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         <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">Bone Density Evaluation for Patients with Prostate Cancer and Receiving Androgen Deprivation TherapyFHIR</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">CMS645FHIR</td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">GUID (Version Independent)</th> 
                  <td class="content-container">urn:uuid:299de9c4-755d-4f5a-ac9e-fa74fe34f759</td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">GUID (Version Specific)</th> 
                  <td class="content-container">urn:uuid:5cd769d8-9a63-4637-b18e-76ee9c68cbf9</td> 
               </tr>  
               <tr> 
                  <th scope="row" class="row-header">CMS Identifier</th> 
                  <td class="content-container">645FHIR</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">Oregon Urology</td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Developer</th> 
                  <td class="content-container">Oregon Urology</td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Description</th> 
                  <td class="content-container">
                     <p>Percentage of patients determined as having prostate cancer who are currently starting or undergoing androgen deprivation therapy (ADT), for an anticipated period of 12 months or greater and who receive an initial bone density evaluation. The bone density evaluation must be prior to the start of ADT or within 3 months of the start of ADT.</p>
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Copyright</th> 
                  <td class="content-container">
                     <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. Oregon Urology Institute (OUI) and Large Urology Group Practice Association (LUGPA) disclaim all liability for the use or accuracy of third-party codes contained in the specifications.</p> 
                     <p>CPT(R) contained in the Measure specifications is copyright 2004-2024. American Medical Association. LOINC(R) copyright 2004-2024 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2024. International Health Terminology Standards Development Organisation. ICD-10 copyright 2024 World Health Organization. All Rights Reserved.</p>
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Disclaimer</th> 
                  <td class="content-container">
                     <p>The performance measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications.</p> 
                     <p>THE MEASURES AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND.</p> 
                     <p>Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].</p>
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Rationale</th> 
                  <td class="content-container">
                     <p>Androgen suppression as a treatment for prostate cancer can cause osteoporosis (Qaseem, 2008). Patients with prostate cancer undergoing prolonged androgen deprivation therapy (ADT) incur bone loss at a rate higher than menopausal patients (Guise, 2007). In preserving bone health, the goal is to prevent or treat osteopenia/osteoporosis for the patient on ADT and to prevent or delay skeletal-related events. The National Osteoporosis Foundation recommendations include a baseline assessment of bone density with a dual-energy X-ray absorptiometry (DEXA) scan and daily calcium and Vitamin D supplementation (Watts, 2012). The DEXA scan is the gold standard for bone density screening. Patients at risk for adverse bone consequences from chronic ADT do not always receive care according to evidence-based guidelines. These findings call for improved processes that standardize evidence-based practice, including baseline and follow-up bone density assessment (Watts, 2012).</p>
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Clinical Recommendation Statement</th> 
                  <td class="content-container">
                     <p>Bone density screening should be performed at the start of Androgen Deprivation Therapy (ADT) for prostate cancer. It should also be performed every 2 years for the patient with continued ADT or for patients with known osteoporosis. Current insurance practice is to possibly cover the cost of bone density screening if osteoporosis is known or if there is a high-risk drug. Some patients choose to delay bone density screening until after ADT is started and they therefore have insurance authorization due to the administration of a high-risk drug.</p>
                  </td> 
               </tr> 
               <tr>   
                  <th scope="row" class="row-header">Citation</th>  
                  <td class="content-container">  
                     <p>Cosman, F., deBeur, S.J., LeBoff, M.S., Lewiecki, E. M., Tanner, B., Randall, S., &amp; Lindsay, R. (2014). Clinician’s Guide to Prevention and Treatment of Osteoporosis. Osteoporosis International, 25(10), 2359–2381. https://doi.org/10.1007/s00198-014-2794-2</p>   
                  </td> 
               </tr> 
               <tr>   
                  <th scope="row" class="row-header">Citation</th>  
                  <td class="content-container">  
                     <p>Finkelstein, J., &amp; Yu, E. (2017). Clinical manifestations, diagnosis, and evaluation of osteoporosis in men. Retrieved from https://www.uptodate.com/contents/clinical-manifestations-diagnosis-and-evaluation-of-osteoporosis-in-men/print?source=see_link</p>   
                  </td> 
               </tr> 
               <tr>   
                  <th scope="row" class="row-header">Citation</th>  
                  <td class="content-container">  
                     <p>Guise, T.A., Oefelein, M.G., Eastham, J.A., Cookson, M.S., Higano, C.S., &amp; Smith, M.R. (2007). Estrogenic side effects of androgen deprivation therapy. Reviews in urology, 9(4), 163-180.</p>   
                  </td> 
               </tr> 
               <tr>   
                  <th scope="row" class="row-header">Citation</th>  
                  <td class="content-container">  
                     <p>Qaseem, A., Snow, V., Shekelle, P., Hopkins, R., Forciea, M. A., Owens, D. K., &amp; for the Clinical Efficacy Assessment Subcommittee of the American College of Physicians. (2008). Annals of Internal Medicine. Screening for osteoporosis in men: A clinical practice guideline from the American College of Physicians, 2008. Annals of Internal Medicine, 148(9), 680-684. https://doi.org/10.7326/0003-4819-148-9-200805060-00008</p>   
                  </td> 
               </tr> 
               <tr>   
                  <th scope="row" class="row-header">Citation</th>  
                  <td class="content-container">  
                     <p>Ward, R. J., Roberts, C. C., Bencardino, J. T., Arnold, E., Baccei, S. J., Cassidy, R. C., … Weissman, B. N. (2017). ACR Appropriateness Criteria (R) Osteoporosis and Bone Mineral Density. Journal of the American College of Radiology, 14(5), S189–S202. https://doi.org/10.1016/j.jacr.2017.02.018</p>   
                  </td> 
               </tr> 
               <tr>   
                  <th scope="row" class="row-header">Citation</th>  
                  <td class="content-container">  
                     <p>Watts, N. B., Adler, R. A., Bilezikian, J. P., Drake, M. T., Eastell, R., Orwoll, E. S., &amp; Finkelstein, J. S. (2012). Osteoporosis in Men: An Endocrine Society Clinical Practice Guideline. The Journal of Clinical Endocrinology &amp; Metabolism, 97(6), 1802–1822. https://doi.org/10.1210/jc.2011-3045</p>   
                  </td> 
               </tr>  
               <tr> 
                  <th scope="row" class="row-header">Definition</th> 
                  <td class="content-container">Dual Energy X-ray Absorptiometry (DEXA): 
                     <p>A scan that measures the bone of the spine, hip, or total body and measures bone mineral density. It is considered one of the most accurate measurements.</p>
                  </td> 
               </tr>  
               <tr> 
                  <th scope="row" class="row-header">Definition</th> 
