"> </a> Logic Definition 
                  </th> 
                  <td class="content-container">
                     <em>Library Name:</em> AHAOverall
                  </td> 
               </tr> 
               <tr> 
                  <td> 
                     <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">/*
@description: Returns certain finished encounter types that overlap a Heart Failure condition and are during the measurement period: 
                * care services in long term residential facility (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1014)
                * home healthcare services (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016)
                * nursing facility visits (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1012)
                * office visits (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001)
                * outpatient consultation (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1008)
*/
define "Heart Failure Outpatient Encounter":
  "Outpatient Encounter" QualifyingEncounter
    with ( [ConditionProblemsHealthConcerns: "Heart Failure"]
      union [ConditionEncounterDiagnosis: "Heart Failure"] ) HeartFailure
      such that HeartFailure.prevalenceInterval ( ) overlaps day of QualifyingEncounter.period
        and HeartFailure.isVerified ( )
    where QualifyingEncounter.period during day of "Measurement Period"
      and QualifyingEncounter.isEncounterFinished ( )</code></pre> 
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" rowspan="2" class="row-header">  
                     <a name="ahaoverall-moderate-or-severe-lvsd-findings"> </a> Logic Definition 
                  </th> 
                  <td class="content-container">
                     <em>Library Name:</em> AHAOverall
                  </td> 
               </tr> 
               <tr> 
                  <td> 
                     <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">/*
@description: Returns a union  of the following:
                * Observations where the final, amended or correction ejection fraction result is &lt;= 40
                * Moderate or Severe LVSD conditions where the diagnosis has been confirmed as active
*/
define "Moderate or Severe LVSD Findings":
  ( [ObservationClinicalResult: "Ejection Fraction"] EjectionFraction
      where EjectionFraction.value as Quantity &lt;= 40 '%'
        and EjectionFraction.status in { 'final', 'amended', 'corrected' }
  )
    union ( ( ( [ConditionProblemsHealthConcerns: "Moderate or Severe LVSD"]
          union [ConditionEncounterDiagnosis: "Moderate or Severe LVSD"]
      )
        union ( ( [ConditionProblemsHealthConcerns: "Left ventricular systolic dysfunction (disorder)"]
            union [ConditionEncounterDiagnosis: "Left ventricular systolic dysfunction (disorder)"] ) LVSDDiagnosis
            where LVSDDiagnosis.severity in "Moderate or Severe"
        ) ) ModerateOrSevereLVSD
        where ModerateOrSevereLVSD.isVerified ( )
    )</code></pre> 
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" rowspan="2" class="row-header">  
                     <a name="ahaoverall-heart-failure-outpatient-encounter-with-history-of-moderate-or-severe-lvsd"> </a> Logic Definition 
                  </th> 
                  <td class="content-container">
                     <em>Library Name:</em> AHAOverall
                  </td> 
               </tr> 
               <tr> 
                  <td> 
                     <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">/*
@description: Returns heart failure outpatient encounters that start before the end of a moderate or severe LVSD finding
*/
define "Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD":
  "Heart Failure Outpatient Encounter" HFOutpatientEncounter
    with "Moderate or Severe LVSD Findings" LVSDFindings
      such that Coalesce(LVSDFindings.prevalenceInterval(), LVSDFindings.effective.toInterval()) starts before end of HFOutpatientEncounter.period</code></pre> 
                  </td> 
               </tr>   
               <tr> 
                  <th scope="row" rowspan="2" class="row-header">  
                     <a name="ahaoverall-outpatient-encounter-or-patient-provider-interaction"> </a> Logic Definition 
                  </th> 
                  <td class="content-container">
                     <em>Library Name:</em> AHAOverall
                  </td> 
               </tr> 
               <tr> 
                  <td> 
                     <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Outpatient Encounter or Patient Provider Interaction":
  "Outpatient Encounter"
    union [Encounter: "Patient Provider Interaction"]</code></pre> 
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" rowspan="2" class="row-header">  
                     <a name="ahaoverall-qualifying-outpatient-encounter-during-measurement-period"> </a> Logic Definition 
                  </th> 
                  <td class="content-container">
                     <em>Library Name:</em> AHAOverall
                  </td> 
               </tr> 
               <tr> 
                  <td> 
                     <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">/*
@description: Returns certain finished encounter types that occurred during the measurement period: 
                * office visits (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001)
                * outpatient consultation (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1008)
                * nursing facility visits (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1012)
                * care services in long term residential facility (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1014)
                * home healthcare services (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016)
                * patient provider interactions (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1012) 
*/
define "Qualifying Outpatient Encounter During Measurement Period":
  "Outpatient Encounter or Patient Provider Interaction" ValidEncounter
    where ValidEncounter.period during day of "Measurement Period"
      and ValidEncounter.isEncounterFinished ( )</code></pre> 
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" rowspan="2" class="row-header">  
                     <a name="ahaoverall-is-adult-with-two-qualifying-outpatient-encounters-and-one-heart-failure-outpatient-encounter-during-the-measurement-period"> </a> Logic Definition 
                  </th> 
                  <td class="content-container">
                     <em>Library Name:</em> AHAOverall
                  </td> 
               </tr> 
               <tr> 
                  <td> 
                     <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">/*
@description: Returns true if the patient meets the following criteria:
                * 18 years of age or older,
                * Has two Qualifying Outpatient Encounters During Measurement Period
                * Has a Heart Failure Outpatient Encounter
*/
define "Is Adult With Two Qualifying Outpatient Encounters and One Heart Failure Outpatient Encounter During the Measurement Period":
  AgeInYearsAt(date from start of "Measurement Period") &gt;= 18
    and exists ( "Qualifying Outpatient Encounter During Measurement Period" Encounter1
        with "Qualifying Outpatient Encounter During Measurement Period" Encounter2
          such that Encounter2.id !~ Encounter1.id
    )
    and exists "Heart Failure Outpatient Encounter"</code></pre> 
                  </td> 
               </tr>    
               <tr> 
                  <th scope="row" rowspan="2" class="row-header">  
                     <a name="ahaoverall-has-heart-transplant"> </a> Logic Definition 
                  </th> 
                  <td class="content-container">
                     <em>Library Name:</em> AHAOverall
                  </td> 
               </tr> 
               <tr> 
                  <td> 
                     <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">/*
@description: Returns completed heart tansplant procedures that start before the end of a heart failure outpatient encounter with history of moderate or severe LVSD
*/
define "Has Heart Transplant":
  exists ( [Procedure: "Heart Transplant"] HeartTransplant
      with "Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter
        such that HeartTransplant.performed.toInterval ( ) starts before end of ModerateOrSevereLVSDHFOutpatientEncounter.period
      where HeartTransplant.status = 'completed'
  )</code></pre> 
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" rowspan="2" class="row-header">  
                     <a name="ahaoverall-has-heart-transplant-complications"> </a> Logic Definition 
                  </th> 
                  <td class="content-container">
                     <em>Library Name:</em> AHAOverall
                  </td> 
               </tr> 
               <tr> 
                  <td> 
                     <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">/*
@description: Returns true if patient has confirmed heart transplant complications that start before the end of a heart failure outpatient encounter with history of moderate or severe LVSD 
*/
define "Has Heart Transplant Complications":
  exists ( ( [ConditionEncounterDiagnosis: "Heart Transplant Complications"]
      union [ConditionProblemsHealthConcerns: "Heart Transplant Complications"] ) HeartTransplantComplications
      let diagnosisStart: Coalesce(start of HeartTransplantComplications.prevalenceInterval(), HeartTransplantComplications.recordedDate)
      with "Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter
        such that date from diagnosisStart on or before date from end of ModerateOrSevereLVSDHFOutpatientEncounter.period
      where HeartTransplantComplications.isVerified ( )
  )</code></pre> 
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" rowspan="2" class="row-header">  
                     <a name="ahaoverall-has-left-ventricular-assist-device"> </a> Logic Definition 
                  </th> 
                  <td class="content-container">
                     <em>Library Name:</em> AHAOverall
                  </td> 
               </tr> 
               <tr> 
                  <td> 
                     <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">/*
@description: Returns true if patient has a completed LVAD placement that starts before the end of a heart failure outpatient encounter with history of moderate or severe LVSD
*/
define "Has Left Ventricular Assist Device":
  exists ( [Procedure: "Left Ventricular Assist Device Placement"] LVADPlacement
      with "Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter
        such that LVADPlacement.performed.toInterval ( ) starts before day of end of ModerateOrSevereLVSDHFOutpatientEncounter.period
      where LVADPlacement.status = 'completed'
  )</code></pre> 
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" rowspan="2" class="row-header">  
                     <a name="ahaoverall-has-left-ventricular-assist-device-complications"> </a> Logic Definition 
                  </th> 
                  <td class="content-container">
                     <em>Library Name:</em> AHAOverall
                  </td> 
               </tr> 
               <tr> 
                  <td> 
                     <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">/*
@description: Returns true if patient has active LVAD complications that start before the end of a heart failure outpatient encounter with history of moderate or severe LVSD
*/
define "Has Left Ventricular Assist Device Complications":
  exists ( ( [ConditionEncounterDiagnosis: "Left Ventricular Assist Device Complications"]
      union [ConditionProblemsHealthConcerns: "Left Ventricular Assist Device Complications"] ) LVADComplications
      let diagnosisStart: Coalesce(start of LVADComplications.prevalenceInterval(), LVADComplications.recordedDate)
      with "Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter
        such that date from diagnosisStart on or before date from end of ModerateOrSevereLVSDHFOutpatientEncounter.period
      where LVADComplications.isVerified ( )
  )</code></pre> 
                  </td> 
               </tr>      
               <tr> 
                  <th scope="row" rowspan="2" class="row-header">  
                     <a name="ahaoverall-isorderedduringheartfailureoutpatientencounter"> </a> Logic Definition 
                  </th> 
                  <td class="content-container">
                     <em>Library Name:</em> AHAOverall
                  </td> 
               </tr> 
               <tr> 
                  <td> 
                     <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">/*
@description: Returns true if the given MedicationRequest is ordered during the heart failure outpatient encounter with history of moderate or severe LVSD at any point
*/
define fluent function isOrderedDuringHeartFailureOutpatientEncounter(MedicationRequest MedicationRequest):
  exists ( "Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter
      where MedicationRequest.authoredOn during day of ModerateOrSevereLVSDHFOutpatientEncounter.period
        and MedicationRequest.status in { 'active', 'completed' }
        and MedicationRequest.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
        and not exists ( ["TaskRejected"] TaskReject
            where TaskReject.focus.references ( MedicationRequest )
              and TaskReject.code ~ QICoreCommon."Fulfill"
        )
  )</code></pre> 
                  </td> 
               </tr>  
               <tr> 
                  <th scope="row" rowspan="2" class="row-header">  
                     <a name="ahaoverall-isverified"> </a> Logic Definition 
                  </th> 
                  <td class="content-container">
                     <em>Library Name:</em> AHAOverall
                  </td> 
               </tr> 
               <tr> 
                  <td> 
                     <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">/*
@description: Returns true if the given Condition has a verification status of "confirmed", "unconfirmed", "provisional", or "differential"
*/
define fluent function isVerified(condition Choice&lt;ConditionEncounterDiagnosis, ConditionProblemsHealthConcerns&gt;):
  condition.verificationStatus is not null implies ( condition.verificationStatus ~ QICoreCommon."confirmed"
      or condition.verificationStatus ~ QICoreCommon."unconfirmed"
      or condition.verificationStatus ~ QICoreCommon."provisional"
      or condition.verificationStatus ~ QICoreCommon."differential"
  )</code></pre> 
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" rowspan="2" class="row-header">  
                     <a name="ahaoverall-isencounterfinished"> </a> Logic Definition 
                  </th> 
                  <td class="content-container">
                     <em>Library Name:</em> AHAOverall
                  </td> 
               </tr> 
               <tr> 
                  <td> 
                     <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">/*
@description: Returns true if the given Encounter is finished
*/
define fluent function isEncounterFinished(Encounter Encounter):
  Encounter.status = 'finished'</code></pre> 
                  </td> 
               </tr>   
               <tr> 
                  <th scope="row" rowspan="2" class="row-header">  
                     <a name="ahaoverall-overlapsafterheartfailureoutpatientencounter"> </a> Logic Definition 
                  </th> 
                  <td class="content-container">
                     <em>Library Name:</em> AHAOverall
                  </td> 
               </tr> 
               <tr> 
                  <td> 
                     <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">/*
@overloaded
@description: Returns true if the given MedicationRequest overlaps after the day of the heart failure outpatient encounter with history of moderate or severe LVSD
*/
define fluent function overlapsAfterHeartFailureOutpatientEncounter(MedicationRequest MedicationRequest):
  exists ( "Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter
      where First((collapse(MedicationRequest.dosageInstruction.timing.repeat.bounds DoseTime
            return TimingBoundToInterval(MedicationRequest.authoredOn, DoseTime)
        )) DrugPeriods
          sort by start of $this
      ) overlaps after day of ModerateOrSevereLVSDHFOutpatientEncounter.period
        and MedicationRequest.status in { 'active', 'completed' }
        and MedicationRequest.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
        and not exists ( ["TaskRejected"] TaskReject
            where TaskReject.focus.references ( MedicationRequest )
              and TaskReject.code ~ QICoreCommon."Fulfill"
        )
  )</code></pre> 
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" rowspan="2" class="row-header">  
                     <a name="ahaoverall-timingboundtointerval"> </a> Logic Definition 
                  </th> 
                  <td class="content-container">
                     <em>Library Name:</em> AHAOverall
                  </td> 
               </tr> 
               <tr> 
                  <td> 
                     <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define function TimingBoundToInterval(startDate System.DateTime, choice Choice&lt;Quantity, Interval&lt;Quantity&gt;, Interval&lt;DateTime&gt;&gt;):
  case
    when choice is Interval&lt;DateTime&gt; then
        choice as Interval&lt;DateTime&gt;
    when choice is Interval&lt;Quantity&gt; then
        Interval[startDate + (choice.low as Quantity), startDate + (choice.high as Quantity)]
    when choice is Quantity then
        Interval[startDate, startDate + (choice as Quantity))
    else
		null as Interval&lt;DateTime&gt;
	end</code></pre> 
                  </td> 
               </tr>  
               <tr> 
                  <th scope="row" rowspan="2" class="row-header">  
                     <a name="ahaoverall-ismedicationnotrequestedorderedduringheartfailureoutpatientencounter"> </a> Logic Definition 
                  </th> 
                  <td class="content-container">
                     <em>Library Name:</em> AHAOverall
                  </td> 
               </tr> 
               <tr> 
                  <td> 
                     <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">/*
@description: Returns true if the given MedicationNotRequested overlaps after the day of the heart failure outpatient encounter with history of moderate or severe LVSD
*/
define fluent function isMedicationNotRequestedOrderedDuringHeartFailureOutpatientEncounter(MedicationRequest MedicationNotRequested):
  exists ( "Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter
      where MedicationRequest.authoredOn during day of ModerateOrSevereLVSDHFOutpatientEncounter.period
        and MedicationRequest.status in { 'completed', 'active' }
        and MedicationRequest.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
        and not exists ( ["TaskRejected"] TaskReject
            where TaskReject.focus.references ( MedicationRequest )
              and TaskReject.code ~ QICoreCommon."Fulfill"
        )
  )</code></pre> 
                  </td> 
               </tr>  
               <tr> 
                  <th scope="row" rowspan="2" class="row-header">  
                     <a name="ahaoverall-overlapsafterheartfailureoutpatientencounter"> </a> Logic Definition 
                  </th> 
                  <td class="content-container">
                     <em>Library Name:</em> AHAOverall
                  </td> 
               </tr> 
               <tr> 
                  <td> 
                     <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">/*
@overloaded
@description: Returns true if the given AllergyIntolerance overlaps after the day of the heart failure outpatient encounter with history of moderate or severe LVSD
*/
define fluent function overlapsAfterHeartFailureOutpatientEncounter(AllergyIntolerance AllergyIntolerance):
  exists ( "Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter
      where Interval[start of AllergyIntolerance.onset.toInterval ( ), AllergyIntolerance.lastOccurrence]overlaps after day of ModerateOrSevereLVSDHFOutpatientEncounter.period
        and AllergyIntolerance.isVerified ( )
  )</code></pre> 
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" rowspan="2" class="row-header">  
                     <a name="ahaoverall-isverified"> </a> Logic Definition 
                  </th> 
                  <td class="content-container">
                     <em>Library Name:</em> AHAOverall
                  </td> 
               </tr> 
               <tr> 
                  <td> 
                     <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">/*
@description: Returns true if the given condition either has no verification status or has a verification status of confirmed, unconfirmed, provisional, or differential
*/
define fluent function isVerified(AllergyIntolerance AllergyIntolerance):
  AllergyIntolerance.verificationStatus is not null implies ( AllergyIntolerance.verificationStatus ~ QICoreCommon."allergy-confirmed"
      or AllergyIntolerance.verificationStatus ~ QICoreCommon."allergy-unconfirmed"
  )</code></pre> 
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" rowspan="2" class="row-header">  
                     <a name="ahaoverall-overlapsafterheartfailureoutpatientencounter"> </a> Logic Definition 
                  </th> 
                  <td class="content-container">
                     <em>Library Name:</em> AHAOverall
                  </td> 
               </tr> 
               <tr> 
                  <td> 
                     <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">/*
@overloaded
@description: Returns true if the given Condition overlaps after the day of the heart failure outpatient encounter with history of moderate or severe LVSD
*/
define fluent function overlapsAfterHeartFailureOutpatientEncounter(Condition Choice&lt;ConditionEncounterDiagnosis, ConditionProblemsHealthConcerns&gt;):
  exists ( "Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter
      where Condition.prevalenceInterval ( ) overlaps after day of ModerateOrSevereLVSDHFOutpatientEncounter.period
        and Condition.isVerified ( )
  )</code></pre> 
                  </td> 
               </tr>  
               <tr> 
                  <th colspan="2" scope="row" class="row-header">
                     <a name="terminology"> </a>Terminology
                  </th> 
               </tr>     
               <tr>  
                  <th scope="row" class="row-header">Code System</th> 
                  <td class="content-container"> 
                     <em>Description</em>: Code system SNOMEDCT  
                     <br></br>    
                     <em>Resource</em>: http://snomed.info/sct 
                     <br></br> 
                     <em>Canonical URL</em>: 
                     <tt>http://snomed.info/sct</tt> 
                  </td> 
               </tr> 
               <tr>  
                  <th scope="row" class="row-header">Code System</th> 
                  <td class="content-container"> 
                     <em>Description</em>: Code system ConditionVerificationStatusCodes  
                     <br></br>    
                     <em>Resource</em>: http://terminology.hl7.org/CodeSystem/condition-ver-status 
                     <br></br> 
                     <em>Canonical URL</em>: 
                     <tt>http://terminology.hl7.org/CodeSystem/condition-ver-status</tt> 
                  </td> 
               </tr> 
               <tr>  
                  <th scope="row" class="row-header">Code System</th> 
                  <td class="content-container"> 
                     <em>Description</em>: Code system ConditionClinicalStatusCodes  
                     <br></br>    
                     <em>Resource</em>: http://terminology.hl7.org/CodeSystem/condition-clinical 
                     <br></br> 
                     <em>Canonical URL</em>: 
                     <tt>http://terminology.hl7.org/CodeSystem/condition-clinical</tt> 
                  </td> 
               </tr> 
               <tr>  
                  <th scope="row" class="row-header">Code System</th> 
                  <td class="content-container"> 
                     <em>Description</em>: Code system TaskCodeSystem  
                     <br></br>    
                     <em>Resource</em>: http://hl7.org/fhir/CodeSystem/task-code 
                     <br></br> 
                     <em>Canonical URL</em>: 
