cqm-reports 4.0.0 → 4.1.0

checksums.yaml

@@ -1,7 +1,7 @@
 ---
 SHA256:
-  metadata.gz: cda8f93792d0efa4c3e4347bd922e32396791952a09ea37d35b2e00daa3284bf
-  data.tar.gz: 062b473dc79d294fa478b50c132c090ad0e4305679d7e834abce9f6f2ca0e0a2
+  metadata.gz: b0938369271d07282db5933dda15b47f0cbe346abbeff4a6004a23fcce61e680
+  data.tar.gz: 4ff25f7dfda32510cccb638966ab51eb76cb04c7ab31778fb2e95bc0cba88a2c
 SHA512:
-  metadata.gz: e67430b3bcb829fc2561a6afb33b2621e727d21fdb388663de0b9d145bed201c39ab5e42385676c918897f88164e13644a869bdd04f23c0a2d64c179a99f5455
-  data.tar.gz: ebfb491113755df26743265723641db1775ce7d53642e455c0d50a91d512974eb53bcd1f0c111284e80641cf5917e7b875f9be6877fd5728ebae9d00fd93d0e3
+  metadata.gz: 3c3c6bd90513f5f83610596a4789a30b0995569efcf7e6598a48f385a00d7cc869265c4f7f6b77c24c3130153df714ad3858d55e4b97f88168282d833e4a2961
+  data.tar.gz: 750f9df81d0cb2c633dbecc2b6be45a77c580dd7bc53defe6cc27ad592e0588cbebd563f3382e7d193f2cfcdf038728f3e01eee1f9fdbb2fc07e3a11f049afdb

data/Gemfile

@@ -2,8 +2,6 @@ source 'https://rubygems.org'
 
 gemspec :development_group => :test
 
-gem 'mongoid', '~> 6.4.2'
-
 gem 'protected_attributes_continued'
 
 group :development, :test do

data/lib/html-export/qdm-patient/data_element/_data_element_other_fields.mustache

@@ -49,7 +49,7 @@
 {{/daysSupplied}}
 {{#diagnoses}}
 	<div class="div-head-row">
-		<div class="div-table-head--no-border"><span class="criteria-heading">Diagnosis{{{diagnosis_rank_string}}}:</span>  {{{nested_code_string}}}</div>
+		<div class="div-table-head--no-border"><span class="criteria-heading">Diagnosis:</span> {{{nested_code_string}}} {{{diagnosis_string}}}</div>
 	</div>
 {{/diagnoses}}
 {{#dischargeDisposition}}

data/lib/html-export/qdm-patient/qdm_patient.rb

@@ -10,6 +10,7 @@ class QdmPatient < Mustache
     @patient = patient
     @qdmPatient = patient.qdmPatient
     @patient_addresses = patient['addresses']
+    @patient_email = patient['email']
     @patient_telecoms = patient['telecoms']
   end
 
@@ -35,6 +36,7 @@ class QdmPatient < Mustache
   def patient_telecoms
     @patient_telecoms ||= [CQM::Telecom.new(use: 'HP', value: '555-555-2003')]
     # create formatted telecoms
+    @patient_telecoms << CQM::Telecom.new(use: 'HP', value: @patient_email) if @patient_email
     @patient_telecoms.map { |telecom| "(#{telecom['use']}) #{telecom['value']}" }.join("<br>")
   end
 
@@ -52,8 +54,14 @@ class QdmPatient < Mustache
   end
 
   def unit_string
-    return "#{self['value']} " if !self['unit'] || self['unit'] == '1'
-    "#{self['value']} #{self['unit']}"
+    return trimed_value(self['value']).to_s if !self['unit'] || self['unit'] == '1'
+    "#{trimed_value(self['value'])} #{self['unit']}"
+  end
+
+  def trimed_value(number)
+    i = number.to_i
+    f = number.to_f
+    i == f ? i : f
   end
 
   def entity_string
@@ -83,7 +91,7 @@ class QdmPatient < Mustache
   end
 
   def identifier_for_element(identifier)
-    "#{identifier['value']} (#{identifier['namingSystem']})"
+    identifier ? "#{identifier['value']} (#{identifier['namingSystem']})" : ''
   end
 
   def code_code_system_string
@@ -91,7 +99,7 @@ class QdmPatient < Mustache
   end
 
   def code_for_element(element)
-    "#{element['code']} (#{HQMF::Util::CodeSystemHelper.code_system_for(element['system'])})#{code_description(element)}"
+    element ? "#{element['code']} (#{HQMF::Util::CodeSystemHelper.code_system_for(element['system'])})#{code_description(element)}" : ''
   end
 
   def code_system_name
@@ -120,15 +128,24 @@ class QdmPatient < Mustache
     return unit_string if self['value']
     return code_code_system_string if self['code']
 
-    self['result']
+    # Checks to see if the result is a DateTime value, String, or Numeric
+    begin
+      DateTime.parse(self['result'])
+    rescue ArgumentError, TypeError
+      # If the value is not numeric, just print out the result
+      self['result'].is_a?(Numeric) ? trimed_value(self['result']) : self['result']
+    end
   end
 
   def nested_code_string
     code_for_element(self['code'])
   end
 
-  def diagnosis_rank_string
-    " (rank: #{self['rank']})" if self['rank']
+  def diagnosis_string
+    dx_string = ''
+    dx_string += "</br>&nbsp; rank: #{self['rank']}" if self['rank']
+    dx_string += "</br>&nbsp; presentOnAdmissionIndicator: #{self['presentOnAdmissionIndicator']['code']}" if self['presentOnAdmissionIndicator']
+    dx_string
   end
 
   def end_time?

data/lib/qrda-export/catI-r5/_header.mustache

@@ -8,8 +8,7 @@
 <!-- QDM-based QRDA templateId -->
 <templateId root="2.16.840.1.113883.10.20.24.1.2" extension="2021-08-01"/>
 <!-- CMS QRDA templateId -->
-<!-- TODO: THIS will also change -->
-<templateId root="2.16.840.1.113883.10.20.24.1.3" extension="2020-02-01"/>
+<templateId root="2.16.840.1.113883.10.20.24.1.3" extension="2022-02-01"/>
 <!-- This is the globally unique identifier for this QRDA document -->
 <id root="{{random_id}}"/>
 <!-- QRDA document type code -->

data/lib/qrda-export/catI-r5/qrda1_r5.mustache

@@ -13,8 +13,8 @@
           <templateId root="2.16.840.1.113883.10.20.17.2.4"/>
           <!-- This is the templateId for Patient Data QDM section -->
           <templateId extension="2021-08-01" root="2.16.840.1.113883.10.20.24.2.1"/>
-          <!-- TODO: This will also change -->
-          <templateId extension="2020-02-01" root="2.16.840.1.113883.10.20.24.2.1.1"/>
+          <!-- Patient Data Section QDM (V8) CMS -->
+          <templateId extension="2022-02-01" root="2.16.840.1.113883.10.20.24.2.1.1"/>
           <code code="55188-7" codeSystem="2.16.840.1.113883.6.1"/>
           <title>Patient Data</title>
           <text/>

