davinci_crd_test_kit 0.13.0 → 0.14.0

data/lib/davinci_crd_test_kit/server/v2.0.1/server_order_sign_group.rb

@@ -0,0 +1,216 @@
+require_relative '../../cross_suite/tags'
+require_relative 'interaction/server_invoke_hook_test'
+require_relative 'verify_request/service_request_required_fields_validation_test'
+require_relative 'verify_request/service_request_optional_fields_validation_test'
+require_relative 'verify_request/service_request_context_validation_test'
+require_relative 'verify_response/service_response_validation_test'
+require_relative 'verify_response/card_optional_fields_validation_test'
+require_relative 'verify_response/external_reference_card_validation_test'
+require_relative 'verify_response/launch_smart_app_card_validation_test'
+require_relative 'verify_response/instructions_card_received_test'
+require_relative 'verify_response/coverage_information_system_action_received_test'
+require_relative 'verify_response/coverage_information_system_action_validation_test'
+require_relative 'verify_response/propose_alternate_request_card_validation_test'
+require_relative 'verify_response/additional_orders_validation_test'
+require_relative 'verify_response/form_completion_response_validation_test'
+require_relative 'verify_response/create_or_update_coverage_info_response_validation_test'
+
+module DaVinciCRDTestKit
+  module V201
+    class ServerOrderSignGroup < Inferno::TestGroup
+      title 'order-sign'
+      id :crd_v201_server_order_sign
+      description %(
+        This group of tests invokes the order-sign hook and ensures that
+        the user-provided requests are valid as per the requirements described
+        in the [CRD IG section on order-sign hook](https://hl7.org/fhir/us/davinci-crd/STU2/hooks.html#order-sign)
+        and the [CDS Hooks specification section on order-sign context](https://cds-hooks.hl7.org/hooks/order-sign/2023SepSTU1Ballot/order-sign/).
+        It also ensures that the contents of the server's response are valid as per the requirements described in
+        the [CRD IG section on order-sign hook](https://hl7.org/fhir/us/davinci-crd/STU2/hooks.html#order-sign)
+        and the [CDS Hooks section on CDS Service Response](https://cds-hooks.hl7.org/2.0/#cds-service-response).
+
+        The [CRD IG section on order-sign hook](https://hl7.org/fhir/us/davinci-crd/STU2/hooks.html#order-sign)
+        states that "servers SHALL, at minimum, support returning and processing the Coverage Information
+        system action for all invocations of this hook."
+
+        This group includes tests to validate the following CRD response types:
+        - [additional orders as companions/prerequisites](https://hl7.org/fhir/us/davinci-crd/STU2/cards.html#identify-additional-orders-as-companionsprerequisites-for-current-order)\
+        - optional
+        - [Coverage Information](https://hl7.org/fhir/us/davinci-crd/STU2/cards.html#coverage-information)
+        - [Create or update coverage information](https://hl7.org/fhir/us/davinci-crd/STU2/cards.html#create-or-update-coverage-information)\
+        - optional
+        - [External Reference](https://hl7.org/fhir/us/davinci-crd/STU2/cards.html#external-reference) - optional
+        - [Instructions](https://hl7.org/fhir/us/davinci-crd/STU2/cards.html#instructions) - optional
+        - [Launch SMART application](https://hl7.org/fhir/us/davinci-crd/STU2/cards.html#launch-smart-application) -
+        optional
+        - [Propose alternate request](https://hl7.org/fhir/us/davinci-crd/STU2/cards.html#propose-alternate-request) -
+        optional
+        - [Request form completion](https://hl7.org/fhir/us/davinci-crd/STU2/cards.html#request-form-completion) -
+        optional
+      )
+      verifies_requirements 'hl7.fhir.us.davinci-crd_2.0.1@164', 'hl7.fhir.us.davinci-crd_2.0.1@168',
+                            'hl7.fhir.us.davinci-crd_2.0.1@217', 'hl7.fhir.us.davinci-crd_2.0.1@226'
+
+      config options: { hook_name: ORDER_SIGN_TAG }
+      run_as_group
+
+      group do
+        title 'Make Hook Requests'
+
+        test from: :crd_v201_server_invoke_hook_test,
+             config: {
+               inputs: {
+                 service_ids: {
+                   name: :order_sign_service_ids,
+                   title: 'Service id for the service that implements the `order-sign` hook'
+                 },
+                 service_request_bodies: {
+                   name: :order_sign_request_bodies,
+                   title: 'Request body or bodies for invoking the `order-sign` hook'
+                 }
+               }
+             }
+      end
+
+      group do
+        title 'Verify Requests'
+