                  <td class="content-container">First Androgen Deprivation Therapy: 
                     <p>The first Androgen Deprivation Therapy (ADT) is measured as the first order or administration of ADT for an anticipated period of 12 months or greater to a patient with prostate cancer.</p>
                  </td> 
               </tr>  
               <tr> 
                  <th scope="row" class="row-header">Definition</th> 
                  <td class="content-container">Peripheral Dual Energy X-ray Absorptiometry (PDXA): 
                     <p>Bone mineral density measurement of the wrist, heel, or finger.</p>
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Guidance (Usage)</th> 
                  <td class="content-container">
                     <p>In order to capture the practitioner's intent of androgen deprivation therapy (ADT) for a period of 12 months or greater, SNOMEDCT 456381000124102 which is Injection of leuprolide acetate for the twelve-month period (regime/therapy) is the correct code.</p> 
                     <p>This eCQM is a patient-based measure.</p> 
                     <p>This FHIR-based measure has been derived from the QDM-based measure CMS645v9. 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>Patients with a qualifying encounter in the measurement period AND with a diagnosis of prostate cancer AND with an order for ADT or an active medication of ADT with an intent for treatment greater than or equal to 12 months during the measurement period AND order for ADT in 3 months before to 9 months after the start of the measurement period</p>
                     </p>   
                     <em>Logic Definition</em>: 
                     <a href="#primary-cms645fhirbonedensitypcadtherapy-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</p>
                     </p>   
                     <em>Logic Definition</em>: 
                     <a href="#primary-cms645fhirbonedensitypcadtherapy-denominator">Denominator</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 with a bone density evaluation within the two years prior to the start of or less than three months after the start of ADT treatment</p>
                     </p>   
                     <em>Logic Definition</em>: 
                     <a href="#primary-cms645fhirbonedensitypcadtherapy-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">
                        <p>Patient refused the bone density evaluation at the time ordered or did not have it performed within 3 months after the start of ADT</p>
                     </p>   
                     <em>Logic Definition</em>: 
                     <a href="#primary-cms645fhirbonedensitypcadtherapy-denominator-exception">Denominator Exception</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="#cms645fhirbonedensitypcadtherapy-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="#cms645fhirbonedensitypcadtherapy-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="#cms645fhirbonedensitypcadtherapy-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="#cms645fhirbonedensitypcadtherapy-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/CMS645FHIRBoneDensityPCADTherapy</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-cms645fhirbonedensitypcadtherapy-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":
  "Has Qualifying Encounter"
    and exists "Order for 12 Months of ADT in 3 Months Before to 9 Months After Start of Measurement Period"</code></pre> 
                  </td> 
               </tr>                               
               <tr> 
                  <th scope="row" rowspan="2" class="row-header">  
                     <a name="primary-cms645fhirbonedensitypcadtherapy-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"</code></pre> 
                  </td> 
               </tr>                        
               <tr> 
                  <th scope="row" rowspan="2" class="row-header">  
                     <a name="primary-cms645fhirbonedensitypcadtherapy-numerator"> </a>  Numerator  
                  </th> 
               </tr> 
               <tr> 
                  <td> 
                     <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Numerator":
  "Has Baseline DEXA Scan Two Years Prior to the Start of or Less than Three Months After the Start of ADT"</code></pre> 
                  </td> 
               </tr>                                 
               <tr> 
                  <th scope="row" rowspan="2" class="row-header">  
                     <a name="primary-cms645fhirbonedensitypcadtherapy-denominator-exception"> </a>  Denominator Exception  
                  </th> 
               </tr> 
               <tr> 
                  <td> 
                     <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Denominator Exception":
  exists ( "No Bone Density Scan Ordered Due to Patient Refusal" )
    or exists ( "No Bone Density Scan Performed Due to Patient Refusal" )</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="cms645fhirbonedensitypcadtherapy-sde-sex"> </a> Logic Definition 
                  </th> 
                  <td class="content-container">
                     <em>Library Name:</em> CMS645FHIRBoneDensityPCADTherapy
                  </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="cms645fhirbonedensitypcadtherapy-androgen-deprivation-therapy-for-urology-care-medication-active-start-dates"> </a> Logic Definition 
                  </th> 
                  <td class="content-container">
                     <em>Library Name:</em> CMS645FHIRBoneDensityPCADTherapy
                  </td> 
               </tr> 
               <tr> 
                  <td> 
                     <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Androgen Deprivation Therapy for Urology Care Medication Active Start Dates":
  [MedicationRequest: "Androgen Deprivation Therapy for Urology Care"] ADTActive
    let firstMedicationPeriod: First((collapse(ADTActive.dosageInstruction.timing.repeat.bounds DoseTime
          return DoseTime.toInterval()
      )) DrugPeriods
        sort by start of $this
    ),

    //get the very first event as interval
    
    firstMedicationEvent: First((ADTActive.dosageInstruction.timing dosageTiming
        //returns first event for the specific dosageTiming
        
        return First(dosageTiming.event dosageTimingEvents
            sort ascending
        )) firstEvents
        sort ascending
    ),
    medicationDateTime: Min({ firstMedicationEvent, start of firstMedicationPeriod, 
      end of firstMedicationPeriod }
    )
    where ADTActive.status in { 'active', 'completed' }
      and ADTActive.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
    return medicationDateTime</code></pre> 
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" rowspan="2" class="row-header">  
                     <a name="cms645fhirbonedensitypcadtherapy-androgen-deprivation-therapy-for-urology-care-medication-order-start-dates"> </a> Logic Definition 
                  </th> 
                  <td class="content-container">
                     <em>Library Name:</em> CMS645FHIRBoneDensityPCADTherapy
                  </td> 
               </tr> 
               <tr> 
                  <td> 
                     <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Androgen Deprivation Therapy for Urology Care Medication Order Start Dates":
  [MedicationRequest: "Androgen Deprivation Therapy for Urology Care"] ADTOrder
    let firstMedicationPeriod: First((collapse(ADTOrder.dosageInstruction.timing.repeat.bounds DoseTime
          return DoseTime.toInterval()
      )) DrugPeriods
        sort by start of $this
    ),
    medicationDateTime: Min({ ADTOrder.authoredOn, start of firstMedicationPeriod, 
      end of firstMedicationPeriod }
    )
    where ADTOrder.status in { 'active', 'completed' }
      and ADTOrder.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
    return medicationDateTime</code></pre> 
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" rowspan="2" class="row-header">  
                     <a name="cms645fhirbonedensitypcadtherapy-prostate-cancer-diagnosis"> </a> Logic Definition 
