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Source1

{
  "resourceType": "PlanDefinition",
  "id": "CXCAD2DTScreeningEligibility-Cytology",
  "meta": {
    "profile": [
      "http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-recommendationdefinition"
    ]
  },
  "text": {
    "status": "extensions",
    "div": "<!-- snip (see above) -->"
  },
  "contained": [
    {
      "resourceType": "Library",
      "id": "effective-data-requirements",
      "extension": [
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CXCAD2DTScreeningEligibilityLogic"
            },
            {
              "url": "name",
              "valueString": "Client age"
            },
            {
              "url": "statement",
              "valueString": "// =============================================================================\n// Helper definitions\n// =============================================================================\n\n/*\n * Client age in years at the encounter date.\n */\ndefine \"Client age\":\n  AgeInYearsAt(Today)"
            },
            {
              "url": "displaySequence",
              "valueInteger": 0
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CXCAD2DTScreeningEligibilityLogic"
            },
            {
              "url": "name",
              "valueString": "Client is at cytology pathway target age"
            },
            {
              "url": "statement",
              "valueString": "// =============================================================================\n// Cytology-pathway eligibility — A/641 section 2.2 (cytology-only facilities)\n// Bindingness: legal — binding to cytology-only facilities under A/641\n//\n// Eleven binding ages on a 3-year cycle: 30, 33, 36, 39, 42, 45, 48, 51, 54, 57, 60.\n// Applied when the facility has no HPV DNA testing capability.\n// =============================================================================\n\n/*\n * The client is at one of the 11 binding cytology-pathway target ages\n * per A/641 section 2.2 (cytology-only facilities, 3-year cycle from 30 to 60).\n */\ndefine \"Client is at cytology pathway target age\":\n  \"Client age\" in { 30, 33, 36, 39, 42, 45, 48, 51, 54, 57, 60 }"
            },
            {
              "url": "displaySequence",
              "valueInteger": 1
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CXCAElements"
            },
            {
              "url": "name",
              "valueString": "Hysterectomy Procedures"
            },
            {
              "url": "statement",
              "valueString": "// =============================================================================\n// Hysterectomy history\n// =============================================================================\n\n/*\n * @internal: All recorded hysterectomy procedures for this patient,\n *   filtered to status = completed.\n */\ndefine \"Hysterectomy Procedures\":\n  [Procedure] P\n    where P.status = 'completed'\n      and exists (P.code.coding C where C.code = 'DE45'\n                                     and C.system = 'http://smart.who.int/cxca/CodeSystem/CXCA.D')"
            },
            {
              "url": "displaySequence",
              "valueInteger": 2
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CXCAElements"
            },
            {
              "url": "name",
              "valueString": "Has Had Hysterectomy"
            },
            {
              "url": "statement",
              "valueString": "/*\n * The patient has a documented completed hysterectomy.\n *\n * NOTE: A/641 section 2.2 only excludes hysterectomy for non-cervical-cancer indication\n * with a documented negative post-op vaginal-smear cytology. This define\n * captures only the hysterectomy fact; the indication and post-op cytology\n * checks live in higher-layer logic that combines this define with others.\n */\ndefine \"Has Had Hysterectomy\":\n  exists \"Hysterectomy Procedures\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 3
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CXCAD2DTScreeningEligibilityLogic"
            },
            {
              "url": "name",
              "valueString": "Client is due for cytology screening (legal binding)"
            },
            {
              "url": "statement",
              "valueString": "/*\n * @output: CXCA.D#DE4 \"Due for HPV screening\" — but the test recommended is\n *   cytology, not HPV (the screening name in CXCA.D#DE4 reflects the WHO\n *   target test; both pathways are flavors of \"cervical cancer screening\").\n * @bindingness: legal\n * Cytology-pathway client is due if at one of the 11 target ages, the facility\n * lacks HPV capability, no hysterectomy, and no recent valid cytology screening.\n */\ndefine \"Client is due for cytology screening (legal binding)\":\n  \"Client is at cytology pathway target age\"\n    and not \"FacilityHasHPVCapability\"\n    and not Elements.\"Has Had Hysterectomy\"\n    and not \"HasRecentCytologyScreening\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 4
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "FHIRHelpers"
            },
            {
              "url": "name",
              "valueString": "ToString"
            },
            {
              "url": "statement",
              "valueString": "define function ToString(value ProcedureStatus): value.value"
            },
            {
              "url": "displaySequence",
              "valueInteger": 5
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "FHIRHelpers"