data/lib/qrda-export/catI-r5/qrda1_r5.rb

@@ -16,9 +16,12 @@ class Qrda1R5 < Mustache
     @provider = options[:provider]
     @patient_address_option = options[:patient_addresses]
     @patient_telecom_option = options[:patient_telecoms]
+    @patient_email_option = options[:patient_email]
     @performance_period_start = options[:start_time]
     @performance_period_end = options[:end_time]
     @submission_program = options[:submission_program]
+    @medicare_beneficiary_identifier = options[:medicare_beneficiary_identifier]
+    @hicn = options[:hicn]
   end
 
   def patient_addresses
@@ -41,6 +44,15 @@ class Qrda1R5 < Mustache
     JSON.parse(@patient_telecom_option.to_json)
   end
 
+  def patient_email
+    return unless @patient_email_option
+    telecom_email = [CQM::Telecom.new(
+      use: 'HP',
+      value: @patient_email_option
+    )]
+    JSON.parse(telecom_email.to_json)
+  end
+
   def patient_characteristic_payer
     JSON.parse(@qdmPatient.get_data_elements('patient_characteristic', 'payer').to_json)
   end

data/lib/qrda-export/catI-r5/qrda_header/_participant.mustache

@@ -1,7 +1,8 @@
 <participant typeCode="DEV">
   <associatedEntity classCode="RGPR">
     <!-- CMS EHR Certification Number (formerly known as Office of the 
-        National Coordinator Certification Number) -->
-    <id extension="123456789" root="2.16.840.1.113883.3.2074.1"/>
+        National Coordinator Certification Number). Note, this is a test
+        file, and the provided ID is not for a certified product set. -->
+    <id extension="0015CPV4ZTB4WBU" root="2.16.840.1.113883.3.2074.1"/>
   </associatedEntity>
 </participant>

data/lib/qrda-export/catI-r5/qrda_header/_record_target.mustache

@@ -1,6 +1,12 @@
 <recordTarget>
   <patientRole>
     <id extension="{{mrn}}" root="1.3.6.1.4.1.115" />
+    {{#medicare_beneficiary_identifier}}
+      <id extension="{{medicare_beneficiary_identifier}}" root="2.16.840.1.113883.4.927" />
+    {{/medicare_beneficiary_identifier}}
+    {{#hicn}}
+      <id extension="{{hicn}}" root="2.16.840.1.113883.4.572" />
+    {{/hicn}}
     {{#patient_addresses}}
       <addr use="{{use}}">
         {{#street}}
@@ -15,6 +21,9 @@
     {{#patient_telecoms}}
       <telecom use="{{use}}" value="tel:{{value}}"/>
     {{/patient_telecoms}}
+    {{#patient_email}}
+      <telecom use="{{use}}" value="mailto:{{value}}"/>
+    {{/patient_email}}
     <patient>
       {{#patient}}
         <name>

data/lib/qrda-export/catI-r5/qrda_templates/encounter_performed.mustache

@@ -1,58 +1,51 @@
 <entry>
-  <act classCode="ACT" moodCode="EVN">
-    <!--Encounter performed Act -->
-    <templateId extension="2021-08-01" root="2.16.840.1.113883.10.20.24.3.133"/>
-    <code code="ENC" codeSystem="2.16.840.1.113883.5.6" codeSystemName="ActClass" displayName="Encounter"/>
-    <entryRelationship typeCode="SUBJ">
-      <encounter classCode="ENC" moodCode="EVN">
-        <!--  Encounter activities template -->
-        <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.4.49"/>
-        <!-- Encounter performed template -->
-        <templateId extension="2021-08-01" root="2.16.840.1.113883.10.20.24.3.23"/>
-        <id extension="{{object_id}}" root="1.3.6.1.4.1.115"/>
-        <!-- QDM Attribute: Code -->
-        {{> _codes}}
-        <text>{{description}}</text>
-        <statusCode code="completed"/>
-        {{#relevantPeriod}}
-          <!-- QDM Attribute: Relevant Period -->
-          {{{relevant_period}}}
-        {{/relevantPeriod}}
-        {{#dischargeDisposition}}
-          <!-- QDM Attribute: Discharge Disposition -->
-          <sdtc:dischargeDispositionCode {{> _code}}/>
-        {{/dischargeDisposition}}
-        {{#authorDatetime}}
-          <!-- QDM Attribute: Author dateTime -->
-          {{> qrda_templates/template_partials/_author}}
-        {{/authorDatetime}}
-        {{#facilityLocations}}
-          <!-- QDM Attribute: Facility Locations -->
-          {{> qrda_templates/template_partials/_facility_location}}
-        {{/facilityLocations}}
-        {{#admissionSource}}
-          <!-- QDM Attribute: Admission Source -->
-          {{> qrda_templates/template_partials/_admission_source}}
-        {{/admissionSource}}
-        {{#participant}}
-          <!-- QDM Attribute: Participant -->
-          <participant typeCode="PRF">
-            {{> qrda_templates/template_partials/_entity}}
-          </participant>
-        {{/participant}}
-        {{#clazz}}
-          <!-- QDM Attribute: Class -->
-          {{> qrda_templates/template_partials/_encounter_class}}
-        {{/clazz}}
-        {{#diagnoses}}
-          <!-- QDM Attribute: Diagnoses -->
-          {{> qrda_templates/template_partials/_encounter_diagnosis_qdm}}
-        {{/diagnoses}}
-        {{#relatedTo}}
-          <!-- QDM Attribute: relatedTo -->
-          {{> qrda_templates/template_partials/_related_to}}
-        {{/relatedTo}}
-      </encounter>
-    </entryRelationship>
-  </act>
+  <encounter classCode="ENC" moodCode="EVN">
+    <!--  Encounter activities template -->
+    <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.4.49"/>
+    <!-- Encounter performed template -->
+    <templateId extension="2021-08-01" root="2.16.840.1.113883.10.20.24.3.23"/>
+    <id extension="{{object_id}}" root="1.3.6.1.4.1.115"/>
+    <!-- QDM Attribute: Code -->
+    {{> _codes}}
+    <text>{{description}}</text>
+    <statusCode code="completed"/>
+    {{#relevantPeriod}}
+      <!-- QDM Attribute: Relevant Period -->
+      {{{relevant_period}}}
+    {{/relevantPeriod}}
+    {{#dischargeDisposition}}
+      <!-- QDM Attribute: Discharge Disposition -->
+      <sdtc:dischargeDispositionCode {{> _code}}/>
+    {{/dischargeDisposition}}
+    {{#authorDatetime}}
+      <!-- QDM Attribute: Author dateTime -->
+      {{> qrda_templates/template_partials/_author}}
+    {{/authorDatetime}}
+    {{#facilityLocations}}
+      <!-- QDM Attribute: Facility Locations -->
+      {{> qrda_templates/template_partials/_facility_location}}
+    {{/facilityLocations}}
+    {{#admissionSource}}
+      <!-- QDM Attribute: Admission Source -->
+      {{> qrda_templates/template_partials/_admission_source}}
+    {{/admissionSource}}
+    {{#participant}}
+      <!-- QDM Attribute: Participant -->
+      <participant typeCode="PRF">
+        {{> qrda_templates/template_partials/_entity}}
+      </participant>
+    {{/participant}}
+    {{#clazz}}
+      <!-- QDM Attribute: Class -->
+      {{> qrda_templates/template_partials/_encounter_class}}
+    {{/clazz}}
+    {{#diagnoses}}
+      <!-- QDM Attribute: Diagnoses -->
+      {{> qrda_templates/template_partials/_encounter_diagnosis_qdm}}
+    {{/diagnoses}}
+    {{#relatedTo}}
+      <!-- QDM Attribute: relatedTo -->
+      {{> qrda_templates/template_partials/_related_to}}
+    {{/relatedTo}}
+  </encounter>
 </entry>

