@cosyte/synth 0.0.1

package/dist/deid/index.cjs

@@ -0,0 +1,2809 @@
+'use strict';
+
+var hl7 = require('@cosyte/deid/hl7');
+var fhir$1 = require('@cosyte/deid/fhir');
+var x12$1 = require('@cosyte/deid/x12');
+var ncpdp = require('@cosyte/deid/ncpdp');
+var ccda$1 = require('@cosyte/deid/ccda');
+var fhir = require('@cosyte/fhir');
+var x12 = require('@cosyte/x12');
+var ccda = require('@cosyte/ccda');
+var telecom = require('@cosyte/ncpdp/telecom');
+var hl7$1 = require('@cosyte/hl7');
+var deid = require('@cosyte/deid');
+
+// src/deid/index.ts
+
+// src/rng/splitmix32.ts
+function splitmix32(seed) {
+  let a = seed | 0;
+  return function next() {
+    a = a + 2654435769 | 0;
+    let t = a ^ a >>> 16;
+    t = Math.imul(t, 569420461);
+    t = t ^ t >>> 15;
+    t = Math.imul(t, 1935289751);
+    t = t ^ t >>> 15;
+    return t >>> 0;
+  };
+}
+
+// src/rng/sfc32.ts
+function sfc32Next(s) {
+  s.a |= 0;
+  s.b |= 0;
+  s.c |= 0;
+  s.d |= 0;
+  const t = (s.a + s.b | 0) + s.d | 0;
+  s.d = s.d + 1 | 0;
+  s.a = s.b ^ s.b >>> 9;
+  s.b = s.c + (s.c << 3) | 0;
+  s.c = s.c << 21 | s.c >>> 11;
+  s.c = s.c + t | 0;
+  return t >>> 0;
+}
+
+// src/rng/rng.ts
+var Sfc32Rng = class {
+  seed;
+  #state;
+  constructor(seed) {
+    this.seed = seed | 0;
+    const mix = splitmix32(this.seed);
+    this.#state = { a: mix(), b: mix(), c: mix(), d: mix() };
+    for (let i = 0; i < 8; i += 1) sfc32Next(this.#state);
+  }
+  nextUint32() {
+    return sfc32Next(this.#state);
+  }
+  float() {
+    return this.nextUint32() / 4294967296;
+  }
+  int(min, max) {
+    if (max < min) throw new RangeError(`Rng.int: max (${String(max)}) < min (${String(min)})`);
+    const span = max - min + 1;
+    return min + Math.floor(this.float() * span);
+  }
+  bool(p = 0.5) {
+    return this.float() < p;
+  }
+  pick(items) {
+    if (items.length === 0) throw new RangeError("Rng.pick: empty array");
+    return items[this.int(0, items.length - 1)];
+  }
+  digits(n) {
+    let out = "";
+    for (let i = 0; i < n; i += 1) out += String(this.int(0, 9));
+    return out;
+  }
+};
+function createRng(seed) {
+  return new Sfc32Rng(seed);
+}
+
+// src/hl7/field.ts
+function componentsField(components) {
+  return {
+    repetitions: [{ components: components.map((c) => ({ subcomponents: [c] })) }],
+    isNull: false
+  };
+}
+
+// src/safe/reserved.ts
+var SYNTHETIC_ASSIGNING_AUTHORITY = Object.freeze({
+  /** The human-readable assigning-authority namespace id (HL7 HD.1). */
+  namespaceId: "COSYTE-SYNTH",
+  /** The universal id — an OID under HL7's example arc `2.16.840.1.113883.19` (HD.2). */
+  universalId: "2.16.840.1.113883.19.999",
+  /** The universal id type (HD.3). */
+  universalIdType: "ISO"
+});
+var RESERVED_EMAIL_DOMAINS = Object.freeze([
+  "example.com",
+  "example.org",
+  "example.net"
+]);
+var TEST_NET_V4_PREFIXES = Object.freeze([
+  "192.0.2",
+  // TEST-NET-1
+  "198.51.100",
+  // TEST-NET-2
+  "203.0.113"
+  // TEST-NET-3
+]);
+var DOC_V6_PREFIX = "2001:db8";
+var NPI_LUHN_PREFIX = "80840";
+function luhnMod10(digits) {
+  let sum = 0;
+  let double = false;
+  for (let i = digits.length - 1; i >= 0; i -= 1) {
+    let d = digits.charCodeAt(i) - 48;
+    if (d < 0 || d > 9) continue;
+    if (double) {
+      d *= 2;
+      if (d > 9) d -= 9;
+    }
+    sum += d;
+    double = !double;
+  }
+  return sum % 10;
+}
+function npiCheckDigit(base9) {
+  const partial = luhnMod10(`${NPI_LUHN_PREFIX}${base9}0`);
+  return (10 - partial) % 10;
+}
+var DEA_REGISTRANT_TYPES = Object.freeze([
+  "A",
+  "B",
+  "F",
+  "G",
+  "M",
+  "P",
+  "R",
+  "X"
+]);
+function deaCheckDigit(base6) {
+  let odd = 0;
+  let even = 0;
+  for (let i = 0; i < 6; i += 1) {
+    const digit = base6.charCodeAt(i) - 48;