+        test from: :crd_v201_service_request_required_fields_validation,
+             config: {
+               outputs: {
+                 contexts: {
+                   name: :order_sign_contexts
+                 }
+               }
+             }
+        test from: :crd_v201_service_request_context_validation,
+             config: {
+               inputs: {
+                 contexts: {
+                   name: :order_sign_contexts
+                 }
+               }
+             }
+        test from: :crd_v201_service_request_optional_fields_validation
+      end
+
+      group do
+        title 'Verify Responses'
+
+        test from: :crd_v201_service_response_validation,
+             config: {
+               outputs: {
+                 valid_cards: {
+                   name: :order_sign_valid_cards
+                 },
+                 valid_system_actions: {
+                   name: :order_sign_valid_system_actions
+                 }
+               }
+             }
+        test from: :crd_v201_card_optional_fields_validation,
+             config: {
+               inputs: {
+                 valid_cards: {
+                   name: :order_sign_valid_cards
+                 }
+               },
+               outputs: {
+                 valid_cards_with_links: {
+                   name: :order_sign_valid_cards_with_links
+                 },
+                 valid_cards_with_suggestions: {
+                   name: :order_sign_valid_cards_with_suggestions
+                 }
+               }
+             }
+        test from: :crd_v201_external_reference_card_validation,
+             config: {
+               inputs: {
+                 valid_cards_with_links: {
+                   name: :order_sign_valid_cards_with_links
+                 }
+               }
+             }
+        test from: :crd_v201_launch_smart_app_card_validation,
+             config: {
+               inputs: {
+                 valid_cards_with_links: {
+                   name: :order_sign_valid_cards_with_links
+                 }
+               }
+             }
+        test from: :crd_v201_valid_instructions_card_received,
+             config: {
+               inputs: {
+                 valid_cards: {
+                   name: :order_sign_valid_cards
+                 }
+               }
+             }
+        test from: :crd_v201_coverage_info_system_action_received,
+             config: {
+               inputs: {
+                 valid_system_actions: {
+                   name: :order_sign_valid_system_actions
+                 }
+               },
+               outputs: {
+                 coverage_info: {
+                   name: :order_sign_coverage_info
+                 }
+               }
+             }
+        test from: :crd_v201_coverage_info_system_action_validation,
+             config: {
+               inputs: {
+                 coverage_info: {
+                   name: :order_sign_coverage_info
+                 }
+               }
+             }
+        test from: :crd_v201_propose_alternate_request_card_validation,
+             config: {
+               inputs: {
+                 valid_cards_with_suggestions: {
+                   name: :order_sign_valid_cards_with_suggestions
+                 },
+                 contexts: {
+                   name: :order_sign_contexts
+                 }
+               }
+             }
+        test from: :crd_v201_additional_orders_card_validation,
+             config: {
+               inputs: {
+                 valid_cards_with_suggestions: {
+                   name: :order_sign_valid_cards_with_suggestions
+                 }
+               }
+             }
+        test from: :crd_v201_request_form_completion_response_validation,
+             config: {
+               inputs: {
+                 valid_system_actions: {
+                   name: :order_sign_valid_system_actions
+                 },
+                 valid_cards_with_suggestions: {
+                   name: :order_sign_valid_cards_with_suggestions
+                 }
+               }
+             }
+        test from: :crd_v201_create_or_update_coverage_info_response_validation,
+             config: {
+               inputs: {
+                 valid_system_actions: {
+                   name: :order_sign_valid_system_actions
+                 },
+                 valid_cards_with_suggestions: {
+                   name: :order_sign_valid_cards_with_suggestions
+                 }
+               }
+             }
+      end
+    end
+  end
+end

data/lib/davinci_crd_test_kit/server/v2.0.1/server_required_card_response_validation_group.rb