                     <tt>http://hl7.org/fhir/CodeSystem/task-code</tt> 
                  </td> 
               </tr> 
               <tr>  
                  <th scope="row" class="row-header">Code System</th> 
                  <td class="content-container"> 
                     <em>Description</em>: Code system AllergyIntoleranceVerificationStatusCodes  
                     <br></br>    
                     <em>Resource</em>: http://terminology.hl7.org/CodeSystem/allergyintolerance-verification 
                     <br></br> 
                     <em>Canonical URL</em>: 
                     <tt>http://terminology.hl7.org/CodeSystem/allergyintolerance-verification</tt> 
                  </td> 
               </tr> 
               <tr>  
                  <th scope="row" class="row-header">Value Set</th>  
                  <td class="content-container"> 
                     <em>Description</em>: Value set ACE Inhibitor or ARB or ARNI  
                     <br></br>    
                     <em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1139 
                     <br></br> 
                     <em>Canonical URL</em>: 
                     <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1139</tt> 
                  </td> 
               </tr> 
               <tr>  
                  <th scope="row" class="row-header">Value Set</th>  
                  <td class="content-container"> 
                     <em>Description</em>: Value set Care Services in Long Term Residential Facility  
                     <br></br>    
                     <em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1014 
                     <br></br> 
                     <em>Canonical URL</em>: 
                     <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1014</tt> 
                  </td> 
               </tr> 
               <tr>  
                  <th scope="row" class="row-header">Value Set</th>  
                  <td class="content-container"> 
                     <em>Description</em>: Value set Home Healthcare Services  
                     <br></br>    
                     <em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016 
                     <br></br> 
                     <em>Canonical URL</em>: 
                     <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016</tt> 
                  </td> 
               </tr> 
               <tr>  
                  <th scope="row" class="row-header">Value Set</th>  
                  <td class="content-container"> 
                     <em>Description</em>: Value set Nursing Facility Visit  
                     <br></br>    
                     <em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1012 
                     <br></br> 
                     <em>Canonical URL</em>: 
                     <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1012</tt> 
                  </td> 
               </tr> 
               <tr>  
                  <th scope="row" class="row-header">Value Set</th>  
                  <td class="content-container"> 
                     <em>Description</em>: Value set Office Visit  
                     <br></br>    
                     <em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001 
                     <br></br> 
                     <em>Canonical URL</em>: 
                     <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001</tt> 
                  </td> 
               </tr> 
               <tr>  
                  <th scope="row" class="row-header">Value Set</th>  
                  <td class="content-container"> 
                     <em>Description</em>: Value set Outpatient Consultation  
                     <br></br>    
                     <em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1008 
                     <br></br> 
                     <em>Canonical URL</em>: 
                     <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1008</tt> 
                  </td> 
               </tr> 
               <tr>  
                  <th scope="row" class="row-header">Value Set</th>  
                  <td class="content-container"> 
                     <em>Description</em>: Value set Heart Failure  
                     <br></br>    
                     <em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.376 
                     <br></br> 
                     <em>Canonical URL</em>: 
                     <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.376</tt> 
                  </td> 
               </tr> 
               <tr>  
                  <th scope="row" class="row-header">Value Set</th>  
                  <td class="content-container"> 
                     <em>Description</em>: Value set Ejection Fraction  
                     <br></br>    
                     <em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1134 
                     <br></br> 
                     <em>Canonical URL</em>: 
                     <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1134</tt> 
                  </td> 
               </tr> 
               <tr>  
                  <th scope="row" class="row-header">Value Set</th>  
                  <td class="content-container"> 
                     <em>Description</em>: Value set Moderate or Severe LVSD  
                     <br></br>    
                     <em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1090 
                     <br></br> 
                     <em>Canonical URL</em>: 
                     <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1090</tt> 
                  </td> 
               </tr> 
               <tr>  
                  <th scope="row" class="row-header">Value Set</th>  
                  <td class="content-container"> 
                     <em>Description</em>: Value set Moderate or Severe  
                     <br></br>    
                     <em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1092 
                     <br></br> 
                     <em>Canonical URL</em>: 
                     <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1092</tt> 
                  </td> 
               </tr> 
               <tr>  
                  <th scope="row" class="row-header">Value Set</th>  
                  <td class="content-container"> 
                     <em>Description</em>: Value set Patient Provider Interaction  
                     <br></br>    
                     <em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1012 
                     <br></br> 
                     <em>Canonical URL</em>: 
                     <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1012</tt> 
                  </td> 
               </tr> 
               <tr>  
                  <th scope="row" class="row-header">Value Set</th>  
                  <td class="content-container"> 
                     <em>Description</em>: Value set Payer Type  
                     <br></br>    
                     <em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591  
                     <br></br> 
                     <em>Canonical URL</em>: 
                     <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591</tt> 
                  </td> 
               </tr> 
               <tr>  
                  <th scope="row" class="row-header">Value Set</th>  
                  <td class="content-container"> 
                     <em>Description</em>: Value set Heart Transplant  
                     <br></br>    
                     <em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1178.33 
                     <br></br> 
                     <em>Canonical URL</em>: 
                     <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1178.33</tt> 
                  </td> 
               </tr> 
               <tr>  
                  <th scope="row" class="row-header">Value Set</th>  
                  <td class="content-container"> 
                     <em>Description</em>: Value set Heart Transplant Complications  
                     <br></br>    
                     <em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1178.56 
                     <br></br> 
                     <em>Canonical URL</em>: 
                     <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1178.56</tt> 
                  </td> 
               </tr> 
               <tr>  
                  <th scope="row" class="row-header">Value Set</th>  
                  <td class="content-container"> 
                     <em>Description</em>: Value set Left Ventricular Assist Device Placement  
                     <br></br>    
                     <em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1178.61 
                     <br></br> 
                     <em>Canonical URL</em>: 
                     <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1178.61</tt> 
                  </td> 
               </tr> 
               <tr>  
                  <th scope="row" class="row-header">Value Set</th>  
                  <td class="content-container"> 
                     <em>Description</em>: Value set Left Ventricular Assist Device Complications  
                     <br></br>    
                     <em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1178.58 
                     <br></br> 
                     <em>Canonical URL</em>: 
                     <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1178.58</tt> 
                  </td> 
               </tr> 
               <tr>  
                  <th scope="row" class="row-header">Value Set</th>  
                  <td class="content-container"> 
                     <em>Description</em>: Value set Medical Reason  
                     <br></br>    
                     <em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1007 
                     <br></br> 
                     <em>Canonical URL</em>: 
                     <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1007</tt> 
                  </td> 
               </tr> 
               <tr>  
                  <th scope="row" class="row-header">Value Set</th>  
                  <td class="content-container"> 
                     <em>Description</em>: Value set Patient Reason  
                     <br></br>    
                     <em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1008 
                     <br></br> 
                     <em>Canonical URL</em>: 
                     <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1008</tt> 
                  </td> 
               </tr> 
               <tr>  
                  <th scope="row" class="row-header">Value Set</th>  
                  <td class="content-container"> 
                     <em>Description</em>: Value set Patient Reason for ACE Inhibitor or ARB Decline  
                     <br></br>    
                     <em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1140 
                     <br></br> 
                     <em>Canonical URL</em>: 
                     <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1140</tt> 
                  </td> 
               </tr> 
               <tr>  
                  <th scope="row" class="row-header">Value Set</th>  
                  <td class="content-container"> 
                     <em>Description</em>: Value set ACE Inhibitor or ARB or ARNI Ingredient  
                     <br></br>    
                     <em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1489 
                     <br></br> 
                     <em>Canonical URL</em>: 
                     <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1489</tt> 
                  </td> 
               </tr> 
               <tr>  
                  <th scope="row" class="row-header">Value Set</th>  
                  <td class="content-container"> 
                     <em>Description</em>: Value set Allergy to ACE Inhibitor or ARB  
                     <br></br>    
                     <em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1211 
                     <br></br> 
                     <em>Canonical URL</em>: 
                     <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1211</tt> 
                  </td> 
               </tr> 
               <tr>  
                  <th scope="row" class="row-header">Value Set</th>  
                  <td class="content-container"> 
                     <em>Description</em>: Value set Intolerance to ACE Inhibitor or ARB  
                     <br></br>    
                     <em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1212 
                     <br></br> 
                     <em>Canonical URL</em>: 
                     <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1212</tt> 
                  </td> 
               </tr> 
               <tr>  
                  <th scope="row" class="row-header">Value Set</th>  
                  <td class="content-container"> 
                     <em>Description</em>: Value set Pregnancy  
                     <br></br>    
                     <em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.378 
                     <br></br> 
                     <em>Canonical URL</em>: 
                     <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.378</tt> 
                  </td> 
               </tr>  
               <tr> 
                  <th scope="row" class="row-header">Direct Reference Code</th> 
                  <td class="content-container"> 
                     <em>Display</em>: Male (finding) 
                     <br></br> 
                     <em>Code</em>: 248153007 
                     <br></br> 
                     <em>System</em>: 
                     <tt>http://snomed.info/sct</tt> 
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Direct Reference Code</th> 
                  <td class="content-container"> 
                     <em>Display</em>: Female (finding) 
                     <br></br> 
                     <em>Code</em>: 248152002 
                     <br></br> 
                     <em>System</em>: 
                     <tt>http://snomed.info/sct</tt> 
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Direct Reference Code</th> 
                  <td class="content-container"> 
                     <em>Display</em>: Confirmed 
                     <br></br> 
                     <em>Code</em>: confirmed 
                     <br></br> 
                     <em>System</em>: 
                     <tt>http://terminology.hl7.org/CodeSystem/condition-ver-status</tt> 
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Direct Reference Code</th> 
                  <td class="content-container"> 
                     <em>Display</em>: Unconfirmed 
                     <br></br> 
                     <em>Code</em>: unconfirmed 
                     <br></br> 
                     <em>System</em>: 
                     <tt>http://terminology.hl7.org/CodeSystem/condition-ver-status</tt> 
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Direct Reference Code</th> 
                  <td class="content-container"> 
                     <em>Display</em>: Provisional 
                     <br></br> 
                     <em>Code</em>: provisional 
                     <br></br> 
                     <em>System</em>: 
                     <tt>http://terminology.hl7.org/CodeSystem/condition-ver-status</tt> 
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Direct Reference Code</th> 
                  <td class="content-container"> 
                     <em>Display</em>: Differential 
                     <br></br> 
                     <em>Code</em>: differential 
                     <br></br> 
                     <em>System</em>: 
                     <tt>http://terminology.hl7.org/CodeSystem/condition-ver-status</tt> 
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Direct Reference Code</th> 
                  <td class="content-container"> 
                     <em>Display</em>: Left ventricular systolic dysfunction (disorder) 
                     <br></br> 
                     <em>Code</em>: 134401001 
                     <br></br> 
                     <em>System</em>: 
                     <tt>http://snomed.info/sct</tt> 
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Direct Reference Code</th> 
                  <td class="content-container"> 
                     <em>Display</em>: Active 
                     <br></br> 
                     <em>Code</em>: active 
                     <br></br> 
                     <em>System</em>: 
                     <tt>http://terminology.hl7.org/CodeSystem/condition-clinical</tt> 
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Direct Reference Code</th> 
                  <td class="content-container"> 
                     <em>Display</em>: Recurrence 
                     <br></br> 
                     <em>Code</em>: recurrence 
                     <br></br> 
                     <em>System</em>: 
                     <tt>http://terminology.hl7.org/CodeSystem/condition-clinical</tt> 
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Direct Reference Code</th> 
                  <td class="content-container"> 
                     <em>Display</em>: Relapse 
                     <br></br> 
                     <em>Code</em>: relapse 
                     <br></br> 
                     <em>System</em>: 
                     <tt>http://terminology.hl7.org/CodeSystem/condition-clinical</tt> 
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Direct Reference Code</th> 
                  <td class="content-container"> 
                     <em>Display</em>: Fulfill 
                     <br></br> 
                     <em>Code</em>: fulfill 
                     <br></br> 
                     <em>System</em>: 
                     <tt>http://hl7.org/fhir/CodeSystem/task-code</tt> 
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Direct Reference Code</th> 
                  <td class="content-container"> 
                     <em>Display</em>: Substance with angiotensin-converting enzyme inhibitor mechanism of action (substance) 
                     <br></br> 
                     <em>Code</em>: 372733002 
                     <br></br> 
                     <em>System</em>: 
                     <tt>http://snomed.info/sct</tt> 
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Direct Reference Code</th> 
                  <td class="content-container"> 
                     <em>Display</em>: Substance with angiotensin II receptor antagonist mechanism of action (substance) 
                     <br></br> 
                     <em>Code</em>: 372913009 
                     <br></br> 
                     <em>System</em>: 
                     <tt>http://snomed.info/sct</tt> 
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Direct Reference Code</th> 
                  <td class="content-container"> 
                     <em>Display</em>: Substance with neprilysin inhibitor mechanism of action (substance) 
                     <br></br> 
                     <em>Code</em>: 786886009 
                     <br></br> 
                     <em>System</em>: 
                     <tt>http://snomed.info/sct</tt> 
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Direct Reference Code</th> 
                  <td class="content-container"> 
                     <em>Display</em>: Confirmed 
                     <br></br> 
                     <em>Code</em>: confirmed 
                     <br></br> 
                     <em>System</em>: 
                     <tt>http://terminology.hl7.org/CodeSystem/allergyintolerance-verification</tt> 
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Direct Reference Code</th> 
                  <td class="content-container"> 
                     <em>Display</em>: Unconfirmed 
                     <br></br> 
                     <em>Code</em>: unconfirmed 
                     <br></br> 
                     <em>System</em>: 
                     <tt>http://terminology.hl7.org/CodeSystem/allergyintolerance-verification</tt> 
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Direct Reference Code</th> 
                  <td class="content-container"> 
                     <em>Display</em>: Acute renal failure caused by angiotensin-converting-enzyme inhibitor (disorder) 
                     <br></br> 
                     <em>Code</em>: 422593004 
                     <br></br> 
                     <em>System</em>: 
                     <tt>http://snomed.info/sct</tt> 
                  </td> 
               </tr>  
               <tr> 
                  <th colspan="2" scope="row" class="row-header">
                     <a name="dependencies"> </a>Dependencies
                  </th> 
               </tr>  
               <tr> 
                  <th scope="row" class="row-header">Dependency</th> 
                  <td class="content-container"> 
                     <em>Description</em>: QICore model information  
                     <br></br>    
                     <em>Resource</em>: http://hl7.org/fhir/Library/QICore-ModelInfo 
                     <br></br> 
                     <em>Canonical URL</em>: 
                     <tt>http://hl7.org/fhir/Library/QICore-ModelInfo</tt> 
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Dependency</th> 
                  <td class="content-container"> 
                     <em>Description</em>: Library SDE  
                     <br></br>    
                     <em>Resource</em>: https://madie.cms.gov/Library/SupplementalDataElements|5.1.000 
                     <br></br> 
                     <em>Canonical URL</em>: 
                     <tt>https://madie.cms.gov/Library/SupplementalDataElements|5.1.000</tt> 
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Dependency</th> 
                  <td class="content-container"> 
                     <em>Description</em>: Library FHIRHelpers  
                     <br></br>    
                     <em>Resource</em>: https://madie.cms.gov/Library/FHIRHelpers|4.4.000 
                     <br></br> 
                     <em>Canonical URL</em>: 
                     <tt>https://madie.cms.gov/Library/FHIRHelpers|4.4.000</tt> 
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Dependency</th> 
                  <td class="content-container"> 
                     <em>Description</em>: Library AHA  
                     <br></br>    
                     <em>Resource</em>: https://madie.cms.gov/Library/AHAOverall|4.1.000 
                     <br></br> 
                     <em>Canonical URL</em>: 
                     <tt>https://madie.cms.gov/Library/AHAOverall|4.1.000</tt> 
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Dependency</th> 
                  <td class="content-container"> 
                     <em>Description</em>: Library QICoreCommon  
                     <br></br>    
                     <em>Resource</em>: https://madie.cms.gov/Library/QICoreCommon|4.0.000 
                     <br></br> 
                     <em>Canonical URL</em>: 
                     <tt>https://madie.cms.gov/Library/QICoreCommon|4.0.000</tt> 
                  </td> 
               </tr>                
               <tr> 
                  <th colspan="2" scope="row" class="row-header">
                     <a name="data-requirements"> </a>Data Requirements
                  </th> 
               </tr>  
               <tr> 
                  <th scope="row" class="row-header">Data Requirement</th> 
                  <td class="content-container"> 
                     <em>Type</em>: Patient 
                     <br></br> 
                     <em>Profile(s)</em>:  http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient 
                     <br></br>   
                     <em>Must Support Elements</em>: extension, birthDate, birthDate.value, url 
                     <br></br>  
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Data Requirement</th> 
                  <td class="content-container"> 
                     <em>Type</em>: Encounter 
                     <br></br> 
                     <em>Profile(s)</em>:  http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter 
                     <br></br>   
                     <em>Must Support Elements</em>: type, period, id, id.value 
                     <br></br>  
                     <em>Code Filter(s)</em>: 
                     <br></br>  
                     <span class="tab-one">
                        <em>Path</em>: type
                     </span> 
                     <br></br>  
                     <span class="tab-one">
                        <em>ValueSet</em>:
                     </span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1014 