+    if (i % 2 === 0) odd += digit;
+    else even += digit;
+  }
+  return (odd + 2 * even) % 10;
+}
+
+// src/safe/names-pool.ts
+var SYNTHETIC_GIVEN_NAMES = Object.freeze([
+  "Testina",
+  "Fixtura",
+  "Synthos",
+  "Placeholda",
+  "Sampleton",
+  "Prototius",
+  "Stubbina",
+  "Exampla",
+  "Quilliam",
+  "Fabrica",
+  "Simula",
+  "Testry",
+  "Seedwin",
+  "Corpora",
+  "Reprodo",
+  "Mocktavia",
+  "Dummett",
+  "Voidwin",
+  "Deteria",
+  "Randomir"
+]);
+var SYNTHETIC_FAMILY_NAMES = Object.freeze([
+  "Testerson",
+  "Fauxman",
+  "Placeholt",
+  "Mockridge",
+  "Fixtingham",
+  "Synthwell",
+  "Dummerton",
+  "Examplewood",
+  "Fabricant",
+  "Simulacre",
+  "Nonesuch",
+  "Seedman",
+  "Corpusworth",
+  "Reprodus",
+  "Voidmark",
+  "Deterwood",
+  "Randomson",
+  "Quillfeather",
+  "Notreal",
+  "Genfield"
+]);
+var SYNTHETIC_STREET_NAMES = Object.freeze([
+  "Fixture Lane",
+  "Sample Street",
+  "Placeholder Avenue",
+  "Synthetic Way",
+  "Example Boulevard",
+  "Testing Terrace",
+  "Mock Road",
+  "Prototype Court"
+]);
+var SYNTHETIC_CITY_NAMES = Object.freeze([
+  "Faketon",
+  "Synthville",
+  "Exampleburg",
+  "Testford",
+  "Mockhaven",
+  "Fixtureton"
+]);
+
+// src/safe/providers.ts
+function ssn(rng, block = "never-issued") {
+  if (block === "advertising") {
+    return `987-65-432${String(rng.int(0, 9))}`;
+  }
+  const area = rng.int(900, 999);
+  const group = rng.digits(2);
+  const serial = rng.digits(4);
+  return `${String(area)}-${group}-${serial}`;
+}
+function phone(rng) {
+  const area = `${String(rng.int(2, 9))}${rng.digits(2)}`;
+  const line = `01${rng.digits(2)}`;
+  return `(${area}) 555-${line}`;
+}
+function name(rng) {
+  return { given: rng.pick(SYNTHETIC_GIVEN_NAMES), family: rng.pick(SYNTHETIC_FAMILY_NAMES) };
+}
+function email(rng, person) {
+  const domain = rng.pick(RESERVED_EMAIL_DOMAINS);
+  const slug = person ? `${person.given}.${person.family}`.toLowerCase() : `synth${rng.digits(6)}`;
+  return `${slug}@${domain}`;
+}
+function ipv4(rng) {
+  return `${rng.pick(TEST_NET_V4_PREFIXES)}.${String(rng.int(1, 254))}`;
+}
+function ipv6(rng) {
+  const tail = rng.nextUint32().toString(16).padStart(4, "0").slice(-4);
+  return `${DOC_V6_PREFIX}::${tail}`;
+}
+function uuid(rng) {
+  const bytes = new Uint8Array(16);
+  for (let i = 0; i < 16; i += 1) bytes[i] = rng.int(0, 255);
+  bytes[6] = (bytes[6] ?? 0) & 15 | 64;
+  bytes[8] = (bytes[8] ?? 0) & 63 | 128;
+  const hex = Array.from(bytes, (b) => b.toString(16).padStart(2, "0"));
+  return `${hex.slice(0, 4).join("")}-${hex.slice(4, 6).join("")}-${hex.slice(6, 8).join("")}-${hex.slice(8, 10).join("")}-${hex.slice(10, 16).join("")}`;
+}
+function npi(rng) {
+  const base9 = rng.digits(9);
+  const wrongCheck = (npiCheckDigit(base9) + 1) % 10;
+  return `${base9}${String(wrongCheck)}`;
+}
+function dea(rng, person) {
+  const type = rng.pick(DEA_REGISTRANT_TYPES);
+  const initialSource = person?.family ?? rng.pick(SYNTHETIC_FAMILY_NAMES);
+  const initial = initialSource.slice(0, 1).toUpperCase();
+  const base6 = rng.digits(6);
+  const wrongCheck = (deaCheckDigit(base6) + 1) % 10;
+  return `${type}${initial}${base6}${String(wrongCheck)}`;
+}
+function identifier(rng, typeCode = "MR") {
+  return {
+    value: rng.digits(8),
+    typeCode,
+    assigningAuthority: SYNTHETIC_ASSIGNING_AUTHORITY.namespaceId,
+    assigningAuthorityOid: SYNTHETIC_ASSIGNING_AUTHORITY.universalId
+  };
+}
+function address(rng) {
+  const number = rng.int(1, 9999);
+  return {
+    street: `${String(number)} ${rng.pick(SYNTHETIC_STREET_NAMES)}`,
+    city: rng.pick(SYNTHETIC_CITY_NAMES),
+    state: rng.pick(US_STATES),
+    zip: "00000"
+  };
+}
+function dateYmd(rng, minYear = 1930, maxYear = 2010) {
+  const year = rng.int(minYear, maxYear);
