cqm-reports 4.1.3 → 4.1.5

checksums.yaml

@@ -1,7 +1,7 @@
 ---
 SHA256:
-  metadata.gz: 2d5f83d79b0b7295876fb917ec83383842ce49e204d01c6005922ff91768b541
-  data.tar.gz: fc5bf5bf6ba3865c0eff6c25aa04dd23f5d9929502e3f989edba6e9602c177a7
+  metadata.gz: '08e7e657c2a3f3cfdde7ed644b30eabcf2fd4be7496b21b89b10e5c7a14def96'
+  data.tar.gz: '0008b828658cbc5b3c787e773aa28649407c03940b1cc913142c50bcd7d3d188'
 SHA512:
-  metadata.gz: d0200cc9134c712897840cf3a580dbd00f33fc2d89f97a75750b6a96db9851104f67e7fe42cd83547de97e5bae0354ab2398340f50a78b8f214a6d6b6c57c25a
-  data.tar.gz: d8959ab387cc0d6fdef054ccebe1d185d287f28fd9f562cef5da888f7394beffad526aaf01a9b2da7fad64833d995a891bae2be74b665b1d1e103554756e0a47
+  metadata.gz: 12ef53ecb61ebe05fab08cdc30b0a04d81122df35947ae4cc15d77e2481ec5c525e5362cdb278f8b559907b5c3f146f0f37edc0909d60556d897f279c5c621c2
+  data.tar.gz: fa94922e97bd9a5760142a2070560f6ca66b63f45667b37098dc86e8012e97f2cfd446f44bc330df04f0d3063aa5b514d38ec2ff1b0757a0498320ac7663d2df

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

@@ -169,10 +169,10 @@
 {{/recorder}}
 {{#referenceRange}}
 	<div class="div-head-row">
-		<div class="div-table-head--no-border"><span class="criteria-heading">Reference Range Start:</span>  {{{low}}}</div>
+		<div class="div-table-head--no-border"><span class="criteria-heading">Reference Range Start:</span>  {{#low}}{{format_time}}{{/low}}</div>
 	</div>
 	<div class="div-head-row">
-		<div class="div-table-head--no-border"><span class="criteria-heading">Reference Range End:</span>  {{{high}}}</div>
+		<div class="div-table-head--no-border"><span class="criteria-heading">Reference Range End:</span>  {{#high}}{{format_time}}{{/high}}</div>
 	</div>
 {{/referenceRange}}
 {{#refills}}

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

@@ -2,77 +2,77 @@
 <div class="div-table-body">
 {{#relevantPeriod}}
 	<div class="div-head-row">
-		<div class="div-table-head--no-border"><span class="criteria-heading">Relevant Period Start:</span>  {{{low}}}</div>
+		<div class="div-table-head--no-border"><span class="criteria-heading">Relevant Period Start:</span>  {{#low}}{{format_time}}{{/low}}</div>
 	</div>
 	{{#end_time?}}
 		<div class="div-head-row">
-			<div class="div-table-head--no-border"><span class="criteria-heading">Relevant Period End:</span>  {{{high}}}</div>
+			<div class="div-table-head--no-border"><span class="criteria-heading">Relevant Period End:</span>  {{#high}}{{format_time}}{{/high}}</div>
 		</div>
 	{{/end_time?}}
 {{/relevantPeriod}}
 {{#relevantDatetime}}
 	<div class="div-head-row">
-		<div class="div-table-head--no-border"><span class="criteria-heading">Relevant Date/Time:</span>  {{{relevantDatetime}}}</div>
+		<div class="div-table-head--no-border"><span class="criteria-heading">Relevant Date/Time:</span>  {{#relevantDatetime}}{{format_time}}{{/relevantDatetime}}</div>
 	</div>
 {{/relevantDatetime}}
 {{#prevalencePeriod}}
 	<div class="div-head-row">
-	    <div class="div-table-head--no-border"><span class="criteria-heading">Prevalence Period Start:</span>  {{{low}}}</div>
+		<div class="div-table-head--no-border"><span class="criteria-heading">Prevalence Period Start:</span>  {{#low}}{{format_time}}{{/low}}</div>
 	</div>
 	{{#end_time?}}
 		<div class="div-head-row">
-		    <div class="div-table-head--no-border"><span class="criteria-heading">Prevalence Period End:</span>  {{{high}}}</div>
+			<div class="div-table-head--no-border"><span class="criteria-heading">Prevalence Period End:</span>  {{#high}}{{format_time}}{{/high}}</div>
 		</div>
 	{{/end_time?}}
 {{/prevalencePeriod}}
 {{#participationPeriod}}
 	<div class="div-head-row">
-		<div class="div-table-head--no-border"><span class="criteria-heading">Participation Period Start:</span>  {{{low}}}</div>
+		<div class="div-table-head--no-border"><span class="criteria-heading">Participation Period Start:</span>  {{#low}}{{format_time}}{{/low}}</div>
 	</div>
 	{{#end_time?}}
 		<div class="div-head-row">
-			<div class="div-table-head--no-border"><span class="criteria-heading">Participation Period End:</span>  {{{high}}}</div>
+			<div class="div-table-head--no-border"><span class="criteria-heading">Participation Period End:</span>  {{#high}}{{format_time}}{{/high}}</div>
 		</div>
 	{{/end_time?}}
 {{/participationPeriod}}
 {{#authorDatetime}}
 	<div class="div-head-row">
-		<div class="div-table-head--no-border"><span class="criteria-heading">Author Date/Time:</span>  {{{authorDatetime}}}</div>
+		<div class="div-table-head--no-border"><span class="criteria-heading">Author Date/Time:</span>  {{#authorDatetime}}{{format_time}}{{/authorDatetime}}</div>
 	</div>
 {{/authorDatetime}}
 {{#resultDatetime}}
 	<div class="div-head-row">
-		<div class="div-table-head--no-border"><span class="criteria-heading">Result Date/Time:</span>  {{{resultDatetime}}}</div>
+		<div class="div-table-head--no-border"><span class="criteria-heading">Result Date/Time:</span>  {{#resultDatetime}}{{format_time}}{{/resultDatetime}}</div>
 	</div>
 {{/resultDatetime}}
 {{#activeDatetime}}
 	<div class="div-head-row">
-		<div class="div-table-head--no-border"><span class="criteria-heading">Active Date/Time:</span>  {{{activeDatetime}}}</div>
+		<div class="div-table-head--no-border"><span class="criteria-heading">Active Date/Time:</span>  {{#activeDatetime}}{{format_time}}{{/activeDatetime}}</div>
 	</div>
 {{/activeDatetime}}
 {{#incisionDatetime}}
 	<div class="div-head-row">
-		<div class="div-table-head--no-border"><span class="criteria-heading">Incision Date/Time:</span>  {{{incisionDatetime}}}</div>
+		<div class="div-table-head--no-border"><span class="criteria-heading">Incision Date/Time:</span>  {{#incisionDatetime}}{{format_time}}{{/incisionDatetime}}</div>
 	</div>
 {{/incisionDatetime}}
 {{#receivedDatetime}}
 	<div class="div-head-row">
-		<div class="div-table-head--no-border"><span class="criteria-heading">Received Date/Time:</span>  {{{receivedDatetime}}}</div>
+		<div class="div-table-head--no-border"><span class="criteria-heading">Received Date/Time:</span>  {{#receivedDatetime}}{{format_time}}{{/receivedDatetime}}</div>
 	</div>
 {{/receivedDatetime}}
 {{#sentDatetime}}
 	<div class="div-head-row">
-		<div class="div-table-head--no-border"><span class="criteria-heading">Sent Date/Time:</span>  {{{sentDatetime}}}</div>
+		<div class="div-table-head--no-border"><span class="criteria-heading">Sent Date/Time:</span>  {{#sentDatetime}}{{format_time}}{{/sentDatetime}}</div>
 	</div>
 {{/sentDatetime}}
 {{#birthDatetime}}
 	<div class="div-head-row">
-		<div class="div-table-head--no-border"><span class="criteria-heading">Birth Date/Time:</span>  {{{birthDatetime}}}</div>
+		<div class="div-table-head--no-border"><span class="criteria-heading">Birth Date/Time:</span>  {{#birthDatetime}}{{format_time}}{{/birthDatetime}}</div>
 	</div>
 {{/birthDatetime}}
 {{#expiredDatetime}}
 	<div class="div-head-row">
-		<div class="div-table-head--no-border"><span class="criteria-heading">Expired Date/Time:</span>  {{{expiredDatetime}}}</div>
+		<div class="div-table-head--no-border"><span class="criteria-heading">Expired Date/Time:</span>  {{#expiredDatetime}}{{format_time}}{{/expiredDatetime}}</div>
 	</div>
 {{/expiredDatetime}}
 </div>