                     <br></br>   
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Data Requirement</th> 
                  <td class="content-container"> 
                     <em>Type</em>: Encounter 
                     <br></br> 
                     <em>Profile(s)</em>:  http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter 
                     <br></br>   
                     <em>Must Support Elements</em>: type, period, id, id.value 
                     <br></br>  
                     <em>Code Filter(s)</em>: 
                     <br></br>  
                     <span class="tab-one">
                        <em>Path</em>: type
                     </span> 
                     <br></br>  
                     <span class="tab-one">
                        <em>ValueSet</em>:
                     </span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016 
                     <br></br>   
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Data Requirement</th> 
                  <td class="content-container"> 
                     <em>Type</em>: Encounter 
                     <br></br> 
                     <em>Profile(s)</em>:  http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter 
                     <br></br>   
                     <em>Must Support Elements</em>: type, period, id, id.value 
                     <br></br>  
                     <em>Code Filter(s)</em>: 
                     <br></br>  
                     <span class="tab-one">
                        <em>Path</em>: type
                     </span> 
                     <br></br>  
                     <span class="tab-one">
                        <em>ValueSet</em>:
                     </span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1012 
                     <br></br>   
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Data Requirement</th> 
                  <td class="content-container"> 
                     <em>Type</em>: Encounter 
                     <br></br> 
                     <em>Profile(s)</em>:  http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter 
                     <br></br>   
                     <em>Must Support Elements</em>: type, period, id, id.value 
                     <br></br>  
                     <em>Code Filter(s)</em>: 
                     <br></br>  
                     <span class="tab-one">
                        <em>Path</em>: type
                     </span> 
                     <br></br>  
                     <span class="tab-one">
                        <em>ValueSet</em>:
                     </span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001 
                     <br></br>   
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Data Requirement</th> 
                  <td class="content-container"> 
                     <em>Type</em>: Encounter 
                     <br></br> 
                     <em>Profile(s)</em>:  http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter 
                     <br></br>   
                     <em>Must Support Elements</em>: type, period, id, id.value 
                     <br></br>  
                     <em>Code Filter(s)</em>: 
                     <br></br>  
                     <span class="tab-one">
                        <em>Path</em>: type
                     </span> 
                     <br></br>  
                     <span class="tab-one">
                        <em>ValueSet</em>:
                     </span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1008 
                     <br></br>   
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Data Requirement</th> 
                  <td class="content-container"> 
                     <em>Type</em>: Encounter 
                     <br></br> 
                     <em>Profile(s)</em>:  http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter 
                     <br></br>   
                     <em>Must Support Elements</em>: status, period, id, id.value, status.value 
                     <br></br>  
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Data Requirement</th> 
                  <td class="content-container"> 
                     <em>Type</em>: Encounter 
                     <br></br> 
                     <em>Profile(s)</em>:  http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter 
                     <br></br>   
                     <em>Must Support Elements</em>: type, period, id, id.value 
                     <br></br>  
                     <em>Code Filter(s)</em>: 
                     <br></br>  
                     <span class="tab-one">
                        <em>Path</em>: type
                     </span> 
                     <br></br>  
                     <span class="tab-one">
                        <em>ValueSet</em>:
                     </span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1012 
                     <br></br>   
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Data Requirement</th> 
                  <td class="content-container"> 
                     <em>Type</em>: Condition 
                     <br></br> 
                     <em>Profile(s)</em>:  http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns 
                     <br></br>   
                     <em>Must Support Elements</em>: code 
                     <br></br>  
                     <em>Code Filter(s)</em>: 
                     <br></br>  
                     <span class="tab-one">
                        <em>Path</em>: code
                     </span> 
                     <br></br>  
                     <span class="tab-one">
                        <em>ValueSet</em>:
                     </span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.376 
                     <br></br>   
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Data Requirement</th> 
                  <td class="content-container"> 
                     <em>Type</em>: Condition 
                     <br></br> 
                     <em>Profile(s)</em>:  http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns 
                     <br></br>   
                     <em>Must Support Elements</em>: code 
                     <br></br>  
                     <em>Code Filter(s)</em>: 
                     <br></br>  
                     <span class="tab-one">
                        <em>Path</em>: code
                     </span> 
                     <br></br>  
                     <span class="tab-one">
                        <em>ValueSet</em>:
                     </span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1090 
                     <br></br>   
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Data Requirement</th> 
                  <td class="content-container"> 
                     <em>Type</em>: Condition 
                     <br></br> 
                     <em>Profile(s)</em>:  http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns 
                     <br></br>   
                     <em>Must Support Elements</em>: code 
                     <br></br>  
                     <em>Code Filter(s)</em>: 
                     <br></br>  
                     <span class="tab-one">
                        <em>Path</em>: code
                     </span> 
                     <br></br>   
                     <span class="tab-one">
                        <em>Code(s)</em>:  http://snomed.info/sct#134401001: 'Left ventricular systolic dysfunction (disorder)'  
                     </span> 
                     <br></br>  
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Data Requirement</th> 
                  <td class="content-container"> 
                     <em>Type</em>: Condition 
                     <br></br> 
                     <em>Profile(s)</em>:  http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns 
                     <br></br>   
                     <em>Must Support Elements</em>: code 
                     <br></br>  
                     <em>Code Filter(s)</em>: 
                     <br></br>  
                     <span class="tab-one">
                        <em>Path</em>: code
                     </span> 
                     <br></br>  
                     <span class="tab-one">
                        <em>ValueSet</em>:
                     </span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1178.56 
                     <br></br>   
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Data Requirement</th> 
                  <td class="content-container"> 
                     <em>Type</em>: Condition 
                     <br></br> 
                     <em>Profile(s)</em>:  http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns 
                     <br></br>   
                     <em>Must Support Elements</em>: code 
                     <br></br>  
                     <em>Code Filter(s)</em>: 
                     <br></br>  
                     <span class="tab-one">
                        <em>Path</em>: code
                     </span> 
                     <br></br>  
                     <span class="tab-one">
                        <em>ValueSet</em>:
                     </span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1178.58 
                     <br></br>   
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Data Requirement</th> 
                  <td class="content-container"> 
                     <em>Type</em>: Condition 
                     <br></br> 
                     <em>Profile(s)</em>:  http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns 
                     <br></br>   
                     <em>Must Support Elements</em>: code 
                     <br></br>  
                     <em>Code Filter(s)</em>: 
                     <br></br>  
                     <span class="tab-one">
                        <em>Path</em>: code
                     </span> 
                     <br></br>  
                     <span class="tab-one">
                        <em>ValueSet</em>:
                     </span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1211 
                     <br></br>   
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Data Requirement</th> 
                  <td class="content-container"> 
                     <em>Type</em>: Condition 
                     <br></br> 
                     <em>Profile(s)</em>:  http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns 
                     <br></br>   
                     <em>Must Support Elements</em>: code 
                     <br></br>  
                     <em>Code Filter(s)</em>: 
                     <br></br>  
                     <span class="tab-one">
                        <em>Path</em>: code
                     </span> 
                     <br></br>  
                     <span class="tab-one">
                        <em>ValueSet</em>:
                     </span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1212 
                     <br></br>   
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Data Requirement</th> 
                  <td class="content-container"> 
                     <em>Type</em>: Condition 
                     <br></br> 
                     <em>Profile(s)</em>:  http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns 
                     <br></br>   
                     <em>Must Support Elements</em>: code 
                     <br></br>  
                     <em>Code Filter(s)</em>: 
                     <br></br>  
                     <span class="tab-one">
                        <em>Path</em>: code
                     </span> 
                     <br></br>  
                     <span class="tab-one">
                        <em>ValueSet</em>:
                     </span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.378 
                     <br></br>   
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Data Requirement</th> 
                  <td class="content-container"> 
                     <em>Type</em>: Condition 
                     <br></br> 
                     <em>Profile(s)</em>:  http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns 
                     <br></br>   
                     <em>Must Support Elements</em>: code 
                     <br></br>  
                     <em>Code Filter(s)</em>: 
                     <br></br>  
                     <span class="tab-one">
                        <em>Path</em>: code
                     </span> 
                     <br></br>   
                     <span class="tab-one">
                        <em>Code(s)</em>:  http://snomed.info/sct#422593004: 'Acute renal failure caused by angiotensin-converting-enzyme inhibitor (disorder)'  
                     </span> 
                     <br></br>  
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Data Requirement</th> 
                  <td class="content-container"> 
                     <em>Type</em>: Condition 
                     <br></br> 
                     <em>Profile(s)</em>:  http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-encounter-diagnosis 
                     <br></br>   
                     <em>Must Support Elements</em>: code 
                     <br></br>  
                     <em>Code Filter(s)</em>: 
                     <br></br>  
                     <span class="tab-one">
                        <em>Path</em>: code
                     </span> 
                     <br></br>  
                     <span class="tab-one">
                        <em>ValueSet</em>:
                     </span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.376 
                     <br></br>   
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Data Requirement</th> 
                  <td class="content-container"> 
                     <em>Type</em>: Condition 
                     <br></br> 
                     <em>Profile(s)</em>:  http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-encounter-diagnosis 
                     <br></br>   
                     <em>Must Support Elements</em>: code 
                     <br></br>  
                     <em>Code Filter(s)</em>: 
                     <br></br>  
                     <span class="tab-one">
                        <em>Path</em>: code
                     </span> 
                     <br></br>  
                     <span class="tab-one">
                        <em>ValueSet</em>:
                     </span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1090 
                     <br></br>   
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Data Requirement</th> 
                  <td class="content-container"> 
                     <em>Type</em>: Condition 
                     <br></br> 
                     <em>Profile(s)</em>:  http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-encounter-diagnosis 
                     <br></br>   
                     <em>Must Support Elements</em>: code 
                     <br></br>  
                     <em>Code Filter(s)</em>: 
                     <br></br>  
                     <span class="tab-one">
                        <em>Path</em>: code
                     </span> 
                     <br></br>   
                     <span class="tab-one">
                        <em>Code(s)</em>:  http://snomed.info/sct#134401001: 'Left ventricular systolic dysfunction (disorder)'  
                     </span> 
                     <br></br>  
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Data Requirement</th> 
                  <td class="content-container"> 
                     <em>Type</em>: Condition 
                     <br></br> 
                     <em>Profile(s)</em>:  http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-encounter-diagnosis 
                     <br></br>   
                     <em>Must Support Elements</em>: code 
                     <br></br>  
                     <em>Code Filter(s)</em>: 
                     <br></br>  
                     <span class="tab-one">
                        <em>Path</em>: code
                     </span> 
                     <br></br>  
                     <span class="tab-one">
                        <em>ValueSet</em>:
                     </span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1178.56 
                     <br></br>   
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Data Requirement</th> 
                  <td class="content-container"> 
                     <em>Type</em>: Condition 
                     <br></br> 
                     <em>Profile(s)</em>:  http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-encounter-diagnosis 
                     <br></br>   
                     <em>Must Support Elements</em>: code 
                     <br></br>  
                     <em>Code Filter(s)</em>: 
                     <br></br>  
                     <span class="tab-one">
                        <em>Path</em>: code
                     </span> 
                     <br></br>  
                     <span class="tab-one">
                        <em>ValueSet</em>:
                     </span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1178.58 
                     <br></br>   
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Data Requirement</th> 
                  <td class="content-container"> 
                     <em>Type</em>: Condition 
                     <br></br> 
                     <em>Profile(s)</em>:  http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-encounter-diagnosis 
                     <br></br>   
                     <em>Must Support Elements</em>: code 
                     <br></br>  
                     <em>Code Filter(s)</em>: 
                     <br></br>  
                     <span class="tab-one">
                        <em>Path</em>: code
                     </span> 
                     <br></br>  
                     <span class="tab-one">
                        <em>ValueSet</em>:
                     </span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1211 
                     <br></br>   
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Data Requirement</th> 
                  <td class="content-container"> 
                     <em>Type</em>: Condition 
                     <br></br> 
                     <em>Profile(s)</em>:  http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-encounter-diagnosis 
                     <br></br>   
                     <em>Must Support Elements</em>: code 
                     <br></br>  
                     <em>Code Filter(s)</em>: 
                     <br></br>  
                     <span class="tab-one">
                        <em>Path</em>: code
                     </span> 
                     <br></br>  
                     <span class="tab-one">
                        <em>ValueSet</em>:
                     </span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1212 
                     <br></br>   
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Data Requirement</th> 
                  <td class="content-container"> 
                     <em>Type</em>: Condition 
                     <br></br> 
                     <em>Profile(s)</em>:  http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-encounter-diagnosis 
                     <br></br>   
                     <em>Must Support Elements</em>: code 
                     <br></br>  
                     <em>Code Filter(s)</em>: 
                     <br></br>  
                     <span class="tab-one">
                        <em>Path</em>: code
                     </span> 
                     <br></br>  
                     <span class="tab-one">
                        <em>ValueSet</em>:
                     </span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.378 
                     <br></br>   
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Data Requirement</th> 
                  <td class="content-container"> 
                     <em>Type</em>: Condition 
                     <br></br> 
                     <em>Profile(s)</em>:  http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-encounter-diagnosis 
                     <br></br>   
                     <em>Must Support Elements</em>: code 
                     <br></br>  
                     <em>Code Filter(s)</em>: 
                     <br></br>  
                     <span class="tab-one">
                        <em>Path</em>: code
                     </span> 
                     <br></br>   
                     <span class="tab-one">
                        <em>Code(s)</em>:  http://snomed.info/sct#422593004: 'Acute renal failure caused by angiotensin-converting-enzyme inhibitor (disorder)'  
                     </span> 
                     <br></br>  
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Data Requirement</th> 
                  <td class="content-container"> 
                     <em>Type</em>: Observation 
                     <br></br> 
                     <em>Profile(s)</em>:  http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation-clinical-result 
                     <br></br>   
                     <em>Must Support Elements</em>: code, value, status, status.value 
                     <br></br>  
                     <em>Code Filter(s)</em>: 
                     <br></br>  
                     <span class="tab-one">
                        <em>Path</em>: code
                     </span> 
                     <br></br>  
                     <span class="tab-one">
                        <em>ValueSet</em>:
                     </span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1134 
                     <br></br>   
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Data Requirement</th> 
                  <td class="content-container"> 
                     <em>Type</em>: Resource 
                     <br></br> 
                     <em>Profile(s)</em>:  http://hl7.org/fhir/StructureDefinition/Resource 
                     <br></br>   
                     <em>Must Support Elements</em>: id, id.value 
                     <br></br>  
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Data Requirement</th> 
                  <td class="content-container"> 
                     <em>Type</em>: MedicationRequest 
                     <br></br> 
                     <em>Profile(s)</em>:  http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest 
                     <br></br>   
                     <em>Must Support Elements</em>: authoredOn, timing, repeat, bounds, authoredOn.value, status, status.value, intent, intent.value 
                     <br></br>  
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Data Requirement</th> 
                  <td class="content-container"> 
                     <em>Type</em>: MedicationRequest 
                     <br></br> 
                     <em>Profile(s)</em>:  http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest 
                     <br></br>   
                     <em>Must Support Elements</em>: medication, timing, repeat, bounds 
                     <br></br>  
                     <em>Code Filter(s)</em>: 
                     <br></br>  
                     <span class="tab-one">
                        <em>Path</em>: medication
                     </span> 
                     <br></br>  
                     <span class="tab-one">
                        <em>ValueSet</em>:
                     </span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1139 
                     <br></br>   
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Data Requirement</th> 
                  <td class="content-container"> 
                     <em>Type</em>: Task 
                     <br></br> 
                     <em>Profile(s)</em>:  http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-taskrejected 
                     <br></br>   
                     <em>Must Support Elements</em>: focus, code 
                     <br></br>  
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Data Requirement</th> 
                  <td class="content-container"> 
                     <em>Type</em>: Coverage 
                     <br></br> 
                     <em>Profile(s)</em>:  http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-coverage 
                     <br></br>   
                     <em>Must Support Elements</em>: type, period 
                     <br></br>  
                     <em>Code Filter(s)</em>: 
                     <br></br>  
                     <span class="tab-one">
                        <em>Path</em>: type
                     </span> 