+  const month = rng.int(1, 12);
+  const daysInMonth = new Date(Date.UTC(year, month, 0)).getUTCDate();
+  const day = rng.int(1, daysInMonth);
+  return `${String(year).padStart(4, "0")}${String(month).padStart(2, "0")}${String(day).padStart(2, "0")}`;
+}
+var US_STATES = Object.freeze([
+  "AL",
+  "AK",
+  "AZ",
+  "AR",
+  "CA",
+  "CO",
+  "CT",
+  "DE",
+  "FL",
+  "GA",
+  "HI",
+  "ID",
+  "IL",
+  "IN",
+  "IA",
+  "KS",
+  "KY",
+  "LA",
+  "ME",
+  "MD",
+  "MA",
+  "MI",
+  "MN",
+  "MS",
+  "MO",
+  "MT",
+  "NE",
+  "NV",
+  "NH",
+  "NJ",
+  "NM",
+  "NY",
+  "NC",
+  "ND",
+  "OH",
+  "OK",
+  "OR",
+  "PA",
+  "RI",
+  "SC",
+  "SD",
+  "TN",
+  "TX",
+  "UT",
+  "VT",
+  "VA",
+  "WA",
+  "WV",
+  "WI",
+  "WY"
+]);
+
+// src/safe/index.ts
+var safe = Object.freeze({
+  ssn,
+  phone,
+  name,
+  email,
+  ipv4,
+  ipv6,
+  uuid,
+  identifier,
+  address,
+  dateYmd,
+  npi,
+  dea
+});
+
+// src/hl7/common.ts
+function seededTimestamp(rng) {
+  const date = safe.dateYmd(rng, 2020, 2025);
+  const hh = String(rng.int(0, 23)).padStart(2, "0");
+  const mm = String(rng.int(0, 59)).padStart(2, "0");
+  const ss = String(rng.int(0, 59)).padStart(2, "0");
+  return `${date}${hh}${mm}${ss}`;
+}
+function mshScaffold(rng, type) {
+  const timestamp = seededTimestamp(rng);
+  const controlId = `SYNTH${rng.digits(10)}`;
+  const message = hl7$1.buildMessage({
+    type,
+    sendingApp: "COSYTE-SYNTH",
+    sendingFacility: "SYNTH-FAC",
+    receivingApp: "RECEIVER",
+    receivingFacility: "RECV-FAC",
+    controlId,
+    timestamp,
+    version: "2.5",
+    processingId: "P"
+  });
+  return { message, timestamp, controlId };
+}
+function patientIdentity(rng) {
+  const person = safe.name(rng);
+  const mrn = safe.identifier(rng, "MR");
+  const dob = safe.dateYmd(rng, 1930, 2010);
+  const sex = rng.pick(["M", "F"]);
+  const address2 = safe.address(rng);
+  const phone2 = safe.phone(rng);
+  const ssnDigits = safe.ssn(rng).replace(/-/g, "");
+  return { person, mrn, dob, sex, address: address2, phone: phone2, ssnDigits };
+}
+function pidSegment(id) {
+  return [
+    "1",
+    // PID-1 set id
+    "",
+    // PID-2 (legacy, absent)
+    componentsField([id.mrn.value, "", "", id.mrn.assigningAuthority, id.mrn.typeCode]),
+    // PID-3 CX
+    "",
+    // PID-4
+    componentsField([id.person.family, id.person.given]),
+    // PID-5 XPN
+    "",
+    // PID-6
+    id.dob,
+    // PID-7 DOB
+    id.sex,
+    // PID-8 sex
+    "",
+    // PID-9
+    "",
+    // PID-10
+    componentsField([id.address.street, "", id.address.city, id.address.state, id.address.zip]),
+    // PID-11 XAD
+    "",
+    // PID-12
+    id.phone,
+    // PID-13 phone
+    "",
+    // PID-14
+    "",
+    // PID-15
+    "",
+    // PID-16
+    "",
+    // PID-17
+    "",
+    // PID-18
+    id.ssnDigits
+    // PID-19 SSN (digits)
+  ];
+}
+
+// src/hl7/adt.ts
+function generateAdt(options = {}) {
+  const seed = options.seed ?? 0;
+  const trigger = options.trigger ?? "A01";
+  const rng = createRng(seed);
+  const { message, timestamp } = mshScaffold(rng, `ADT^${trigger}`);
+  message.addSegment("EVN", [trigger, timestamp]);
+  message.addSegment("PID", pidSegment(patientIdentity(rng)));
+  const patientClass = rng.pick(["I", "O", "E"]);
+  message.addSegment("PV1", [
+    "1",
+    // PV1-1 set id
+    patientClass,
+    // PV1-2 patient class
+    componentsField(["SYNTHWARD", String(rng.int(1, 999)).padStart(3, "0"), "01"])
+    // PV1-3 PL
+  ]);
+  return message;
+}
+
+// src/hl7/example-codes.ts
+var EXAMPLE_LAB_OBSERVATIONS = Object.freeze([
+  Object.freeze({ code: "4548-4", text: "Hemoglobin A1c", system: "LN", units: "%" }),
+  Object.freeze({ code: "718-7", text: "Hemoglobin", system: "LN", units: "g/dL" }),