data/lib/qrda-export/catI-r5/qrda_templates/medication_discharge.mustache

@@ -61,7 +61,7 @@
     {{/daysSupplied}}
     {{#supply}}
       <!-- QDM Attribute: Supply -->
-      <entryRelationship typeCode="REFR">
+      <entryRelationship typeCode="COMP">
           {{> qrda_templates/template_partials/_medication_supply_request}}
       </entryRelationship>
     {{/supply}}

data/lib/qrda-export/catI-r5/qrda_templates/medication_dispensed.mustache

@@ -69,7 +69,7 @@
         </entryRelationship>
         {{#supply}}
           <!-- QDM Attribute: Supply -->
-          <entryRelationship typeCode="REFR">
+          <entryRelationship typeCode="COMP">
               {{> qrda_templates/template_partials/_medication_supply_request}}
           </entryRelationship>
         {{/supply}}

data/lib/qrda-export/catI-r5/qrda_templates/medication_order.mustache

@@ -62,7 +62,7 @@
     {{/daysSupplied}}
     {{#supply}}
       <!-- QDM Attribute: Supply -->
-      <entryRelationship typeCode="REFR">
+      <entryRelationship typeCode="COMP">
           {{> qrda_templates/template_partials/_medication_supply_request}}
       </entryRelationship>
     {{/supply}}

data/lib/qrda-export/catI-r5/qrda_templates/template_partials/_medication_details.mustache

@@ -17,7 +17,7 @@
 {{^negated}}
 {{#refills}}
 <!--  QDM Attribute: Refills -->
-<repeatNumber value="{{.}}"/>
+<repeatNumber value="{{{refills_as_repeat_number}}}"/>
 {{/refills}}
 {{/negated}}
 {{#route}}