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

@@ -22,9 +22,9 @@
         </div>
         <div class="div-head-row patient_narr_tr panel panel-default patient-details">
           <div class="div-table-head patient_narr_th panel-heading"><span class="td_label">Date of birth</span></div>
-          <div class="div-table-head">{{{birthdate}}}</div>
+          <div class="div-table-head">{{#birthdate}}{{format_time}}{{/birthdate}}</div>
           <div class="div-table-head patient_narr_th panel-heading"><span class="td_label">Date of expiration</span></div>
-          <div class="div-table-head">{{{expiration}}}</div>
+          <div class="div-table-head">{{#expiration}}{{format_time}}{{/expiration}}</div>
         </div>
         <div class="div-head-row patient_narr_tr panel panel-default patient-details">
           <div class="div-table-head patient_narr_th panel-heading"><span class="td_label">Race</span></div>

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

@@ -1,4 +1,5 @@
 require 'mustache'
+require 'time'
 class QdmPatient < Mustache
   include Qrda::Export::Helper::PatientViewHelper
   include HQMF::Util::EntityHelper
@@ -151,4 +152,17 @@ class QdmPatient < Mustache
   def end_time?
     self['high'] && DateTime.parse(self['high']).year < 3000
   end
+
+  def format_time
+    str = render('{{.}}').to_s.strip # current section value
+    return "" if str.empty? || str == "null"
+    convert_iso_timestamp_to_human_readable(str)
+  rescue ArgumentError, TypeError => _e
+    str
+  end
+
+  def convert_iso_timestamp_to_human_readable(iso)
+    t = Time.parse(iso).in_time_zone
+    t.strftime('%B %e, %Y %l:%M%P')
+  end
 end

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

@@ -8,7 +8,14 @@
 <!-- QDM-based QRDA templateId -->
 <templateId root="2.16.840.1.113883.10.20.24.1.2" extension="2021-08-01"/>
 <!-- CMS QRDA templateId -->
+{{#ry2026_submission?}}
+<!-- QRDA Category I Report - CMS (V9) -->
+<templateId root="2.16.840.1.113883.10.20.24.1.3" extension="2025-03-01"/>
+{{/ry2026_submission?}}
+{{^ry2026_submission?}}
+<!-- QRDA Category I Report - CMS (V8) -->
 <templateId root="2.16.840.1.113883.10.20.24.1.3" extension="2022-02-01"/>
+{{/ry2026_submission?}}
 <!-- 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.rb

@@ -20,11 +20,17 @@ class Qrda1R5 < Mustache
     @performance_period_start = options[:start_time]
     @performance_period_end = options[:end_time]
     @submission_program = options[:submission_program]
+    @ry2026_submission = options[:ry2026_submission]
     @medicare_beneficiary_identifier = options[:medicare_beneficiary_identifier]
     @hicn = options[:hicn]
     @authoring_system = options[:authoring_system]
   end
 
+  # use 2026 template ids if 2026 submission is specified as true, or if it unspecified
+  def ry2026_submission?
+    @ry2026_submission || @ry2026_submission.nil?
+  end
+
   def authoring_system
     @authoring_system || 'TestSystem'
   end

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

@@ -33,7 +33,14 @@
       {{/patient}}
       {{#patient_characteristic_sex}}
         {{#dataElementCodes}}
-          <administrativeGenderCode {{> _code}}/>
+          {{#onc_gender_code?}}
+            <administrativeGenderCode {{> _code}}/>
+          {{/onc_gender_code?}}
+          {{^onc_gender_code?}}
+            <administrativeGenderCode nullFlavor="OTH">
+              <translation {{> _code}}/>
+            </administrativeGenderCode>
+          {{/onc_gender_code?}}
         {{/dataElementCodes}}
       {{/patient_characteristic_sex}}
       {{^patient_characteristic_sex}}

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

@@ -3,14 +3,20 @@
 <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"/>
-{{#ry2025_submission?}}
-<!-- QRDA Category III Report - CMS (V9) -->
-<templateId root="2.16.840.1.113883.10.20.27.1.2" extension="2024-12-01"/>
-{{/ry2025_submission?}}
-{{^ry2025_submission?}}
-<!-- QRDA Category III Report - CMS (V7) -->
-<templateId root="2.16.840.1.113883.10.20.27.1.2" extension="2022-12-01"/>
-{{/ry2025_submission?}}
+{{#ry2026_submission?}}
+  <!-- QRDA Category III Report - CMS (V10) -->
+  <templateId root="2.16.840.1.113883.10.20.27.1.2" extension="2025-05-01"/>
+{{/ry2026_submission?}}
+{{^ry2026_submission?}}
+  {{#ry2025_submission?}}
+  <!-- QRDA Category III Report - CMS (V9) -->
+  <templateId root="2.16.840.1.113883.10.20.27.1.2" extension="2024-12-01"/>
+  {{/ry2025_submission?}}
+  {{^ry2025_submission?}}
+  <!-- QRDA Category III Report - CMS (V7) -->
+  <templateId root="2.16.840.1.113883.10.20.27.1.2" extension="2022-12-01"/>
+  {{/ry2025_submission?}}
+{{/ry2026_submission?}}
 <!-- This is the globally unique identifier for this QRDA document -->
 <id root="{{random_id}}"/>
 <!-- QRDA III document type code -->

