Childhood Immunization Status

"Hib 3 or 4 Dose Immunizations" AllHibDoses1
  without "Hib 3 or 4 Dose Immunizations" AllHibDoses2
    such that AllHibDoses1.relevantDatetime less than 1 day before AllHibDoses2.relevantDatetime

"Rotavirus 2 or 3 Dose Immunizations" AllRotavirusDoses1
  without "Rotavirus 2 or 3 Dose Immunizations" AllRotavirusDoses2
    such that AllRotavirusDoses1.relevantDatetime less than 1 day before AllRotavirusDoses2.relevantDatetime

date from Patient.birthDatetime + 2 years

"Initial Population"

Hospice."Has Hospice"

( ( ["Immunization, Administered": "DTaP Vaccine"]
    union ["Procedure, Performed": "DTaP Vaccine Administered"] ) DTaPVaccination
    where DTaPVaccination.relevantDatetime during "Vaccine Administration Interval - 42 Days up to 2 Years Old"
)

( ["Diagnosis": "Anaphylactic Reaction to DTaP Vaccine"]
  union ["Diagnosis": "Encephalopathy due to Childhood Vaccination"] ) DTaPConditions
  where start of DTaPConditions.prevalencePeriod during "First Two Years"

Interval[date from Patient.birthDatetime, "Date of Second Birthday"]

from
  "DTaP Immunizations or Procedures" DTaPVaccination1,
  "DTaP Immunizations or Procedures" DTaPVaccination2,
  "DTaP Immunizations or Procedures" DTaPVaccination3,
  "DTaP Immunizations or Procedures" DTaPVaccination4
  where DTaPVaccination2.relevantDatetime 1 day or more after day of DTaPVaccination1.relevantDatetime
    and DTaPVaccination3.relevantDatetime 1 day or more after day of DTaPVaccination2.relevantDatetime
    and DTaPVaccination4.relevantDatetime 1 day or more after day of DTaPVaccination3.relevantDatetime
  return DTaPVaccination1

from
  "Pneumococcal Conjugate Immunizations or Procedures" PneumococcalVaccination1,
  "Pneumococcal Conjugate Immunizations or Procedures" PneumococcalVaccination2,
  "Pneumococcal Conjugate Immunizations or Procedures" PneumococcalVaccination3,
  "Pneumococcal Conjugate Immunizations or Procedures" PneumococcalVaccination4
  where PneumococcalVaccination2.relevantDatetime 1 day or more after day of PneumococcalVaccination1.relevantDatetime
    and PneumococcalVaccination3.relevantDatetime 1 day or more after day of PneumococcalVaccination2.relevantDatetime
    and PneumococcalVaccination4.relevantDatetime 1 day or more after day of PneumococcalVaccination3.relevantDatetime
  return PneumococcalVaccination1

exists ( "All Hib Vaccinations" HibImmunization //union of 3 and 4 dose immunizations
//4 dose test
    let has_4_dose: Count("Hib 4 Dose Immunizations or Procedures")> 0
    where ( has_4_dose //if pt had at least one 4 dose code
        and Count(distinct("All Hib Vaccinations" HibVaccinations
              return HibVaccinations.relevantDatetime
          )
        )>= 4 //pt must have 4 regimens (e.g., 3,3,4,4 or 4,3,4,4)
    )
      or ( has_4_dose is false //if pt did not have at least one 4 dose code
          and Count(distinct("All Hib Vaccinations" HibVaccinations
                return HibVaccinations.relevantDatetime
            )
          )>= 3 //pt must have 3 regimens of 3 dose codes
      )
)

exists ( "All Rotavirus Vaccinations" RotavirusImmunization
    let has_3_dose: Count("Rotavirus 3 Dose Immunizations or Procedures")> 0
    where ( has_3_dose
        and Count(distinct("All Rotavirus Vaccinations" RotavirusVaccinations
              return RotavirusVaccinations.relevantDatetime
          )
        )>= 3
    )
      or ( has_3_dose is false
          and Count(distinct("All Rotavirus Vaccinations" RotavirusVaccinations
                return RotavirusVaccinations.relevantDatetime
            )
          )>= 2
      )
)