data/lib/qrda-export/catI-r52/qrda1_r52.rb

@@ -0,0 +1,258 @@
+require 'mustache'
+class Qrda1R52 < Mustache
+  include Qrda::Export::Helper::DateHelper
+  include Qrda::Export::Helper::ViewHelper
+  include Qrda::Export::Helper::Cat1ViewHelper
+  include Qrda::Export::Helper::PatientViewHelper
+  include Qrda::Export::Helper::FrequencyHelper
+  include HQMF::Util::EntityHelper
+
+  self.template_path = __dir__
+
+  def initialize(patient, measures, options = {})
+    @patient = patient
+    @qdmPatient = patient.qdmPatient
+    @measures = measures
+    @provider = options[:provider]
+    @patient_address_option = options[:patient_addresses]
+    @patient_telecom_option = options[:patient_telecoms]
+    @patient_email_option = options[:patient_email]
+    @performance_period_start = options[:start_time]
+    @performance_period_end = options[:end_time]
+    @submission_program = options[:submission_program]
+    @medicare_beneficiary_identifier = options[:medicare_beneficiary_identifier]
+  end
+
+  def patient_addresses
+    @patient_address_option ||= [CQM::Address.new(
+      use: 'HP',
+      street: ['202 Burlington Rd.'],
+      city: 'Bedford',
+      state: 'MA',
+      zip: '01730',
+      country: 'US'
+    )]
+    JSON.parse(@patient_address_option.to_json)
+  end
+
+  def patient_telecoms
+    @patient_telecom_option ||= [CQM::Telecom.new(
+      use: 'HP',
+      value: '555-555-2003'
+    )]
+    JSON.parse(@patient_telecom_option.to_json)
+  end
+
+  def patient_email
+    return unless @patient_email_option
+    telecom_email = [CQM::Telecom.new(
+      use: 'HP',
+      value: @patient_email_option
+    )]
+    JSON.parse(telecom_email.to_json)
+  end
+
+  def patient_characteristic_payer
+    JSON.parse(@qdmPatient.get_data_elements('patient_characteristic', 'payer').to_json)
+  end
+
+  def patient_characteristic_birthdate
+    JSON.parse(@qdmPatient.get_data_elements('patient_characteristic', 'birthdate').to_json)
+  end
+
+  def patient_characteristic_sex
+    JSON.parse(@qdmPatient.get_data_elements('patient_characteristic', 'gender').to_json)
+  end
+
+  def patient_characteristic_race
+    JSON.parse(@qdmPatient.get_data_elements('patient_characteristic', 'race').to_json)
+  end
+
+  def patient_characteristic_ethnicity
+    JSON.parse(@qdmPatient.get_data_elements('patient_characteristic', 'ethnicity').to_json)
+  end
+
+  def adverse_event
+    JSON.parse(@qdmPatient.get_data_elements('adverse_event', nil).to_json)
+  end
+
+  def allergy_intolerance
+    JSON.parse(@qdmPatient.get_data_elements('allergy', 'intolerance').to_json)
+  end
+
+  def assessment_order
+    JSON.parse(@qdmPatient.get_data_elements('assessment', 'order').to_json)
+  end
+
+  def assessment_performed
+    JSON.parse(@qdmPatient.get_data_elements('assessment', 'performed').to_json)
+  end
+
+  def assessment_recommended
+    JSON.parse(@qdmPatient.get_data_elements('assessment', 'recommended').to_json)
+  end
+
+  def communication_performed
+    JSON.parse(@qdmPatient.get_data_elements('communication', 'performed').to_json)
+  end
+
+  def diagnosis
+    JSON.parse(@qdmPatient.get_data_elements('condition', nil).to_json)
+  end
+
+  def device_applied
+    JSON.parse(@qdmPatient.get_data_elements('device', 'applied').to_json)
+  end
+
+  def device_order
+    JSON.parse(@qdmPatient.get_data_elements('device', 'order').to_json)
+  end
+
+  def device_recommended
+    JSON.parse(@qdmPatient.get_data_elements('device', 'recommended').to_json)
+  end
+
+  def diagnostic_study_order
+    JSON.parse(@qdmPatient.get_data_elements('diagnostic_study', 'order').to_json)
+  end
+
+  def diagnostic_study_performed
+    JSON.parse(@qdmPatient.get_data_elements('diagnostic_study', 'performed').to_json)
+  end
+
+  def diagnostic_study_recommended
+    JSON.parse(@qdmPatient.get_data_elements('diagnostic_study', 'recommended').to_json)
+  end
+
+  def encounter_order
+    JSON.parse(@qdmPatient.get_data_elements('encounter', 'order').to_json)
+  end
+
+  def encounter_performed
+    JSON.parse(@qdmPatient.get_data_elements('encounter', 'performed').to_json)
+  end
+
+  def encounter_recommended
+    JSON.parse(@qdmPatient.get_data_elements('encounter', 'recommended').to_json)
+  end
+
+  def family_history
+    JSON.parse(@qdmPatient.get_data_elements('family_history', nil).to_json)
+  end
+
+  def immunization_administered
+    JSON.parse(@qdmPatient.get_data_elements('immunization', 'administered').to_json)
+  end
+
+  def immunization_order
+    JSON.parse(@qdmPatient.get_data_elements('immunization', 'order').to_json)
+  end
+
+  def intervention_order
+    JSON.parse(@qdmPatient.get_data_elements('intervention', 'order').to_json)
+  end
+
+  def intervention_performed
+    JSON.parse(@qdmPatient.get_data_elements('intervention', 'performed').to_json)
+  end
+
+  def intervention_recommended
+    JSON.parse(@qdmPatient.get_data_elements('intervention', 'recommended').to_json)
+  end
+
+  def laboratory_test_order
+    JSON.parse(@qdmPatient.get_data_elements('laboratory_test', 'order').to_json)
+  end
+
+  def laboratory_test_performed
+    JSON.parse(@qdmPatient.get_data_elements('laboratory_test', 'performed').to_json)
+  end
+
+  def laboratory_test_recommended
+    JSON.parse(@qdmPatient.get_data_elements('laboratory_test', 'recommended').to_json)
+  end
+
+  def medication_active
+    JSON.parse(@qdmPatient.get_data_elements('medication', 'active').to_json)
+  end
+
+  def medication_administered
+    JSON.parse(@qdmPatient.get_data_elements('medication', 'administered').to_json) + JSON.parse(@qdmPatient.get_data_elements('substance', 'administered').to_json)
+  end
+
+  def medication_discharge
+    JSON.parse(@qdmPatient.get_data_elements('medication', 'discharge').to_json)
+  end
+
+  def medication_dispensed
+    JSON.parse(@qdmPatient.get_data_elements('medication', 'dispensed').to_json)
+  end
+
+  def medication_order
+    JSON.parse(@qdmPatient.get_data_elements('medication', 'order').to_json)
+  end
+
+  def patient_care_experience
+    JSON.parse(@qdmPatient.dataElements.where(hqmfOid: { '$in' => HQMF::Util::HQMFTemplateHelper.get_all_hqmf_oids('patient_care_experience', '') }).to_json)
+  end
+
+  def patient_characteristic_clinical_trial_participant
+    JSON.parse(@qdmPatient.get_data_elements('patient_characteristic', 'clinical_trial_participant').to_json)
+  end
+
+  def patient_characteristic_expired
+    JSON.parse(@qdmPatient.get_data_elements('patient_characteristic', 'expired').to_json)
+  end
+
+  def physical_exam_order
+    JSON.parse(@qdmPatient.get_data_elements('physical_exam', 'order').to_json)
+  end
+
+  def physical_exam_performed
+    JSON.parse(@qdmPatient.get_data_elements('physical_exam', 'performed').to_json)
+  end
+
+  def physical_exam_recommended
+    JSON.parse(@qdmPatient.get_data_elements('physical_exam', 'recommended').to_json)
+  end
+
+  def procedure_order
+    JSON.parse(@qdmPatient.get_data_elements('procedure', 'order').to_json)
+  end
+
+  def procedure_performed
+    JSON.parse(@qdmPatient.get_data_elements('procedure', 'performed').to_json)
+  end
+
+  def procedure_recommended
+    JSON.parse(@qdmPatient.get_data_elements('procedure', 'recommended').to_json)
+  end
+
+  def program_participation
+    JSON.parse(@qdmPatient.get_data_elements('participation', nil).to_json)
+  end
+
+  def provider_care_experience
+    JSON.parse(@qdmPatient.dataElements.where(hqmfOid: { '$in' => HQMF::Util::HQMFTemplateHelper.get_all_hqmf_oids('provider_care_experience', '') }).to_json)
+  end
+
+  def related_person
+    JSON.parse(@qdmPatient.get_data_elements('related_person', nil).to_json)
+  end
+
+  def substance_administered
+    JSON.parse(@qdmPatient.get_data_elements('substance', 'administered').to_json)
+  end
+
+  def substance_order
+    JSON.parse(@qdmPatient.get_data_elements('substance', 'order').to_json)
+  end
+
+  def substance_recommended
+    JSON.parse(@qdmPatient.get_data_elements('substance', 'recommended').to_json)
+  end
+
+  def symptom
+    JSON.parse(@qdmPatient.get_data_elements('symptom', nil).to_json)
+  end
+end

data/lib/qrda-export/catI-r52/qrda_header/_participant.mustache

@@ -0,0 +1,8 @@
+<participant typeCode="DEV">
+  <associatedEntity classCode="RGPR">
+    <!-- CMS EHR Certification Number (formerly known as Office of the 
+        National Coordinator Certification Number). Note, this is a test
+        file, and the provided ID is not for a certified product set. -->
+    <id extension="0015CPV4ZTB4WBU" root="2.16.840.1.113883.3.2074.1"/>
+  </associatedEntity>
+</participant>