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

@@ -5,8 +5,14 @@
   <observation classCode="OBS" moodCode="EVN">
     <!-- Measure Data template -->
     <templateId root="2.16.840.1.113883.10.20.27.3.5" extension="2016-09-01"/>
-    <!-- Measure Data - CMS (V4) -->
-    <templateId root="2.16.840.1.113883.10.20.27.3.16" extension="2019-05-01"/>
+    {{#ry2026_submission?}}
+      <!-- Measure Data - CMS (V5) -->
+      <templateId root="2.16.840.1.113883.10.20.27.3.16" extension="2025-05-01"/>
+    {{/ry2026_submission?}}
+    {{^ry2026_submission?}}
+      <!-- Measure Data - CMS (V4) -->
+      <templateId root="2.16.840.1.113883.10.20.27.3.16" extension="2019-05-01"/>
+    {{/ry2026_submission?}}
     <code code="ASSERTION" codeSystem="2.16.840.1.113883.5.4" displayName="Assertion" codeSystemName="ActCode"/>
     <statusCode code="completed"/>
     <value xsi:type="CD" code="{{population_type}}" codeSystem="2.16.840.1.113883.5.4" codeSystemName="ActCode"/>

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

@@ -10,8 +10,14 @@
     <!-- In this case the query is using an eMeasure -->
     <!-- QRDA Category III Measure Section template -->
     <templateId extension="2020-12-01" root="2.16.840.1.113883.10.20.27.2.1"/>
-    <!-- QRDA Category III Measure Section - CMS (V4) -->
-    <templateId extension="2022-05-01" root="2.16.840.1.113883.10.20.27.2.3"/>
+    {{#ry2026_submission?}}
+      <!-- QRDA Category III Measure Section - CMS (V6) -->
+      <templateId extension="2025-05-01" root="2.16.840.1.113883.10.20.27.2.3"/>
+    {{/ry2026_submission?}}
+    {{^ry2026_submission?}}
+      <!-- QRDA Category III Measure Section - CMS (V5) -->
+      <templateId extension="2022-05-01" root="2.16.840.1.113883.10.20.27.2.3"/>
+    {{/ry2026_submission?}}
     <code code="55186-1" codeSystem="2.16.840.1.113883.6.1"/>
     <title>Measure Section</title>
     <text>
@@ -41,7 +47,12 @@
         <templateId root="2.16.840.1.113883.10.20.24.3.98"/>
         <!-- SHALL 1..* (one for each referenced measure) Measure Reference and Results template -->
         <templateId extension="2020-12-01" root="2.16.840.1.113883.10.20.27.3.1"/>
-        <templateId extension="2022-05-01" root="2.16.840.1.113883.10.20.27.3.17"/>
+        {{#ry2026_submission?}}
+          <templateId extension="2025-05-01" root="2.16.840.1.113883.10.20.27.3.17"/>
+        {{/ry2026_submission?}}
+        {{^ry2026_submission?}}
+          <templateId extension="2022-05-01" root="2.16.840.1.113883.10.20.27.3.17"/>
+        {{/ry2026_submission?}}
         <id extension="{{random_id}}" root="1.3.6.1.4.1.115"/>
         <statusCode code="completed"/>
         <!-- Containing isBranch external references -->

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

@@ -19,7 +19,19 @@
         </value>
       {{/payer_code?}}
       {{^payer_code?}}
-        <value xsi:type="CD" code="{{code}}" codeSystem="{{supplemental_data_value_code_system}}"/>
+        {{#gender_code?}}
+          {{#other_gender_code?}}
+            <value xsi:type="CD" nullFlavor="OTH">
+              <translation code="{{{code}}}" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMEDCT"/>
+            </value>
+          {{/other_gender_code?}}
+          {{^other_gender_code?}}
+            <value xsi:type="CD" code="{{code}}" codeSystem="{{supplemental_data_value_code_system}}"/>
+          {{/other_gender_code?}}
+        {{/gender_code?}}
+        {{^gender_code?}}
+          <value xsi:type="CD" code="{{code}}" codeSystem="{{supplemental_data_value_code_system}}"/>
+        {{/gender_code?}}
       {{/payer_code?}}
     {{/unknown_supplemental_value?}}
     <entryRelationship typeCode="SUBJ" inversionInd="true">

data/lib/qrda-export/catIII/qrda3.rb

@@ -29,6 +29,7 @@ class Qrda3 < Mustache
     @submission_program = options[:submission_program]
     @ry2022_submission = options[:ry2022_submission]
     @ry2025_submission = options[:ry2025_submission]
+    @ry2026_submission = options[:ry2026_submission]
     @authoring_system = options[:authoring_system]
   end
 
@@ -75,7 +76,12 @@ class Qrda3 < Mustache
     when 'ETHNICITY'
       [{ tid: '2.16.840.1.113883.10.20.27.3.7', extension: '2016-09-01' }]
     when 'SEX'
-      [{ tid: '2.16.840.1.113883.10.20.27.3.6', extension: '2016-09-01' }]
+      if other_gender_code?
+        [{ tid: '2.16.840.1.113883.10.20.27.3.6', extension: '2016-09-01' },
+         { tid: '2.16.840.1.113883.10.20.27.3.21', extension: '2025-05-01' }]
+      else
+        [{ tid: '2.16.840.1.113883.10.20.27.3.6', extension: '2016-09-01' }]
+      end
     when 'PAYER'
       [{ tid: '2.16.840.1.113883.10.20.27.3.9', extension: '2016-02-01' },
        { tid: '2.16.840.1.113883.10.20.27.3.18', extension: '2018-05-01' }]
@@ -98,6 +104,11 @@ class Qrda3 < Mustache
     @ry2025_submission
   end
 
+  # use 2026 template ids if 2026 submission is specified as true, or if it unspecified
+  def ry2026_submission?
+    @ry2026_submission || @ry2026_submission.nil?
+  end
+
   def authoring_system
     @authoring_system || 'TestSystem'
   end
@@ -106,6 +117,14 @@ class Qrda3 < Mustache
     self['type'] == 'PAYER'
   end
 
+  def gender_code?
+    self['type'] == 'SEX'
+  end
+
+  def other_gender_code?
+    !%w[M F].include?(self['code'])
+  end
+
   def supplemental_data_code
     case self['type']
     when 'RACE'

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

@@ -44,6 +44,12 @@ module Qrda
           self['givenNames'].join(' ')
         end
 
+        def onc_gender_code?
+          gender_elements = @qdmPatient.dataElements.select { |de| de._type == "QDM::PatientCharacteristicSex" }
+          return false if gender_elements.empty?
+          gender_elements.first.dataElementCodes.first['system'] == '2.16.840.1.113883.5.1'
+        end
+
         def gender
           gender_elements = @qdmPatient.dataElements.select { |de| de._type == "QDM::PatientCharacteristicSex" }
           return if gender_elements.empty?