                  </th> 
                  <td class="content-container">
                     <em>Library Name:</em> CMS645FHIRBoneDensityPCADTherapy
                  </td> 
               </tr> 
               <tr> 
                  <td> 
                     <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Prostate Cancer Diagnosis":
  ( [ConditionProblemsHealthConcerns: "Prostate Cancer"]
    union [ConditionEncounterDiagnosis: "Prostate Cancer"] ) ProstateCancer
    where ProstateCancer.prevalenceInterval ( ) overlaps day of "Measurement Period"
      and ProstateCancer.isVerified ( )</code></pre> 
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" rowspan="2" class="row-header">  
                     <a name="cms645fhirbonedensitypcadtherapy-first-adt-in-3-months-before-to-9-months-after-start-of-measurement-period"> </a> Logic Definition 
                  </th> 
                  <td class="content-container">
                     <em>Library Name:</em> CMS645FHIRBoneDensityPCADTherapy
                  </td> 
               </tr> 
               <tr> 
                  <td> 
                     <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "First ADT in 3 Months Before to 9 Months After Start of Measurement Period":
  First(("Androgen Deprivation Therapy for Urology Care Medication Active Start Dates"
      union "Androgen Deprivation Therapy for Urology Care Medication Order Start Dates") ADTDateTime
      with "Prostate Cancer Diagnosis" ProstateCancer
        such that ADTDateTime during day of ProstateCancer.prevalenceInterval()
          and ADTDateTime during day of Interval[start of "Measurement Period" - 3 months, start of "Measurement Period" + 9 months]
      sort ascending
  )</code></pre> 
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" rowspan="2" class="row-header">  
                     <a name="cms645fhirbonedensitypcadtherapy-order-for-12-months-of-adt-in-3-months-before-to-9-months-after-start-of-measurement-period"> </a> Logic Definition 
                  </th> 
                  <td class="content-container">
                     <em>Library Name:</em> CMS645FHIRBoneDensityPCADTherapy
                  </td> 
               </tr> 
               <tr> 
                  <td> 
                     <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Order for 12 Months of ADT in 3 Months Before to 9 Months After Start of Measurement Period":
  [ServiceRequest: "Injection of leuprolide acetate for twelve month period (regime/therapy)"] OrderTwelveMonthADT
    with "First ADT in 3 Months Before to 9 Months After Start of Measurement Period" FirstADTMP
      such that OrderTwelveMonthADT.authoredOn on or after day of FirstADTMP
        and OrderTwelveMonthADT.authoredOn during day of Interval[start of "Measurement Period" - 3 months, start of "Measurement Period" + 9 months]
        and OrderTwelveMonthADT.status in { 'active', 'completed' }
        and OrderTwelveMonthADT.intent = 'order'</code></pre> 
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" rowspan="2" class="row-header">  
                     <a name="cms645fhirbonedensitypcadtherapy-has-baseline-dexa-scan-two-years-prior-to-the-start-of-or-less-than-three-months-after-the-start-of-adt"> </a> Logic Definition 
                  </th> 
                  <td class="content-container">
                     <em>Library Name:</em> CMS645FHIRBoneDensityPCADTherapy
                  </td> 
               </tr> 
               <tr> 
                  <td> 
                     <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Has Baseline DEXA Scan Two Years Prior to the Start of or Less than Three Months After the Start of ADT":
  exists ( ( [ServiceRequest: "DEXA Bone Density for Urology Care"] DEXAOrdered
        with "Order for 12 Months of ADT in 3 Months Before to 9 Months After Start of Measurement Period" OrderTwelveMonthsADT
          such that DEXAOrdered.authoredOn 3 months or less on or after day of OrderTwelveMonthsADT.authoredOn
            or DEXAOrdered.authoredOn 2 years or less before day of OrderTwelveMonthsADT.authoredOn
        where DEXAOrdered.status in { 'active', 'completed' }
          and DEXAOrdered.intent = 'order'
    )
      union ( [ObservationClinicalResult: "DEXA Bone Density for Urology Care"] DEXAPerformed
          with "Order for 12 Months of ADT in 3 Months Before to 9 Months After Start of Measurement Period" OrderTwelveMonthsADT
            such that DEXAPerformed.effective.toInterval ( ) 3 months or less on or after day of OrderTwelveMonthsADT.authoredOn
              or DEXAPerformed.effective.toInterval ( ) 2 years or less before day of OrderTwelveMonthsADT.authoredOn
          where DEXAPerformed.status in { 'final', 'amended', 'corrected' }
      )
  )</code></pre> 
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" rowspan="2" class="row-header">  
                     <a name="cms645fhirbonedensitypcadtherapy-numerator"> </a> Logic Definition 
                  </th> 
                  <td class="content-container">
                     <em>Library Name:</em> CMS645FHIRBoneDensityPCADTherapy
                  </td> 
               </tr> 
               <tr> 
                  <td> 
                     <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Numerator":
  "Has Baseline DEXA Scan Two Years Prior to the Start of or Less than Three Months After the Start of ADT"</code></pre> 
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" rowspan="2" class="row-header">  
                     <a name="cms645fhirbonedensitypcadtherapy-no-bone-density-scan-ordered-due-to-patient-refusal"> </a> Logic Definition 
                  </th> 
                  <td class="content-container">
                     <em>Library Name:</em> CMS645FHIRBoneDensityPCADTherapy
                  </td> 
               </tr> 
               <tr> 
                  <td> 
                     <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "No Bone Density Scan Ordered Due to Patient Refusal":
  [ServiceNotRequested: "DEXA Bone Density for Urology Care"] DEXANotOrdered
    with "Order for 12 Months of ADT in 3 Months Before to 9 Months After Start of Measurement Period" OrderTwelveMonthsADT
      such that DEXANotOrdered.authoredOn 3 months or less on or after day of OrderTwelveMonthsADT.authoredOn
        and DEXANotOrdered.reasonRefused in "Patient Declined"</code></pre> 
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" rowspan="2" class="row-header">  
                     <a name="cms645fhirbonedensitypcadtherapy-no-bone-density-scan-performed-due-to-patient-refusal"> </a> Logic Definition 
                  </th> 
                  <td class="content-container">
                     <em>Library Name:</em> CMS645FHIRBoneDensityPCADTherapy
                  </td> 
               </tr> 
               <tr> 
                  <td> 
                     <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "No Bone Density Scan Performed Due to Patient Refusal":
  [ObservationCancelled: "DEXA Bone Density for Urology Care"] DEXANotPerformed
    with "Order for 12 Months of ADT in 3 Months Before to 9 Months After Start of Measurement Period" OrderTwelveMonthsADT
      such that DEXANotPerformed.issued 3 months or less on or after day of OrderTwelveMonthsADT.authoredOn
        and DEXANotPerformed.notDoneReason in "Patient Declined"</code></pre> 
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" rowspan="2" class="row-header">  
                     <a name="cms645fhirbonedensitypcadtherapy-denominator-exception"> </a> Logic Definition 
                  </th> 
                  <td class="content-container">
                     <em>Library Name:</em> CMS645FHIRBoneDensityPCADTherapy
                  </td> 
               </tr> 
               <tr> 
                  <td> 
                     <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Denominator Exception":
  exists ( "No Bone Density Scan Ordered Due to Patient Refusal" )
    or exists ( "No Bone Density Scan Performed Due to Patient Refusal" )</code></pre> 