( ( ["Laboratory Test, Performed": "Anti Hepatitis A IgG Antigen Test"] HepatitisAAntigenTest
    where HepatitisAAntigenTest.result as Code in "Positive Finding"
)
  union ( ["Diagnosis": "Adverse reaction to vaccine product containing Hepatitis A virus antigen (disorder)"] HepatitisAReaction
      return "Laboratory Test, Performed" { relevantDatetime: start of HepatitisAReaction.prevalencePeriod }
  )
  union ( ["Diagnosis": "Hepatitis A"] HepatitisADiagnosis
      return "Laboratory Test, Performed" { relevantDatetime: start of HepatitisADiagnosis.prevalencePeriod }
  ) ) HepatitisAConditions
  where Global."NormalizeInterval" ( HepatitisAConditions.relevantDatetime, HepatitisAConditions.relevantPeriod ) during "First Two Years"

( ( ["Immunization, Administered": "Hepatitis B Vaccine"]
    union ["Procedure, Performed": "Hepatitis B Vaccine Administered"] ) HepatitisBVaccination
    where HepatitisBVaccination.relevantDatetime during "First Two Years"
)

( ( ["Laboratory Test, Performed": "Anti Hepatitis B Virus Surface Ab"] HepatitisBAntigenTest
    where HepatitisBAntigenTest.result as Code in "Positive Finding"
)
  union ( ["Diagnosis": "Anaphylaxis due to Hepatitis B vaccine (disorder)"] HepatitisBReaction
      return "Laboratory Test, Performed" { relevantDatetime: start of HepatitisBReaction.prevalencePeriod }
  )
  union ( ["Diagnosis": "Anaphylactic Reaction to Common Baker's Yeast"] YeastReaction
      return "Laboratory Test, Performed" { relevantDatetime: start of YeastReaction.prevalencePeriod }
  )
  union ( ["Diagnosis": "Hepatitis B"] HepatitisBDiagnosis
      return "Laboratory Test, Performed" { relevantDatetime: start of HepatitisBDiagnosis.prevalencePeriod }
  ) ) HepBConditions
  where Global."NormalizeInterval" ( HepBConditions.relevantDatetime, HepBConditions.relevantPeriod ) ends during "First Two Years"

( ( ["Immunization, Administered": "Hib Vaccine (3 dose schedule)"]
    union ["Procedure, Performed": "Hib Vaccine (3 dose schedule) Administered"] ) ThreeDoseHib
    where ThreeDoseHib.relevantDatetime during "Vaccine Administration Interval - 42 Days up to 2 Years Old"
)

"Hib 3 Dose Immunizations or Procedures"
  union "Hib 4 Dose Immunizations or Procedures"

( ( ["Immunization, Administered": "Hib Vaccine (4 dose schedule)"]
    union ["Procedure, Performed": "Hib Vaccine (4 dose schedule) Administered"] ) FourDoseHib
    where FourDoseHib.relevantDatetime during "Vaccine Administration Interval - 42 Days up to 2 Years Old"
)

["Diagnosis": "Anaphylaxis due to Haemophilus influenzae type b vaccine (disorder)"] HibReaction
  where start of HibReaction.prevalencePeriod during "First Two Years"

exists ( ["Encounter, Performed": "Encounter Inpatient"] DischargeHospice
    where ( DischargeHospice.dischargeDisposition ~ "Discharge to home for hospice care (procedure)"
        or DischargeHospice.dischargeDisposition ~ "Discharge to healthcare facility for hospice care (procedure)"
    )
      and DischargeHospice.relevantPeriod ends during "Measurement Period"
)
  or exists ( ["Intervention, Order": "Hospice care ambulatory"] HospiceOrder
      where HospiceOrder.authorDatetime during "Measurement Period"
  )
  or exists ( ["Intervention, Performed": "Hospice care ambulatory"] HospicePerformed
      where Global."NormalizeInterval" ( HospicePerformed.relevantDatetime, HospicePerformed.relevantPeriod ) overlaps "Measurement Period"
  )

( ( ["Immunization, Administered": "Influenza Vaccine"]
    union ["Procedure, Performed": "Influenza Vaccine Administered"] ) InfluenzaAdministration
    where InfluenzaAdministration.relevantDatetime during "Vaccine Administration Interval - 180 Days up to 2 Years Old"
)