data/lib/qrda-export/catI-r52/qrda_header/_record_target.mustache

@@ -0,0 +1,65 @@
+<recordTarget>
+  <patientRole>
+    <id extension="{{mrn}}" root="1.3.6.1.4.1.115" />
+    {{#medicare_beneficiary_identifier}}
+      <id extension="{{medicare_beneficiary_identifier}}" root="2.16.840.1.113883.4.927" />
+    {{/medicare_beneficiary_identifier}}
+    {{#patient_addresses}}
+      <addr use="{{use}}">
+        {{#street}}
+          <streetAddressLine>{{.}}</streetAddressLine>
+        {{/street}}
+        <city>{{city}}</city>
+        <state>{{state}}</state>
+        <postalCode>{{zip}}</postalCode>
+        <country>{{country}}</country>
+      </addr>
+    {{/patient_addresses}}
+    {{#patient_telecoms}}
+      <telecom use="{{use}}" value="tel:{{value}}"/>
+    {{/patient_telecoms}}
+    {{#patient_email}}
+      <telecom use="{{use}}" value="mailto:{{value}}"/>
+    {{/patient_email}}
+    <patient>
+      {{#patient}}
+        <name>
+          <given>{{given_name}}</given>
+          <family>{{familyName}}</family>
+        </name>
+      {{/patient}}
+      {{#patient_characteristic_sex}}
+        {{#dataElementCodes}}
+          <administrativeGenderCode {{> _code}}/>
+        {{/dataElementCodes}}
+      {{/patient_characteristic_sex}}
+      {{^patient_characteristic_sex}}
+          <administrativeGenderCode nullFlavor="UNK"/>
+      {{/patient_characteristic_sex}}
+      {{#patient_characteristic_birthdate}}
+        {{{birth_date_time}}}
+      {{/patient_characteristic_birthdate}}
+      {{#patient_characteristic_race}}
+        {{#dataElementCodes}}
+          <raceCode {{> _code}}/>
+        {{/dataElementCodes}}
+      {{/patient_characteristic_race}}
+      {{^patient_characteristic_race}}
+          <raceCode nullFlavor="UNK"/>
+      {{/patient_characteristic_race}}
+      {{#patient_characteristic_ethnicity}}
+        {{#dataElementCodes}}
+          <ethnicGroupCode {{> _code}}/>
+        {{/dataElementCodes}}
+      {{/patient_characteristic_ethnicity}}
+      {{^patient_characteristic_ethnicity}}
+          <ethnicGroupCode nullFlavor="UNK"/>
+      {{/patient_characteristic_ethnicity}}
+      <languageCommunication>
+        <templateId root="2.16.840.1.113883.3.88.11.83.2" assigningAuthorityName="HITSP/C83"/>
+        <templateId root="1.3.6.1.4.1.19376.1.5.3.1.2.1" assigningAuthorityName="IHE/PCC"/>
+        <languageCode code="eng"/>
+      </languageCommunication>
+    </patient>
+  </patientRole>
+</recordTarget>

data/lib/qrda-export/catI-r52/qrda_templates/medication_order.mustache

@@ -0,0 +1,70 @@
+<entry>
+  <!--Medication Order -->
+  <substanceAdministration classCode="SBADM" moodCode="RQO" {{{negation_ind}}}>
+    <templateId root="2.16.840.1.113883.10.20.22.4.42" extension="2014-06-09"/>
+    <!-- Medication, Order template -->
+    <templateId root="2.16.840.1.113883.10.20.24.3.47" extension="2019-12-01"/>
+    <id root="1.3.6.1.4.1.115" extension="{{object_id}}"/>
+    <text>{{description}}</text>
+    <statusCode code="active"/>
+    {{#relevantPeriod}}
+      <!-- QDM Attribute: Relevant Period -->
+      {{{medication_duration_effective_time}}}
+    {{/relevantPeriod}}
+    {{^relevantPeriod}}
+      {{#authorDatetime}}
+        <!-- QDM Attribute: Relevant Period -->
+        {{{medication_duration_author_effective_time}}}
+      {{/authorDatetime}}
+    {{/relevantPeriod}}
+    {{> qrda_templates/template_partials/_medication_details}}
+    <consumable>
+      <manufacturedProduct classCode="MANU">
+        <!-- Medication Information (consolidation) template -->
+        <templateId root="2.16.840.1.113883.10.20.22.4.23" extension="2014-06-09"/>
+        <id root="{{random_id}}"/>
+        <manufacturedMaterial>
+          <!--  QDM Attribute: Code -->
+          {{> _codes}}
+        </manufacturedMaterial>
+      </manufacturedProduct>
+    </consumable>
+    {{#authorDatetime}}
+      <!-- QDM Attribute: Author dateTime -->
+      {{> qrda_templates/template_partials/_author}}
+    {{/authorDatetime}}
+    {{#setting}}
+    <participant typeCode="LOC">
+      <participantRole>
+          <!-- QDM Attribute: Setting -->
+          <code {{> _code}}/>
+      </participantRole>
+    </participant>      
+    {{/setting}}
+    {{#prescriber}}
+      <!-- QDM Attribute: Prescriber -->
+      <participant typeCode="PRF">
+        {{> qrda_templates/template_partials/_entity}}
+      </participant>
+    {{/prescriber}}
+    {{#reason}}
+      <!-- QDM Attribute: Reason -->
+      {{> qrda_templates/template_partials/_reason}}
+    {{/reason}}
+    {{#negationRationale}}
+      <!-- QDM Attribute: Negation Rationale -->
+      {{> qrda_templates/template_partials/_reason}}
+    {{/negationRationale}}
+    {{#daysSupplied}}
+      <entryRelationship typeCode="REFR">
+          {{> qrda_templates/template_partials/_days_supplied}}
+      </entryRelationship>
+    {{/daysSupplied}}
+    {{#supply}}
+      <!-- QDM Attribute: Supply -->
+      <entryRelationship typeCode="COMP">
+          {{> qrda_templates/template_partials/_medication_supply_request}}
+      </entryRelationship>
+    {{/supply}}
+  </substanceAdministration>
+</entry>

data/lib/qrda-export/catIII/_header.mustache

@@ -3,10 +3,8 @@
 <typeId root="2.16.840.1.113883.1.3" extension="POCD_HD000040"/>
 <!-- US Realm Header Template Id -->
 <templateId root="2.16.840.1.113883.10.20.27.1.1" extension="2020-12-01"/>
-{{#ry2022_submission?}}
-<!-- QRDA Category III Report - CMS (V6) -->
-<templateId root="2.16.840.1.113883.10.20.27.1.2" extension="2021-07-01"/>
-{{/ry2022_submission?}}
+<!-- QRDA Category III Report - CMS (V7) -->
+<templateId root="2.16.840.1.113883.10.20.27.1.2" extension="2022-12-01"/>
 <!-- This is the globally unique identifier for this QRDA document -->
 <id root="{{random_id}}"/>
 <!-- QRDA III document type code -->