                     <br></br>  
                     <span class="tab-one">
                        <em>ValueSet</em>:
                     </span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591 
                     <br></br>   
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Data Requirement</th> 
                  <td class="content-container"> 
                     <em>Type</em>: Procedure 
                     <br></br> 
                     <em>Profile(s)</em>:  http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure 
                     <br></br>   
                     <em>Must Support Elements</em>: code, performed, status, status.value 
                     <br></br>  
                     <em>Code Filter(s)</em>: 
                     <br></br>  
                     <span class="tab-one">
                        <em>Path</em>: code
                     </span> 
                     <br></br>  
                     <span class="tab-one">
                        <em>ValueSet</em>:
                     </span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1178.33 
                     <br></br>   
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Data Requirement</th> 
                  <td class="content-container"> 
                     <em>Type</em>: Procedure 
                     <br></br> 
                     <em>Profile(s)</em>:  http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure 
                     <br></br>   
                     <em>Must Support Elements</em>: code, performed, status, status.value 
                     <br></br>  
                     <em>Code Filter(s)</em>: 
                     <br></br>  
                     <span class="tab-one">
                        <em>Path</em>: code
                     </span> 
                     <br></br>  
                     <span class="tab-one">
                        <em>ValueSet</em>:
                     </span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1178.61 
                     <br></br>   
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Data Requirement</th> 
                  <td class="content-container"> 
                     <em>Type</em>: MedicationRequest 
                     <br></br> 
                     <em>Profile(s)</em>:  http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationnotrequested 
                     <br></br>   
                     <em>Must Support Elements</em>: authoredOn, authoredOn.value, status, status.value, intent, intent.value 
                     <br></br>  
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Data Requirement</th> 
                  <td class="content-container"> 
                     <em>Type</em>: MedicationRequest 
                     <br></br> 
                     <em>Profile(s)</em>:  http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationnotrequested 
                     <br></br>   
                     <em>Must Support Elements</em>: medication, reasonCode 
                     <br></br>  
                     <em>Code Filter(s)</em>: 
                     <br></br>  
                     <span class="tab-one">
                        <em>Path</em>: medication
                     </span> 
                     <br></br>  
                     <span class="tab-one">
                        <em>ValueSet</em>:
                     </span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1139 
                     <br></br>   
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Data Requirement</th> 
                  <td class="content-container"> 
                     <em>Type</em>: AllergyIntolerance 
                     <br></br> 
                     <em>Profile(s)</em>:  http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-allergyintolerance 
                     <br></br>   
                     <em>Must Support Elements</em>: verificationStatus, onset, lastOccurrence, lastOccurrence.value 
                     <br></br>  
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Data Requirement</th> 
                  <td class="content-container"> 
                     <em>Type</em>: AllergyIntolerance 
                     <br></br> 
                     <em>Profile(s)</em>:  http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-allergyintolerance 
                     <br></br>   
                     <em>Must Support Elements</em>: code 
                     <br></br>  
                     <em>Code Filter(s)</em>: 
                     <br></br>  
                     <span class="tab-one">
                        <em>Path</em>: code
                     </span> 
                     <br></br>  
                     <span class="tab-one">
                        <em>ValueSet</em>:
                     </span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1489 
                     <br></br>   
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Data Requirement</th> 
                  <td class="content-container"> 
                     <em>Type</em>: AllergyIntolerance 
                     <br></br> 
                     <em>Profile(s)</em>:  http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-allergyintolerance 
                     <br></br>   
                     <em>Must Support Elements</em>: code 
                     <br></br>  
                     <em>Code Filter(s)</em>: 
                     <br></br>  
                     <span class="tab-one">
                        <em>Path</em>: code
                     </span> 
                     <br></br>   
                     <span class="tab-one">
                        <em>Code(s)</em>:  http://snomed.info/sct#372733002: 'Substance with angiotensin-converting enzyme inhibitor mechanism of action (substance)'  
                     </span> 
                     <br></br>  
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Data Requirement</th> 
                  <td class="content-container"> 
                     <em>Type</em>: AllergyIntolerance 
                     <br></br> 
                     <em>Profile(s)</em>:  http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-allergyintolerance 
                     <br></br>   
                     <em>Must Support Elements</em>: code 
                     <br></br>  
                     <em>Code Filter(s)</em>: 
                     <br></br>  
                     <span class="tab-one">
                        <em>Path</em>: code
                     </span> 
                     <br></br>   
                     <span class="tab-one">
                        <em>Code(s)</em>:  http://snomed.info/sct#372913009: 'Substance with angiotensin II receptor antagonist mechanism of action (substance)'  
                     </span> 
                     <br></br>  
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Data Requirement</th> 
                  <td class="content-container"> 
                     <em>Type</em>: AllergyIntolerance 
                     <br></br> 
                     <em>Profile(s)</em>:  http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-allergyintolerance 
                     <br></br>   
                     <em>Must Support Elements</em>: code 
                     <br></br>  
                     <em>Code Filter(s)</em>: 
                     <br></br>  
                     <span class="tab-one">
                        <em>Path</em>: code
                     </span> 
                     <br></br>   
                     <span class="tab-one">
                        <em>Code(s)</em>:  http://snomed.info/sct#786886009: 'Substance with neprilysin inhibitor mechanism of action (substance)'  
                     </span> 
                     <br></br>  
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Data Requirement</th> 
                  <td class="content-container"> 
                     <em>Type</em>: Observation 
                     <br></br> 
                     <em>Profile(s)</em>:  http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-pregnancystatus 
                     <br></br>   
                     <em>Must Support Elements</em>: effective, effective.value, value, status, status.value 
                     <br></br>  
                  </td> 
               </tr>  
               <tr> 
                  <th colspan="2" scope="row" class="row-header">Generated using version 0.4.8 of the sample-content-ig Liquid templates</th> 
               </tr> 
            </tbody> 
         </table> 
      </div>
   </text>
   <contained>
      <Library xmlns="http://hl7.org/fhir">
         <id value="effective-data-requirements"></id>
         <extension url="http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode">
            <valueCoding>
               <system value="http://snomed.info/sct"></system>
               <code value="248153007"></code>
               <display value="Male (finding)"></display>
            </valueCoding>
         </extension>
         <extension url="http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode">
            <valueCoding>
               <system value="http://snomed.info/sct"></system>
               <code value="248152002"></code>
               <display value="Female (finding)"></display>
            </valueCoding>
         </extension>
         <extension url="http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode">
            <valueCoding>
               <system value="http://terminology.hl7.org/CodeSystem/condition-ver-status"></system>
               <code value="confirmed"></code>
               <display value="Confirmed"></display>
            </valueCoding>
         </extension>
         <extension url="http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode">
            <valueCoding>
               <system value="http://terminology.hl7.org/CodeSystem/condition-ver-status"></system>
               <code value="unconfirmed"></code>
               <display value="Unconfirmed"></display>
            </valueCoding>
         </extension>
         <extension url="http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode">
            <valueCoding>
               <system value="http://terminology.hl7.org/CodeSystem/condition-ver-status"></system>
               <code value="provisional"></code>
               <display value="Provisional"></display>
            </valueCoding>
         </extension>
         <extension url="http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode">
            <valueCoding>
               <system value="http://terminology.hl7.org/CodeSystem/condition-ver-status"></system>
               <code value="differential"></code>
               <display value="Differential"></display>
            </valueCoding>
         </extension>
         <extension url="http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode">
            <valueCoding>
               <system value="http://snomed.info/sct"></system>
               <code value="134401001"></code>
               <display value="Left ventricular systolic dysfunction (disorder)"></display>
            </valueCoding>
         </extension>
         <extension url="http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode">
            <valueCoding>
               <system value="http://terminology.hl7.org/CodeSystem/condition-clinical"></system>
               <code value="active"></code>
               <display value="Active"></display>
            </valueCoding>
         </extension>
         <extension url="http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode">
            <valueCoding>
               <system value="http://terminology.hl7.org/CodeSystem/condition-clinical"></system>
               <code value="recurrence"></code>
               <display value="Recurrence"></display>
            </valueCoding>
         </extension>
         <extension url="http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode">
            <valueCoding>
               <system value="http://terminology.hl7.org/CodeSystem/condition-clinical"></system>
               <code value="relapse"></code>
               <display value="Relapse"></display>
            </valueCoding>
         </extension>
         <extension url="http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode">
            <valueCoding>
               <system value="http://hl7.org/fhir/CodeSystem/task-code"></system>
               <code value="fulfill"></code>
               <display value="Fulfill"></display>
            </valueCoding>
         </extension>
         <extension url="http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode">
            <valueCoding>
               <system value="http://snomed.info/sct"></system>
               <code value="372733002"></code>
               <display value="Substance with angiotensin-converting enzyme inhibitor mechanism of action (substance)"></display>
            </valueCoding>
         </extension>
         <extension url="http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode">
            <valueCoding>
               <system value="http://snomed.info/sct"></system>
               <code value="372913009"></code>
               <display value="Substance with angiotensin II receptor antagonist mechanism of action (substance)"></display>
            </valueCoding>
         </extension>
         <extension url="http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode">
            <valueCoding>
               <system value="http://snomed.info/sct"></system>
               <code value="786886009"></code>
               <display value="Substance with neprilysin inhibitor mechanism of action (substance)"></display>
            </valueCoding>
         </extension>
         <extension url="http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode">
            <valueCoding>
               <system value="http://terminology.hl7.org/CodeSystem/allergyintolerance-verification"></system>
               <code value="confirmed"></code>
               <display value="Confirmed"></display>
            </valueCoding>
         </extension>
         <extension url="http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode">
            <valueCoding>
               <system value="http://terminology.hl7.org/CodeSystem/allergyintolerance-verification"></system>
               <code value="unconfirmed"></code>
               <display value="Unconfirmed"></display>
            </valueCoding>
         </extension>
         <extension url="http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode">
            <valueCoding>
               <system value="http://snomed.info/sct"></system>
               <code value="422593004"></code>
               <display value="Acute renal failure caused by angiotensin-converting-enzyme inhibitor (disorder)"></display>
            </valueCoding>
         </extension>
         <extension url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
               <valueString value="SupplementalDataElements"></valueString>
            </extension>
            <extension url="name">
               <valueString value="SDE Sex"></valueString>
            </extension>
            <extension url="statement">
               <valueString value="define &quot;SDE Sex&quot;:
  case
    when Patient.sex = '248153007' then &quot;Male (finding)&quot;
    when Patient.sex = '248152002' then &quot;Female (finding)&quot;
    else null
  end"></valueString>
            </extension>
            <extension url="displaySequence">
               <valueInteger value="0"></valueInteger>
            </extension>
         </extension>
         <extension url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
               <valueString value="CMS135FHIRACEIorARBorARNIforHF"></valueString>
            </extension>
            <extension url="name">
               <valueString value="SDE Sex"></valueString>
            </extension>
            <extension url="statement">
               <valueString value="define &quot;SDE Sex&quot;:
  SDE.&quot;SDE Sex&quot;"></valueString>
            </extension>
            <extension url="displaySequence">
               <valueInteger value="1"></valueInteger>
            </extension>
         </extension>
         <extension url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
               <valueString value="AHAOverall"></valueString>
            </extension>
            <extension url="name">
               <valueString value="Outpatient Encounter"></valueString>
            </extension>
            <extension url="statement">
               <valueString value="define &quot;Outpatient Encounter&quot;:
  ( [Encounter: &quot;Care Services in Long Term Residential Facility&quot;]
      union [Encounter: &quot;Home Healthcare Services&quot;]
      union [Encounter: &quot;Nursing Facility Visit&quot;]
      union [Encounter: &quot;Office Visit&quot;]
      union [Encounter: &quot;Outpatient Consultation&quot;]
  )"></valueString>
            </extension>
            <extension url="displaySequence">
               <valueInteger value="2"></valueInteger>
            </extension>
         </extension>
         <extension url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
               <valueString value="AHAOverall"></valueString>
            </extension>
            <extension url="name">
               <valueString value="Heart Failure Outpatient Encounter"></valueString>
            </extension>
            <extension url="statement">
               <valueString value="/*
@description: Returns certain finished encounter types that overlap a Heart Failure condition and are during the measurement period: 
                * care services in long term residential facility (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1014)
                * home healthcare services (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016)
                * nursing facility visits (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1012)
                * office visits (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001)
                * outpatient consultation (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1008)
*/
define &quot;Heart Failure Outpatient Encounter&quot;:
  &quot;Outpatient Encounter&quot; QualifyingEncounter
    with ( [ConditionProblemsHealthConcerns: &quot;Heart Failure&quot;]
      union [ConditionEncounterDiagnosis: &quot;Heart Failure&quot;] ) HeartFailure
      such that HeartFailure.prevalenceInterval ( ) overlaps day of QualifyingEncounter.period
        and HeartFailure.isVerified ( )
    where QualifyingEncounter.period during day of &quot;Measurement Period&quot;
      and QualifyingEncounter.isEncounterFinished ( )"></valueString>
            </extension>
            <extension url="displaySequence">
               <valueInteger value="3"></valueInteger>
            </extension>
         </extension>
         <extension url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
               <valueString value="AHAOverall"></valueString>
            </extension>
            <extension url="name">
               <valueString value="Moderate or Severe LVSD Findings"></valueString>
            </extension>
            <extension url="statement">
               <valueString value="/*
@description: Returns a union  of the following:
                * Observations where the final, amended or correction ejection fraction result is &lt;= 40
                * Moderate or Severe LVSD conditions where the diagnosis has been confirmed as active
*/
define &quot;Moderate or Severe LVSD Findings&quot;:
  ( [ObservationClinicalResult: &quot;Ejection Fraction&quot;] EjectionFraction
      where EjectionFraction.value as Quantity &lt;= 40 '%'
        and EjectionFraction.status in { 'final', 'amended', 'corrected' }
  )
    union ( ( ( [ConditionProblemsHealthConcerns: &quot;Moderate or Severe LVSD&quot;]
          union [ConditionEncounterDiagnosis: &quot;Moderate or Severe LVSD&quot;]
      )
        union ( ( [ConditionProblemsHealthConcerns: &quot;Left ventricular systolic dysfunction (disorder)&quot;]
            union [ConditionEncounterDiagnosis: &quot;Left ventricular systolic dysfunction (disorder)&quot;] ) LVSDDiagnosis
            where LVSDDiagnosis.severity in &quot;Moderate or Severe&quot;
        ) ) ModerateOrSevereLVSD
        where ModerateOrSevereLVSD.isVerified ( )
    )"></valueString>
            </extension>
            <extension url="displaySequence">
               <valueInteger value="4"></valueInteger>
            </extension>
         </extension>
         <extension url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
               <valueString value="AHAOverall"></valueString>
            </extension>
            <extension url="name">
               <valueString value="Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD"></valueString>
            </extension>
            <extension url="statement">
               <valueString value="/*
@description: Returns heart failure outpatient encounters that start before the end of a moderate or severe LVSD finding
*/
define &quot;Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD&quot;:
  &quot;Heart Failure Outpatient Encounter&quot; HFOutpatientEncounter
    with &quot;Moderate or Severe LVSD Findings&quot; LVSDFindings
      such that Coalesce(LVSDFindings.prevalenceInterval(), LVSDFindings.effective.toInterval()) starts before end of HFOutpatientEncounter.period"></valueString>
            </extension>
            <extension url="displaySequence">
               <valueInteger value="5"></valueInteger>
            </extension>
         </extension>
         <extension url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
               <valueString value="CMS135FHIRACEIorARBorARNIforHF"></valueString>
            </extension>
            <extension url="name">
               <valueString value="Has ACEI or ARB or ARNI Ordered"></valueString>
            </extension>
            <extension url="statement">
               <valueString value="define &quot;Has ACEI or ARB or ARNI Ordered&quot;:
  exists ( [MedicationRequest: medication in &quot;ACE Inhibitor or ARB or ARNI&quot;] ACEIOrARBOrARNIOrdered
      where ACEIOrARBOrARNIOrdered.isOrderedDuringHeartFailureOutpatientEncounter ( )
  )"></valueString>
            </extension>
            <extension url="displaySequence">
               <valueInteger value="6"></valueInteger>
            </extension>
         </extension>
         <extension url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
               <valueString value="CMS135FHIRACEIorARBorARNIforHF"></valueString>
            </extension>
            <extension url="name">
               <valueString value="Is Currently Taking ACEI or ARB or ARNI"></valueString>
            </extension>
            <extension url="statement">
               <valueString value="define &quot;Is Currently Taking ACEI or ARB or ARNI&quot;:
  exists ( [MedicationRequest: medication in &quot;ACE Inhibitor or ARB or ARNI&quot;] ActiveACEIOrARBOrARNI
      where ActiveACEIOrARBOrARNI.overlapsAfterHeartFailureOutpatientEncounter ( )
  )"></valueString>
            </extension>
            <extension url="displaySequence">
               <valueInteger value="7"></valueInteger>
            </extension>
         </extension>
         <extension url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
               <valueString value="CMS135FHIRACEIorARBorARNIforHF"></valueString>
            </extension>
            <extension url="name">
               <valueString value="Numerator"></valueString>
            </extension>
            <extension url="statement">
               <valueString value="define &quot;Numerator&quot;:
  &quot;Has ACEI or ARB or ARNI Ordered&quot;
    or &quot;Is Currently Taking ACEI or ARB or ARNI&quot;"></valueString>
            </extension>
            <extension url="displaySequence">
               <valueInteger value="8"></valueInteger>
            </extension>
         </extension>
         <extension url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
               <valueString value="AHAOverall"></valueString>
            </extension>
            <extension url="name">
               <valueString value="Outpatient Encounter or Patient Provider Interaction"></valueString>
            </extension>
            <extension url="statement">
               <valueString value="define &quot;Outpatient Encounter or Patient Provider Interaction&quot;:
  &quot;Outpatient Encounter&quot;
    union [Encounter: &quot;Patient Provider Interaction&quot;]"></valueString>
            </extension>
            <extension url="displaySequence">
               <valueInteger value="9"></valueInteger>
            </extension>