( ["Diagnosis": "Adverse reaction to vaccine product containing Influenza virus antigen (disorder)"]
  union ["Diagnosis": "Malignant Neoplasm of Lymphatic and Hematopoietic Tissue"]
  union ["Diagnosis": "Neomycin adverse reaction (disorder)"]
  union ["Diagnosis": "HIV"]
  union ["Diagnosis": "Disorders of the Immune System"] ) InfluenzaConditions
  where start of InfluenzaConditions.prevalencePeriod during "First Two Years"

exists ( ["Patient Characteristic Birthdate": "Birth date"] BirthDate
    where Global."CalendarAgeInYearsAt" ( date from BirthDate.birthDatetime, 
    end of "Measurement Period" ) = 2
)
  and exists ( "Qualifying Encounter" )

( ["Immunization, Administered": "Influenza Virus LAIV Immunization"]
  union ["Procedure, Performed": "Influenza Virus LAIV Procedure"] ) InfluenzaAdministration
  where date from InfluenzaAdministration.relevantDatetime = "Date of Second Birthday"

( ( ["Laboratory Test, Performed": "Measles Antibody Test (IgG Antibody Titer)"] MeaslesTiter
    where MeaslesTiter.result >= 1.10
)
  union ( ["Laboratory Test, Performed": "Measles Antibody Test (IgG Antibody presence)"] MeaslesIgGPresence
      where MeaslesIgGPresence.result as Code in "Positive Finding"
  )
  union ( ["Diagnosis": "Measles"] MeaslesDiagnosis
      return "Laboratory Test, Performed" { relevantDatetime: start of MeaslesDiagnosis.prevalencePeriod }
  ) ) Measles
  where Global."NormalizeInterval" ( Measles.relevantDatetime, Measles.relevantPeriod ) ends during "First Two Years"

( ["Diagnosis": "Disorders of the Immune System"]
  union ["Diagnosis": "HIV"]
  union ["Diagnosis": "Malignant Neoplasm of Lymphatic and Hematopoietic Tissue"]
  union ["Diagnosis": "Neomycin adverse reaction (disorder)"] ) MMRConditions
  where ( start of MMRConditions.prevalencePeriod during Interval[Patient.birthDatetime, "Date of Second Birthday"])

( ( ["Laboratory Test, Performed": "Mumps Antibody Test (IgG Antibody Titer)"] MumpsTiter
    where MumpsTiter.result >= 1.10
)
  union ( ["Laboratory Test, Performed": "Mumps Antibody Test (IgG Antibody presence)"] MumpsIgGPresence
      where MumpsIgGPresence.result as Code in "Positive Finding"
  )
  union ( ["Diagnosis": "Mumps"] MumpsDiagnosis
      return "Laboratory Test, Performed" { relevantDatetime: start of MumpsDiagnosis.prevalencePeriod }
  ) ) Mumps
  where Global."NormalizeInterval" ( Mumps.relevantDatetime, Mumps.relevantPeriod ) during "First Two Years"

( exists ( "Four DTaP Vaccinations" )
    or exists ( "DTaP Numerator Inclusion Conditions" )
)
  and ( exists ( "Three Polio Vaccinations" )
      or exists ( "Polio Numerator Inclusion Conditions" )
  )
  and ( exists ( "One MMR Vaccination" )
      or exists ( "MMR Numerator Inclusion Conditions" )
      or ( exists ( "Measles Indicators" )
          and exists ( "Mumps Indicators" )
          and exists ( "Rubella Indicators" )
      )
  )
  and ( "Has Appropriate Number of Hib Immunizations"
      or exists ( "Hib Numerator Inclusion Conditions" )
  )
  and ( exists ( "Three Hepatitis B Vaccinations" )
      or exists ( "Hepatitis B Numerator Inclusion Conditions" )
  )
  and ( exists ( "One Chicken Pox Vaccination" )
      or exists ( "Varicella Zoster Numerator Inclusion Conditions" )
  )
  and ( exists ( "Four Pneumococcal Conjugate Vaccinations" )
      or exists ( "Pneumococcal Conjugate Numerator Inclusion Conditions" )
  )
  and ( exists ( "One Hepatitis A Vaccinations" )
      or exists ( "Hepatitis A Numerator Inclusion Conditions" )
  )
  and ( "Has Appropriate Number of Rotavirus Immunizations"
      or exists ( "Rotavirus Numerator Inclusion Conditions" )
  )
  and ( exists ( "Two Influenza Vaccinations" )
      or ( "Two Influenza Vaccinations Including One LAIV Vaccination" )
      or exists ( "Influenza Numerator Inclusion Conditions" )
  )