+  Object.freeze({ code: "2345-7", text: "Glucose", system: "LN", units: "mg/dL" }),
+  Object.freeze({ code: "2951-2", text: "Sodium", system: "LN", units: "mmol/L" }),
+  Object.freeze({ code: "2823-3", text: "Potassium", system: "LN", units: "mmol/L" }),
+  Object.freeze({ code: "789-8", text: "Erythrocytes", system: "LN", units: "10*6/uL" })
+]);
+var EXAMPLE_ORDER_SERVICES = Object.freeze([
+  Object.freeze({ code: "24323-8", text: "Comprehensive metabolic panel", system: "LN" }),
+  Object.freeze({ code: "58410-2", text: "CBC panel", system: "LN" }),
+  Object.freeze({ code: "24356-8", text: "Urinalysis panel", system: "LN" }),
+  Object.freeze({ code: "24331-1", text: "Lipid panel", system: "LN" })
+]);
+var EXAMPLE_VACCINES = Object.freeze([
+  Object.freeze({ code: "08", text: "Hep B, adolescent or pediatric", system: "CVX" }),
+  Object.freeze({ code: "20", text: "DTaP", system: "CVX" }),
+  Object.freeze({ code: "03", text: "MMR", system: "CVX" }),
+  Object.freeze({ code: "10", text: "IPV", system: "CVX" }),
+  Object.freeze({ code: "141", text: "Influenza, seasonal, injectable", system: "CVX" }),
+  Object.freeze({ code: "21", text: "Varicella", system: "CVX" })
+]);
+
+// src/hl7/oru.ts
+function obxSegment(rng, setId) {
+  const obs = rng.pick(EXAMPLE_LAB_OBSERVATIONS);
+  const value = `${String(rng.int(1, 300))}.${String(rng.int(0, 9))}`;
+  const observedAt = seededTimestamp(rng);
+  return [
+    String(setId),
+    // OBX-1 set id
+    "NM",
+    // OBX-2 value type (numeric)
+    componentsField([obs.code, obs.text, obs.system]),
+    // OBX-3 observation identifier (CE)
+    "",
+    // OBX-4 observation sub-id
+    value,
+    // OBX-5 observation value
+    obs.units ?? "",
+    // OBX-6 units
+    "",
+    // OBX-7 reference range
+    "N",
+    // OBX-8 abnormal flags (normal)
+    "",
+    // OBX-9
+    "",
+    // OBX-10
+    "F",
+    // OBX-11 observation result status (final)
+    "",
+    // OBX-12
+    "",
+    // OBX-13
+    observedAt
+    // OBX-14 date/time of the observation
+  ];
+}
+function generateOru(options = {}) {
+  const seed = options.seed ?? 0;
+  const rng = createRng(seed);
+  const { message } = mshScaffold(rng, "ORU^R01");
+  message.addSegment("PID", pidSegment(patientIdentity(rng)));
+  const service = rng.pick(EXAMPLE_ORDER_SERVICES);
+  const placer = rng.digits(8);
+  const filler = rng.digits(8);
+  message.addSegment("OBR", [
+    "1",
+    // OBR-1 set id
+    placer,
+    // OBR-2 placer order number
+    filler,
+    // OBR-3 filler order number
+    componentsField([service.code, service.text, service.system]),
+    // OBR-4 universal service id (CE)
+    "",
+    // OBR-5
+    "",
+    // OBR-6
+    seededTimestamp(rng)
+    // OBR-7 observation date/time
+  ]);
+  const obxCount = rng.int(1, 3);
+  for (let i = 1; i <= obxCount; i += 1) {
+    message.addSegment("OBX", obxSegment(rng, i));
+  }
+  return message;
+}
+
+// src/hl7/orm.ts
+function generateOrm(options = {}) {
+  const seed = options.seed ?? 0;
+  const rng = createRng(seed);
+  const { message } = mshScaffold(rng, "ORM^O01");
+  message.addSegment("PID", pidSegment(patientIdentity(rng)));
+  const service = rng.pick(EXAMPLE_ORDER_SERVICES);
+  const placer = rng.digits(8);
+  const filler = rng.digits(8);
+  const orderedAt = seededTimestamp(rng);
+  message.addSegment("ORC", [
+    "NW",
+    // ORC-1 order control (new order)
+    placer,
+    // ORC-2 placer order number
+    filler,
+    // ORC-3 filler order number
+    "",
+    // ORC-4 placer group number
+    "",
+    // ORC-5 order status
+    "",
+    // ORC-6
+    "",
+    // ORC-7 quantity/timing
+    "",
+    // ORC-8
+    orderedAt
+    // ORC-9 date/time of transaction
+  ]);
+  message.addSegment("OBR", [
+    "1",
+    // OBR-1 set id