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

@@ -30,10 +30,22 @@ module QRDA
       end
 
       def code_if_present(code_element, codes)
+        other_code = other_code_if_present(code_element, codes)
+        return other_code if other_code
         return unless code_element && code_element['code'] && code_element['codeSystem']
         codes.add("#{code_element['code']}:#{code_element['codeSystem']}")
         QDM::Code.new(code_element['code'], code_element['codeSystem'])
       end
+
+      def other_code_if_present(code_element, codes)
+        return unless code_element['nullFlavor']
+        translations = code_element.xpath('cda:translation')
+        return if translations.blank?
+
+        translations.each do |translation|
+          return code_if_present(translation, codes)
+        end
+      end
     end
   end
 end

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

@@ -4,12 +4,12 @@ module QRDA
       def initialize(entry_finder = QRDA::Cat1::EntryFinder.new("./cda:entry/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.146']"))
         super(entry_finder)
         @id_xpath = './cda:id'
-        @code_xpath = "./cda:entryRelationship/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.148']/cda:value"
+        @code_xpath = "./cda:entryRelationship[@typeCode='CAUS']/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.148']/cda:value"
         @author_datetime_xpath = "./cda:author[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.155']/cda:time"
         @relevant_date_time_xpath = './cda:effectiveTime[@value]'
         @facility_locations_xpath = "./cda:participant[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.100']"
-        @severity_xpath = "./cda:entryRelationship/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.8']/cda:value"
-        @type_xpath = "./cda:entryRelationship/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.9']/cda:value"
+        @severity_xpath = "./cda:entryRelationship[@typeCode='REFR']/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.8']/cda:value"
+        @type_xpath = "./cda:entryRelationship[@typeCode='MFST']/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.9']/cda:value"
         @entry_class = QDM::AdverseEvent
       end
 

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

@@ -7,8 +7,8 @@ module QRDA
         @code_xpath = "./cda:participant[@typeCode='CSM']/cda:participantRole/cda:playingEntity/cda:code"
         @author_datetime_xpath = "./cda:author[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.155']/cda:time"
         @prevalence_period_xpath = "./cda:effectiveTime"
-        @severity_xpath = "./cda:entryRelationship/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.8']/cda:value"
-        @type_xpath = "./cda:entryRelationship/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.9']/cda:value"
+        @severity_xpath = "./cda:entryRelationship[@typeCode='REFR']/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.8']/cda:value"
+        @type_xpath = "./cda:entryRelationship[@typeCode='MFST']/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.9']/cda:value"
         @entry_class = QDM::AllergyIntolerance
       end
 

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

@@ -3,10 +3,10 @@ module QRDA
     class DeviceOrderImporter < SectionImporter
       def initialize(entry_finder = QRDA::Cat1::EntryFinder.new("./cda:entry/cda:act[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.130']"))
         super(entry_finder)
-        @id_xpath = "./cda:entryRelationship/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.9']/cda:id"
-        @code_xpath = "./cda:entryRelationship/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.9']/cda:participant/cda:participantRole/cda:playingDevice/cda:code"
-        @author_datetime_xpath = "./cda:entryRelationship/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.9']/cda:author[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.155']/cda:time"
-        @reason_xpath = "./cda:entryRelationship/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.9']/cda:entryRelationship[@typeCode='RSON']/cda:observation[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.88']/cda:value"
+        @id_xpath = "./cda:entryRelationship[@typeCode='SUBJ']/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.9']/cda:id"
+        @code_xpath = "./cda:entryRelationship[@typeCode='SUBJ']/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.9']/cda:participant/cda:participantRole/cda:playingDevice/cda:code"
+        @author_datetime_xpath = "./cda:entryRelationship[@typeCode='SUBJ']/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.9']/cda:author[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.155']/cda:time"
+        @reason_xpath = "./cda:entryRelationship[@typeCode='SUBJ']/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.9']/cda:entryRelationship[@typeCode='RSON']/cda:observation[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.88']/cda:value"
         @entry_class = QDM::DeviceOrder
       end
 

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

@@ -3,10 +3,10 @@ module QRDA
     class DeviceRecommendedImporter < SectionImporter
       def initialize(entry_finder = QRDA::Cat1::EntryFinder.new("./cda:entry/cda:act[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.131']"))
         super(entry_finder)
-        @id_xpath = "./cda:entryRelationship/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.10']/cda:id"
-        @code_xpath = "./cda:entryRelationship/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.10']/cda:participant/cda:participantRole/cda:playingDevice/cda:code"
-        @author_datetime_xpath = "./cda:entryRelationship/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.10']/cda:author[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.155']/cda:time"
-        @reason_xpath = "./cda:entryRelationship/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.10']/cda:entryRelationship[@typeCode='RSON']/cda:observation[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.88']/cda:value"
+        @id_xpath = "./cda:entryRelationship[@typeCode='SUBJ']/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.10']/cda:id"
+        @code_xpath = "./cda:entryRelationship[@typeCode='SUBJ']/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.10']/cda:participant/cda:participantRole/cda:playingDevice/cda:code"
+        @author_datetime_xpath = "./cda:entryRelationship[@typeCode='SUBJ']/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.10']/cda:author[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.155']/cda:time"
+        @reason_xpath = "./cda:entryRelationship[@typeCode='SUBJ']/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.10']/cda:entryRelationship[@typeCode='RSON']/cda:observation[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.88']/cda:value"
         @entry_class = QDM::DeviceRecommended
       end
 