( ( ["Immunization, Administered": "Varicella Zoster Vaccine (VZV)"]
    union ["Procedure, Performed": "Varicella Zoster Vaccine (VZV) Administered"] ) ChickenPoxVaccination
    where ChickenPoxVaccination.relevantDatetime during "First Two Years"
)

( ( ["Immunization, Administered": "Hepatitis A Vaccine"]
    union ["Procedure, Performed": "Hepatitis A Vaccine Administered"] ) HepatitisAVaccination
    where HepatitisAVaccination.relevantDatetime during "First Two Years"
)

( ( ["Immunization, Administered": "Measles, Mumps and Rubella (MMR) Vaccine"]
    union ["Procedure, Performed": "Measles, Mumps and Rubella (MMR) Vaccine Administered"] ) MMRVaccination
    where MMRVaccination.relevantDatetime during "First Two Years"
)

( ( ["Immunization, Administered": "Pneumococcal Conjugate Vaccine"]
    union ["Procedure, Performed": "Pneumococcal Conjugate Vaccine Administered"] ) PneumococcalVaccination
    where PneumococcalVaccination.relevantDatetime during "Vaccine Administration Interval - 42 Days up to 2 Years Old"
)

["Diagnosis": "Adverse reaction to vaccine product containing Streptococcus pneumoniae antigen (disorder)"] PneumococcalReaction
  where start of PneumococcalReaction.prevalencePeriod during "First Two Years"

( ( ["Immunization, Administered": "Inactivated Polio Vaccine (IPV)"]
    union ["Procedure, Performed": "Inactivated Polio Vaccine (IPV) Administered"] ) PolioVaccination
    where PolioVaccination.relevantDatetime during "Vaccine Administration Interval - 42 Days up to 2 Years Old"
)

( ["Diagnosis": "Adverse reaction to vaccine product containing Human poliovirus antigen (disorder)"]
  union ["Diagnosis": "Streptomycin adverse reaction (disorder)"]
  union ["Diagnosis": "Polymyxin B adverse reaction (disorder)"]
  union ["Diagnosis": "Neomycin adverse reaction (disorder)"] ) PolioConditions
  where start of PolioConditions.prevalencePeriod during "First Two Years"

( ["Encounter, Performed": "Office Visit"]
  union ["Encounter, Performed": "Home Healthcare Services"]
  union ["Encounter, Performed": "Preventive Care, Established Office Visit, 0 to 17"]
  union ["Encounter, Performed": "Preventive Care Services, Initial Office Visit, 0 to 17"]
  union ["Encounter, Performed": "Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem(s) are minimal."]
  union ["Encounter, Performed": "Online Assessments"]
  union ["Encounter, Performed": "Telephone Visits"] ) ValidEncounter
  where ValidEncounter.relevantPeriod during "Measurement Period"

( ( ["Immunization, Administered": "rotavirus, live, monovalent vaccine"]
    union ["Procedure, Performed": "Rotavirus Vaccine (2 dose schedule) Administered"] ) TwoDoseRotavirus
    where TwoDoseRotavirus.relevantDatetime during "Vaccine Administration Interval - 42 Days up to 2 Years Old"
)

"Rotavirus 2 Dose Immunizations or Procedures"
  union "Rotavirus 3 Dose Immunizations or Procedures"

( ( ["Immunization, Administered": "Rotavirus Vaccine (3 dose schedule)"]
    union ["Procedure, Performed": "Rotavirus Vaccine (3 dose schedule) Administered"] ) ThreeDoseRotavirus
    where ThreeDoseRotavirus.relevantDatetime during "Vaccine Administration Interval - 42 Days up to 2 Years Old"
)

( ( ["Diagnosis": "Anaphylaxis due to rotavirus vaccine (disorder)"]
    union ["Diagnosis": "Severe Combined Immunodeficiency"]
    union ["Diagnosis": "Intussusception"] ) RotavirusConditions
    where start of RotavirusConditions.prevalencePeriod during "First Two Years"
)