+    placer,
+    // OBR-2 placer order number (matches ORC)
+    filler,
+    // OBR-3 filler order number (matches ORC)
+    componentsField([service.code, service.text, service.system])
+    // OBR-4 universal service id (CE)
+  ]);
+  return message;
+}
+
+// src/hl7/siu.ts
+function generateSiu(options = {}) {
+  const seed = options.seed ?? 0;
+  const rng = createRng(seed);
+  const { message } = mshScaffold(rng, "SIU^S12");
+  const placerAppt = rng.digits(8);
+  const fillerAppt = rng.digits(8);
+  const startAt = seededTimestamp(rng);
+  const durationMinutes = String(rng.int(15, 90));
+  message.addSegment("SCH", [
+    placerAppt,
+    // SCH-1 placer appointment id
+    fillerAppt,
+    // SCH-2 filler appointment id
+    "",
+    // SCH-3 occurrence number
+    "",
+    // SCH-4 placer group number
+    "",
+    // SCH-5 schedule id
+    "",
+    // SCH-6 event reason
+    componentsField(["ROUTINE", "Routine appointment", "L"]),
+    // SCH-7 appointment reason (CE)
+    "",
+    // SCH-8 appointment type
+    durationMinutes,
+    // SCH-9 appointment duration
+    componentsField(["min", "minutes", "UCUM"]),
+    // SCH-10 appointment duration units (CE)
+    componentsField(["1", "", startAt, "", "", "", durationMinutes])
+    // SCH-11 appointment timing quantity (TQ)
+  ]);
+  message.addSegment("PID", pidSegment(patientIdentity(rng)));
+  message.addSegment("RGS", [
+    "1",
+    // RGS-1 set id
+    "A"
+    // RGS-2 segment action code (add)
+  ]);
+  message.addSegment("AIL", [
+    "1",
+    // AIL-1 set id
+    "A",
+    // AIL-2 segment action code
+    componentsField(["SYNTHCLINIC", "Synthetic Clinic", "COSYTE-SYNTH"])
+    // AIL-3 location resource id
+  ]);
+  return message;
+}
+
+// src/hl7/vxu.ts
+function generateVxu(options = {}) {
+  const seed = options.seed ?? 0;
+  const rng = createRng(seed);
+  const { message } = mshScaffold(rng, "VXU^V04");
+  message.addSegment("PID", pidSegment(patientIdentity(rng)));
+  const placer = rng.digits(8);
+  const filler = rng.digits(8);
+  message.addSegment("ORC", [
+    "RE",
+    // ORC-1 order control (observation to follow / record)
+    placer,
+    // ORC-2 placer order number
+    filler
+    // ORC-3 filler order number
+  ]);
+  const vaccine = rng.pick(EXAMPLE_VACCINES);
+  const administeredAt = seededTimestamp(rng);
+  const doseAmount = String(rng.int(1, 5) / 10);
+  message.addSegment("RXA", [
+    "0",
+    // RXA-1 give sub-id counter
+    "1",
+    // RXA-2 administration sub-id counter
+    administeredAt,
+    // RXA-3 date/time start of administration
+    administeredAt,
+    // RXA-4 date/time end of administration
+    componentsField([vaccine.code, vaccine.text, vaccine.system]),
+    // RXA-5 administered code (CE)
+    doseAmount,
+    // RXA-6 administered amount
+    componentsField(["mL", "milliliters", "UCUM"]),
+    // RXA-7 administered units (CE)
+    "",
+    // RXA-8
+    "",
+    // RXA-9 administration notes
+    "",
+    // RXA-10
+    "",
+    // RXA-11
+    "",
+    // RXA-12
+    "",
+    // RXA-13
+    "",
+    // RXA-14
+    "",
+    // RXA-15 substance lot number
+    "",
+    // RXA-16
+    "",
+    // RXA-17
+    "",
+    // RXA-18
+    "",
+    // RXA-19
+    "CP"
+    // RXA-20 completion status (complete)
+  ]);
+  message.addSegment("RXR", [
+    componentsField(["IM", "Intramuscular", "HL70162"]),
+    // RXR-1 route (CE)
+    componentsField(["LD", "Left Deltoid", "HL70163"])
+    // RXR-2 administration site (CE)
+  ]);
+  return message;
+}
+function generateHl7(kind, seed) {
+  switch (kind) {
+    case "ADT^A01":
+      return generateAdt({ seed, trigger: "A01" });
+    case "ADT^A04":
+      return generateAdt({ seed, trigger: "A04" });
+    case "ADT^A08":