@@ -0,0 +1,28 @@
+require_relative 'must_support/external_reference_card_across_hooks_validation_test'
+require_relative 'must_support/instructions_card_received_across_hooks_test'
+require_relative 'must_support/coverage_information_system_action_across_hooks_validation_test'
+
+module DaVinciCRDTestKit
+  module V201
+    class ServerRequiredCardResponseValidationGroup < Inferno::TestGroup
+      title 'Required Card Response Validation'
+      description %(
+        This group contains tests to verify the presence and validity of required response types
+        across all hooks invoked. As per the [Da Vinci CRD Implementation Guide](https://hl7.org/fhir/us/davinci-crd/STU2/cards.html#potential-crd-response-types),
+        CRD Servers SHALL, at minimum, demonstrate an ability to return the following response types:
+        - Coverage Information System Action
+        - External Reference Card
+        - Instructions Card
+      )
+      verifies_requirements 'hl7.fhir.us.davinci-crd_2.0.1@247', 'hl7.fhir.us.davinci-crd_2.0.1@248',
+                            'hl7.fhir.us.davinci-crd_2.0.1@249'
+
+      id :crd_v201_server_required_card_response_validation
+      run_as_group
+
+      test from: :crd_v201_external_reference_card_across_hooks_validation
+      test from: :crd_v201_valid_instructions_card_received_across_hooks
+      test from: :crd_v201_coverage_info_system_action_across_hooks_validation
+    end
+  end
+end

data/lib/davinci_crd_test_kit/server/v2.0.1/server_urls.rb

@@ -0,0 +1,13 @@
+require_relative '../server_base_urls'
+
+module DaVinciCRDTestKit
+  module V201
+    module ServerURLs
+      include ServerBaseURLs
+
+      def suite_id
+        DaVinciCRDTestKit::V201::CRDServerSuite.id
+      end
+    end
+  end
+end

data/lib/davinci_crd_test_kit/server/v2.0.1/verify_request/service_request_context_validation_test.rb

@@ -0,0 +1,30 @@
+require_relative '../../server_hook_request_validation'
+require_relative '../../server_test_helper'
+require_relative '../../server_hook_helper'
+
+module DaVinciCRDTestKit
+  module V201
+    class ServiceRequestContextValidationTest < Inferno::Test
+      include DaVinciCRDTestKit::ServerHookRequestValidation
+      include DaVinciCRDTestKit::ServerTestHelper
+      include DaVinciCRDTestKit::ServerHookHelper
+
+      title 'All service requests contain valid context'
+      id :crd_v201_service_request_context_validation
+      description %(
+        This test verifies that all service requests `context` field is valid and contains all the
+        required fields.
+      )
+      input :contexts, :invoked_hook
+
+      run do
+        parsed_contexts = parse_json(contexts)
+        parsed_contexts.each do |context|
+          hook_request_context_check(context, invoked_hook, ig_version: 'v201')
+        end
+
+        no_error_validation('Some contexts are not valid.')
+      end
+    end
+  end
+end

data/lib/davinci_crd_test_kit/server/v2.0.1/verify_request/service_request_optional_fields_validation_test.rb

@@ -0,0 +1,39 @@
+require_relative '../../server_hook_request_validation'
+require_relative '../../server_hook_helper'
+
+module DaVinciCRDTestKit
+  module V201
+    class ServiceRequestOptionalFieldsValidationTest < Inferno::Test
+      include DaVinciCRDTestKit::ServerHookRequestValidation
+      include DaVinciCRDTestKit::ServerHookHelper
+
+      title 'All service requests contain optional fields'
+      id :crd_v201_service_request_optional_fields_validation
+      description %(
+        This optional test reviews the user-submitted CRD service requests for the presence of optional fields:
+        `fhirAuthorization` and `prefetch`.
+
+        The test will not fail if these optional fields are missing from a service request; instead, it generates an
+        informational message.
+      )
+      optional
+
+      run do
+        load_tagged_requests(tested_hook_name)
+        skip_if requests.empty?, "No #{tested_hook_name} request was made in a previous test as expected."
+
+        requests.each_with_index do |request, index|
+          @request_number = index + 1
+          request_body = json_parse(request.request_body)
+          if request_body.blank?
+            add_message('error', "#{request_number}Hook request body cannot be empty.")
+            next
+          end
+
+          hook_request_optional_fields_check(request_body, ig_version: 'v201')
+        end
+        no_error_validation('Some service requests have invalid optional fields.')
+      end
+    end
+  end
+end

data/lib/davinci_crd_test_kit/server/v2.0.1/verify_request/service_request_required_fields_validation_test.rb