( ( ["Laboratory Test, Performed": "Rubella Antibody Test (IgG Antibody Titer)"] RubellaTiter
    where RubellaTiter.result >= 1.10
)
  union ( ["Laboratory Test, Performed": "Rubella Antibody Test (IgG Antibody presence)"] RubellaIgGPresence
      where RubellaIgGPresence.result as Code in "Positive Finding"
  )
  union ( ["Diagnosis": "Rubella"] RubellaDiagnosis
      return "Laboratory Test, Performed" { relevantDatetime: start of RubellaDiagnosis.prevalencePeriod }
  ) ) Rubella
  where Global."NormalizeInterval" ( Rubella.relevantDatetime, Rubella.relevantPeriod ) ends during "First Two Years"

["Patient Characteristic Ethnicity": "Ethnicity"]

["Patient Characteristic Payer": "Payer"]

["Patient Characteristic Race": "Race"]

["Patient Characteristic Sex": "ONC Administrative Sex"]

from
  "Hepatitis B Immunizations or Procedures" HepatitisBVaccination1,
  "Hepatitis B Immunizations or Procedures" HepatitisBVaccination2,
  "Hepatitis B Immunizations or Procedures" HepatitisBVaccination3
  where HepatitisBVaccination2.relevantDatetime 1 day or more after day of HepatitisBVaccination1.relevantDatetime
    and HepatitisBVaccination3.relevantDatetime 1 day or more after day of HepatitisBVaccination2.relevantDatetime
  return HepatitisBVaccination1

from
  "Polio Immunizations or Procedures" PolioVaccination1,
  "Polio Immunizations or Procedures" PolioVaccination2,
  "Polio Immunizations or Procedures" PolioVaccination3
  where PolioVaccination2.relevantDatetime 1 day or more after day of PolioVaccination1.relevantDatetime
    and PolioVaccination3.relevantDatetime 1 day or more after day of PolioVaccination2.relevantDatetime
  return PolioVaccination1

from
  "Influenza Immunizations or Procedures" FluVaccination1,
  "Influenza Immunizations or Procedures" FluVaccination2
  where FluVaccination2.relevantDatetime 1 day or more after day of FluVaccination1.relevantDatetime
  return FluVaccination1

exists "LAIV Vaccinations"
  and exists "Influenza Immunizations or Procedures"

Interval[date from Patient.birthDatetime + 180 days, "Date of Second Birthday"]

Interval[date from Patient.birthDatetime + 42 days, "Date of Second Birthday"]

( ( ["Laboratory Test, Performed": "Varicella Zoster Antibody Test (IgG Antibody Titer)"] ChickenPoxTiter
    where ChickenPoxTiter.result >= 1.10
)
  union ( ["Laboratory Test, Performed": "Varicella Zoster Antibody Test (IgG Antibody Presence)"] ChickenPoxIgGPresence
      where ChickenPoxIgGPresence.result as Code in "Positive Finding"
  )
  union ( ["Diagnosis": "Disorders of the Immune System"] ImmuneDisorder
      return "Laboratory Test, Performed" { relevantDatetime: start of ImmuneDisorder.prevalencePeriod }
  )
  union ( ["Diagnosis": "HIV"] HIV
      return "Laboratory Test, Performed" { relevantDatetime: start of HIV.prevalencePeriod }
  )
  union ( ["Diagnosis": "Malignant Neoplasm of Lymphatic and Hematopoietic Tissue"] LymphaticMalignantNeoplasm
      return "Laboratory Test, Performed" { relevantDatetime: start of LymphaticMalignantNeoplasm.prevalencePeriod }
  )
  union ( ["Diagnosis": "Neomycin adverse reaction (disorder)"] NeomycinReaction
      return "Laboratory Test, Performed" { relevantDatetime: start of NeomycinReaction.prevalencePeriod }
  )
  union ( ["Diagnosis": "Varicella Zoster"] VaricellaZoster
      return "Laboratory Test, Performed" { relevantDatetime: start of VaricellaZoster.prevalencePeriod }
  ) ) VaricellaZosterConditions
  where Global."NormalizeInterval" ( VaricellaZosterConditions.relevantDatetime, VaricellaZosterConditions.relevantPeriod ) ends during "First Two Years"

years between ToDate(BirthDateTime)and ToDate(AsOf)

if pointInTime is not null then Interval[pointInTime, pointInTime]
  else if period is not null then period 
  else null as Interval<DateTime>

DateTime(year from Value, month from Value, day from Value, 0, 0, 0, 0, timezoneoffset from Value)