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" rowspan="2" class="row-header">  
                     <a name="cms645fhirbonedensitypcadtherapy-has-qualifying-encounter"> </a> Logic Definition 
                  </th> 
                  <td class="content-container">
                     <em>Library Name:</em> CMS645FHIRBoneDensityPCADTherapy
                  </td> 
               </tr> 
               <tr> 
                  <td> 
                     <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Has Qualifying Encounter":
  exists ( ["Encounter": "Office Visit"] OfficeVisit
      where OfficeVisit.period during day of "Measurement Period"
        and OfficeVisit.status = 'finished'
  )</code></pre> 
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" rowspan="2" class="row-header">  
                     <a name="cms645fhirbonedensitypcadtherapy-initial-population"> </a> Logic Definition 
                  </th> 
                  <td class="content-container">
                     <em>Library Name:</em> CMS645FHIRBoneDensityPCADTherapy
                  </td> 
               </tr> 
               <tr> 
                  <td> 
                     <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Initial Population":
  "Has Qualifying Encounter"
    and exists "Order for 12 Months of ADT in 3 Months Before to 9 Months After Start of Measurement Period"</code></pre> 
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" rowspan="2" class="row-header">  
                     <a name="cms645fhirbonedensitypcadtherapy-denominator"> </a> Logic Definition 
                  </th> 
                  <td class="content-container">
                     <em>Library Name:</em> CMS645FHIRBoneDensityPCADTherapy
                  </td> 
               </tr> 
               <tr> 
                  <td> 
                     <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Denominator":
  "Initial Population"</code></pre> 
                  </td> 
               </tr>  
               <tr> 
                  <th scope="row" rowspan="2" class="row-header">  
                     <a name="cms645fhirbonedensitypcadtherapy-sde-payer"> </a> Logic Definition 
                  </th> 
                  <td class="content-container">
                     <em>Library Name:</em> CMS645FHIRBoneDensityPCADTherapy
                  </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="cms645fhirbonedensitypcadtherapy-sde-ethnicity"> </a> Logic Definition 
                  </th> 
                  <td class="content-container">
                     <em>Library Name:</em> CMS645FHIRBoneDensityPCADTherapy
                  </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="cms645fhirbonedensitypcadtherapy-sde-race"> </a> Logic Definition 
                  </th> 
                  <td class="content-container">
                     <em>Library Name:</em> CMS645FHIRBoneDensityPCADTherapy
                  </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="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 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">Value Set</th>  
                  <td class="content-container"> 
                     <em>Description</em>: Value set DEXA Bone Density for Urology Care  
                     <br></br>    
                     <em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.359 
                     <br></br> 
                     <em>Canonical URL</em>: 
                     <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.359</tt> 
                  </td> 
               </tr> 
               <tr>  
                  <th scope="row" class="row-header">Value Set</th>  
                  <td class="content-container"> 
                     <em>Description</em>: Value set Androgen Deprivation Therapy for Urology Care  
                     <br></br>    
                     <em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.352 
                     <br></br> 
                     <em>Canonical URL</em>: 
                     <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.352</tt> 
                  </td> 
               </tr> 
               <tr>  
                  <th scope="row" class="row-header">Value Set</th>  
                  <td class="content-container"> 
                     <em>Description</em>: Value set Prostate Cancer  
                     <br></br>    
                     <em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.319 
                     <br></br> 
                     <em>Canonical URL</em>: 
                     <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.319</tt> 
                  </td> 
               </tr> 
               <tr>  
                  <th scope="row" class="row-header">Value Set</th>  
                  <td class="content-container"> 
                     <em>Description</em>: Value set Patient Declined  
                     <br></br>    
                     <em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1582 
                     <br></br> 
                     <em>Canonical URL</em>: 
                     <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1582</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 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">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>: Injection of leuprolide acetate for twelve month period (regime/therapy) 
                     <br></br> 
                     <em>Code</em>: 456381000124102 
                     <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 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, url 
                     <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, dosageInstruction, status, status.value, intent, intent.value, authoredOn, authoredOn.value 
                     <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/2.16.840.1.113762.1.4.1248.352 
                     <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.reference.value, dosageInstruction, status, status.value, intent, intent.value, authoredOn, authoredOn.value 
                     <br></br>  
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Data Requirement</th> 
                  <td class="content-container"> 
                     <em>Type</em>: Medication 
                     <br></br> 
                     <em>Profile(s)</em>:  http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medication 
                     <br></br>   
                     <em>Must Support Elements</em>: id.value, code 
                     <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/2.16.840.1.113883.3.526.3.319 
                     <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/2.16.840.1.113883.3.526.3.319 
                     <br></br>   
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Data Requirement</th> 
                  <td class="content-container"> 
                     <em>Type</em>: ServiceRequest 
                     <br></br> 
                     <em>Profile(s)</em>:  http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-servicerequest 
                     <br></br>   
                     <em>Must Support Elements</em>: code, authoredOn, authoredOn.value, status, status.value, intent, intent.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>Code(s)</em>:  http://snomed.info/sct#456381000124102: 'Injection of leuprolide acetate for twelve month period (regime/therapy)'  
                     </span> 
                     <br></br>  
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Data Requirement</th> 
                  <td class="content-container"> 
                     <em>Type</em>: ServiceRequest 
                     <br></br> 
                     <em>Profile(s)</em>:  http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-servicerequest 
                     <br></br>   
                     <em>Must Support Elements</em>: code, authoredOn, authoredOn.value, status, status.value, intent, intent.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/2.16.840.1.113762.1.4.1248.359 