@@ -0,0 +1,40 @@
+require_relative '../../server_hook_request_validation'
+require_relative '../../server_hook_helper'
+
+module DaVinciCRDTestKit
+  module V201
+    class ServiceRequestRequiredFieldsValidationTest < Inferno::Test
+      include DaVinciCRDTestKit::ServerHookRequestValidation
+      include DaVinciCRDTestKit::ServerHookHelper
+
+      title 'All service requests contain required fields'
+      id :crd_v201_service_request_required_fields_validation
+      description %(
+        This test validates all CRD service requests provided by the user, ensuring each includes all required fields
+        specified in the [CDS Hooks spec section on Calling a CDS Service](https://cds-hooks.hl7.org/2.0/#calling-a-cds-service):
+        `hook`, `hookInstance`, and `context`. Furthermore, the test checks for the conditional presence of the
+        `fhirServer` field if `fhirAuthorization` is included.
+      )
+      input :invoked_hook
+      output :contexts
+
+      run do
+        load_tagged_requests(tested_hook_name)
+        skip_if requests.empty?, "No #{tested_hook_name} request was made in a previous test as expected."
+        contexts = []
+        requests.each_with_index do |request, index|
+          @request_number = index + 1
+          request_body = json_parse(request.request_body)
+          next if request_body.blank?
+
+          contexts << request_body['context'] if request_body['context'].is_a?(Hash)
+          hook_request_required_fields_check(request_body, invoked_hook, ig_version: 'v201')
+        end
+
+        output contexts: contexts.to_json
+
+        no_error_validation('Some service requests made are not valid.')
+      end
+    end
+  end
+end

data/lib/davinci_crd_test_kit/server/v2.0.1/verify_response/additional_orders_validation_test.rb