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

@@ -3,12 +3,12 @@ module QRDA
     class DiagnosisImporter < SectionImporter
       def initialize(entry_finder = QRDA::Cat1::EntryFinder.new("./cda:entry/cda:act[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.137']"))
         super(entry_finder)
-        @id_xpath = './cda:entryRelationship/cda:observation/cda:id'
-        @code_xpath = "./cda:entryRelationship/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.135']/cda:value"
-        @author_datetime_xpath = "./cda:entryRelationship/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.135']/cda:author[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.155']/cda:time"
-        @prevalence_period_xpath = "./cda:entryRelationship/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.135']/cda:effectiveTime"
-        @anatomical_location_site_xpath = "./cda:entryRelationship/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.135']/cda:targetSiteCode"
-        @severity_xpath = "./cda:entryRelationship/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.135']/cda:entryRelationship/cda:observation[cda:templateId/@root='2.16.840.1.113883.10.20.22.4.8']/cda:value"
+        @id_xpath = "./cda:entryRelationship[@typeCode='SUBJ']/cda:observation/cda:id"
+        @code_xpath = "./cda:entryRelationship[@typeCode='SUBJ']/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.135']/cda:value"
+        @author_datetime_xpath = "./cda:entryRelationship[@typeCode='SUBJ']/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.135']/cda:author[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.155']/cda:time"
+        @prevalence_period_xpath = "./cda:entryRelationship[@typeCode='SUBJ']/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.135']/cda:effectiveTime"
+        @anatomical_location_site_xpath = "./cda:entryRelationship[@typeCode='SUBJ']/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.135']/cda:targetSiteCode"
+        @severity_xpath = "./cda:entryRelationship[@typeCode='SUBJ']/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.135']/cda:entryRelationship[@typeCode='REFR']/cda:observation[cda:templateId/@root='2.16.840.1.113883.10.20.22.4.8']/cda:value"
         @entry_class = QDM::Diagnosis
       end
 

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

@@ -8,13 +8,13 @@ module QRDA
         @relevant_period_xpath = "./cda:effectiveTime"
         @relevant_date_time_xpath = './cda:effectiveTime[@value]'
         @author_datetime_xpath = "./cda:author[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.155']/cda:time"
-        @result_xpath = "./cda:entryRelationship/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.2']/cda:value"
-        @result_datetime_xpath = "./cda:entryRelationship/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.2']/cda:effectiveTime"
-        @status_xpath = "./cda:entryRelationship/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.93']/cda:value"
+        @result_xpath = "./cda:entryRelationship[@typeCode='REFR']/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.2']/cda:value"
+        @result_datetime_xpath = "./cda:entryRelationship[@typeCode='REFR']/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.2']/cda:effectiveTime"
+        @status_xpath = "./cda:entryRelationship[@typeCode='REFR']/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.93']/cda:value"
         @method_xpath = './cda:methodCode'
         @interpretation_xpath = './cda:interpretationCode'
         @facility_locations_xpath = "./cda:participant[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.100']"
-        @components_xpath = "./cda:entryRelationship/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.149']"
+        @components_xpath = "./cda:entryRelationship[@typeCode='REFR']/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.149']"
         @reason_xpath = "./cda:entryRelationship[@typeCode='RSON']/cda:observation[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.88']/cda:value"
         @related_to_xpath = "./sdtc:inFulfillmentOf1/sdtc:actReference"
         @entry_class = QDM::DiagnosticStudyPerformed

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

@@ -3,12 +3,12 @@ module QRDA
     class EncounterOrderImporter < SectionImporter
       def initialize(entry_finder = QRDA::Cat1::EntryFinder.new("./cda:entry/cda:act[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.132']"))
         super(entry_finder)
-        @id_xpath = './cda:entryRelationship/cda:encounter/cda:id'
-        @code_xpath = "./cda:entryRelationship/cda:encounter[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.22']/cda:code"
-        @author_datetime_xpath = "./cda:entryRelationship/cda:encounter[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.22']/cda:author[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.155']/cda:time"
-        @facility_locations_xpath = "./cda:entryRelationship/cda:encounter[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.22']/cda:participant[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.100']"
-        @reason_xpath = "./cda:entryRelationship/cda:encounter[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.22']/cda:entryRelationship[@typeCode='RSON']/cda:observation[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.88']/cda:value"
-        @priority_xpath = './cda:entryRelationship/cda:encounter/cda:priorityCode'
+        @id_xpath = "./cda:entryRelationship[@typeCode='SUBJ']/cda:encounter/cda:id"
+        @code_xpath = "./cda:entryRelationship[@typeCode='SUBJ']/cda:encounter[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.22']/cda:code"
+        @author_datetime_xpath = "./cda:entryRelationship[@typeCode='SUBJ']/cda:encounter[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.22']/cda:author[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.155']/cda:time"
+        @facility_locations_xpath = "./cda:entryRelationship[@typeCode='SUBJ']/cda:encounter[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.22']/cda:participant[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.100']"
+        @reason_xpath = "./cda:entryRelationship[@typeCode='SUBJ']/cda:encounter[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.22']/cda:entryRelationship[@typeCode='RSON']/cda:observation[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.88']/cda:value"
+        @priority_xpath = "./cda:entryRelationship[@typeCode='SUBJ']/cda:encounter/cda:priorityCode"
         @entry_class = QDM::EncounterOrder
       end
 
@@ -17,7 +17,7 @@ module QRDA
         encounter_order.facilityLocation = extract_facility_locations(entry_element)[0]
         encounter_order.reason = extract_reason(entry_element)
         encounter_order.priority = code_if_present(entry_element.at_xpath(@priority_xpath))
-        entity = extract_entity(entry_element, "./cda:entryRelationship/cda:encounter//cda:participant[@typeCode='PRF']")
+        entity = extract_entity(entry_element, "./cda:entryRelationship[@typeCode='SUBJ']/cda:encounter//cda:participant[@typeCode='PRF']")
         encounter_order.requester.concat(entity) if entity
         encounter_order
       end

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

@@ -10,8 +10,8 @@ module QRDA
         @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']"
+        @clazz_xpath = "./cda:entryRelationship[@typeCode='REFR']/cda:act[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.171']/cda:code"
+        @diagnosis_xpath = "./cda:entryRelationship[@typeCode='REFR']/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
@@ -51,8 +51,8 @@ module QRDA
         diagnosis_elements.each do |diagnosis_element|
           diagnosis_component = QDM::DiagnosisComponent.new
           diagnosis_component.code = code_if_present(diagnosis_element.at_xpath('./cda:value'))
-          diagnosis_component.presentOnAdmissionIndicator = code_if_present(diagnosis_element.at_xpath("./cda:entryRelationship/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.169']/cda:value"))
-          diagnosis_component.rank = diagnosis_element.at_xpath("./cda:entryRelationship/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.166']/cda:value/@value")&.value&.strip.to_i
+          diagnosis_component.presentOnAdmissionIndicator = code_if_present(diagnosis_element.at_xpath("./cda:entryRelationship[@typeCode='REFR']/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.169']/cda:value"))
+          diagnosis_component.rank = diagnosis_element.at_xpath("./cda:entryRelationship[@typeCode='REFR']/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.166']/cda:value/@value")&.value&.strip.to_i
           diagnosis_list << diagnosis_component
         end
         diagnosis_list.empty? ? nil : diagnosis_list