data/lib/qrda-export/catIII/qrda_header/_participant_ehr.mustache

@@ -1,6 +1,9 @@
 <participant typeCode="DEV">
   <associatedEntity classCode="RGPR">
-    <id root="2.16.840.1.113883.3.2074.1" extension="12345abcde67890"/>
+    <!-- CMS EHR Certification Number (formerly known as Office of the 
+        National Coordinator Certification Number). Note, this is a test
+        file, and the provided ID is not for a certified product set. -->
+    <id root="2.16.840.1.113883.3.2074.1" extension="0015CPV4ZTB4WBU"/>
     <code code="129465004" displayName="medical record, device" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED-CT"/>
   </associatedEntity>
 </participant>

data/lib/qrda-export/catIII-r2-1/qrda_header/_participant_ehr.mustache

@@ -0,0 +1,9 @@
+<participant typeCode="DEV">
+  <associatedEntity classCode="RGPR">
+  <!-- CMS EHR Certification Number (formerly known as Office of the 
+        National Coordinator Certification Number). Note, this is a test
+        file, and the provided ID is not for a certified product set. -->
+    <id root="2.16.840.1.113883.3.2074.1" extension="0015CPV4ZTB4WBU"/>
+    <code code="129465004" displayName="medical record, device" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED-CT"/>
+  </associatedEntity>
+</participant>

data/lib/qrda-export/helper/cat1_view_helper.rb

@@ -55,22 +55,30 @@ module Qrda
           self['value'].to_f
         end
 
+        def refills_as_repeat_number
+          self['refills'] + 1
+        end
+
         def dose_quantity_value
-          return "<doseQuantity value=\"#{value_as_float}\" unit=\"#{self['unit']}\"/>" if self['unit']
+          return "<doseQuantity value=\"#{value_as_float}\" unit=\"#{self['unit']}\"/>" if self['unit'] && self['unit'] != ''
           "<doseQuantity value=\"#{value_as_float}\" />"
         end
 
         def result_value
           return "<value xsi:type=\"CD\" nullFlavor=\"UNK\"/>" unless self['result']
-
           result_string = if self['result'].is_a? Array
                             result_value_as_string(self['result'][0])
                           elsif self['result'].is_a? Hash
                             result_value_as_string(self['result'])
                           elsif self['result'].is_a? String
-                            "<value xsi:type=\"ST\">#{self['result']}</value>"
+                            begin
+                              DateTime.parse self['result']
+                              "<value xsi:type=\"TS\" #{value_or_null_flavor(self['result'])}/>"
+                            rescue StandardError
+                              "<value xsi:type=\"ST\">#{self['result']}</value>"
+                            end
                           elsif !self['result'].nil?
-                            "<value xsi:type=\"PQ\" value=\"#{self['result']}\" unit=\"1\"/>"
+                            integer_or_pq(self['result'])
                           end
           result_string
         end
@@ -79,7 +87,17 @@ module Qrda
           return "<value xsi:type=\"CD\" nullFlavor=\"UNK\"/>" unless result
           oid = result['system'] || result['codeSystem']
           return "<value xsi:type=\"CD\" code=\"#{result['code']}\" codeSystem=\"#{oid}\" codeSystemName=\"#{HQMF::Util::CodeSystemHelper.code_system_for(oid)}\"/>" if result['code']
-          return "<value xsi:type=\"PQ\" value=\"#{result['value']}\" unit=\"#{result['unit']}\"/>" if result['unit']
+          return integer_or_pq(result['value'], result['unit']) if result['unit'] && result['unit'] != ''
+        end
+
+        def integer_or_pq(number, unit = nil)
+          i = number.to_i
+          f = number.to_f
+          if i == f
+            unit ? "<value xsi:type=\"PQ\" value=\"#{i}\" unit=\"#{unit}\"/>" : "<value xsi:type=\"INT\" value=\"#{i}\"/>"
+          else
+            unit ? "<value xsi:type=\"PQ\" value=\"#{f}\" unit=\"#{unit}\"/>" : "<value xsi:type=\"REAL\" value=\"#{f}\"/>"
+          end
         end
 
         def authordatetime_or_dispenserid?

data/lib/qrda-export/helper/view_helper.rb

@@ -4,7 +4,7 @@ module Qrda
     module Helper
       module ViewHelper
         def measures
-          @measures.only(:hqmf_id, :hqmf_set_id, :description).as_json
+          @measures.as_json
         end
 
         def random_id
@@ -22,6 +22,14 @@ module Qrda
         def submission_program
           @submission_program
         end
+
+        def medicare_beneficiary_identifier
+          @medicare_beneficiary_identifier
+        end
+
+        def hicn
+          @hicn
+        end
       end
     end
   end

data/lib/qrda-import/base-importers/section_importer.rb

@@ -47,8 +47,8 @@ module QRDA
         entry_qrda_id = extract_id(entry_element, @id_xpath)
         # Create a hash to map all of entry.ids to the same QRDA ids. This will be used to merge QRDA entries
         # that represent the same event.
-        @entry_id_map["#{entry_qrda_id.value}_#{entry_qrda_id.namingSystem}"] ||= []
-        @entry_id_map["#{entry_qrda_id.value}_#{entry_qrda_id.namingSystem}"] << entry.id
+        @entry_id_map["#{entry_qrda_id.value}***#{entry_qrda_id.namingSystem}"] ||= []
+        @entry_id_map["#{entry_qrda_id.value}***#{entry_qrda_id.namingSystem}"] << entry.id
         entry.dataElementCodes = extract_codes(entry_element, @code_xpath)
         extract_dates(entry_element, entry)
         if @result_xpath
@@ -77,7 +77,12 @@ module QRDA
           code_list << code_if_present(code_element)
           translations = code_element.xpath('cda:translation')
           translations.each do |translation|
-            code_list << code_if_present(translation)
+            translation_code = code_if_present(translation)
+            next unless translation_code
+
+            code_list << translation_code
+            @warnings << ValidationError.new(message: "Translation code #{translation_code.system}:#{translation_code.code} may not be used for eCQM calculation by a receiving system.  Ensure that the root code includes a code from the eCQM valueset.",
+                                             location: coded_element.path)
           end
         end
         code_list.compact
@@ -193,7 +198,14 @@ module QRDA
         return unless value_element && !value_element['nullFlavor']
         value = value_element['value']
         if value.present?
-          return value.strip.to_f if (value_element['unit'] == "1" || value_element['unit'].nil?)
+          if ['TS'].include? value_element.at_xpath("@xsi:type")&.value
+            begin
+              return DateTime.parse(value_element['value'])
+            rescue StandardError
+              return nil
+            end
+          end
+          return value.strip.to_f if unitless?(value_element)
 
           return QDM::Quantity.new(value.strip.to_f, value_element['unit'])
         elsif value_element['code'].present?
@@ -208,6 +220,12 @@ module QRDA
         end
       end
 