         </extension>
         <extension url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
               <valueString value="AHAOverall"></valueString>
            </extension>
            <extension url="name">
               <valueString value="Qualifying Outpatient Encounter During Measurement Period"></valueString>
            </extension>
            <extension url="statement">
               <valueString value="/*
@description: Returns certain finished encounter types that occurred during the measurement period: 
                * office visits (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001)
                * outpatient consultation (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1008)
                * nursing facility visits (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1012)
                * care services in long term residential facility (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1014)
                * home healthcare services (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016)
                * patient provider interactions (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1012) 
*/
define &quot;Qualifying Outpatient Encounter During Measurement Period&quot;:
  &quot;Outpatient Encounter or Patient Provider Interaction&quot; ValidEncounter
    where ValidEncounter.period during day of &quot;Measurement Period&quot;
      and ValidEncounter.isEncounterFinished ( )"></valueString>
            </extension>
            <extension url="displaySequence">
               <valueInteger value="10"></valueInteger>
            </extension>
         </extension>
         <extension url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
               <valueString value="AHAOverall"></valueString>
            </extension>
            <extension url="name">
               <valueString value="Is Adult With Two Qualifying Outpatient Encounters and One Heart Failure Outpatient Encounter During the Measurement Period"></valueString>
            </extension>
            <extension url="statement">
               <valueString value="/*
@description: Returns true if the patient meets the following criteria:
                * 18 years of age or older,
                * Has two Qualifying Outpatient Encounters During Measurement Period
                * Has a Heart Failure Outpatient Encounter
*/
define &quot;Is Adult With Two Qualifying Outpatient Encounters and One Heart Failure Outpatient Encounter During the Measurement Period&quot;:
  AgeInYearsAt(date from start of &quot;Measurement Period&quot;) &gt;= 18
    and exists ( &quot;Qualifying Outpatient Encounter During Measurement Period&quot; Encounter1
        with &quot;Qualifying Outpatient Encounter During Measurement Period&quot; Encounter2
          such that Encounter2.id !~ Encounter1.id
    )
    and exists &quot;Heart Failure Outpatient Encounter&quot;"></valueString>
            </extension>
            <extension url="displaySequence">
               <valueInteger value="11"></valueInteger>
            </extension>
         </extension>
         <extension url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
               <valueString value="CMS135FHIRACEIorARBorARNIforHF"></valueString>
            </extension>
            <extension url="name">
               <valueString value="Initial Population"></valueString>
            </extension>
            <extension url="statement">
               <valueString value="define &quot;Initial Population&quot;:
  AHA.&quot;Is Adult With Two Qualifying Outpatient Encounters and One Heart Failure Outpatient Encounter During the Measurement Period&quot;"></valueString>
            </extension>
            <extension url="displaySequence">
               <valueInteger value="12"></valueInteger>
            </extension>
         </extension>
         <extension url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
               <valueString value="CMS135FHIRACEIorARBorARNIforHF"></valueString>
            </extension>
            <extension url="name">
               <valueString value="Denominator"></valueString>
            </extension>
            <extension url="statement">
               <valueString value="define &quot;Denominator&quot;:
  &quot;Initial Population&quot;
    and exists AHA.&quot;Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD&quot;"></valueString>
            </extension>
            <extension url="displaySequence">
               <valueInteger value="13"></valueInteger>
            </extension>
         </extension>
         <extension url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
               <valueString value="SupplementalDataElements"></valueString>
            </extension>
            <extension url="name">
               <valueString value="SDE Payer"></valueString>
            </extension>
            <extension url="statement">
               <valueString value="define &quot;SDE Payer&quot;:
  [Coverage: type in &quot;Payer Type&quot;] Payer
    return {
      code: Payer.type,
      period: Payer.period
    }"></valueString>
            </extension>
            <extension url="displaySequence">
               <valueInteger value="14"></valueInteger>
            </extension>
         </extension>
         <extension url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
               <valueString value="CMS135FHIRACEIorARBorARNIforHF"></valueString>
            </extension>
            <extension url="name">
               <valueString value="SDE Payer"></valueString>
            </extension>
            <extension url="statement">
               <valueString value="define &quot;SDE Payer&quot;:
  SDE.&quot;SDE Payer&quot;"></valueString>
            </extension>
            <extension url="displaySequence">
               <valueInteger value="15"></valueInteger>
            </extension>
         </extension>
         <extension url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
               <valueString value="SupplementalDataElements"></valueString>
            </extension>
            <extension url="name">
               <valueString value="SDE Ethnicity"></valueString>
            </extension>
            <extension url="statement">
               <valueString value="define &quot;SDE Ethnicity&quot;:
  Patient.ethnicity E
    return Tuple {
      codes: { E.ombCategory } union E.detailed,
      display: E.text
    }"></valueString>
            </extension>
            <extension url="displaySequence">
               <valueInteger value="16"></valueInteger>
            </extension>
         </extension>
         <extension url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
               <valueString value="CMS135FHIRACEIorARBorARNIforHF"></valueString>
            </extension>
            <extension url="name">
               <valueString value="SDE Ethnicity"></valueString>
            </extension>
            <extension url="statement">
               <valueString value="define &quot;SDE Ethnicity&quot;:
  SDE.&quot;SDE Ethnicity&quot;"></valueString>
            </extension>
            <extension url="displaySequence">
               <valueInteger value="17"></valueInteger>
            </extension>
         </extension>
         <extension url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
               <valueString value="AHAOverall"></valueString>
            </extension>
            <extension url="name">
               <valueString value="Has Heart Transplant"></valueString>
            </extension>
            <extension url="statement">
               <valueString value="/*
@description: Returns completed heart tansplant procedures that start before the end of a heart failure outpatient encounter with history of moderate or severe LVSD
*/
define &quot;Has Heart Transplant&quot;:
  exists ( [Procedure: &quot;Heart Transplant&quot;] HeartTransplant
      with &quot;Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD&quot; ModerateOrSevereLVSDHFOutpatientEncounter
        such that HeartTransplant.performed.toInterval ( ) starts before end of ModerateOrSevereLVSDHFOutpatientEncounter.period
      where HeartTransplant.status = 'completed'
  )"></valueString>
            </extension>
            <extension url="displaySequence">
               <valueInteger value="18"></valueInteger>
            </extension>
         </extension>
         <extension url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
               <valueString value="AHAOverall"></valueString>
            </extension>
            <extension url="name">
               <valueString value="Has Heart Transplant Complications"></valueString>
            </extension>
            <extension url="statement">
               <valueString value="/*
@description: Returns true if patient has confirmed heart transplant complications that start before the end of a heart failure outpatient encounter with history of moderate or severe LVSD 
*/
define &quot;Has Heart Transplant Complications&quot;:
  exists ( ( [ConditionEncounterDiagnosis: &quot;Heart Transplant Complications&quot;]
      union [ConditionProblemsHealthConcerns: &quot;Heart Transplant Complications&quot;] ) HeartTransplantComplications
      let diagnosisStart: Coalesce(start of HeartTransplantComplications.prevalenceInterval(), HeartTransplantComplications.recordedDate)
      with &quot;Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD&quot; ModerateOrSevereLVSDHFOutpatientEncounter
        such that date from diagnosisStart on or before date from end of ModerateOrSevereLVSDHFOutpatientEncounter.period
      where HeartTransplantComplications.isVerified ( )
  )"></valueString>
            </extension>
            <extension url="displaySequence">
               <valueInteger value="19"></valueInteger>
            </extension>
         </extension>
         <extension url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
               <valueString value="AHAOverall"></valueString>
            </extension>
            <extension url="name">
               <valueString value="Has Left Ventricular Assist Device"></valueString>
            </extension>
            <extension url="statement">
               <valueString value="/*
@description: Returns true if patient has a completed LVAD placement that starts before the end of a heart failure outpatient encounter with history of moderate or severe LVSD
*/
define &quot;Has Left Ventricular Assist Device&quot;:
  exists ( [Procedure: &quot;Left Ventricular Assist Device Placement&quot;] LVADPlacement
      with &quot;Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD&quot; ModerateOrSevereLVSDHFOutpatientEncounter
        such that LVADPlacement.performed.toInterval ( ) starts before day of end of ModerateOrSevereLVSDHFOutpatientEncounter.period
      where LVADPlacement.status = 'completed'
  )"></valueString>
            </extension>
            <extension url="displaySequence">
               <valueInteger value="20"></valueInteger>
            </extension>
         </extension>
         <extension url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
               <valueString value="AHAOverall"></valueString>
            </extension>
            <extension url="name">
               <valueString value="Has Left Ventricular Assist Device Complications"></valueString>
            </extension>
            <extension url="statement">
               <valueString value="/*
@description: Returns true if patient has active LVAD complications that start before the end of a heart failure outpatient encounter with history of moderate or severe LVSD
*/
define &quot;Has Left Ventricular Assist Device Complications&quot;:
  exists ( ( [ConditionEncounterDiagnosis: &quot;Left Ventricular Assist Device Complications&quot;]
      union [ConditionProblemsHealthConcerns: &quot;Left Ventricular Assist Device Complications&quot;] ) LVADComplications
      let diagnosisStart: Coalesce(start of LVADComplications.prevalenceInterval(), LVADComplications.recordedDate)
      with &quot;Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD&quot; ModerateOrSevereLVSDHFOutpatientEncounter
        such that date from diagnosisStart on or before date from end of ModerateOrSevereLVSDHFOutpatientEncounter.period
      where LVADComplications.isVerified ( )
  )"></valueString>
            </extension>
            <extension url="displaySequence">
               <valueInteger value="21"></valueInteger>
            </extension>
         </extension>
         <extension url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
               <valueString value="CMS135FHIRACEIorARBorARNIforHF"></valueString>
            </extension>
            <extension url="name">
               <valueString value="Denominator Exclusions"></valueString>
            </extension>
            <extension url="statement">
               <valueString value="define &quot;Denominator Exclusions&quot;:
  AHA.&quot;Has Heart Transplant&quot;
    or AHA.&quot;Has Heart Transplant Complications&quot;
    or AHA.&quot;Has Left Ventricular Assist Device&quot;
    or AHA.&quot;Has Left Ventricular Assist Device Complications&quot;"></valueString>
            </extension>
            <extension url="displaySequence">
               <valueInteger value="22"></valueInteger>
            </extension>
         </extension>
         <extension url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
               <valueString value="SupplementalDataElements"></valueString>
            </extension>
            <extension url="name">
               <valueString value="SDE Race"></valueString>
            </extension>
            <extension url="statement">
               <valueString value="define &quot;SDE Race&quot;:
  Patient.race R
    return Tuple {
      codes: R.ombCategory union R.detailed,
      display: R.text
    }"></valueString>
            </extension>
            <extension url="displaySequence">
               <valueInteger value="23"></valueInteger>
            </extension>
         </extension>
         <extension url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
               <valueString value="CMS135FHIRACEIorARBorARNIforHF"></valueString>
            </extension>
            <extension url="name">
               <valueString value="SDE Race"></valueString>
            </extension>
            <extension url="statement">
               <valueString value="define &quot;SDE Race&quot;:
  SDE.&quot;SDE Race&quot;"></valueString>
            </extension>
            <extension url="displaySequence">
               <valueInteger value="24"></valueInteger>
            </extension>
         </extension>
         <extension url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
               <valueString value="CMS135FHIRACEIorARBorARNIforHF"></valueString>
            </extension>
            <extension url="name">
               <valueString value="Has Medical or Patient Reason for Not Ordering ACEI or ARB or ARNI"></valueString>
            </extension>
            <extension url="statement">
               <valueString value="define &quot;Has Medical or Patient Reason for Not Ordering ACEI or ARB or ARNI&quot;:
  exists ( [MedicationNotRequested: medication in &quot;ACE Inhibitor or ARB or ARNI&quot;] NoACEIOrARBOrARNIOrdered
      where NoACEIOrARBOrARNIOrdered.isMedicationNotRequestedOrderedDuringHeartFailureOutpatientEncounter ( )
        and ( NoACEIOrARBOrARNIOrdered.reasonCode in &quot;Medical Reason&quot;
            or NoACEIOrARBOrARNIOrdered.reasonCode in &quot;Patient Reason&quot;
            or NoACEIOrARBOrARNIOrdered.reasonCode in &quot;Patient Reason for ACE Inhibitor or ARB Decline&quot;
        )
  )"></valueString>
            </extension>
            <extension url="displaySequence">
               <valueInteger value="25"></valueInteger>
            </extension>
         </extension>
         <extension url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
               <valueString value="CMS135FHIRACEIorARBorARNIforHF"></valueString>
            </extension>
            <extension url="name">
               <valueString value="Has Allergy or Intolerance to ACEI or ARB or ARNI Ingredient"></valueString>
            </extension>
            <extension url="statement">
               <valueString value="define &quot;Has Allergy or Intolerance to ACEI or ARB or ARNI Ingredient&quot;:
  exists ( ( [AllergyIntolerance: &quot;ACE Inhibitor or ARB or ARNI Ingredient&quot;]
      union [AllergyIntolerance: &quot;Substance with angiotensin-converting enzyme inhibitor mechanism of action (substance)&quot;]
      union [AllergyIntolerance: &quot;Substance with angiotensin II receptor antagonist mechanism of action (substance)&quot;]
      union [AllergyIntolerance: &quot;Substance with neprilysin inhibitor mechanism of action (substance)&quot;] ) ACEIOrARBOrARNIAllergyIntolerance
      where ACEIOrARBOrARNIAllergyIntolerance.overlapsAfterHeartFailureOutpatientEncounter ( )
  )"></valueString>
            </extension>
            <extension url="displaySequence">
               <valueInteger value="26"></valueInteger>
            </extension>
         </extension>
         <extension url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
               <valueString value="CMS135FHIRACEIorARBorARNIforHF"></valueString>
            </extension>
            <extension url="name">
               <valueString value="Has Diagnosis of Allergy or Intolerance to ACEI or ARB"></valueString>
            </extension>
            <extension url="statement">
               <valueString value="define &quot;Has Diagnosis of Allergy or Intolerance to ACEI or ARB&quot;:
  exists ( ( ( [&quot;ConditionProblemsHealthConcerns&quot;: &quot;Allergy to ACE Inhibitor or ARB&quot;]
        union [&quot;ConditionEncounterDiagnosis&quot;: &quot;Allergy to ACE Inhibitor or ARB&quot;]
    )
      union ( [&quot;ConditionProblemsHealthConcerns&quot;: &quot;Intolerance to ACE Inhibitor or ARB&quot;] )
      union [&quot;ConditionEncounterDiagnosis&quot;: &quot;Intolerance to ACE Inhibitor or ARB&quot;] ) ACEIOrARBAllergyOrIntoleranceDiagnosis
      where ACEIOrARBAllergyOrIntoleranceDiagnosis.overlapsAfterHeartFailureOutpatientEncounter ( )
  )"></valueString>
            </extension>
            <extension url="displaySequence">
               <valueInteger value="27"></valueInteger>
            </extension>
         </extension>
         <extension url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
               <valueString value="CMS135FHIRACEIorARBorARNIforHF"></valueString>
            </extension>
            <extension url="name">
               <valueString value="Has Diagnosis of Pregnancy"></valueString>
            </extension>
            <extension url="statement">
               <valueString value="define &quot;Has Diagnosis of Pregnancy&quot;:
  exists ( ( [ConditionProblemsHealthConcerns: &quot;Pregnancy&quot;]
      union [&quot;ConditionEncounterDiagnosis&quot;: &quot;Pregnancy&quot;] ) PregnancyDiagnosis
      with AHA.&quot;Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD&quot; ModerateOrSevereLVSDHFOutpatientEncounter
        such that PregnancyDiagnosis.prevalenceInterval ( ) starts 9 months or less before or on start of ModerateOrSevereLVSDHFOutpatientEncounter.period
          and PregnancyDiagnosis.isVerified ( )
  )
    or exists ( [USCoreObservationPregnancyStatusProfile] PregnantObservation
        with AHA.&quot;Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD&quot; ModerateOrSevereLVSDHFOutpatientEncounter
          such that PregnantObservation.effective.toInterval ( ) starts 9 months or less before or on start of ModerateOrSevereLVSDHFOutpatientEncounter.period
            and ( PregnantObservation.value in &quot;Pregnancy&quot;
                and PregnantObservation.status in { 'final', 'amended', 'corrected' }
            )
    )"></valueString>
            </extension>
            <extension url="displaySequence">
               <valueInteger value="28"></valueInteger>
            </extension>
         </extension>
         <extension url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
               <valueString value="CMS135FHIRACEIorARBorARNIforHF"></valueString>
            </extension>
            <extension url="name">
               <valueString value="Has Diagnosis of Renal Failure Due to ACEI"></valueString>
            </extension>
            <extension url="statement">
               <valueString value="define &quot;Has Diagnosis of Renal Failure Due to ACEI&quot;:
  exists ( ( [ConditionProblemsHealthConcerns: &quot;Acute renal failure caused by angiotensin-converting-enzyme inhibitor (disorder)&quot;]
      union [ConditionEncounterDiagnosis: &quot;Acute renal failure caused by angiotensin-converting-enzyme inhibitor (disorder)&quot;] ) RenalFailureDueToACEI
      where RenalFailureDueToACEI.overlapsHeartFailureOutpatientEncounter ( )
  )"></valueString>
            </extension>
            <extension url="displaySequence">
               <valueInteger value="29"></valueInteger>
            </extension>
         </extension>
         <extension url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
               <valueString value="CMS135FHIRACEIorARBorARNIforHF"></valueString>
            </extension>
            <extension url="name">
               <valueString value="Denominator Exceptions"></valueString>
            </extension>
            <extension url="statement">
               <valueString value="define &quot;Denominator Exceptions&quot;:
  &quot;Has Medical or Patient Reason for Not Ordering ACEI or ARB or ARNI&quot;
    or &quot;Has Allergy or Intolerance to ACEI or ARB or ARNI Ingredient&quot;
    or &quot;Has Diagnosis of Allergy or Intolerance to ACEI or ARB&quot;
    or &quot;Has Diagnosis of Pregnancy&quot;
    or &quot;Has Diagnosis of Renal Failure Due to ACEI&quot;"></valueString>
            </extension>
            <extension url="displaySequence">
               <valueInteger value="30"></valueInteger>
            </extension>
         </extension>
         <extension url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
               <valueString value="FHIRHelpers"></valueString>
            </extension>
            <extension url="name">
               <valueString value="ToString"></valueString>
            </extension>
            <extension url="statement">
               <valueString value="define function ToString(value uri): value.value"></valueString>
            </extension>
            <extension url="displaySequence">
               <valueInteger value="31"></valueInteger>
            </extension>
         </extension>
         <extension url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
               <valueString value="AHAOverall"></valueString>
            </extension>
            <extension url="name">
               <valueString value="isOrderedDuringHeartFailureOutpatientEncounter"></valueString>
            </extension>
            <extension url="statement">
               <valueString value="/*
@description: Returns true if the given MedicationRequest is ordered during the heart failure outpatient encounter with history of moderate or severe LVSD at any point
*/
define fluent function isOrderedDuringHeartFailureOutpatientEncounter(MedicationRequest MedicationRequest):
  exists ( &quot;Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD&quot; ModerateOrSevereLVSDHFOutpatientEncounter
      where MedicationRequest.authoredOn during day of ModerateOrSevereLVSDHFOutpatientEncounter.period
        and MedicationRequest.status in { 'active', 'completed' }
        and MedicationRequest.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
        and not exists ( [&quot;TaskRejected&quot;] TaskReject
            where TaskReject.focus.references ( MedicationRequest )
              and TaskReject.code ~ QICoreCommon.&quot;Fulfill&quot;
        )
  )"></valueString>
            </extension>
            <extension url="displaySequence">
               <valueInteger value="32"></valueInteger>
            </extension>
         </extension>
         <extension url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
               <valueString value="FHIRHelpers"></valueString>
            </extension>
            <extension url="name">
               <valueString value="ToInterval"></valueString>
            </extension>
            <extension url="statement">
               <valueString 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.&quot;start&quot; is null then
            Interval(period.&quot;start&quot;.value, period.&quot;end&quot;.value]
        else
            Interval[period.&quot;start&quot;.value, period.&quot;end&quot;.value]"></valueString>
            </extension>