@@ -0,0 +1,59 @@
+require_relative '../../server_test_helper'
+require_relative '../../server_hook_helper'
+require_relative '../../../cross_suite/suggestion_actions_validation'
+require_relative '../../../cross_suite/cards_identification'
+
+module DaVinciCRDTestKit
+  module V201
+    class AdditionalOrdersValidationTest < Inferno::Test
+      include DaVinciCRDTestKit::ServerTestHelper
+      include DaVinciCRDTestKit::SuggestionActionsValidation
+      include DaVinciCRDTestKit::ServerHookHelper
+      include DaVinciCRDTestKit::CardsIdentification
+
+      title 'Valid Additional Orders as companions/prerequisites cards received'
+      id :crd_v201_additional_orders_card_validation
+      description %(
+        This test validates that an [Additional Orders as companions/prerequisites](https://hl7.org/fhir/us/davinci-crd/STU2/cards.html#identify-additional-orders-as-companionsprerequisites-for-current-order)
+        card was received. It does so by:
+        - Filtering cards with the following criteria:
+          - For each suggestion in the card's suggestions array, all actions have a type of 'create'
+            and the action's resource type is one of the expected types: CommunicationRequest, Device,
+            DeviceRequest, Medication, MedicationRequest, NutritionOrder, ServiceRequest, or VisionPrescription.
+        - Then, for each valid Additional Orders card retrieved, verifying that each action within the
+        card's suggestions complies with their respective profiles as specified in the
+        [CRD IG section on Additional Orders as companions/prerequisites](https://hl7.org/fhir/us/davinci-crd/STU2/cards.html#identify-additional-orders-as-companionsprerequisites-for-current-order):
+          - [crd-profile-communicationrequest](https://hl7.org/fhir/us/davinci-crd/STU2/StructureDefinition-profile-communicationrequest.html)
+          - [crd-profile-device](https://hl7.org/fhir/us/davinci-crd/STU2/StructureDefinition-profile-device.html)
+          - [crd-profile-deviceRequest](https://hl7.org/fhir/us/davinci-crd/STU2/StructureDefinition-profile-devicerequest.html)
+          - [us-core-medication](http://hl7.org/fhir/us/core/STU3.1.1/StructureDefinition-us-core-medication.html)
+          - [crd-profile-medicationRequest](https://hl7.org/fhir/us/davinci-crd/STU2/StructureDefinition-profile-medicationrequest.html)
+          - [crd-profile-nutritionOrder](https://hl7.org/fhir/us/davinci-crd/STU2/StructureDefinition-profile-nutritionorder.html)
+          - [crd-profile-serviceRequest](https://hl7.org/fhir/us/davinci-crd/STU2/StructureDefinition-profile-servicerequest.html)
+          - [crd-profile-visionPrescription](https://hl7.org/fhir/us/davinci-crd/STU2/StructureDefinition-profile-visionprescription.html).
+
+        The test will skip if no Additional Orders cards are found.
+      )
+
+      optional
+      input :valid_cards_with_suggestions
+
+      run do
+        parsed_cards = parse_json(valid_cards_with_suggestions)
+        additional_orders_cards = parsed_cards.filter do |card|
+          additional_orders_response_type?(card)
+        end
+        skip_if additional_orders_cards.blank?,
+                "#{tested_hook_name} hook response does not include Additional Orders as companion/prerequisite cards."
+
+        additional_orders_cards.each do |card|
+          card['suggestions'].each do |suggestion|
+            actions_check(suggestion['actions'], ig_version: 'v201')
+          end
+        end
+
+        no_error_validation('Some companions/prerequisites Additional Order cards are not valid.')
+      end
+    end
+  end
+end

data/lib/davinci_crd_test_kit/server/v2.0.1/verify_response/card_optional_fields_validation_test.rb

@@ -0,0 +1,51 @@
+require_relative '../../server_test_helper'
+require_relative '../../server_hook_request_validation'
+require_relative '../../../cross_suite/cards_validation'
+
+module DaVinciCRDTestKit
+  module V201
+    class CardOptionalFieldsValidationTest < Inferno::Test
+      include DaVinciCRDTestKit::ServerTestHelper
+      include DaVinciCRDTestKit::ServerHookRequestValidation
+      include DaVinciCRDTestKit::CardsValidation
+
+      title 'Cards contain valid optional fields'
+      id :crd_v201_card_optional_fields_validation
+      description %(
+        This test checks for the presence and validity of optional fields in a card,
+        but only if the card's required fields are valid. As specified in the
+        [CDS Hooks specification section on Card Attributes](https://cds-hooks.hl7.org/2.0/#card-attributes),
+        the optional fields include `uuid`, `detail`, `suggestions`, `overrideReasons`, and `links`.
+
+        Additionally, the test validates the presence of the conditional field `selectionBehavior`
+        only if the `suggestions` field is present.
+      )
+      optional
+      input :valid_cards
+      output :valid_cards_with_links, :valid_cards_with_suggestions
+
+      def cards_with_suggestions
+        @cards_with_suggestions ||= []
+      end
+
+      def cards_with_links
+        @cards_with_links ||= []
+      end
+
+      run do
+        parsed_cards = parse_json(valid_cards)
+        parsed_cards.each do |card|
+          if valid_card_with_optionals?(card, 'v201')
+            cards_with_links << card if card['links']
+            cards_with_suggestions << card if card['suggestions']
+          end
+        end
+
+        output valid_cards_with_links: cards_with_links.to_json
+        output valid_cards_with_suggestions: cards_with_suggestions.to_json
+
+        no_error_validation('Some cards with valid required fields have invalid optional fields.')
+      end
+    end
+  end
+end

data/lib/davinci_crd_test_kit/server/v2.0.1/verify_response/coverage_information_system_action_received_test.rb