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

@@ -3,11 +3,11 @@ module QRDA
     class EncounterRecommendedImporter < SectionImporter
       def initialize(entry_finder = QRDA::Cat1::EntryFinder.new("./cda:entry/cda:act[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.134']"))
         super(entry_finder)
-        @id_xpath = './cda:entryRelationship/cda:encounter/cda:id'
-        @code_xpath = "./cda:entryRelationship/cda:encounter[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.24']/cda:code"
-        @author_datetime_xpath = "./cda:entryRelationship/cda:encounter[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.24']/cda:author[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.155']/cda:time"
-        @facility_locations_xpath = "./cda:entryRelationship/cda:encounter[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.24']/cda:participant[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.100']"
-        @reason_xpath = "./cda:entryRelationship/cda:encounter[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.24']/cda:entryRelationship[@typeCode='RSON']/cda:observation[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.88']/cda:value"
+        @id_xpath = "./cda:entryRelationship[@typeCode='SUBJ']/cda:encounter/cda:id"
+        @code_xpath = "./cda:entryRelationship[@typeCode='SUBJ']/cda:encounter[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.24']/cda:code"
+        @author_datetime_xpath = "./cda:entryRelationship[@typeCode='SUBJ']/cda:encounter[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.24']/cda:author[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.155']/cda:time"
+        @facility_locations_xpath = "./cda:entryRelationship[@typeCode='SUBJ']/cda:encounter[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.24']/cda:participant[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.100']"
+        @reason_xpath = "./cda:entryRelationship[@typeCode='SUBJ']/cda:encounter[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.24']/cda:entryRelationship[@typeCode='RSON']/cda:observation[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.88']/cda:value"
         @entry_class = QDM::EncounterRecommended
       end
 
@@ -15,7 +15,7 @@ module QRDA
         encounter_recommended = super
         encounter_recommended.facilityLocation = extract_facility_locations(entry_element)[0]
         encounter_recommended.reason = extract_reason(entry_element)
-        entity = extract_entity(entry_element, "./cda:entryRelationship/cda:encounter//cda:participant[@typeCode='PRF']")
+        entity = extract_entity(entry_element, "./cda:entryRelationship[@typeCode='SUBJ']/cda:encounter//cda:participant[@typeCode='PRF']")
         encounter_recommended.requester.concat(entity) if entity
         encounter_recommended
       end

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

@@ -8,7 +8,7 @@ module QRDA
         @active_datetime_xpath = "./cda:effectiveTime[@value]"
         @author_datetime_xpath = "./cda:author[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.155']/cda:time"
         @dosage_xpath = "./cda:doseQuantity"
-        @supply_xpath = "./cda:entryRelationship/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.167']/cda:quantity"
+        @supply_xpath = "./cda:entryRelationship[@typeCode='REFR']/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.167']/cda:quantity"
         @route_xpath = "./cda:routeCode"
         @reason_xpath = "./cda:entryRelationship[@typeCode='RSON']/cda:observation[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.88']/cda:value"
         @entry_class = QDM::ImmunizationOrder

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

@@ -8,8 +8,8 @@ module QRDA
         @relevant_period_xpath = "./cda:effectiveTime"
         @relevant_date_time_xpath = './cda:effectiveTime'
         @author_datetime_xpath = "./cda:author[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.155']/cda:time"
-        @result_xpath = "./cda:entryRelationship/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.2']/cda:value"
-        @status_xpath = "./cda:entryRelationship/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.93']/cda:value"
+        @result_xpath = "./cda:entryRelationship[@typeCode='REFR']/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.2']/cda:value"
+        @status_xpath = "./cda:entryRelationship[@typeCode='REFR']/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.93']/cda:value"
         @reason_xpath = "./cda:entryRelationship[@typeCode='RSON']/cda:observation[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.88']/cda:value"
         @related_to_xpath = "./sdtc:inFulfillmentOf1/sdtc:actReference"
         @entry_class = QDM::InterventionPerformed

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

@@ -10,9 +10,9 @@ module QRDA
         @author_datetime_xpath = "./cda:author[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.155']/cda:time"
         @status_xpath = "./cda:entryRelationship/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.93']/cda:value"
         @method_xpath = './cda:methodCode'
-        @result_xpath = "./cda:entryRelationship/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.2']/cda:value"
+        @result_xpath = "./cda:entryRelationship[@typeCode='REFR']/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.2']/cda:value"
         @result_datetime_xpath = "./cda:entryRelationship[@typeCode='REFR']/cda:observation/cda:effectiveTime"
-        @components_xpath = "./cda:entryRelationship/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.149']"
+        @components_xpath = "./cda:entryRelationship[@typeCode='REFR']/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.149']"
         @reason_xpath = "./cda:entryRelationship[@typeCode='RSON']/cda:observation[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.88']/cda:value"
         @related_to_xpath = "./sdtc:inFulfillmentOf1/sdtc:actReference"
         @entry_class = QDM::LaboratoryTestPerformed

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

@@ -3,15 +3,15 @@ module QRDA
     class MedicationDischargeImporter < SectionImporter
       def initialize(entry_finder = QRDA::Cat1::EntryFinder.new("./cda:entry/cda:act[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.105']"))
         super(entry_finder)
-        @id_xpath = './cda:entryRelationship/cda:substanceAdministration/cda:id'
-        @code_xpath = "./cda:entryRelationship/cda:substanceAdministration[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.16']/cda:consumable/cda:manufacturedProduct/cda:manufacturedMaterial/cda:code"
-        @author_datetime_xpath = "./cda:entryRelationship/cda:substanceAdministration[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.16']/cda:author[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.155']/cda:time"
-        @refills_xpath = "./cda:entryRelationship/cda:substanceAdministration[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.16']/cda:repeatNumber"
-        @dosage_xpath = "./cda:entryRelationship/cda:substanceAdministration[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.16']/cda:doseQuantity"
-        @supply_xpath = "./cda:entryRelationship/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.99']/cda:quantity"
-        @frequency_xpath = "./cda:entryRelationship/cda:substanceAdministration[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.16']/cda:effectiveTime[@operator='A']/cda:period"
-        @days_supplied_xpath = "./cda:entryRelationship/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.157']/cda:quantity"
-        @route_xpath = "./cda:entryRelationship/cda:substanceAdministration[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.16']/cda:routeCode"
+        @id_xpath = "./cda:entryRelationship[@typeCode='SUBJ']/cda:substanceAdministration/cda:id"
+        @code_xpath = "./cda:entryRelationship[@typeCode='SUBJ']/cda:substanceAdministration[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.16']/cda:consumable/cda:manufacturedProduct/cda:manufacturedMaterial/cda:code"
+        @author_datetime_xpath = "./cda:entryRelationship[@typeCode='SUBJ']/cda:substanceAdministration[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.16']/cda:author[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.155']/cda:time"
+        @refills_xpath = "./cda:entryRelationship[@typeCode='SUBJ']/cda:substanceAdministration[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.16']/cda:repeatNumber"
+        @dosage_xpath = "./cda:entryRelationship[@typeCode='SUBJ']/cda:substanceAdministration[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.16']/cda:doseQuantity"
+        @supply_xpath = "./cda:entryRelationship[@typeCode='COMP']/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.99']/cda:quantity"
+        @frequency_xpath = "./cda:entryRelationship[@typeCode='SUBJ']/cda:substanceAdministration[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.16']/cda:effectiveTime[@operator='A']/cda:period"
+        @days_supplied_xpath = "./cda:entryRelationship[@typeCode='REFR']/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.157']/cda:quantity"
+        @route_xpath = "./cda:entryRelationship[@typeCode='SUBJ']/cda:substanceAdministration[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.16']/cda:routeCode"
 