+      return generateAdt({ seed, trigger: "A08" });
+    case "ORU^R01":
+      return generateOru({ seed });
+    case "ORM^O01":
+      return generateOrm({ seed });
+    case "SIU^S12":
+      return generateSiu({ seed });
+    case "VXU^V04":
+      return generateVxu({ seed });
+  }
+}
+
+// src/fhir/us-core.ts
+var US_CORE_PROFILE = Object.freeze({
+  /** US Core Patient. */
+  PATIENT: "http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient",
+  /** US Core Condition (Problems and Health Concerns). */
+  CONDITION: "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-problems-health-concerns",
+  /** US Core Laboratory Result Observation. */
+  OBSERVATION_LAB: "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab",
+  /** US Core Vital Signs (derived from the base FHIR vital-signs profile). */
+  VITAL_SIGNS: "http://hl7.org/fhir/us/core/StructureDefinition/us-core-vital-signs",
+  /** US Core MedicationRequest. */
+  MEDICATION_REQUEST: "http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest",
+  /** US Core Encounter. */
+  ENCOUNTER: "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter",
+  /** US Core DiagnosticReport Profile for Laboratory Results Reporting. */
+  DIAGNOSTIC_REPORT_LAB: "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-lab",
+  /** US Core Immunization. */
+  IMMUNIZATION: "http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization",
+  /** US Core AllergyIntolerance. */
+  ALLERGY_INTOLERANCE: "http://hl7.org/fhir/us/core/StructureDefinition/us-core-allergyintolerance",
+  /** US Core Procedure. */
+  PROCEDURE: "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure"
+});
+var US_CORE_RACE_EXTENSION = "http://hl7.org/fhir/us/core/StructureDefinition/us-core-race";
+var US_CORE_ETHNICITY_EXTENSION = "http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity";
+var US_CORE_BIRTHSEX_EXTENSION = "http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex";
+var SYSTEM = Object.freeze({
+  /** FHIR `administrative-gender` (`Patient.gender`). */
+  ADMINISTRATIVE_GENDER: "http://hl7.org/fhir/administrative-gender",
+  /** HL7 Terminology `observation-category`. */
+  OBSERVATION_CATEGORY: "http://terminology.hl7.org/CodeSystem/observation-category",
+  /** HL7 Terminology `condition-category`. */
+  CONDITION_CATEGORY: "http://terminology.hl7.org/CodeSystem/condition-category",
+  /** HL7 Terminology `condition-clinical`. */
+  CONDITION_CLINICAL: "http://terminology.hl7.org/CodeSystem/condition-clinical",
+  /** HL7 Terminology `condition-ver-status`. */
+  CONDITION_VER_STATUS: "http://terminology.hl7.org/CodeSystem/condition-ver-status",
+  /** HL7 v2 `0203` identifier-type (`Identifier.type.coding.code` = `MR`). */
+  IDENTIFIER_TYPE: "http://terminology.hl7.org/CodeSystem/v2-0203",
+  /** OMB race & ethnicity category system (US Core race/ethnicity `ombCategory`). */
+  OMB_RACE_ETHNICITY: "urn:oid:2.16.840.1.113883.6.238",
+  /** LOINC — `Observation.code` (lab + vital-signs). */
+  LOINC: "http://loinc.org",
+  /** SNOMED CT — `Condition.code`. */
+  SNOMED: "http://snomed.info/sct",
+  /** RxNorm — `MedicationRequest.medicationCodeableConcept` + an allergen substance. */
+  RXNORM: "http://www.nlm.nih.gov/research/umls/rxnorm",
+  /** UCUM — `Quantity.system` for units of measure. */
+  UCUM: "http://unitsofmeasure.org",
+  /** CVX (CDC vaccine administered) — `Immunization.vaccineCode`. */
+  CVX: "http://hl7.org/fhir/sid/cvx",
+  /** HL7 v3 `ActCode` — `Encounter.class`. */
+  V3_ACT_CODE: "http://terminology.hl7.org/CodeSystem/v3-ActCode",
+  /** HL7 v2 `0074` diagnostic-service-section — `DiagnosticReport.category` (`LAB`). */
+  DIAGNOSTIC_SERVICE_SECTION: "http://terminology.hl7.org/CodeSystem/v2-0074",
+  /** HL7 Terminology `allergyintolerance-clinical` — `AllergyIntolerance.clinicalStatus`. */