+      def unitless?(value_element)
+        return true if value_element['unit'].nil?
+        return true if value_element['unit'] == '1'
+        return true if value_element['unit'][0] == '{' && value_element['unit'][-1] == '}'
+      end
+
       def extract_reason(parent_element)
         return unless @reason_xpath
         reason_element = parent_element.xpath(@reason_xpath)
@@ -254,6 +272,15 @@ module QRDA
         QDM::Quantity.new(scalar_element['value'].to_f, scalar_element['unit'])
       end
 
+      def extract_refills(parent_element, repeat_number_xpath)
+        repeat_number_element = parent_element.at_xpath(repeat_number_xpath)
+        return unless repeat_number_element && repeat_number_element['value'].present?
+
+        # Refills is the Repeat Number - 1
+        repeat_number = repeat_number_element['value'].to_i
+        repeat_number.positive? ? repeat_number - 1 : 0
+      end
+
       def extract_components(parent_element)
         component_elements = parent_element.xpath(@components_xpath)
         components = []

data/lib/qrda-import/data-element-importers/encounter_performed_importer.rb

@@ -1,18 +1,18 @@
 module QRDA
   module Cat1
     class EncounterPerformedImporter < SectionImporter
-      def initialize(entry_finder = QRDA::Cat1::EntryFinder.new("./cda:entry/cda:act[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.133']"))
+      def initialize(entry_finder = QRDA::Cat1::EntryFinder.new("./cda:entry/cda:encounter[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.23']"))
         super(entry_finder)
-        @id_xpath = './cda:entryRelationship/cda:encounter/cda:id'
-        @code_xpath = "./cda:entryRelationship/cda:encounter[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.23']/cda:code"
-        @relevant_period_xpath = "./cda:entryRelationship/cda:encounter[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.23']/cda:effectiveTime"
-        @author_datetime_xpath = "./cda:entryRelationship/cda:encounter[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.23']/cda:author[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.155']/cda:time"
-        @admission_source_xpath = "./cda:entryRelationship/cda:encounter[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.23']/cda:participant/cda:participantRole[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.151']/cda:code"
-        @discharge_disposition_xpath = "./cda:entryRelationship/cda:encounter[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.23']/sdtc:dischargeDispositionCode"
-        @facility_locations_xpath = "./cda:entryRelationship/cda:encounter/cda:participant[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.100']"
-        @clazz_xpath = "./cda:entryRelationship/cda:encounter[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.23']/cda:entryRelationship/cda:act[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.171']/cda:code"
-        @diagnosis_xpath = "./cda:entryRelationship/cda:encounter[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.23']/cda:entryRelationship/cda:observation[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.168']"
-        @related_to_xpath = "./cda:entryRelationship/cda:encounter/sdtc:inFulfillmentOf1/sdtc:actReference"
+        @id_xpath = './cda:id'
+        @code_xpath = "./cda:code"
+        @relevant_period_xpath = "./cda:effectiveTime"
+        @author_datetime_xpath = "./cda:author[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.155']/cda:time"
+        @admission_source_xpath = "./cda:participant/cda:participantRole[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.151']/cda:code"
+        @discharge_disposition_xpath = "./sdtc:dischargeDispositionCode"
+        @facility_locations_xpath = "./cda:participant[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.100']"
+        @clazz_xpath = "./cda:entryRelationship/cda:act[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.171']/cda:code"
+        @diagnosis_xpath = "./cda:entryRelationship/cda:observation[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.168']"
+        @related_to_xpath = "./sdtc:inFulfillmentOf1/sdtc:actReference"
         @entry_class = QDM::EncounterPerformed
       end
 
@@ -27,7 +27,7 @@ module QRDA
           los = encounter_performed.relevantPeriod.high.to_date - encounter_performed.relevantPeriod.low.to_date
           encounter_performed.lengthOfStay = QDM::Quantity.new(los.to_i, 'd')
         end
-        entity = extract_entity(entry_element, "./cda:entryRelationship/cda:encounter//cda:participant[@typeCode='PRF']")
+        entity = extract_entity(entry_element, "./cda:participant[@typeCode='PRF']")
         encounter_performed.participant.concat(entity) if entity
         extract_modifier_code(encounter_performed, entry_element)
         encounter_performed.relatedTo = extract_related_to(entry_element)

data/lib/qrda-import/data-element-importers/medication_discharge_importer.rb

@@ -18,7 +18,7 @@ module QRDA
 
       def create_entry(entry_element, nrh = NarrativeReferenceHandler.new)
         medication_discharge = super
-        medication_discharge.refills = extract_scalar(entry_element, @refills_xpath)&.value
+        medication_discharge.refills = extract_refills(entry_element, @refills_xpath)
         medication_discharge.dosage = extract_scalar(entry_element, @dosage_xpath)
         medication_discharge.supply = extract_scalar(entry_element, @supply_xpath)
         medication_discharge.frequency = frequency_as_coded_value(entry_element, @frequency_xpath)

data/lib/qrda-import/data-element-importers/medication_dispensed_importer.rb

@@ -19,7 +19,7 @@ module QRDA
 
       def create_entry(entry_element, nrh = NarrativeReferenceHandler.new)
         medication_dispensed = super
-        medication_dispensed.refills = extract_scalar(entry_element, @refills_xpath)&.value
+        medication_dispensed.refills = extract_refills(entry_element, @refills_xpath)
         medication_dispensed.dosage = extract_scalar(entry_element, @dosage_xpath)
         medication_dispensed.supply = extract_scalar(entry_element, @supply_xpath)
         medication_dispensed.frequency = frequency_as_coded_value(entry_element, @frequency_xpath)

data/lib/qrda-import/data-element-importers/medication_order_importer.rb

@@ -25,7 +25,7 @@ module QRDA
         medication_order.dosage = extract_scalar(entry_element, @dosage_xpath)
         medication_order.supply = extract_scalar(entry_element, @supply_xpath)
         medication_order.frequency = frequency_as_coded_value(entry_element, @frequency_xpath)
-        medication_order.refills = extract_scalar(entry_element, @refills_xpath)&.value
+        medication_order.refills = extract_refills(entry_element, @refills_xpath)
         medication_order.route = code_if_present(entry_element.at_xpath(@route_xpath))
         medication_order.setting = code_if_present(entry_element.at_xpath(@setting_xpath))
         medication_order.daysSupplied = extract_scalar(entry_element, @days_supplied_xpath)&.value