                     <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, effective, 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/2.16.840.1.113762.1.4.1248.359 
                     <br></br>   
                  </td> 
               </tr> 
               <tr> 
                  <th scope="row" class="row-header">Data Requirement</th> 
                  <td class="content-container"> 
                     <em>Type</em>: ServiceRequest 
                     <br></br> 
                     <em>Profile(s)</em>:  http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-servicenotrequested 
                     <br></br>   
                     <em>Must Support Elements</em>: code, authoredOn, authoredOn.value, extension 
                     <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/2.16.840.1.113762.1.4.1248.359 
                     <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-observationcancelled 
                     <br></br>   
                     <em>Must Support Elements</em>: code, issued, issued.value, extension 
                     <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/2.16.840.1.113762.1.4.1248.359 
                     <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, status, status.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>: 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 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://snomed.info/sct"></system>
               <code value="456381000124102"></code>
               <display value="Injection of leuprolide acetate for twelve month period (regime/therapy)"></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="CMS645FHIRBoneDensityPCADTherapy"></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="CMS645FHIRBoneDensityPCADTherapy"></valueString>
            </extension>
            <extension url="name">
               <valueString value="Androgen Deprivation Therapy for Urology Care Medication Active Start Dates"></valueString>
            </extension>
            <extension url="statement">
               <valueString value="define &quot;Androgen Deprivation Therapy for Urology Care Medication Active Start Dates&quot;:
  [MedicationRequest: &quot;Androgen Deprivation Therapy for Urology Care&quot;] ADTActive
    let firstMedicationPeriod: First((collapse(ADTActive.dosageInstruction.timing.repeat.bounds DoseTime
          return DoseTime.toInterval()
      )) DrugPeriods
        sort by start of $this
    ),

    //get the very first event as interval
    
    firstMedicationEvent: First((ADTActive.dosageInstruction.timing dosageTiming
        //returns first event for the specific dosageTiming
        
        return First(dosageTiming.event dosageTimingEvents
            sort ascending
        )) firstEvents
        sort ascending
    ),
    medicationDateTime: Min({ firstMedicationEvent, start of firstMedicationPeriod, 
      end of firstMedicationPeriod }
    )
    where ADTActive.status in { 'active', 'completed' }
      and ADTActive.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
    return medicationDateTime"></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="CMS645FHIRBoneDensityPCADTherapy"></valueString>
            </extension>
            <extension url="name">
               <valueString value="Androgen Deprivation Therapy for Urology Care Medication Order Start Dates"></valueString>
            </extension>
            <extension url="statement">
               <valueString value="define &quot;Androgen Deprivation Therapy for Urology Care Medication Order Start Dates&quot;:
  [MedicationRequest: &quot;Androgen Deprivation Therapy for Urology Care&quot;] ADTOrder
    let firstMedicationPeriod: First((collapse(ADTOrder.dosageInstruction.timing.repeat.bounds DoseTime
          return DoseTime.toInterval()
      )) DrugPeriods
        sort by start of $this
    ),
    medicationDateTime: Min({ ADTOrder.authoredOn, start of firstMedicationPeriod, 
      end of firstMedicationPeriod }
    )
    where ADTOrder.status in { 'active', 'completed' }
      and ADTOrder.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
    return medicationDateTime"></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="CMS645FHIRBoneDensityPCADTherapy"></valueString>
            </extension>
            <extension url="name">
               <valueString value="Prostate Cancer Diagnosis"></valueString>
            </extension>
            <extension url="statement">
               <valueString value="define &quot;Prostate Cancer Diagnosis&quot;:
  ( [ConditionProblemsHealthConcerns: &quot;Prostate Cancer&quot;]
    union [ConditionEncounterDiagnosis: &quot;Prostate Cancer&quot;] ) ProstateCancer
    where ProstateCancer.prevalenceInterval ( ) overlaps day of &quot;Measurement Period&quot;
      and ProstateCancer.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="CMS645FHIRBoneDensityPCADTherapy"></valueString>
            </extension>
            <extension url="name">
               <valueString value="First ADT in 3 Months Before to 9 Months After Start of Measurement Period"></valueString>
            </extension>
            <extension url="statement">
               <valueString value="define &quot;First ADT in 3 Months Before to 9 Months After Start of Measurement Period&quot;:
  First((&quot;Androgen Deprivation Therapy for Urology Care Medication Active Start Dates&quot;
      union &quot;Androgen Deprivation Therapy for Urology Care Medication Order Start Dates&quot;) ADTDateTime
      with &quot;Prostate Cancer Diagnosis&quot; ProstateCancer
        such that ADTDateTime during day of ProstateCancer.prevalenceInterval()
          and ADTDateTime during day of Interval[start of &quot;Measurement Period&quot; - 3 months, start of &quot;Measurement Period&quot; + 9 months]
      sort ascending
  )"></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="CMS645FHIRBoneDensityPCADTherapy"></valueString>
            </extension>
            <extension url="name">
               <valueString value="Order for 12 Months of ADT in 3 Months Before to 9 Months After Start of Measurement Period"></valueString>
            </extension>
            <extension url="statement">
               <valueString value="define &quot;Order for 12 Months of ADT in 3 Months Before to 9 Months After Start of Measurement Period&quot;:
  [ServiceRequest: &quot;Injection of leuprolide acetate for twelve month period (regime/therapy)&quot;] OrderTwelveMonthADT
    with &quot;First ADT in 3 Months Before to 9 Months After Start of Measurement Period&quot; FirstADTMP
      such that OrderTwelveMonthADT.authoredOn on or after day of FirstADTMP
        and OrderTwelveMonthADT.authoredOn during day of Interval[start of &quot;Measurement Period&quot; - 3 months, start of &quot;Measurement Period&quot; + 9 months]
        and OrderTwelveMonthADT.status in { 'active', 'completed' }
        and OrderTwelveMonthADT.intent = 'order'"></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="CMS645FHIRBoneDensityPCADTherapy"></valueString>
            </extension>
            <extension url="name">
               <valueString value="Has Baseline DEXA Scan Two Years Prior to the Start of or Less than Three Months After the Start of ADT"></valueString>
            </extension>
            <extension url="statement">
               <valueString value="define &quot;Has Baseline DEXA Scan Two Years Prior to the Start of or Less than Three Months After the Start of ADT&quot;:
  exists ( ( [ServiceRequest: &quot;DEXA Bone Density for Urology Care&quot;] DEXAOrdered
        with &quot;Order for 12 Months of ADT in 3 Months Before to 9 Months After Start of Measurement Period&quot; OrderTwelveMonthsADT
          such that DEXAOrdered.authoredOn 3 months or less on or after day of OrderTwelveMonthsADT.authoredOn
            or DEXAOrdered.authoredOn 2 years or less before day of OrderTwelveMonthsADT.authoredOn
        where DEXAOrdered.status in { 'active', 'completed' }
          and DEXAOrdered.intent = 'order'
    )
      union ( [ObservationClinicalResult: &quot;DEXA Bone Density for Urology Care&quot;] DEXAPerformed