@@ -0,0 +1,65 @@
+require_relative '../../server_test_helper'
+require_relative '../../server_hook_helper'
+require_relative '../../../cross_suite/cards_identification'
+
+module DaVinciCRDTestKit
+  module V201
+    class CoverageInformationSystemActionReceivedTest < Inferno::Test
+      include DaVinciCRDTestKit::ServerTestHelper
+      include DaVinciCRDTestKit::ServerHookHelper
+      include DaVinciCRDTestKit::CardsIdentification
+
+      title 'Coverage Information system action was received'
+      id :crd_v201_coverage_info_system_action_received
+      description %(
+        This test validates that a [Coverage Information](https://hl7.org/fhir/us/davinci-crd/STU2/cards.html#coverage-information)
+        system action was returned. It does so by:
+        - First checking for the presence of actions with a `resource` element of the following types:
+          - For `appointment-book`: Appointment
+          - For `order-sign` or `order-dispatch`: DeviceRequest, MedicationRequest, NutritionOrder,
+            ServiceRequest, or VisionPrescription
+        - Then, among the target actions, checking if their resource has the [coverage-information extension](http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information).
+      )
+      verifies_requirements 'hl7.fhir.us.davinci-crd_2.0.1@272', 'hl7.fhir.us.davinci-crd_2.0.1@273',
+                            'hl7.fhir.us.davinci-crd_2.0.1@274', 'hl7.fhir.us.davinci-crd_2.0.1@275',
+                            'hl7.fhir.us.davinci-crd_2.0.1@276', 'hl7.fhir.us.davinci-crd_2.0.1@277'
+
+      input :valid_system_actions, :invoked_hook
+      output :coverage_info
+
+      def resources_by_hook
+        shared_resources = [
+          'DeviceRequest', 'MedicationRequest', 'NutritionOrder',
+          'ServiceRequest', 'VisionPrescription'
+        ]
+        {
+          'appointment-book' => ['Appointment'],
+          'order-sign' => shared_resources,
+          'order-dispatch' => shared_resources,
+          'order-select' => shared_resources,
+          'encounter-start' => ['Encounter'],
+          'encounter-discharge' => ['Encounter']
+        }
+      end
+
+      run do
+        parsed_actions = parse_json(valid_system_actions)
+        target_resources = resources_by_hook[invoked_hook]
+
+        target_actions = parsed_actions.select do |action|
+          resource = FHIR.from_contents(action['resource'].to_json)
+          target_resources.include?(resource&.resourceType)
+        end
+
+        coverage_info_system_actions = target_actions.select do |action|
+          coverage_information_response_type?(action)
+        end
+
+        assert coverage_info_system_actions.present?,
+               "Coverage Information system action was not returned in the #{tested_hook_name} hook response."
+
+        output coverage_info: coverage_info_system_actions.to_json
+      end
+    end
+  end
+end

data/lib/davinci_crd_test_kit/server/v2.0.1/verify_response/coverage_information_system_action_validation_test.rb