data/lib/qrda-import/data-element-importers/substance_order_importer.rb

@@ -21,7 +21,7 @@ module QRDA
         substance_order.dosage = extract_scalar(entry_element, @dosage_xpath)
         substance_order.supply = extract_scalar(entry_element, @supply_xpath)
         substance_order.frequency = frequency_as_coded_value(entry_element, @frequency_xpath)
-        substance_order.refills = extract_scalar(entry_element, @refills_xpath)&.value
+        substance_order.refills = extract_refills(entry_element, @refills_xpath)
         substance_order.route = code_if_present(entry_element.at_xpath(@route_xpath))
         substance_order.reason = extract_reason(entry_element)
         substance_order

data/lib/qrda-import/data-element-importers/substance_recommended_importer.rb

@@ -18,7 +18,7 @@ module QRDA
         substance_recommended = super
         substance_recommended.dosage = extract_scalar(entry_element, @dosage_xpath)
         substance_recommended.frequency = frequency_as_coded_value(entry_element, @frequency_xpath)
-        substance_recommended.refills = extract_scalar(entry_element, @refills_xpath)&.value
+        substance_recommended.refills = extract_refills(entry_element, @refills_xpath)
         substance_recommended.route = code_if_present(entry_element.at_xpath(@route_xpath))
         substance_recommended.reason = extract_reason(entry_element)
         entity = extract_entity(entry_element, "./cda:participant[@typeCode='PRF']")

data/lib/qrda-import/patient_importer.rb

@@ -67,7 +67,7 @@ module QRDA
         codes_modifiers = {}
         entry_id_map = {}
         import_data_elements(patient, doc, entry_id_map, codes, codes_modifiers, warnings)
-        normalize_references(patient, entry_id_map)
+        normalize_references(patient, entry_id_map, warnings)
         get_demographics(patient, doc, codes)
         [patient, warnings, codes, codes_modifiers]
       end
@@ -80,9 +80,19 @@ module QRDA
           data_elements, id_map = importer.create_entries(context, nrh)
           new_data_elements = []
 
-          id_map.each_value do |elem_ids|
-            elem_id = elem_ids.first
+          id_map.each_pair do |key, elem_ids|
+            split_id = key.split('***')
+            id_string = "#{split_id[1]}(root), #{split_id[0]}(extension)"
+            warnings << ValidationError.new(message: "Two or more entries share the Id: #{id_string}.") if elem_ids.length > 1
+            elem_id = elem_ids.last
             data_element = data_elements.find { |de| de.id == elem_id }
+
+            # If a data_element isn't returned, there was an issue parsing the template, provide a warning
+            if data_element.nil?
+              warnings << ValidationError.new(message: "Error parsing template with Id: #{id_string}.")
+              next
+            end
+
             # Keep the first element with a shared ID
             new_data_elements << data_element
 
@@ -94,7 +104,7 @@ module QRDA
             unique_element_keys << key_elements_for_determining_encounter_uniqueness(data_element)
 
             # Loop through all other data elements with the same id
-            elem_ids[1,elem_ids.length].each do |dup_id|
+            elem_ids[0,elem_ids.length - 1].each do |dup_id|
               dup_element = data_elements.find { |de| de.id == dup_id }
               dup_element_keys = key_elements_for_determining_encounter_uniqueness(dup_element)
               # See if a previously selected data element shared all of the keys files
@@ -134,13 +144,19 @@ module QRDA
         record.deathdate = DateTime.parse(entry_elements.at_xpath("./cda:effectiveTime/cda:low")['value']).to_i
       end
 
-      def normalize_references(patient, entry_id_map)
+      def normalize_references(patient, entry_id_map, warnings)
         patient.qdmPatient.dataElements.each do |data_element|
           next unless data_element.respond_to?(:relatedTo) && data_element.relatedTo
 
           relations_to_add = []
           data_element.relatedTo.each do |related_to|
-            relations_to_add += entry_id_map["#{related_to['value']}_#{related_to['namingSystem']}"]
+            relation_to_add = entry_id_map["#{related_to['value']}***#{related_to['namingSystem']}"]
+            # Add the relation if it can be found, otherwise return a warning
+            relations_to_add += relation_to_add unless relation_to_add.nil?
+            if relation_to_add.nil?
+              id_warning_str = "Related To Id: #{related_to['namingSystem']}(root), #{related_to['value']}(extension) cannot be found in QRDA file."
+              warnings << ValidationError.new(message: id_warning_str)
+            end
           end
           data_element.relatedTo = relations_to_add.map(&:to_s)
         end

metadata

@@ -1,14 +1,14 @@
 --- !ruby/object:Gem::Specification
 name: cqm-reports
 version: !ruby/object:Gem::Version
-  version: 4.0.0
+  version: 4.1.0
 platform: ruby
 authors:
 - The MITRE Corporation
 autorequire:
 bindir: bin
 cert_chain: []
-date: 2021-12-17 00:00:00.000000000 Z
+date: 2023-11-01 00:00:00.000000000 Z
 dependencies:
 - !ruby/object:Gem::Dependency
   name: cqm-models
@@ -89,7 +89,7 @@ dependencies:
         version: 1.8.5
     - - "<"
       - !ruby/object:Gem::Version
-        version: 1.13.0
+        version: 1.15.0
   type: :runtime
   prerelease: false
   version_requirements: !ruby/object:Gem::Requirement
@@ -99,7 +99,7 @@ dependencies:
         version: 1.8.5
     - - "<"
       - !ruby/object:Gem::Version
-        version: 1.13.0
+        version: 1.15.0
 - !ruby/object:Gem::Dependency
   name: uuid
   requirement: !ruby/object:Gem::Requirement
@@ -263,6 +263,11 @@ files:
 - lib/qrda-export/catI-r5/qrda_templates/template_partials/_results.mustache
 - lib/qrda-export/catI-r5/qrda_templates/template_partials/_severity.mustache
 - lib/qrda-export/catI-r5/qrda_templates/template_partials/_status.mustache
+- lib/qrda-export/catI-r52/qrda1_r52.rb
+- lib/qrda-export/catI-r52/qrda_header/_participant.mustache
+- lib/qrda-export/catI-r52/qrda_header/_record_target.mustache
+- lib/qrda-export/catI-r52/qrda_templates/medication_order.mustache
+- lib/qrda-export/catIII-r2-1/qrda_header/_participant_ehr.mustache
 - lib/qrda-export/catIII/_continuous_variable_value.mustache
 - lib/qrda-export/catIII/_header.mustache
 - lib/qrda-export/catIII/_measure_data.mustache
@@ -365,7 +370,7 @@ required_rubygems_version: !ruby/object:Gem::Requirement
     - !ruby/object:Gem::Version
       version: '0'
 requirements: []
-rubygems_version: 3.0.2
+rubygems_version: 3.1.4
 signing_key:
 specification_version: 4
 summary: A library for import and export of reports for use with electronic Clinical