          with &quot;Order for 12 Months of ADT in 3 Months Before to 9 Months After Start of Measurement Period&quot; OrderTwelveMonthsADT
            such that DEXAPerformed.effective.toInterval ( ) 3 months or less on or after day of OrderTwelveMonthsADT.authoredOn
              or DEXAPerformed.effective.toInterval ( ) 2 years or less before day of OrderTwelveMonthsADT.authoredOn
          where DEXAPerformed.status in { 'final', 'amended', 'corrected' }
      )
  )"></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="CMS645FHIRBoneDensityPCADTherapy"></valueString>
            </extension>
            <extension url="name">
               <valueString value="Numerator"></valueString>
            </extension>
            <extension url="statement">
               <valueString value="define &quot;Numerator&quot;:
  &quot;Has Baseline DEXA Scan Two Years Prior to the Start of or Less than Three Months After the Start of ADT&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="CMS645FHIRBoneDensityPCADTherapy"></valueString>
            </extension>
            <extension url="name">
               <valueString value="No Bone Density Scan Ordered Due to Patient Refusal"></valueString>
            </extension>
            <extension url="statement">
               <valueString value="define &quot;No Bone Density Scan Ordered Due to Patient Refusal&quot;:
  [ServiceNotRequested: &quot;DEXA Bone Density for Urology Care&quot;] DEXANotOrdered
    with &quot;Order for 12 Months of ADT in 3 Months Before to 9 Months After Start of Measurement Period&quot; OrderTwelveMonthsADT
      such that DEXANotOrdered.authoredOn 3 months or less on or after day of OrderTwelveMonthsADT.authoredOn
        and DEXANotOrdered.reasonRefused in &quot;Patient Declined&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="CMS645FHIRBoneDensityPCADTherapy"></valueString>
            </extension>
            <extension url="name">
               <valueString value="No Bone Density Scan Performed Due to Patient Refusal"></valueString>
            </extension>
            <extension url="statement">
               <valueString value="define &quot;No Bone Density Scan Performed Due to Patient Refusal&quot;:
  [ObservationCancelled: &quot;DEXA Bone Density for Urology Care&quot;] DEXANotPerformed
    with &quot;Order for 12 Months of ADT in 3 Months Before to 9 Months After Start of Measurement Period&quot; OrderTwelveMonthsADT
      such that DEXANotPerformed.issued 3 months or less on or after day of OrderTwelveMonthsADT.authoredOn
        and DEXANotPerformed.notDoneReason in &quot;Patient Declined&quot;"></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="CMS645FHIRBoneDensityPCADTherapy"></valueString>
            </extension>
            <extension url="name">
               <valueString value="Denominator Exception"></valueString>
            </extension>
            <extension url="statement">
               <valueString value="define &quot;Denominator Exception&quot;:
  exists ( &quot;No Bone Density Scan Ordered Due to Patient Refusal&quot; )
    or exists ( &quot;No Bone Density Scan Performed Due to Patient Refusal&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="CMS645FHIRBoneDensityPCADTherapy"></valueString>
            </extension>
            <extension url="name">
               <valueString value="Has Qualifying Encounter"></valueString>
            </extension>
            <extension url="statement">
               <valueString value="define &quot;Has Qualifying Encounter&quot;:
  exists ( [&quot;Encounter&quot;: &quot;Office Visit&quot;] OfficeVisit
      where OfficeVisit.period during day of &quot;Measurement Period&quot;
        and OfficeVisit.status = 'finished'
  )"></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="CMS645FHIRBoneDensityPCADTherapy"></valueString>
            </extension>
            <extension url="name">
               <valueString value="Initial Population"></valueString>
            </extension>
            <extension url="statement">
               <valueString value="define &quot;Initial Population&quot;:
  &quot;Has Qualifying Encounter&quot;
    and exists &quot;Order for 12 Months of ADT in 3 Months Before to 9 Months After Start of Measurement Period&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="CMS645FHIRBoneDensityPCADTherapy"></valueString>
            </extension>
            <extension url="name">
               <valueString value="Denominator"></valueString>
            </extension>
            <extension url="statement">
               <valueString value="define &quot;Denominator&quot;:
  &quot;Initial Population&quot;"></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="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="15"></valueInteger>
            </extension>
         </extension>
         <extension url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
               <valueString value="CMS645FHIRBoneDensityPCADTherapy"></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="16"></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="17"></valueInteger>
            </extension>
         </extension>
         <extension url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
               <valueString value="CMS645FHIRBoneDensityPCADTherapy"></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="18"></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="19"></valueInteger>
            </extension>
         </extension>
         <extension url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
               <valueString value="CMS645FHIRBoneDensityPCADTherapy"></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="20"></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="21"></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="22"></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="23"></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 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="Value set DEXA Bone Density for Urology Care"></display>
            <resource value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.359"></resource>
         </relatedArtifact>
         <relatedArtifact>
            <type value="depends-on"></type>
            <display value="Value set Androgen Deprivation Therapy for Urology Care"></display>
            <resource value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.352"></resource>
         </relatedArtifact>
         <relatedArtifact>
            <type value="depends-on"></type>
            <display value="Value set Prostate Cancer"></display>
            <resource value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.319"></resource>
         </relatedArtifact>
         <relatedArtifact>
            <type value="depends-on"></type>
            <display value="Value set Patient Declined"></display>
            <resource value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1582"></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 Payer Type"></display>
            <resource value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"></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 Exception"></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="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="url"></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="dosageInstruction"></mustSupport>
            <mustSupport value="status"></mustSupport>
            <mustSupport value="status.value"></mustSupport>
            <mustSupport value="intent"></mustSupport>
            <mustSupport value="intent.value"></mustSupport>
            <mustSupport value="authoredOn"></mustSupport>
            <mustSupport value="authoredOn.value"></mustSupport>
            <codeFilter>
               <path value="medication"></path>
               <valueSet value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.352"></valueSet>
            </codeFilter>
         </dataRequirement>
         <dataRequirement>
            <type value="MedicationRequest"></type>