+  ALLERGY_CLINICAL: "http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical",
+  /** HL7 Terminology `allergyintolerance-verification` — `AllergyIntolerance.verificationStatus`. */
+  ALLERGY_VERIFICATION: "http://terminology.hl7.org/CodeSystem/allergyintolerance-verification"
+});
+
+// src/fhir/builder.ts
+function prop(name2, value) {
+  return { name: name2, value };
+}
+function str(value) {
+  return fhir.primitive(value);
+}
+function dec(raw) {
+  return fhir.primitive(fhir.decimal(raw));
+}
+function bool(value) {
+  return fhir.primitive(value);
+}
+function coding(concept) {
+  return fhir.complex([
+    prop("system", str(concept.system)),
+    prop("code", str(concept.code)),
+    prop("display", str(concept.display))
+  ]);
+}
+function codeableConcept(concept) {
+  return fhir.complex([prop("coding", fhir.list([coding(concept)]))]);
+}
+function reference(ref) {
+  return fhir.complex([prop("reference", str(ref))]);
+}
+function narrative(text) {
+  const escaped = text.replace(/&/g, "&amp;").replace(/</g, "&lt;").replace(/>/g, "&gt;");
+  return fhir.complex([
+    prop("status", str("generated")),
+    prop("div", str(`<div xmlns="http://www.w3.org/1999/xhtml"><p>${escaped}</p></div>`))
+  ]);
+}
+function meta(profiles) {
+  return fhir.complex([prop("profile", fhir.list(profiles.map((p) => str(p))))]);
+}
+function toFhirDate(ymd) {
+  return `${ymd.slice(0, 4)}-${ymd.slice(4, 6)}-${ymd.slice(6, 8)}`;
+}
+function fhirPatientIdentity(rng) {
+  const id = safe.uuid(rng);
+  const person = safe.name(rng);
+  const mrn = safe.identifier(rng, "MR");
+  const birthDate = toFhirDate(safe.dateYmd(rng, 1930, 2010));
+  const gender = rng.pick(["male", "female"]);
+  const address2 = safe.address(rng);
+  const phone2 = safe.phone(rng);
+  const email2 = safe.email(rng, person);
+  return { id, person, mrn, birthDate, gender, address: address2, phone: phone2, email: email2 };
+}
+function mrnIdentifier(mrn) {
+  return fhir.complex([
+    prop(
+      "type",
+      fhir.complex([
+        prop(
+          "coding",
+          fhir.list([
+            coding({
+              system: SYSTEM.IDENTIFIER_TYPE,
+              code: "MR",
+              display: "Medical Record Number"
+            })
+          ])
+        )
+      ])
+    ),
+    prop("system", str(`urn:oid:${mrn.assigningAuthorityOid}`)),
+    prop("value", str(mrn.value))
+  ]);
+}
+
+// src/fhir/example-codes.ts
+var EXAMPLE_LAB_OBSERVATIONS2 = Object.freeze([
+  Object.freeze({
+    system: SYSTEM.LOINC,
+    code: "2345-7",
+    display: "Glucose [Mass/volume] in Serum or Plasma",
+    unit: "mg/dL",
+    low: 70,
+    high: 140,
+    decimals: 0
+  }),
+  Object.freeze({
+    system: SYSTEM.LOINC,
+    code: "718-7",
+    display: "Hemoglobin [Mass/volume] in Blood",
+    unit: "g/dL",
+    low: 12,
+    high: 17,
+    decimals: 1
+  }),
+  Object.freeze({
+    system: SYSTEM.LOINC,
+    code: "2951-2",
+    display: "Sodium [Moles/volume] in Serum or Plasma",
+    unit: "mmol/L",
+    low: 135,
+    high: 145,
+    decimals: 0
+  }),
+  Object.freeze({
+    system: SYSTEM.LOINC,
+    code: "2823-3",
+    display: "Potassium [Moles/volume] in Serum or Plasma",
+    unit: "mmol/L",
+    low: 4,
+    high: 5,
+    decimals: 1
+  }),
+  Object.freeze({
+    system: SYSTEM.LOINC,
+    code: "4548-4",
+    display: "Hemoglobin A1c/Hemoglobin.total in Blood",
+    unit: "%",
+    low: 4,
+    high: 9,
+    decimals: 1
+  })
+]);
+var EXAMPLE_VITAL_SIGNS = Object.freeze([
+  Object.freeze({
+    system: SYSTEM.LOINC,
+    code: "8867-4",
+    display: "Heart rate",
+    unit: "/min",
+    low: 55,
+    high: 100,
+    decimals: 0
+  }),
+  Object.freeze({
+    system: SYSTEM.LOINC,
+    code: "9279-1",