         @entry_class = QDM::MedicationDischarge
       end

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

@@ -3,17 +3,17 @@ module QRDA
     class MedicationDispensedImporter < SectionImporter
       def initialize(entry_finder = QRDA::Cat1::EntryFinder.new("./cda:entry/cda:act[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.139']"))
         super(entry_finder)
-        @id_xpath = './cda:entryRelationship/cda:supply/cda:id'
-        @code_xpath = "./cda:entryRelationship/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.18']/cda:product/cda:manufacturedProduct/cda:manufacturedMaterial/cda:code"
-        @relevant_period_xpath = "./cda:entryRelationship/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.18']/cda:effectiveTime"
-        @relevant_date_time_xpath = "./cda:entryRelationship/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.18']/cda:effectiveTime"
-        @author_datetime_xpath = "./cda:entryRelationship/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.18']/cda:author[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.155']/cda:time"
-        @refills_xpath = "./cda:entryRelationship/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.18']/cda:entryRelationship/cda:substanceAdministration/cda:repeatNumber"
-        @dosage_xpath = "./cda:entryRelationship/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.18']/cda:entryRelationship/cda:substanceAdministration/cda:doseQuantity"
-        @supply_xpath = "./cda:entryRelationship/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.18']/cda:entryRelationship/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.99']/cda:quantity"
-        @frequency_xpath = "./cda:entryRelationship/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.18']/cda:entryRelationship/cda:substanceAdministration/cda:effectiveTime[@operator='A']/cda:period"
-        @days_supplied_xpath = "./cda:entryRelationship/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.18']/cda:entryRelationship/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.157']/cda:quantity"
-        @route_xpath = "./cda:entryRelationship/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.18']/cda:entryRelationship/cda:substanceAdministration/cda:routeCode"
+        @id_xpath = "./cda:entryRelationship[@typeCode='SUBJ']/cda:supply/cda:id"
+        @code_xpath = "./cda:entryRelationship[@typeCode='SUBJ']/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.18']/cda:product/cda:manufacturedProduct/cda:manufacturedMaterial/cda:code"
+        @relevant_period_xpath = "./cda:entryRelationship[@typeCode='SUBJ']/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.18']/cda:effectiveTime"
+        @relevant_date_time_xpath = "./cda:entryRelationship[@typeCode='SUBJ']/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.18']/cda:effectiveTime"
+        @author_datetime_xpath = "./cda:entryRelationship[@typeCode='SUBJ']/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.18']/cda:author[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.155']/cda:time"
+        @refills_xpath = "./cda:entryRelationship[@typeCode='SUBJ']/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.18']/cda:entryRelationship[@typeCode='REFR']/cda:substanceAdministration/cda:repeatNumber"
+        @dosage_xpath = "./cda:entryRelationship[@typeCode='SUBJ']/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.18']/cda:entryRelationship[@typeCode='REFR']/cda:substanceAdministration/cda:doseQuantity"
+        @supply_xpath = "./cda:entryRelationship[@typeCode='SUBJ']/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.18']/cda:entryRelationship[@typeCode='COMP']/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.99']/cda:quantity"
+        @frequency_xpath = "./cda:entryRelationship[@typeCode='SUBJ']/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.18']/cda:entryRelationship[@typeCode='REFR']/cda:substanceAdministration/cda:effectiveTime[@operator='A']/cda:period"
+        @days_supplied_xpath = "./cda:entryRelationship[@typeCode='SUBJ']/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.18']/cda:entryRelationship[@typeCode='REFR']/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.157']/cda:quantity"
+        @route_xpath = "./cda:entryRelationship[@typeCode='SUBJ']/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.18']/cda:entryRelationship[@typeCode='REFR']/cda:substanceAdministration/cda:routeCode"
         @entry_class = QDM::MedicationDispensed
       end
 
@@ -25,9 +25,9 @@ module QRDA
         medication_dispensed.frequency = frequency_as_coded_value(entry_element, @frequency_xpath)
         medication_dispensed.daysSupplied = extract_scalar(entry_element, @days_supplied_xpath)&.value
         medication_dispensed.route = code_if_present(entry_element.at_xpath(@route_xpath))
-        entity1 = extract_entity(entry_element, "./cda:entryRelationship/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.18']//cda:participant[@typeCode='PRF']")
+        entity1 = extract_entity(entry_element, "./cda:entryRelationship[@typeCode='SUBJ']/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.18']//cda:participant[@typeCode='PRF']")
         medication_dispensed.prescriber.concat(entity1) if entity1
-        entity2 = extract_entity(entry_element, "./cda:entryRelationship/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.18']/cda:participant[@typeCode='DIST']")
+        entity2 = extract_entity(entry_element, "./cda:entryRelationship[@typeCode='SUBJ']/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.18']/cda:participant[@typeCode='DIST']")
         medication_dispensed.dispenser.concat(entity2) if entity2
         medication_dispensed
       end

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

@@ -8,13 +8,13 @@ module QRDA
         @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"
         @dosage_xpath = "./cda:doseQuantity"
-        @supply_xpath = "./cda:entryRelationship/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.99']/cda:quantity"
+        @supply_xpath = "./cda:entryRelationship[@typeCode='COMP']/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.99']/cda:quantity"
         @frequency_xpath = "./cda:effectiveTime[@operator='A']/cda:period"
         @refills_xpath = "./cda:repeatNumber"
         @route_xpath = "./cda:routeCode"
         @setting_xpath = "./cda:participant[@typeCode='LOC']/cda:participantRole/cda:code"
         @prescriber_id_xpath = "./cda:author/cda:assignedAuthor/cda:id"
-        @days_supplied_xpath = "./cda:entryRelationship/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.157']/cda:quantity"
+        @days_supplied_xpath = "./cda:entryRelationship[@typeCode='REFR']/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.157']/cda:quantity"
         @reason_xpath = "./cda:entryRelationship[@typeCode='RSON']/cda:observation[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.88']/cda:value"
         @related_to_xpath = "./sdtc:inFulfillmentOf1/sdtc:actReference"
         @entry_class = QDM::MedicationOrder