            <profile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest"></profile>
            <mustSupport value="medication.reference.value"></mustSupport>
            <mustSupport value="dosageInstruction"></mustSupport>
            <mustSupport value="status"></mustSupport>
            <mustSupport value="status.value"></mustSupport>
            <mustSupport value="intent"></mustSupport>
            <mustSupport value="intent.value"></mustSupport>
            <mustSupport value="authoredOn"></mustSupport>
            <mustSupport value="authoredOn.value"></mustSupport>
         </dataRequirement>
         <dataRequirement>
            <type value="Medication"></type>
            <profile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medication"></profile>
            <mustSupport value="id.value"></mustSupport>
            <mustSupport value="code"></mustSupport>
         </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/2.16.840.1.113883.3.526.3.319"></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/2.16.840.1.113883.3.526.3.319"></valueSet>
            </codeFilter>
         </dataRequirement>
         <dataRequirement>
            <type value="ServiceRequest"></type>
            <profile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-servicerequest"></profile>
            <mustSupport value="code"></mustSupport>
            <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>
            <codeFilter>
               <path value="code"></path>
               <code>
                  <system value="http://snomed.info/sct"></system>
                  <code value="456381000124102"></code>
                  <display value="Injection of leuprolide acetate for twelve month period (regime/therapy)"></display>
               </code>
            </codeFilter>
         </dataRequirement>
         <dataRequirement>
            <type value="ServiceRequest"></type>
            <profile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-servicerequest"></profile>
            <mustSupport value="code"></mustSupport>
            <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>
            <codeFilter>
               <path value="code"></path>
               <valueSet value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.359"></valueSet>
            </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="effective"></mustSupport>
            <mustSupport value="status"></mustSupport>
            <mustSupport value="status.value"></mustSupport>
            <codeFilter>
               <path value="code"></path>
               <valueSet value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.359"></valueSet>
            </codeFilter>
         </dataRequirement>
         <dataRequirement>
            <type value="ServiceRequest"></type>
            <profile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-servicenotrequested"></profile>
            <mustSupport value="code"></mustSupport>
            <mustSupport value="authoredOn"></mustSupport>
            <mustSupport value="authoredOn.value"></mustSupport>
            <mustSupport value="extension"></mustSupport>
            <codeFilter>
               <path value="code"></path>
               <valueSet value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.359"></valueSet>
            </codeFilter>
         </dataRequirement>
         <dataRequirement>
            <type value="ServiceRequest"></type>
            <profile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-servicenotrequested"></profile>
            <mustSupport value="code"></mustSupport>
            <mustSupport value="authoredOn"></mustSupport>
            <mustSupport value="authoredOn.value"></mustSupport>
            <mustSupport value="extension"></mustSupport>
            <codeFilter>
               <path value="code"></path>
               <valueSet value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.359"></valueSet>
            </codeFilter>
         </dataRequirement>
         <dataRequirement>
            <type value="Observation"></type>
            <profile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observationcancelled"></profile>
            <mustSupport value="code"></mustSupport>
            <mustSupport value="issued"></mustSupport>
            <mustSupport value="issued.value"></mustSupport>
            <mustSupport value="extension"></mustSupport>
            <codeFilter>
               <path value="code"></path>
               <valueSet value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.359"></valueSet>
            </codeFilter>
         </dataRequirement>
         <dataRequirement>
            <type value="Observation"></type>
            <profile value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observationcancelled"></profile>
            <mustSupport value="code"></mustSupport>
            <mustSupport value="issued"></mustSupport>
            <mustSupport value="issued.value"></mustSupport>
            <mustSupport value="extension"></mustSupport>
            <codeFilter>
               <path value="code"></path>
               <valueSet value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.359"></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="status"></mustSupport>
            <mustSupport value="status.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="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>
      </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="Dual Energy X-ray Absorptiometry (DEXA)"></valueString>
      </extension>
      <extension url="definition">
         <valueMarkdown value="A scan that measures the bone of the spine, hip, or total body and measures bone mineral density. It is considered one of the most accurate measurements.
"></valueMarkdown>
      </extension>
   </extension>
   <extension url="http://hl7.org/fhir/StructureDefinition/cqf-definitionTerm">
      <extension url="term">
         <valueString value="First Androgen Deprivation Therapy"></valueString>
      </extension>
      <extension url="definition">
         <valueMarkdown value="The first Androgen Deprivation Therapy (ADT) is measured as the first order or administration of ADT for an anticipated period of 12 months or greater to a patient with prostate cancer.
"></valueMarkdown>
      </extension>
   </extension>
   <extension url="http://hl7.org/fhir/StructureDefinition/cqf-definitionTerm">
      <extension url="term">
         <valueString value="Peripheral Dual Energy X-ray Absorptiometry (PDXA)"></valueString>
      </extension>
      <extension url="definition">
         <valueMarkdown value="Bone mineral density measurement of the wrist, heel, or finger.
"></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/CMS645FHIRBoneDensityPCADTherapy"></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="CMS645FHIR"></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:299de9c4-755d-4f5a-ac9e-fa74fe34f759"></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:5cd769d8-9a63-4637-b18e-76ee9c68cbf9"></value>
   </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="645FHIR"></value>
      <assigner>
         <display value="CMS"></display>
      </assigner>
   </identifier>
   <version value="1.0.000"></version>
   <name value="CMS645FHIRBoneDensityPCADTherapy"></name>
   <title value="Bone Density Evaluation for Patients with Prostate Cancer and Receiving Androgen Deprivation TherapyFHIR
"></title>
   <status value="active"></status>
   <experimental value="false"></experimental>
   <date value="2025-08-22T18:20:09+00:00"></date>
   <publisher value="Oregon Urology"></publisher>
   <contact>
      <telecom>
         <system value="url"></system>
         <value value="www.oregonurology.com"></value>
      </telecom>
   </contact>
   <description value="Percentage of patients determined as having prostate cancer who are currently starting or undergoing androgen deprivation therapy (ADT), for an anticipated period of 12 months or greater and who receive an initial bone density evaluation. The bone density evaluation must be prior to the start of ADT or within 3 months of the start of ADT.