            <extension url="displaySequence">
               <valueInteger value="33"></valueInteger>
            </extension>
         </extension>
         <extension url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
               <valueString value="AHAOverall"></valueString>
            </extension>
            <extension url="name">
               <valueString value="isVerified"></valueString>
            </extension>
            <extension url="statement">
               <valueString value="/*
@description: Returns true if the given Condition has a verification status of &quot;confirmed&quot;, &quot;unconfirmed&quot;, &quot;provisional&quot;, or &quot;differential&quot;
*/
define fluent function isVerified(condition Choice&lt;ConditionEncounterDiagnosis, ConditionProblemsHealthConcerns&gt;):
  condition.verificationStatus is not null implies ( condition.verificationStatus ~ QICoreCommon.&quot;confirmed&quot;
      or condition.verificationStatus ~ QICoreCommon.&quot;unconfirmed&quot;
      or condition.verificationStatus ~ QICoreCommon.&quot;provisional&quot;
      or condition.verificationStatus ~ QICoreCommon.&quot;differential&quot;
  )"></valueString>
            </extension>
            <extension url="displaySequence">
               <valueInteger value="34"></valueInteger>
            </extension>
         </extension>
         <extension url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
               <valueString value="AHAOverall"></valueString>
            </extension>
            <extension url="name">
               <valueString value="isEncounterFinished"></valueString>
            </extension>
            <extension url="statement">
               <valueString value="/*
@description: Returns true if the given Encounter is finished
*/
define fluent function isEncounterFinished(Encounter Encounter):
  Encounter.status = 'finished'"></valueString>
            </extension>
            <extension url="displaySequence">
               <valueInteger value="35"></valueInteger>
            </extension>
         </extension>
         <extension url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
               <valueString value="QICoreCommon"></valueString>
            </extension>
            <extension url="name">
               <valueString value="prevalenceInterval"></valueString>
            </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 Choice&lt;&quot;ConditionEncounterDiagnosis&quot;, &quot;ConditionProblemsHealthConcerns&quot;&gt;):
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]"></valueString>
            </extension>
            <extension url="displaySequence">
               <valueInteger value="36"></valueInteger>
            </extension>
         </extension>
         <extension url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
               <valueString value="QICoreCommon"></valueString>
            </extension>
            <extension url="name">
               <valueString value="abatementInterval"></valueString>
            </extension>
            <extension url="statement">
               <valueString value="/*
@description: Returns an interval representing the normalized abatement of a given Condition.
@comment: If the abatement element of the Condition is represented as a DateTime, the result
is an interval beginning and ending on that DateTime.
If the abatement is represented as a Quantity, the quantity is expected to be a calendar-duration and is interpreted as the age of the patient. The
result is an interval from the date the patient turned that age to immediately before one year later.
If the abatement is represented as a Quantity Interval, the quantities are expected to be calendar-durations and are interpreted as an age range during
which the abatement occurred. The result is an interval from the date the patient turned the starting age of the quantity interval, and ending immediately
before one year later than the date the patient turned the ending age of the quantity interval.
*/
define fluent function abatementInterval(condition Choice&lt;&quot;ConditionEncounterDiagnosis&quot;, &quot;ConditionProblemsHealthConcerns&quot;&gt;):
	if condition.abatement is DateTime then
	  Interval[condition.abatement as DateTime, condition.abatement as DateTime]
	else if condition.abatement is Quantity then
		Interval[Patient.birthDate + (condition.abatement as Quantity),
			Patient.birthDate + (condition.abatement as Quantity) + 1 year)
	else if condition.abatement is Interval&lt;Quantity&gt; then
	  Interval[Patient.birthDate + (condition.abatement.low as Quantity),
		  Patient.birthDate + (condition.abatement.high as Quantity) + 1 year)
	else if condition.abatement is Interval&lt;DateTime&gt; then
	  Interval[condition.abatement.low, condition.abatement.high)
	else null as Interval&lt;DateTime&gt;"></valueString>
            </extension>
            <extension url="displaySequence">
               <valueInteger value="37"></valueInteger>
            </extension>
         </extension>
         <extension url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
               <valueString value="QICoreCommon"></valueString>
            </extension>
            <extension url="name">
               <valueString value="references"></valueString>
            </extension>
            <extension url="statement">
               <valueString value="/*
@description: Returns true if the given reference is to the given resource
@comment: Returns true if the `id` element of the given resource exactly equals the tail of the given reference.
NOTE: This function assumes resources from the same source server.
*/
define fluent function references(reference Reference, resource Resource):
  resource.id = Last(Split(reference.reference, '/'))"></valueString>
            </extension>
            <extension url="displaySequence">
               <valueInteger value="38"></valueInteger>
            </extension>
         </extension>
         <extension url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
               <valueString value="AHAOverall"></valueString>
            </extension>
            <extension url="name">
               <valueString value="overlapsAfterHeartFailureOutpatientEncounter"></valueString>
            </extension>
            <extension url="statement">
               <valueString value="/*
@overloaded
@description: Returns true if the given MedicationRequest overlaps after the day of the heart failure outpatient encounter with history of moderate or severe LVSD
*/
define fluent function overlapsAfterHeartFailureOutpatientEncounter(MedicationRequest MedicationRequest):
  exists ( &quot;Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD&quot; ModerateOrSevereLVSDHFOutpatientEncounter
      where First((collapse(MedicationRequest.dosageInstruction.timing.repeat.bounds DoseTime
            return TimingBoundToInterval(MedicationRequest.authoredOn, DoseTime)
        )) DrugPeriods
          sort by start of $this
      ) overlaps after day of ModerateOrSevereLVSDHFOutpatientEncounter.period
        and MedicationRequest.status in { 'active', 'completed' }
        and MedicationRequest.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
        and not exists ( [&quot;TaskRejected&quot;] TaskReject
            where TaskReject.focus.references ( MedicationRequest )
              and TaskReject.code ~ QICoreCommon.&quot;Fulfill&quot;
        )
  )"></valueString>
            </extension>
            <extension url="displaySequence">
               <valueInteger value="39"></valueInteger>
            </extension>
         </extension>
         <extension url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
               <valueString value="AHAOverall"></valueString>
            </extension>
            <extension url="name">
               <valueString value="TimingBoundToInterval"></valueString>
            </extension>
            <extension url="statement">
               <valueString value="define function TimingBoundToInterval(startDate System.DateTime, choice Choice&lt;Quantity, Interval&lt;Quantity&gt;, Interval&lt;DateTime&gt;&gt;):
  case
    when choice is Interval&lt;DateTime&gt; then
        choice as Interval&lt;DateTime&gt;
    when choice is Interval&lt;Quantity&gt; then
        Interval[startDate + (choice.low as Quantity), startDate + (choice.high as Quantity)]
    when choice is Quantity then
        Interval[startDate, startDate + (choice as Quantity))
    else
		null as Interval&lt;DateTime&gt;
	end"></valueString>
            </extension>
            <extension url="displaySequence">
               <valueInteger value="40"></valueInteger>
            </extension>
         </extension>
         <extension url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
               <valueString value="FHIRHelpers"></valueString>
            </extension>
            <extension url="name">
               <valueString value="ToCode"></valueString>
            </extension>
            <extension url="statement">
               <valueString 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
        }"></valueString>
            </extension>
            <extension url="displaySequence">
               <valueInteger value="41"></valueInteger>
            </extension>
         </extension>
         <extension url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
               <valueString value="QICoreCommon"></valueString>
            </extension>
            <extension url="name">
               <valueString value="toInterval"></valueString>
            </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"></valueString>
            </extension>
            <extension url="displaySequence">
               <valueInteger value="42"></valueInteger>
            </extension>
         </extension>
         <extension url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
               <valueString value="AHAOverall"></valueString>
            </extension>
            <extension url="name">
               <valueString value="isMedicationNotRequestedOrderedDuringHeartFailureOutpatientEncounter"></valueString>
            </extension>
            <extension url="statement">
               <valueString value="/*
@description: Returns true if the given MedicationNotRequested overlaps after the day of the heart failure outpatient encounter with history of moderate or severe LVSD
*/
define fluent function isMedicationNotRequestedOrderedDuringHeartFailureOutpatientEncounter(MedicationRequest MedicationNotRequested):
  exists ( &quot;Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD&quot; ModerateOrSevereLVSDHFOutpatientEncounter
      where MedicationRequest.authoredOn during day of ModerateOrSevereLVSDHFOutpatientEncounter.period
        and MedicationRequest.status in { 'completed', 'active' }
        and MedicationRequest.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
        and not exists ( [&quot;TaskRejected&quot;] TaskReject
            where TaskReject.focus.references ( MedicationRequest )
              and TaskReject.code ~ QICoreCommon.&quot;Fulfill&quot;
        )
  )"></valueString>
            </extension>
            <extension url="displaySequence">
               <valueInteger value="43"></valueInteger>
            </extension>
         </extension>
         <extension url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
               <valueString value="FHIRHelpers"></valueString>
            </extension>
            <extension url="name">
               <valueString value="ToConcept"></valueString>
            </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
        }"></valueString>
            </extension>
            <extension url="displaySequence">
               <valueInteger value="44"></valueInteger>
            </extension>
         </extension>
         <extension url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
               <valueString value="AHAOverall"></valueString>
            </extension>
            <extension url="name">
               <valueString value="overlapsAfterHeartFailureOutpatientEncounter"></valueString>
            </extension>
            <extension url="statement">
               <valueString value="/*
@overloaded
@description: Returns true if the given AllergyIntolerance overlaps after the day of the heart failure outpatient encounter with history of moderate or severe LVSD
*/
define fluent function overlapsAfterHeartFailureOutpatientEncounter(AllergyIntolerance AllergyIntolerance):
  exists ( &quot;Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD&quot; ModerateOrSevereLVSDHFOutpatientEncounter
      where Interval[start of AllergyIntolerance.onset.toInterval ( ), AllergyIntolerance.lastOccurrence]overlaps after day of ModerateOrSevereLVSDHFOutpatientEncounter.period
        and AllergyIntolerance.isVerified ( )
  )"></valueString>
            </extension>
            <extension url="displaySequence">
               <valueInteger value="45"></valueInteger>
            </extension>
         </extension>
         <extension url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
               <valueString value="AHAOverall"></valueString>
            </extension>
            <extension url="name">
               <valueString value="isVerified"></valueString>
            </extension>
            <extension url="statement">
               <valueString value="/*
@description: Returns true if the given condition either has no verification status or has a verification status of confirmed, unconfirmed, provisional, or differential
*/
define fluent function isVerified(AllergyIntolerance AllergyIntolerance):
  AllergyIntolerance.verificationStatus is not null implies ( AllergyIntolerance.verificationStatus ~ QICoreCommon.&quot;allergy-confirmed&quot;
      or AllergyIntolerance.verificationStatus ~ QICoreCommon.&quot;allergy-unconfirmed&quot;
  )"></valueString>
            </extension>
            <extension url="displaySequence">
               <valueInteger value="46"></valueInteger>
            </extension>
         </extension>
         <extension url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
               <valueString value="AHAOverall"></valueString>
            </extension>
            <extension url="name">
               <valueString value="overlapsAfterHeartFailureOutpatientEncounter"></valueString>
            </extension>
            <extension url="statement">
               <valueString value="/*
@overloaded
@description: Returns true if the given Condition overlaps after the day of the heart failure outpatient encounter with history of moderate or severe LVSD
*/
define fluent function overlapsAfterHeartFailureOutpatientEncounter(Condition Choice&lt;ConditionEncounterDiagnosis, ConditionProblemsHealthConcerns&gt;):
  exists ( &quot;Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD&quot; ModerateOrSevereLVSDHFOutpatientEncounter
      where Condition.prevalenceInterval ( ) overlaps after day of ModerateOrSevereLVSDHFOutpatientEncounter.period
        and Condition.isVerified ( )
  )"></valueString>
            </extension>
            <extension url="displaySequence">
               <valueInteger value="47"></valueInteger>
            </extension>
         </extension>
         <name value="EffectiveDataRequirements"></name>
         <status value="active"></status>
         <type>
            <coding>
               <system value="http://terminology.hl7.org/CodeSystem/library-type"></system>
               <code value="module-definition"></code>
            </coding>
         </type>
         <relatedArtifact>
            <type value="depends-on"></type>
            <display value="QICore model information"></display>
            <resource value="http://hl7.org/fhir/Library/QICore-ModelInfo"></resource>
         </relatedArtifact>
         <relatedArtifact>
            <type value="depends-on"></type>
            <display value="Library SDE"></display>
            <resource value="https://madie.cms.gov/Library/SupplementalDataElements|5.1.000"></resource>
         </relatedArtifact>
         <relatedArtifact>
            <type value="depends-on"></type>
            <display value="Library FHIRHelpers"></display>
            <resource value="https://madie.cms.gov/Library/FHIRHelpers|4.4.000"></resource>
         </relatedArtifact>
         <relatedArtifact>
            <type value="depends-on"></type>
            <display value="Library AHA"></display>
            <resource value="https://madie.cms.gov/Library/AHAOverall|4.1.000"></resource>
         </relatedArtifact>
         <relatedArtifact>
            <type value="depends-on"></type>
            <display value="Library QICoreCommon"></display>
            <resource value="https://madie.cms.gov/Library/QICoreCommon|4.0.000"></resource>
         </relatedArtifact>
         <relatedArtifact>
            <type value="depends-on"></type>
            <display value="Code system SNOMEDCT"></display>
            <resource value="http://snomed.info/sct"></resource>
         </relatedArtifact>
         <relatedArtifact>
            <type value="depends-on"></type>
            <display value="Code system ConditionVerificationStatusCodes"></display>
            <resource value="http://terminology.hl7.org/CodeSystem/condition-ver-status"></resource>
         </relatedArtifact>
         <relatedArtifact>
            <type value="depends-on"></type>
            <display value="Code system ConditionClinicalStatusCodes"></display>
            <resource value="http://terminology.hl7.org/CodeSystem/condition-clinical"></resource>
         </relatedArtifact>
         <relatedArtifact>
            <type value="depends-on"></type>
            <display value="Code system TaskCodeSystem"></display>
            <resource value="http://hl7.org/fhir/CodeSystem/task-code"></resource>
         </relatedArtifact>
         <relatedArtifact>
            <type value="depends-on"></type>
            <display value="Code system AllergyIntoleranceVerificationStatusCodes"></display>
            <resource value="http://terminology.hl7.org/CodeSystem/allergyintolerance-verification"></resource>
         </relatedArtifact>
         <relatedArtifact>
            <type value="depends-on"></type>
            <display value="Value set ACE Inhibitor or ARB or ARNI"></display>
            <resource value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1139"></resource>
         </relatedArtifact>
         <relatedArtifact>
            <type value="depends-on"></type>
            <display value="Value set Care Services in Long Term Residential Facility"></display>
            <resource value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1014"></resource>
         </relatedArtifact>
         <relatedArtifact>
            <type value="depends-on"></type>
            <display value="Value set Home Healthcare Services"></display>
            <resource value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016"></resource>
         </relatedArtifact>
         <relatedArtifact>
            <type value="depends-on"></type>
            <display value="Value set Nursing Facility Visit"></display>
            <resource value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1012"></resource>
         </relatedArtifact>
         <relatedArtifact>
            <type value="depends-on"></type>
            <display value="Value set Office Visit"></display>
            <resource value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001"></resource>
         </relatedArtifact>
         <relatedArtifact>
            <type value="depends-on"></type>
            <display value="Value set Outpatient Consultation"></display>
            <resource value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1008"></resource>
         </relatedArtifact>
         <relatedArtifact>
            <type value="depends-on"></type>
            <display value="Value set Heart Failure"></display>
            <resource value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.376"></resource>
         </relatedArtifact>
         <relatedArtifact>
            <type value="depends-on"></type>
            <display value="Value set Ejection Fraction"></display>
            <resource value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1134"></resource>
         </relatedArtifact>
         <relatedArtifact>
            <type value="depends-on"></type>
            <display value="Value set Moderate or Severe LVSD"></display>
            <resource value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1090"></resource>
         </relatedArtifact>
         <relatedArtifact>
            <type value="depends-on"></type>
            <display value="Value set Moderate or Severe"></display>
            <resource value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1092"></resource>
         </relatedArtifact>
         <relatedArtifact>
            <type value="depends-on"></type>
            <display value="Value set Patient Provider Interaction"></display>
            <resource value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1012"></resource>
         </relatedArtifact>
         <relatedArtifact>
            <type value="depends-on"></type>
            <display value="Value set Payer Type"></display>
            <resource value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"></resource>
         </relatedArtifact>
         <relatedArtifact>
            <type value="depends-on"></type>
            <display value="Value set Heart Transplant"></display>
            <resource value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1178.33"></resource>
         </relatedArtifact>
         <relatedArtifact>
            <type value="depends-on"></type>
            <display value="Value set Heart Transplant Complications"></display>
            <resource value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1178.56"></resource>
         </relatedArtifact>
         <relatedArtifact>
            <type value="depends-on"></type>
            <display value="Value set Left Ventricular Assist Device Placement"></display>
            <resource value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1178.61"></resource>
         </relatedArtifact>
         <relatedArtifact>
            <type value="depends-on"></type>
            <display value="Value set Left Ventricular Assist Device Complications"></display>
            <resource value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1178.58"></resource>
         </relatedArtifact>
         <relatedArtifact>
            <type value="depends-on"></type>
            <display value="Value set Medical Reason"></display>
            <resource value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1007"></resource>
         </relatedArtifact>
         <relatedArtifact>
            <type value="depends-on"></type>
            <display value="Value set Patient Reason"></display>
            <resource value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1008"></resource>
         </relatedArtifact>
         <relatedArtifact>
            <type value="depends-on"></type>
            <display value="Value set Patient Reason for ACE Inhibitor or ARB Decline"></display>
            <resource value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1140"></resource>
         </relatedArtifact>
         <relatedArtifact>
            <type value="depends-on"></type>
            <display value="Value set ACE Inhibitor or ARB or ARNI Ingredient"></display>
            <resource value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1489"></resource>
         </relatedArtifact>
         <relatedArtifact>
            <type value="depends-on"></type>
            <display value="Value set Allergy to ACE Inhibitor or ARB"></display>
            <resource value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1211"></resource>
         </relatedArtifact>
         <relatedArtifact>
            <type value="depends-on"></type>
            <display value="Value set Intolerance to ACE Inhibitor or ARB"></display>
            <resource value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1212"></resource>
         </relatedArtifact>
         <relatedArtifact>
            <type value="depends-on"></type>
            <display value="Value set Pregnancy"></display>
            <resource value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.378"></resource>
         </relatedArtifact>
         <parameter>
            <name value="Measurement Period"></name>
            <use value="in"></use>
            <min value="0"></min>
            <max value="1"></max>
            <type value="Period"></type>
         </parameter>
         <parameter>
            <name value="Numerator"></name>
            <use value="out"></use>