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

@@ -6,7 +6,7 @@ module QRDA
         @id_xpath = './cda:id'
         @code_xpath = './cda:value'
         @expired_datetime_xpath = './cda:effectiveTime/cda:low'
-        @cause = "./cda:entryRelationship/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.4']/cda:value"
+        @cause = "./cda:entryRelationship[@typeCode='CAUS']/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.4']/cda:value"
         @entry_class = QDM::PatientCharacteristicExpired
       end
 

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

@@ -11,7 +11,7 @@ module QRDA
         @method_xpath = './cda:methodCode'
         @result_xpath = "./cda:value"
         @anatomical_location_site_xpath = "./cda:targetSiteCode"
-        @components_xpath = "./cda:entryRelationship/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.149']"
+        @components_xpath = "./cda:entryRelationship[@typeCode='REFR']/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.149']"
         @reason_xpath = "./cda:entryRelationship[@typeCode='RSON']/cda:observation[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.88']/cda:value"
         @related_to_xpath = "./sdtc:inFulfillmentOf1/sdtc:actReference"
         @entry_class = QDM::PhysicalExamPerformed

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

@@ -8,7 +8,7 @@ module QRDA
         @author_datetime_xpath = "./cda:author[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.155']/cda:time"
         @anatomical_location_site_xpath = "./cda:targetSiteCode"
         @reason_xpath = "./cda:entryRelationship[@typeCode='RSON']/cda:observation[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.88']/cda:value"
-        @rank_xpath = "./cda:entryRelationship/cda:observation[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.166']/cda:value/@value"
+        @rank_xpath = "./cda:entryRelationship[@typeCode='REFR']/cda:observation[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.166']/cda:value/@value"
         @entry_class = QDM::ProcedureOrder
       end
 

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

@@ -9,13 +9,13 @@ module QRDA
         @relevant_date_time_xpath = './cda:effectiveTime'
         @author_datetime_xpath = "./cda:author[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.155']/cda:time"
         @method_xpath = './cda:methodCode'
-        @result_xpath = "./cda:entryRelationship/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.2']/cda:value"
-        @status_xpath = "./cda:entryRelationship/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.93']/cda:value"
+        @result_xpath = "./cda:entryRelationship[@typeCode='REFR']/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.2']/cda:value"
+        @status_xpath = "./cda:entryRelationship[@typeCode='REFR']/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.93']/cda:value"
         @anatomical_location_site_xpath = "./cda:targetSiteCode"
-        @incision_datetime_xpath = "./cda:entryRelationship/cda:procedure[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.89']/cda:effectiveTime"
-        @components_xpath = "./cda:entryRelationship/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.149']"
+        @incision_datetime_xpath = "./cda:entryRelationship[@typeCode='REFR']/cda:procedure[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.89']/cda:effectiveTime"
+        @components_xpath = "./cda:entryRelationship[@typeCode='REFR']/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.149']"
         @reason_xpath = "./cda:entryRelationship[@typeCode='RSON']/cda:observation[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.88']/cda:value"
-        @rank_xpath = "./cda:entryRelationship/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.166']/cda:value/@value"
+        @rank_xpath = "./cda:entryRelationship[@typeCode='REFR']/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.166']/cda:value/@value"
         @related_to_xpath = "./sdtc:inFulfillmentOf1/sdtc:actReference"
         @entry_class = QDM::ProcedurePerformed
       end

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

@@ -8,7 +8,7 @@ module QRDA
         @author_datetime_xpath = "./cda:author[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.155']/cda:time"
         @anatomical_location_site_xpath = "./cda:targetSiteCode"
         @reason_xpath = "./cda:entryRelationship[@typeCode='RSON']/cda:observation[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.88']/cda:value"
-        @rank_xpath = "./cda:entryRelationship/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.166']/cda:value/@value"
+        @rank_xpath = "./cda:entryRelationship[@typeCode='REFR']/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.166']/cda:value/@value"
         @entry_class = QDM::ProcedureRecommended
       end
 

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

@@ -8,7 +8,7 @@ module QRDA
         @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"
         @dosage_xpath = "./cda:doseQuantity"
-        @supply_xpath = "./cda:entryRelationship/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.99']/cda:quantity"
+        @supply_xpath = "./cda:entryRelationship[@typeCode='COMP']/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.99']/cda:quantity"
         @frequency_xpath = "./cda:effectiveTime[@operator='A']/cda:period"
         @refills_xpath = "./cda:repeatNumber"
         @route_xpath = "./cda:routeCode"

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

@@ -3,10 +3,10 @@ module QRDA
     class SymptomImporter < SectionImporter
       def initialize(entry_finder = QRDA::Cat1::EntryFinder.new("./cda:entry/cda:act[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.138']"))
         super(entry_finder)
-        @id_xpath = './cda:entryRelationship/cda:observation/cda:id'
-        @code_xpath = "./cda:entryRelationship/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.136']/cda:value"
-        @prevalence_period_xpath = "./cda:entryRelationship/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.136']/cda:effectiveTime"
-        @severity_xpath = "./cda:entryRelationship/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.136']/cda:entryRelationship/cda:observation[cda:templateId/@root='2.16.840.1.113883.10.20.22.4.8']/cda:value"
+        @id_xpath = "./cda:entryRelationship[@typeCode='SUBJ']/cda:observation/cda:id"
+        @code_xpath = "./cda:entryRelationship[@typeCode='SUBJ']/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.136']/cda:value"
+        @prevalence_period_xpath = "./cda:entryRelationship[@typeCode='SUBJ']/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.136']/cda:effectiveTime"
+        @severity_xpath = "./cda:entryRelationship[@typeCode='SUBJ']/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.136']/cda:entryRelationship/cda:observation[cda:templateId/@root='2.16.840.1.113883.10.20.22.4.8']/cda:value"
         @entry_class = QDM::Symptom
       end
 

metadata

@@ -1,14 +1,14 @@
 --- !ruby/object:Gem::Specification
 name: cqm-reports
 version: !ruby/object:Gem::Version
-  version: 4.1.3
+  version: 4.1.5
 platform: ruby
 authors:
 - The MITRE Corporation
 autorequire:
 bindir: bin
 cert_chain: []
-date: 2025-01-08 00:00:00.000000000 Z
+date: 2025-11-14 00:00:00.000000000 Z
 dependencies:
 - !ruby/object:Gem::Dependency
   name: cqm-models