"></description>
   <usage value="In order to capture the practitioner's intent of androgen deprivation therapy (ADT) for a period of 12 months or greater, SNOMEDCT 456381000124102 which is Injection of leuprolide acetate for the twelve-month period (regime/therapy) is the correct code.

This eCQM is a patient-based measure.

This FHIR-based measure has been derived from the QDM-based measure CMS645v9. 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="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. Oregon Urology Institute (OUI) and Large Urology Group Practice Association (LUGPA) disclaim all liability for the use or accuracy of third-party codes contained in the specifications.

CPT(R) contained in the Measure specifications is copyright 2004-2024. American Medical Association. LOINC(R) copyright 2004-2024 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT\[R\]) copyright 2004-2024. International Health Terminology Standards Development Organisation. ICD-10 copyright 2024 World Health Organization. All Rights Reserved.
"></copyright>
   <effectivePeriod>
      <start value="2026-01-01"></start>
      <end value="2026-12-31"></end>
   </effectivePeriod>
   <author>
      <name value="Oregon Urology"></name>
      <telecom>
         <system value="url"></system>
         <value value="www.oregonurology.com"></value>
      </telecom>
   </author>
   <relatedArtifact>
      <type value="citation"></type>
      <citation value="Cosman, F., deBeur, S.J., LeBoff, M.S., Lewiecki, E. M., Tanner, B., Randall, S., \&amp; Lindsay, R. (2014). Clinician's Guide to Prevention and Treatment of Osteoporosis. Osteoporosis International, 25(10), 2359--2381. https://doi.org/10.1007/s00198-014-2794-2
"></citation>
   </relatedArtifact>
   <relatedArtifact>
      <type value="citation"></type>
      <citation value="Finkelstein, J., \&amp; Yu, E. (2017). Clinical manifestations, diagnosis, and evaluation of osteoporosis in men. Retrieved from https://www.uptodate.com/contents/clinical-manifestations-diagnosis-and-evaluation-of-osteoporosis-in-men/print?source=see_link
"></citation>
   </relatedArtifact>
   <relatedArtifact>
      <type value="citation"></type>
      <citation value="Guise, T.A., Oefelein, M.G., Eastham, J.A., Cookson, M.S., Higano, C.S., \&amp; Smith, M.R. (2007). Estrogenic side effects of androgen deprivation therapy. Reviews in urology, 9(4), 163-180.
"></citation>
   </relatedArtifact>
   <relatedArtifact>
      <type value="citation"></type>
      <citation value="Qaseem, A., Snow, V., Shekelle, P., Hopkins, R., Forciea, M. A., Owens, D. K., \&amp; for the Clinical Efficacy Assessment Subcommittee of the American College of Physicians. (2008). Annals of Internal Medicine. Screening for osteoporosis in men: A clinical practice guideline from the American College of Physicians, 2008. Annals of Internal Medicine, 148(9), 680-684. https://doi.org/10.7326/0003-4819-148-9-200805060-00008
"></citation>
   </relatedArtifact>
   <relatedArtifact>
      <type value="citation"></type>
      <citation value="Ward, R. J., Roberts, C. C., Bencardino, J. T., Arnold, E., Baccei, S. J., Cassidy, R. C., ... Weissman, B. N. (2017). ACR Appropriateness Criteria (R) Osteoporosis and Bone Mineral Density. Journal of the American College of Radiology, 14(5), S189--S202. https://doi.org/10.1016/j.jacr.2017.02.018
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      <citation value="Watts, N. B., Adler, R. A., Bilezikian, J. P., Drake, M. T., Eastell, R., Orwoll, E. S., \&amp; Finkelstein, J. S. (2012). Osteoporosis in Men: An Endocrine Society Clinical Practice Guideline. The Journal of Clinical Endocrinology \&amp; Metabolism, 97(6), 1802--1822. https://doi.org/10.1210/jc.2011-3045
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   <disclaimer value="The performance measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications.

THE MEASURES AND SPECIFICATIONS ARE PROVIDED &quot;AS IS&quot; WITHOUT WARRANTY OF ANY KIND.

Due to technical limitations, registered trademarks are indicated by (R) or \[R\] and unregistered trademarks are indicated by (TM) or \[TM\].
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   <rationale value="Androgen suppression as a treatment for prostate cancer can cause osteoporosis (Qaseem, 2008). Patients with prostate cancer undergoing prolonged androgen deprivation therapy (ADT) incur bone loss at a rate higher than menopausal patients (Guise, 2007). In preserving bone health, the goal is to prevent or treat osteopenia/osteoporosis for the patient on ADT and to prevent or delay skeletal-related events. The National Osteoporosis Foundation recommendations include a baseline assessment of bone density with a dual-energy X-ray absorptiometry (DEXA) scan and daily calcium and Vitamin D supplementation (Watts, 2012). The DEXA scan is the gold standard for bone density screening. Patients at risk for adverse bone consequences from chronic ADT do not always receive care according to evidence-based guidelines. These findings call for improved processes that standardize evidence-based practice, including baseline and follow-up bone density assessment (Watts, 2012).
"></rationale>
   <clinicalRecommendationStatement value="Bone density screening should be performed at the start of Androgen Deprivation Therapy (ADT) for prostate cancer. It should also be performed every 2 years for the patient with continued ADT or for patients with known osteoporosis. Current insurance practice is to possibly cover the cost of bone density screening if osteoporosis is known or if there is a high-risk drug. Some patients choose to delay bone density screening until after ADT is started and they therefore have insurance authorization due to the administration of a high-risk drug.
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         <description value="Patients with a qualifying encounter in the measurement period AND with a diagnosis of prostate cancer AND with an order for ADT or an active medication of ADT with an intent for treatment greater than or equal to 12 months during the measurement period AND order for ADT in 3 months before to 9 months after the start of the measurement period
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