            <min value="0"></min>
            <max value="1"></max>
            <type value="boolean"></type>
         </parameter>
         <parameter>
            <name value="Denominator"></name>
            <use value="out"></use>
            <min value="0"></min>
            <max value="1"></max>
            <type value="boolean"></type>
         </parameter>
         <parameter>
            <name value="Initial Population"></name>
            <use value="out"></use>
            <min value="0"></min>
            <max value="1"></max>
            <type value="boolean"></type>
         </parameter>
         <parameter>
            <name value="Denominator Exclusions"></name>
            <use value="out"></use>
            <min value="0"></min>
            <max value="1"></max>
            <type value="boolean"></type>
         </parameter>
         <parameter>
            <name value="Denominator Exceptions"></name>
            <use value="out"></use>
            <min value="0"></min>
            <max value="1"></max>
            <type value="boolean"></type>
         </parameter>
         <parameter>
            <name value="SDE Sex"></name>
            <use value="out"></use>
            <min value="0"></min>
            <max value="1"></max>
            <type value="Coding"></type>
         </parameter>
         <parameter>
            <name value="SDE Payer"></name>
            <use value="out"></use>
            <min value="0"></min>
            <max value="*"></max>
            <type value="Resource"></type>
         </parameter>
         <parameter>
            <name value="SDE Ethnicity"></name>
            <use value="out"></use>
            <min value="0"></min>
            <max value="1"></max>
            <type value="Resource"></type>
         </parameter>
         <parameter>
            <name value="SDE Race"></name>
            <use value="out"></use>
            <min value="0"></min>
            <max value="1"></max>
            <type value="Resource"></type>
         </parameter>
         <dataRequirement>
            <type value="Patient"></type>
            <profile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"></profile>
            <mustSupport value="extension"></mustSupport>
            <mustSupport value="birthDate"></mustSupport>
            <mustSupport value="birthDate.value"></mustSupport>
            <mustSupport value="url"></mustSupport>
         </dataRequirement>
         <dataRequirement>
            <type value="Encounter"></type>
            <profile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"></profile>
            <mustSupport value="type"></mustSupport>
            <mustSupport value="period"></mustSupport>
            <mustSupport value="id"></mustSupport>
            <mustSupport value="id.value"></mustSupport>
            <codeFilter>
               <path value="type"></path>
               <valueSet value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1014"></valueSet>
            </codeFilter>
         </dataRequirement>
         <dataRequirement>
            <type value="Encounter"></type>
            <profile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"></profile>
            <mustSupport value="type"></mustSupport>
            <mustSupport value="period"></mustSupport>
            <mustSupport value="id"></mustSupport>
            <mustSupport value="id.value"></mustSupport>
            <codeFilter>
               <path value="type"></path>
               <valueSet value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016"></valueSet>
            </codeFilter>
         </dataRequirement>
         <dataRequirement>
            <type value="Encounter"></type>
            <profile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"></profile>
            <mustSupport value="type"></mustSupport>
            <mustSupport value="period"></mustSupport>
            <mustSupport value="id"></mustSupport>
            <mustSupport value="id.value"></mustSupport>
            <codeFilter>
               <path value="type"></path>
               <valueSet value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1012"></valueSet>
            </codeFilter>
         </dataRequirement>
         <dataRequirement>
            <type value="Encounter"></type>
            <profile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"></profile>
            <mustSupport value="type"></mustSupport>
            <mustSupport value="period"></mustSupport>
            <mustSupport value="id"></mustSupport>
            <mustSupport value="id.value"></mustSupport>
            <codeFilter>
               <path value="type"></path>
               <valueSet value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001"></valueSet>
            </codeFilter>
         </dataRequirement>
         <dataRequirement>
            <type value="Encounter"></type>
            <profile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"></profile>
            <mustSupport value="type"></mustSupport>
            <mustSupport value="period"></mustSupport>
            <mustSupport value="id"></mustSupport>
            <mustSupport value="id.value"></mustSupport>
            <codeFilter>
               <path value="type"></path>
               <valueSet value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1008"></valueSet>
            </codeFilter>
         </dataRequirement>
         <dataRequirement>
            <type value="Encounter"></type>
            <profile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"></profile>
            <mustSupport value="status"></mustSupport>
            <mustSupport value="period"></mustSupport>
            <mustSupport value="id"></mustSupport>
            <mustSupport value="id.value"></mustSupport>
            <mustSupport value="status.value"></mustSupport>
         </dataRequirement>
         <dataRequirement>
            <type value="Encounter"></type>
            <profile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"></profile>
            <mustSupport value="type"></mustSupport>
            <mustSupport value="period"></mustSupport>
            <mustSupport value="id"></mustSupport>
            <mustSupport value="id.value"></mustSupport>
            <codeFilter>
               <path value="type"></path>
               <valueSet value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1012"></valueSet>
            </codeFilter>
         </dataRequirement>
         <dataRequirement>
            <type value="Condition"></type>
            <profile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns"></profile>
            <mustSupport value="code"></mustSupport>
            <codeFilter>
               <path value="code"></path>
               <valueSet value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.376"></valueSet>
            </codeFilter>
         </dataRequirement>
         <dataRequirement>
            <type value="Condition"></type>
            <profile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns"></profile>
            <mustSupport value="code"></mustSupport>
            <codeFilter>
               <path value="code"></path>
               <valueSet value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1090"></valueSet>
            </codeFilter>
         </dataRequirement>
         <dataRequirement>
            <type value="Condition"></type>
            <profile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns"></profile>
            <mustSupport value="code"></mustSupport>
            <codeFilter>
               <path value="code"></path>
               <code>
                  <system value="http://snomed.info/sct"></system>
                  <code value="134401001"></code>
                  <display value="Left ventricular systolic dysfunction (disorder)"></display>
               </code>
            </codeFilter>
         </dataRequirement>
         <dataRequirement>
            <type value="Condition"></type>
            <profile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns"></profile>
            <mustSupport value="code"></mustSupport>
            <codeFilter>
               <path value="code"></path>
               <valueSet value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1178.56"></valueSet>
            </codeFilter>
         </dataRequirement>
         <dataRequirement>
            <type value="Condition"></type>
            <profile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns"></profile>
            <mustSupport value="code"></mustSupport>
            <codeFilter>
               <path value="code"></path>
               <valueSet value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1178.58"></valueSet>
            </codeFilter>
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            <type value="Condition"></type>
            <profile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns"></profile>
            <mustSupport value="code"></mustSupport>
            <codeFilter>
               <path value="code"></path>
               <valueSet value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1211"></valueSet>
            </codeFilter>
         </dataRequirement>
         <dataRequirement>
            <type value="Condition"></type>
            <profile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns"></profile>
            <mustSupport value="code"></mustSupport>
            <codeFilter>
               <path value="code"></path>
               <valueSet value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1212"></valueSet>
            </codeFilter>
         </dataRequirement>
         <dataRequirement>
            <type value="Condition"></type>
            <profile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns"></profile>
            <mustSupport value="code"></mustSupport>
            <codeFilter>
               <path value="code"></path>
               <valueSet value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.378"></valueSet>
            </codeFilter>
         </dataRequirement>
         <dataRequirement>
            <type value="Condition"></type>
            <profile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns"></profile>
            <mustSupport value="code"></mustSupport>
            <codeFilter>
               <path value="code"></path>
               <code>
                  <system value="http://snomed.info/sct"></system>
                  <code value="422593004"></code>
                  <display value="Acute renal failure caused by angiotensin-converting-enzyme inhibitor (disorder)"></display>
               </code>
            </codeFilter>
         </dataRequirement>
         <dataRequirement>
            <type value="Condition"></type>
            <profile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-encounter-diagnosis"></profile>
            <mustSupport value="code"></mustSupport>
            <codeFilter>
               <path value="code"></path>
               <valueSet value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.376"></valueSet>
            </codeFilter>
         </dataRequirement>
         <dataRequirement>
            <type value="Condition"></type>
            <profile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-encounter-diagnosis"></profile>
            <mustSupport value="code"></mustSupport>
            <codeFilter>
               <path value="code"></path>
               <valueSet value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1090"></valueSet>
            </codeFilter>
         </dataRequirement>
         <dataRequirement>
            <type value="Condition"></type>
            <profile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-encounter-diagnosis"></profile>
            <mustSupport value="code"></mustSupport>
            <codeFilter>
               <path value="code"></path>
               <code>
                  <system value="http://snomed.info/sct"></system>
                  <code value="134401001"></code>
                  <display value="Left ventricular systolic dysfunction (disorder)"></display>
               </code>
            </codeFilter>
         </dataRequirement>
         <dataRequirement>
            <type value="Condition"></type>
            <profile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-encounter-diagnosis"></profile>
            <mustSupport value="code"></mustSupport>
            <codeFilter>
               <path value="code"></path>
               <valueSet value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1178.56"></valueSet>
            </codeFilter>
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         <dataRequirement>
            <type value="Condition"></type>
            <profile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-encounter-diagnosis"></profile>
            <mustSupport value="code"></mustSupport>
            <codeFilter>
               <path value="code"></path>
               <valueSet value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1178.58"></valueSet>
            </codeFilter>
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            <type value="Condition"></type>
            <profile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-encounter-diagnosis"></profile>
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               <path value="code"></path>
               <valueSet value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1211"></valueSet>
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            <profile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-encounter-diagnosis"></profile>
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               <path value="code"></path>
               <valueSet value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1212"></valueSet>
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               <path value="code"></path>
               <valueSet value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.378"></valueSet>
            </codeFilter>
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         <dataRequirement>
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            <profile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-encounter-diagnosis"></profile>
            <mustSupport value="code"></mustSupport>
            <codeFilter>
               <path value="code"></path>
               <code>
                  <system value="http://snomed.info/sct"></system>
                  <code value="422593004"></code>
                  <display value="Acute renal failure caused by angiotensin-converting-enzyme inhibitor (disorder)"></display>
               </code>
            </codeFilter>
         </dataRequirement>
         <dataRequirement>
            <type value="Observation"></type>
            <profile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation-clinical-result"></profile>
            <mustSupport value="code"></mustSupport>
            <mustSupport value="value"></mustSupport>
            <mustSupport value="status"></mustSupport>
            <mustSupport value="status.value"></mustSupport>
            <codeFilter>
               <path value="code"></path>
               <valueSet value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1134"></valueSet>
            </codeFilter>
         </dataRequirement>
         <dataRequirement>
            <type value="Resource"></type>
            <profile value="http://hl7.org/fhir/StructureDefinition/Resource"></profile>
            <mustSupport value="id"></mustSupport>
            <mustSupport value="id.value"></mustSupport>
         </dataRequirement>
         <dataRequirement>
            <type value="MedicationRequest"></type>
            <profile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest"></profile>
            <mustSupport value="authoredOn"></mustSupport>
            <mustSupport value="timing"></mustSupport>
            <mustSupport value="repeat"></mustSupport>
            <mustSupport value="bounds"></mustSupport>
            <mustSupport value="authoredOn.value"></mustSupport>
            <mustSupport value="status"></mustSupport>
            <mustSupport value="status.value"></mustSupport>
            <mustSupport value="intent"></mustSupport>
            <mustSupport value="intent.value"></mustSupport>
         </dataRequirement>
         <dataRequirement>
            <type value="MedicationRequest"></type>
            <profile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest"></profile>
            <mustSupport value="medication"></mustSupport>
            <mustSupport value="timing"></mustSupport>
            <mustSupport value="repeat"></mustSupport>
            <mustSupport value="bounds"></mustSupport>
            <codeFilter>
               <path value="medication"></path>
               <valueSet value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1139"></valueSet>
            </codeFilter>
         </dataRequirement>
         <dataRequirement>
            <type value="Task"></type>
            <profile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-taskrejected"></profile>
            <mustSupport value="focus"></mustSupport>
            <mustSupport value="code"></mustSupport>
         </dataRequirement>
         <dataRequirement>
            <type value="Coverage"></type>
            <profile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-coverage"></profile>
            <mustSupport value="type"></mustSupport>
            <mustSupport value="period"></mustSupport>
            <codeFilter>
               <path value="type"></path>
               <valueSet value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"></valueSet>
            </codeFilter>
         </dataRequirement>
         <dataRequirement>
            <type value="Procedure"></type>
            <profile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure"></profile>
            <mustSupport value="code"></mustSupport>
            <mustSupport value="performed"></mustSupport>
            <mustSupport value="status"></mustSupport>
            <mustSupport value="status.value"></mustSupport>
            <codeFilter>
               <path value="code"></path>
               <valueSet value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1178.33"></valueSet>
            </codeFilter>
         </dataRequirement>
         <dataRequirement>
            <type value="Procedure"></type>
            <profile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure"></profile>
            <mustSupport value="code"></mustSupport>
            <mustSupport value="performed"></mustSupport>
            <mustSupport value="status"></mustSupport>
            <mustSupport value="status.value"></mustSupport>
            <codeFilter>
               <path value="code"></path>
               <valueSet value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1178.61"></valueSet>
            </codeFilter>
         </dataRequirement>
         <dataRequirement>
            <type value="MedicationRequest"></type>
            <profile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationnotrequested"></profile>
            <mustSupport value="authoredOn"></mustSupport>
            <mustSupport value="authoredOn.value"></mustSupport>
            <mustSupport value="status"></mustSupport>
            <mustSupport value="status.value"></mustSupport>
            <mustSupport value="intent"></mustSupport>
            <mustSupport value="intent.value"></mustSupport>
         </dataRequirement>
         <dataRequirement>
            <type value="MedicationRequest"></type>
            <profile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationnotrequested"></profile>
            <mustSupport value="medication"></mustSupport>
            <mustSupport value="reasonCode"></mustSupport>
            <codeFilter>
               <path value="medication"></path>
               <valueSet value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1139"></valueSet>
            </codeFilter>
         </dataRequirement>
         <dataRequirement>
            <type value="AllergyIntolerance"></type>
            <profile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-allergyintolerance"></profile>
            <mustSupport value="verificationStatus"></mustSupport>
            <mustSupport value="onset"></mustSupport>
            <mustSupport value="lastOccurrence"></mustSupport>
            <mustSupport value="lastOccurrence.value"></mustSupport>
         </dataRequirement>
         <dataRequirement>
            <type value="AllergyIntolerance"></type>
            <profile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-allergyintolerance"></profile>
            <mustSupport value="code"></mustSupport>
            <codeFilter>
               <path value="code"></path>
               <valueSet value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1489"></valueSet>
            </codeFilter>
         </dataRequirement>
         <dataRequirement>
            <type value="AllergyIntolerance"></type>
            <profile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-allergyintolerance"></profile>
            <mustSupport value="code"></mustSupport>
            <codeFilter>
               <path value="code"></path>
               <code>
                  <system value="http://snomed.info/sct"></system>
                  <code value="372733002"></code>
                  <display value="Substance with angiotensin-converting enzyme inhibitor mechanism of action (substance)"></display>
               </code>
            </codeFilter>
         </dataRequirement>
         <dataRequirement>
            <type value="AllergyIntolerance"></type>
            <profile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-allergyintolerance"></profile>
            <mustSupport value="code"></mustSupport>
            <codeFilter>
               <path value="code"></path>
               <code>
                  <system value="http://snomed.info/sct"></system>
                  <code value="372913009"></code>
                  <display value="Substance with angiotensin II receptor antagonist mechanism of action (substance)"></display>
               </code>
            </codeFilter>
         </dataRequirement>
         <dataRequirement>
            <type value="AllergyIntolerance"></type>
            <profile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-allergyintolerance"></profile>
            <mustSupport value="code"></mustSupport>
            <codeFilter>
               <path value="code"></path>
               <code>
                  <system value="http://snomed.info/sct"></system>
                  <code value="786886009"></code>
                  <display value="Substance with neprilysin inhibitor mechanism of action (substance)"></display>
               </code>
            </codeFilter>
         </dataRequirement>
         <dataRequirement>
            <type value="Observation"></type>
            <profile value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-pregnancystatus"></profile>
            <mustSupport value="effective"></mustSupport>
            <mustSupport value="effective.value"></mustSupport>
            <mustSupport value="value"></mustSupport>
            <mustSupport value="status"></mustSupport>
            <mustSupport value="status.value"></mustSupport>
         </dataRequirement>
      </Library>
   </contained>
   <extension id="supplementalDataGuidance" url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-supplementalDataGuidance">
      <extension url="guidance">
         <valueString value="&lt;p&gt;For every patient evaluated by this measure also identify payer, race, ethnicity and sex&lt;/p&gt;"></valueString>
      </extension>
      <extension url="usage">
         <valueCodeableConcept>
            <coding>
               <system value="http://terminology.hl7.org/CodeSystem/measure-data-usage"></system>
               <code value="supplemental-data"></code>
               <display value="Supplemental Data"></display>
            </coding>
            <text value="Supplemental Data Guidance"></text>
         </valueCodeableConcept>
      </extension>
   </extension>
   <extension url="http://hl7.org/fhir/StructureDefinition/cqf-definitionTerm">
      <extension url="term">
         <valueString value="Moderate or Severe LVSD"></valueString>
      </extension>
      <extension url="definition">
         <valueMarkdown value="LVEF \&lt;=40% corresponds to qualitative documentation of moderate dysfunction or severe dysfunction (LVSD). The LVSD may be determined by quantitative or qualitative assessment, which may be current or historical. Examples of a quantitative or qualitative assessment may include an echocardiogram:

1. that provides a numerical value of LVSD or

2. that uses descriptive terms such as moderately or severely depressed left ventricular systolic function. Any current or prior ejection fraction study documenting LVSD can be used to identify patients.

"></valueMarkdown>
      </extension>
   </extension>
   <extension url="http://hl7.org/fhir/StructureDefinition/cqf-definitionTerm">
      <extension url="term">
         <valueString value="Prescribed"></valueString>
      </extension>
      <extension url="definition">
         <valueMarkdown value="Denotes that a prescription has been given to the patient for ACE inhibitor or ARB or ARNI therapy at one or more visits in the measurement period OR that the patient is already taking an ACE inhibitor or ARB or ARNI therapy as documented in their current medication list
"></valueMarkdown>
      </extension>
   </extension>
   <extension url="http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-effectiveDataRequirements">
      <valueReference>
         <reference value="#effective-data-requirements"></reference>
      </valueReference>
   </extension>
   <url value="https://madie.cms.gov/Measure/CMS135FHIRACEIorARBorARNIforHF"></url>
   <identifier>
      <use value="usual"></use>
      <type>
         <coding>
            <system value="http://terminology.hl7.org/CodeSystem/artifact-identifier-type"></system>
            <code value="short-name"></code>
            <display value="Short Name"></display>
         </coding>
      </type>
      <system value="https://madie.cms.gov/measure/shortName"></system>
      <value value="CMS135FHIR"></value>
   </identifier>
   <identifier>
      <use value="official"></use>
      <type>
         <coding>
            <system value="http://terminology.hl7.org/CodeSystem/artifact-identifier-type"></system>
            <code value="version-independent"></code>
            <display value="Version Independent"></display>
         </coding>
      </type>
      <system value="urn:ietf:rfc:3986"></system>
      <value value="urn:uuid:86136d6c-dbe1-4b7f-89f3-406cb90f08d5"></value>
   </identifier>
   <identifier>
      <use value="official"></use>
      <type>
         <coding>
            <system value="http://terminology.hl7.org/CodeSystem/artifact-identifier-type"></system>
            <code value="version-specific"></code>
            <display value="Version Specific"></display>
         </coding>
      </type>
      <system value="urn:ietf:rfc:3986"></system>
      <value value="urn:uuid:a0aa7f51-9882-4ceb-b4e5-bb94669b62ca"></value>
   </identifier>
   <identifier>
      <use value="official"></use>
      <type>
         <coding>
            <system value="http://terminology.hl7.org/CodeSystem/artifact-identifier-type"></system>
            <code value="endorser"></code>
            <display value="Endorser"></display>
         </coding>
      </type>
      <system value="https://madie.cms.gov/measure/cbeId"></system>
      <value value="0081e"></value>
      <assigner>
         <display value="CMS Consensus Based Entity"></display>
      </assigner>
   </identifier>
   <identifier>
      <use value="official"></use>
      <type>
         <coding>
            <system value="http://terminology.hl7.org/CodeSystem/artifact-identifier-type"></system>
            <code value="publisher"></code>
            <display value="Publisher"></display>
         </coding>
      </type>
      <system value="https://madie.cms.gov/measure/cmsId"></system>
      <value value="135FHIR"></value>
      <assigner>
         <display value="CMS"></display>
      </assigner>
   </identifier>
   <version value="1.0.000"></version>
   <name value="CMS135FHIRACEIorARBorARNIforHF"></name>
   <title value="Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) or Angiotensin Receptor-Neprilysin Inhibitor (ARNI) Therapy for Left Ventricular Systolic Dysfunction (LVSD)FHIR
"></title>
   <status value="active"></status>
   <experimental value="false"></experimental>
   <date value="2025-08-22T19:19:00+00:00"></date>
   <publisher value="American Heart Association"></publisher>
   <contact>
      <telecom>
         <system value="url"></system>
         <value value="https://www.heart.org/"></value>
      </telecom>
   </contact>
   <description value="Percentage of patients aged 18 years and older with a diagnosis of heart failure (HF) with a current or prior left ventricular ejection fraction (LVEF) \&lt;=40% who were prescribed or already taking ACE inhibitor or ARB or ARNI therapy during the measurement period
"></description>
   <usage value="This eCQM is to be reported as patient-based. To satisfy this measure, it must be reported for all heart failure patients at least once during the measurement period.

The requirement of two or more visits is used to establish that the eligible clinician has an existing relationship with the patient.

A range value should satisfy the logic requirement for 'Ejection Fraction' as long as the ranged observation value clearly meets the less than or equal to 40% threshold noted in the denominator logic. A range that is greater than 40% would not meet the measure requirement.

In order for the Ejection Fraction result pathway to be recognized as below 40%, the result must be reported as a number with unit of %. A text string of &quot;below 40%&quot; or &quot;ejection fraction between 35 and 40%&quot; will not be recognized through electronic data capture. Although, this criteria can also be met using the Diagnosis pathway if specified as &quot;Moderate or Severe.&quot;

Eligible clinicians who have given a prescription for or whose patient is already taking an Angiotensin-Converting Enzyme Inhibitor (ACEI) or Angiotensin Receptor Blocker (ARB) would meet performance for this measure. Other combination therapies that consist of an ACEI plus diuretic, ARB + neprilysin inhibitor (ARNI), ARB plus diuretic, ACEI plus calcium channel blocker, ARB plus calcium channel blocker, or ARB plus calcium channel blocker plus diuretic would also meet performance for this measure.

This FHIR-based measure has been derived from the QDM-based measure CMS135v14. Please refer to the HL7 QI-Core Implementation Guide (https://hl7.org/fhir/us/qicore/STU6/) for more information on QI-Core and mapping recommendations from QDM to QI-Core STU 6 (https://hl7.org/fhir/us/qicore/STU6/qdm-to-qicore.html).
"></usage>
   <copyright value="Copyright 2025 American College of Cardiology and American Heart Association. All Rights Reserved.
"></copyright>
   <effectivePeriod>
      <start value="2026-01-01"></start>
      <end value="2026-12-31"></end>
   </effectivePeriod>
   <author>
      <name value="American Heart Association"></name>
      <telecom>
         <system value="url"></system>
         <value value="https://www.heart.org/"></value>
      </telecom>
   </author>
   <author>
      <name value="American Medical Association (AMA)"></name>
      <telecom>
         <system value="url"></system>
         <value value="https://www.ama-assn.org/"></value>
      </telecom>
   </author>
   <relatedArtifact>
      <type value="citation"></type>
      <citation value="Heidenreich, P.A., Bozkurt, B, Aguilar, D., ... Allen, L. A. (2022). 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 145(18), e895-e1032. doi: 10.1161/CIR.0000000000001063
"></citation>
   </relatedArtifact>
   <library value="https://madie.cms.gov/Library/CMS135FHIRACEIorARBorARNIforHF"></library>
   <disclaimer value="The Measure is not a clinical guideline, does not establish a standard of medical care, and has not been tested for all potential applications.

The Measure, while copyrighted, can be reproduced and distributed, without modification, for noncommercial purposes, e.g., use by health care providers in connection with their practices. Commercial use is defined as the sale, license, 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.

Commercial uses of the Measure require a license agreement between the user and the American College of Cardiology (ACC) or the American Heart Association (AHA). Neither the ACC, nor AHA, nor their members shall be responsible for any use of the Measure.

ACC and AHA encourage use of the Measure by other health care professionals, where appropriate. THE MEASURE AND SPECIFICATIONS ARE PROVIDED &quot;AS IS&quot; WITHOUT WARRANTY OF ANY KIND.

Limited proprietary coding is contained in the Measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. The ACC and AHA and their members disclaim all liability for use or accuracy of any Current Procedural Terminology (CPT\[R\]) or other coding contained in the specifications.

CPT(R) contained in the Measure specifications is copyright 2004-20234 American Medical Association. LOINC(R) is copyright 2004-20234 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT\[R\]) copyright 2004-20234 International Health Terminology Standards Development Organisation. ICD-10 is copyright 20234 World Health Organization. All Rights Reserved.

The American Medical Association's and the PCPI(R) Foundation's significant past efforts and contributions to the performance measure are gratefully acknowledged. Due to technical limitations, registered trademarks are indicated by (R) or \[R\].
"></disclaimer>
   <rationale value="Use of ACE inhibitor, ARB, or ARNI therapy has been associated with improved outcomes in patients with reduced LVEF. Long-term therapy with ARBs have also been shown to reduce morbidity and mortality, especially in ACE inhibitor--intolerant patients. More recently, ARNI therapy has also been shown to more significantly improve outcomes, such that the newest guidelines recommend replacement of ACE inhibitors or ARBs with ARNI therapy in eligible patients. However, despite the benefits of these drugs, use of ACE inhibitor, ARB, or ARNI remains suboptimal.
"></rationale>
   <clinicalRecommendationStatement value="In patients with Heart Failure with Reduced Ejection Fraction (HFrEF) and New York Heart Association (NYHA) class II to III symptoms, the use of ARNI is recommended to reduce morbidity and mortality (Class I, Level of Evidence A) (Heidenreich et al., 2022). In patients with previous or current symptoms of chronic HFrEF, the use of angiotension-converting enzyme inhibitors (ACEi) is beneficial to reduce morbidity and mortality when the use of ARNI is not feasible (Class I, Level of Evidence A) (Heidenreich et al., 2022). In patients with previous or current symptoms of chronic HFrEF who are intolerant to ACEi because of cough or angioedema and when the use of ARNI is not feasible, the use of ARB is recommended to reduce morbidity and mortality (Class I, Level of Evidence A) (Heidenreich et al., 2022). In patients with chronic symptomatic HFrEF NYHA class II or III who tolerate an ACEi or ARB, replacement by an ARNI is recommended to further reduce morbidity and mortality (Class I, Level of Evidence B-R) (Heidenreich et al., 2022). ARNI should not be administered concomitantly with ACEi or within 36 hours of the last dose of an ACEi (Class II: Harm, Level of Evidence B-R) (Heidenreich et al., 2022). ARNI should not be administered to patients with any history of angioedema (Class III: Harm, Level of Evidence C-LD) (Heidenreich et al., 2022). ACEi should not be administered to patients with any history of angioedema (Class III: Harm, Level of Evidence C-LD) (Heidenreich et al., 2022).

Drugs Commonly Used for Stage C HFrEF (abbreviated to align with focus of measure to include only ACE inhibitors, ARB and ARNI therapy)

|         Drug         |         Initial Daily Dose(s)         |             Target Dose(s)             |                           Mean Doses Achieved in Clinical Trials                           |
|----------------------|---------------------------------------|----------------------------------------|--------------------------------------------------------------------------------------------|
| *ACEi*               | &lt;br /&gt;                                | &lt;br /&gt;                                 | &lt;br /&gt;                                                                                     |
| Captopril            | 6.25 mg 3 times                       | 50 mg 3 times                          | 122.7 mg total daily                                                                       |
| Enalapril            | 2.5 mg twice                          | 10 to 20 mg twice                      | 16.6 mg total daily                                                                        |
| Fosinopril           | 5 to 10 mg once                       | 40 mg once                             | N/A                                                                                        |
| Lisinopril           | 2.5 to 5 mg once                      | 20 to 40 mg once                       | 32.5 to 35.0 mg total daily                                                                |
| Perindopril          | 2 mg once                             | 8 to 16 mg once                        | N/A                                                                                        |
| Quinapril            | 5 mg twice                            | 20 mg twice                            | N/A                                                                                        |
| Ramipril             | 1.25 to 2.5 mg once                   | 10 mg once                             | N/A                                                                                        |
| Trandolapril         | 1 mg once                             | 4 mg once                              | N/A                                                                                        |
| *ARB*                | &lt;br /&gt;                                | &lt;br /&gt;                                 | &lt;br /&gt;                                                                                     |
| Candesartan          | 4 to 8 mg once                        | 32 mg once                             | 24 mg total daily                                                                          |
| Losartan             | 25 to 50 mg once                      | 50 to 150 mg once                      | 129 mg total daily                                                                         |
| Valsartan            | 20 to 40 mg twice                     | 160 mg twice                           | 254 mg total daily                                                                         |
| *ARNI*               | &lt;br /&gt;                                | &lt;br /&gt;                                 | &lt;br /&gt;                                                                                     |
| Sacubitril-valsartan | 49/51 mg twice (sacubitril/valsartan) | 97/103 mg twice (sacubitril/valsartan) | 182/193 mg (sacubitril/valsartan) total daily (therapy may be initiated at 24/26 mg twice) |

"></clinicalRecommendationStatement>
   <group id="Group_1">
      <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring">
         <valueCodeableConcept>
            <coding>
               <system value="http://terminology.hl7.org/CodeSystem/measure-scoring"></system>
               <code value="proportion"></code>
               <display value="Proportion"></display>
            </coding>
         </valueCodeableConcept>
      </extension>
      <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis">
         <valueCode value="boolean"></valueCode>
      </extension>
      <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-type">
         <valueCodeableConcept>
            <coding>
               <system value="http://terminology.hl7.org/CodeSystem/measure-type"></system>
               <code value="process"></code>
               <display value="Process"></display>
            </coding>
         </valueCodeableConcept>
      </extension>
      <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-improvementNotation">
         <valueCodeableConcept>
            <coding>
               <system value="http://terminology.hl7.org/CodeSystem/measure-improvement-notation"></system>
               <code value="increase"></code>
               <display value="Increased score indicates improvement"></display>
            </coding>
         </valueCodeableConcept>
      </extension>
      <population id="InitialPopulation_1">
         <code>
            <coding>
               <system value="http://terminology.hl7.org/CodeSystem/measure-population"></system>
               <code value="initial-population"></code>
               <display value="Initial Population"></display>
            </coding>
         </code>
         <description value="All patients aged 18 years and older with two qualifying encounters during the measurement period and a diagnosis of heart failure on or before at least one qualifying encounter
"></description>
         <criteria>
            <language value="text/cql-identifier"></language>
            <expression value="Initial Population"></expression>
         </criteria>
      </population>
      <population id="Denominator_1">
         <code>
            <coding>
               <system value="http://terminology.hl7.org/CodeSystem/measure-population"></system>
               <code value="denominator"></code>
               <display value="Denominator"></display>
            </coding>
         </code>
         <description value="Equals Initial Population with a current or prior LVEF \&lt;= 40%
"></description>
         <criteria>
            <language value="text/cql-identifier"></language>
            <expression value="Denominator"></expression>
         </criteria>
      </population>
      <population id="DenominatorExclusion_1">
         <code>
            <coding>
               <system value="http://terminology.hl7.org/CodeSystem/measure-population"></system>
               <code value="denominator-exclusion"></code>
               <display value="Denominator Exclusion"></display>
            </coding>
         </code>
         <description value="Patients with a history of heart transplant or with a Left Ventricular Assist Device (LVAD) prior to the end of the outpatient encounter with Moderate or Severe LVSD
"></description>
         <criteria>
            <language value="text/cql-identifier"></language>
            <expression value="Denominator Exclusions"></expression>
         </criteria>
      </population>
      <population id="Numerator_1">
         <code>
            <coding>
               <system value="http://terminology.hl7.org/CodeSystem/measure-population"></system>
               <code value="numerator"></code>
               <display value="Numerator"></display>
            </coding>
         </code>
         <description value="Patients who were prescribed or already taking ACE inhibitor or ARB or ARNI therapy during the measurement period
"></description>
         <criteria>
            <language value="text/cql-identifier"></language>
            <expression value="Numerator"></expression>
         </criteria>
      </population>
      <population id="DenominatorException_1">
         <code>
            <coding>
               <system value="http://terminology.hl7.org/CodeSystem/measure-population"></system>
               <code value="denominator-exception"></code>
               <display value="Denominator Exception"></display>
            </coding>
         </code>
         <description value="* Documentation of medical reason(s) for not prescribing ACE inhibitor or ARB or ARNI therapy (e.g., pregnancy, renal failure due to ACEI, allergy, intolerance, other medical reasons).

* Documentation of patient reason(s) for not prescribing ACE inhibitor or ARB or ARNI therapy (e.g., patient declined, other patient reasons).

"></description>
         <criteria>
            <language value="text/cql-identifier"></language>
            <expression value="Denominator Exceptions"></expression>
         </criteria>
      </population>
   </group>
   <supplementalData id="sde-ethnicity">
      <usage>
         <coding>
            <system value="http://terminology.hl7.org/CodeSystem/measure-data-usage"></system>
            <code value="supplemental-data"></code>
         </coding>
      </usage>
      <description value="SDE Ethnicity
"></description>
      <criteria>
         <language value="text/cql-identifier"></language>
         <expression value="SDE Ethnicity"></expression>
      </criteria>
   </supplementalData>
   <supplementalData id="sde-payer">
      <usage>
         <coding>
            <system value="http://terminology.hl7.org/CodeSystem/measure-data-usage"></system>
            <code value="supplemental-data"></code>
         </coding>
      </usage>
      <description value="SDE Payer
"></description>
      <criteria>
         <language value="text/cql-identifier"></language>
         <expression value="SDE Payer"></expression>
      </criteria>
   </supplementalData>
   <supplementalData id="sde-race">
      <usage>
         <coding>
            <system value="http://terminology.hl7.org/CodeSystem/measure-data-usage"></system>
            <code value="supplemental-data"></code>
         </coding>
      </usage>
      <description value="SDE Race
"></description>
      <criteria>
         <language value="text/cql-identifier"></language>
         <expression value="SDE Race"></expression>
      </criteria>
   </supplementalData>
   <supplementalData id="sde-sex">
      <usage>
         <coding>
            <system value="http://terminology.hl7.org/CodeSystem/measure-data-usage"></system>
            <code value="supplemental-data"></code>
         </coding>
      </usage>
      <description value="SDE Sex
"></description>
      <criteria>
         <language value="text/cql-identifier"></language>
         <expression value="SDE Sex"></expression>
      </criteria>
   </supplementalData>
</Measure>