            },
            {
              "url": "name",
              "valueString": "ToString"
            },
            {
              "url": "statement",
              "valueString": "define function ToString(value string): value.value"
            },
            {
              "url": "displaySequence",
              "valueInteger": 6
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "FHIRHelpers"
            },
            {
              "url": "name",
              "valueString": "ToString"
            },
            {
              "url": "statement",
              "valueString": "define function ToString(value uri): value.value"
            },
            {
              "url": "displaySequence",
              "valueInteger": 7
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        }
      ],
      "name": "EffectiveDataRequirements",
      "status": "active",
      "type": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/library-type",
            "code": "module-definition"
          }
        ]
      },
      "relatedArtifact": [
        {
          "type": "depends-on",
          "display": "FHIR model information",
          "resource": "http://fhir.org/guides/cqf/common/Library/FHIR-ModelInfo|4.0.1"
        },
        {
          "type": "depends-on",
          "display": "Library Elements",
          "resource": "http://smart.who.int/cxca/Library/CXCAElements"
        },
        {
          "type": "depends-on",
          "display": "Library FHIRHelpers",
          "resource": "http://fhir.org/guides/cqf/common/Library/FHIRHelpers|4.0.1"
        }
      ],
      "parameter": [
        {
          "name": "Today",
          "use": "in",
          "min": 0,
          "max": "1",
          "type": "date"
        },
        {
          "name": "FacilityHasHPVCapability",
          "use": "in",
          "min": 0,
          "max": "1",
          "type": "boolean"
        },
        {
          "name": "HasRecentCytologyScreening",
          "use": "in",
          "min": 0,
          "max": "1",
          "type": "boolean"
        },
        {
          "name": "Client is due for cytology screening (legal binding)",
          "use": "out",
          "min": 0,
          "max": "1",
          "type": "boolean"
        }
      ],
      "dataRequirement": [
        {
          "type": "Patient",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/Patient"
          ]
        },
        {
          "type": "Procedure",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/Procedure"
          ],
          "mustSupport": [
            "status",
            "code",
            "code.coding"
          ]
        },
        {
          "type": "Procedure",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/Procedure"
          ],
          "mustSupport": [
            "status",
            "code",
            "code.coding"
          ]
        }
      ]
    }
  ],
  "extension": [
    {
      "url": "http://smart.who.int/cxca/StructureDefinition/cxca-bindingness",
      "valueCoding": {
        "system": "http://smart.who.int/cxca/CodeSystem/CXCA.Bindingness",
        "code": "legal",
        "display": "Legal — binding regulatory instrument"
      }
    },
    {
      "url": "http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-effectiveDataRequirements",
      "valueCanonical": "#effective-data-requirements"
    }
  ],
  "url": "http://smart.who.int/cxca/PlanDefinition/CXCAD2DTScreeningEligibility-Cytology",
  "version": "0.0.1",
  "name": "CXCAD2DTScreeningEligibilityCytology",
  "title": "CXCA.D2.DT — Screening Eligibility (Cytology Pathway)",
  "type": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/plan-definition-type",
        "code": "eca-rule"
      }
    ]
  },
  "status": "draft",
  "experimental": false,
  "date": "2026-05-14T00:50:23+00:00",
  "publisher": "Dan Heslinga (independent contributor)",
  "contact": [
    {
      "name": "Dan Heslinga (independent contributor)",
      "telecom": [
        {
          "system": "url",
          "value": "https://github.com/dhes"
        }
      ]
    }
  ],
  "description": "Decision support recommendation for the cytology-pathway branch of cervical cancer screening eligibility (CXCA.D2). Applies to facilities that lack HPV DNA testing capability. Per A/641 (2020) section 2.2, women in this branch are screened with cervical cytology at ages 30, 33, 36, 39, 42, 45, 48, 51, 54, 57, and 60 (every 3 years). Sibling artifact CXCAD2DTScreeningEligibility covers the HPV-pathway branch (ages 35 and 45). Both reference the same CXCAD2DTScreeningEligibilityLogic library.",
  "library": [
    "http://smart.who.int/cxca/Library/CXCAD2DTScreeningEligibilityLogic"
  ],
  "action": [
    {
      "title": "Recommend cervical cytology screening (cytology-pathway client is due)",
      "description": "Client is at one of the 11 binding cytology-pathway target ages (per A/641 section 2.2: 30, 33, 36, 39, 42, 45, 48, 51, 54, 57, 60), the facility lacks HPV DNA testing capability, the client has not had a hysterectomy, and has not been screened in the current 3-year cycle. Create a proposed ServiceRequest for cervical cytology testing.",
      "condition": [
        {
          "kind": "applicability",
          "expression": {
            "language": "text/cql-identifier",
            "expression": "Client is due for cytology screening (legal binding)"
          }
        }
      ],
      "definitionCanonical": "http://smart.who.int/cxca/ActivityDefinition/CXCAD2CytologyScreeningServiceRequest"
    }
  ]
}