@@ -0,0 +1,120 @@
+require_relative '../../server_hook_request_validation'
+require_relative '../../server_test_helper'
+
+module DaVinciCRDTestKit
+  module V201
+    class CoverageInformationSystemActionValidationTest < Inferno::Test
+      include DaVinciCRDTestKit::ServerHookRequestValidation
+      include DaVinciCRDTestKit::ServerTestHelper
+
+      title 'All Coverage Information system actions received are valid'
+      id :crd_v201_coverage_info_system_action_validation
+      description %(
+        This test validates all [Coverage Information](https://hl7.org/fhir/us/davinci-crd/STU2/cards.html#coverage-information)
+        system actions received. It verifies the following for each action:
+        - The action type is `update`.
+        - The resource within the action conforms its respective FHIR profile.
+
+        Additionally, the test examines the `coverage-info` extensions within the resource to ensure that:
+        - Entries referencing differing coverage have distinct `coverage-assertion-ids` and `satisfied-pa-ids`
+        (if present).
+        - Entries referencing the same coverage have the same `coverage-assertion-ids` and `satisfied-pa-ids`
+        (if present).
+      )
+      input :coverage_info
+      verifies_requirements 'hl7.fhir.us.davinci-crd_2.0.1@264', 'hl7.fhir.us.davinci-crd_2.0.1@265'
+
+      def find_extension_value(extension, url, *properties)
+        found_extension = extension.extension.find { |ext| ext.url == url }
+        return nil unless found_extension
+
+        properties.reduce(found_extension) do |current, prop|
+          return current unless current.respond_to?(prop)
+
+          current.send(prop)
+        end
+      end
+
+      def extract_and_group_coverage_info(resource)
+        resource.extension.each_with_object({}) do |extension, grouped_extensions|
+          next unless extension.url == 'http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information'
+
+          coverage_key = find_extension_value(extension, 'coverage', 'valueReference', 'reference')
+          grouped_extensions[coverage_key] ||= []
+          grouped_extensions[coverage_key] << extension
+        end
+      end
+
+      # For the same coverage, ensure coverage-assertion-ids and satisfied-pa-ids are the same.
+      # For different coverages, ensure coverage-assertion-ids and satisfied-pa-ids are distinct.
+      def multiple_extensions_conformance_check(grouped_coverage_info, resource)
+        resource_ref = "#{resource.resourceType}/#{resource.id}"
+        assertion_ids_across_coverages = Set.new
+        pa_ids_across_coverages = Set.new
+
+        grouped_coverage_info.each do |coverage, extensions|
+          coverage_assertion_ids = collect_extensions_id(extensions, 'coverage-assertion-id', 'valueString').uniq
+          satisfied_pa_ids = collect_extensions_id(extensions, 'satisfied-pa-id', 'valueString').uniq.compact
+          assert coverage_assertion_ids.length == 1,
+                 same_coverage_conformance_error_msg(resource_ref, coverage, 'coverage-assertion-ids')
+
+          assert satisfied_pa_ids.length <= 1,
+                 same_coverage_conformance_error_msg(resource_ref, coverage, 'satisfied-pa-ids')
+
+          assertion_id = coverage_assertion_ids.first
+          assert !assertion_ids_across_coverages.include?(assertion_id),
+                 different_coverage_conformance_error_msg(resource_ref, 'coverage-assertion-ids')
+          assertion_ids_across_coverages.add(assertion_id)
+          pa_id = satisfied_pa_ids.first
+          next unless pa_id
+
+          assert !pa_ids_across_coverages.include?(pa_id),
+                 different_coverage_conformance_error_msg(resource_ref, 'satisfied-pa-ids')
+          pa_ids_across_coverages.add(pa_id)
+        end
+      end
+
+      def collect_extensions_id(extensions, url, *properties)
+        extensions.map do |extension|
+          find_extension_value(extension, url, *properties)
+        end
+      end
+
+      def same_coverage_conformance_error_msg(resource_ref, coverage, id_name)
+        "#{resource_ref}: extension has multiple repetitions of coverage `#{coverage}` with different #{id_name}."
+      end
+
+      def different_coverage_conformance_error_msg(resource_ref, id_name)
+        "#{resource_ref}: extensions referencing differing coverage SHALL have distinct #{id_name}."
+      end
+
+      def coverage_info_system_action_check(coverage_info_system_action)
+        type = coverage_info_system_action['type']
+        assert type, '`type` field is missing.'
+        assert type == 'update', "`type` must be `update`, but was `#{type}`"
+
+        resource = FHIR.from_contents(coverage_info_system_action['resource'].to_json)
+        profile_url = structure_definition_map('v201')[resource.resourceType]
+        assert_valid_resource(resource:, profile_url:)
+
+        grouped_coverage_info = extract_and_group_coverage_info(resource)
+        multiple_extensions_conformance_check(grouped_coverage_info, resource)
+      end
+
+      run do
+        parsed_coverage_info = parse_json(coverage_info)
+        error_messages = []
+        parsed_coverage_info.each do |action|
+          coverage_info_system_action_check(action)
+        rescue Inferno::Exceptions::AssertionException => e
+          error_messages << "Coverage Info system action `#{action}`: #{e.message}"
+        end
+
+        error_messages.each do |msg|
+          messages << { type: 'error', message: msg }
+        end
+        assert error_messages.empty?, 'Some Coverage Info system actions are not valid.'
+      end
+    end
+  end
+end