+    display: "Respiratory rate",
+    unit: "/min",
+    low: 12,
+    high: 20,
+    decimals: 0
+  }),
+  Object.freeze({
+    system: SYSTEM.LOINC,
+    code: "8310-5",
+    display: "Body temperature",
+    unit: "Cel",
+    low: 36,
+    high: 38,
+    decimals: 1
+  }),
+  Object.freeze({
+    system: SYSTEM.LOINC,
+    code: "29463-7",
+    display: "Body weight",
+    unit: "kg",
+    low: 50,
+    high: 100,
+    decimals: 1
+  }),
+  Object.freeze({
+    system: SYSTEM.LOINC,
+    code: "8302-2",
+    display: "Body height",
+    unit: "cm",
+    low: 150,
+    high: 190,
+    decimals: 0
+  })
+]);
+var EXAMPLE_CONDITIONS = Object.freeze([
+  Object.freeze({ system: SYSTEM.SNOMED, code: "59621000", display: "Essential hypertension" }),
+  Object.freeze({ system: SYSTEM.SNOMED, code: "44054006", display: "Type 2 diabetes mellitus" }),
+  Object.freeze({ system: SYSTEM.SNOMED, code: "195967001", display: "Asthma" }),
+  Object.freeze({
+    system: SYSTEM.SNOMED,
+    code: "13645005",
+    display: "Chronic obstructive lung disease"
+  }),
+  Object.freeze({ system: SYSTEM.SNOMED, code: "38341003", display: "Hypertensive disorder" })
+]);
+var EXAMPLE_MEDICATIONS = Object.freeze([
+  Object.freeze({
+    system: SYSTEM.RXNORM,
+    code: "1049221",
+    display: "Acetaminophen 325 MG Oral Tablet"
+  }),
+  Object.freeze({ system: SYSTEM.RXNORM, code: "197361", display: "Amlodipine 5 MG Oral Tablet" }),
+  Object.freeze({
+    system: SYSTEM.RXNORM,
+    code: "860975",
+    display: "24 HR Metformin hydrochloride 500 MG Extended Release Oral Tablet"
+  }),
+  Object.freeze({
+    system: SYSTEM.RXNORM,
+    code: "308136",
+    display: "Amoxicillin 250 MG Oral Capsule"
+  }),
+  Object.freeze({
+    system: SYSTEM.RXNORM,
+    code: "617314",
+    display: "Atorvastatin 40 MG Oral Tablet"
+  })
+]);
+var EXAMPLE_RACE_CATEGORIES = Object.freeze([
+  Object.freeze({ system: SYSTEM.OMB_RACE_ETHNICITY, code: "2106-3", display: "White" }),
+  Object.freeze({
+    system: SYSTEM.OMB_RACE_ETHNICITY,
+    code: "2054-5",
+    display: "Black or African American"
+  }),
+  Object.freeze({ system: SYSTEM.OMB_RACE_ETHNICITY, code: "2028-9", display: "Asian" }),
+  Object.freeze({
+    system: SYSTEM.OMB_RACE_ETHNICITY,
+    code: "1002-5",
+    display: "American Indian or Alaska Native"
+  }),
+  Object.freeze({
+    system: SYSTEM.OMB_RACE_ETHNICITY,
+    code: "2076-8",
+    display: "Native Hawaiian or Other Pacific Islander"
+  })
+]);
+var EXAMPLE_ETHNICITY_CATEGORIES = Object.freeze([
+  Object.freeze({
+    system: SYSTEM.OMB_RACE_ETHNICITY,
+    code: "2135-2",
+    display: "Hispanic or Latino"
+  }),
+  Object.freeze({
+    system: SYSTEM.OMB_RACE_ETHNICITY,
+    code: "2186-5",
+    display: "Not Hispanic or Latino"
+  })
+]);
+var EXAMPLE_VACCINES2 = Object.freeze([
+  Object.freeze({
+    system: SYSTEM.CVX,
+    code: "140",
+    display: "Influenza, seasonal, injectable, preservative free"
+  }),
+  Object.freeze({ system: SYSTEM.CVX, code: "03", display: "MMR" }),
+  Object.freeze({ system: SYSTEM.CVX, code: "20", display: "DTaP" }),
+  Object.freeze({ system: SYSTEM.CVX, code: "133", display: "Pneumococcal conjugate PCV 13" }),
+  Object.freeze({
+    system: SYSTEM.CVX,
+    code: "208",
+    display: "COVID-19, mRNA, LNP-S, PF, 30 mcg/0.3 mL dose"
+  })
+]);
+var EXAMPLE_ALLERGENS = Object.freeze([
+  Object.freeze({ system: SYSTEM.RXNORM, code: "7980", display: "Penicillin G" }),
+  Object.freeze({ system: SYSTEM.RXNORM, code: "2670", display: "Codeine" }),
+  Object.freeze({ system: SYSTEM.SNOMED, code: "762952008", display: "Peanut (substance)" }),
+  Object.freeze({ system: SYSTEM.SNOMED, code: "227493005", display: "Cashew nuts (substance)" }),
+  Object.freeze({ system: SYSTEM.SNOMED, code: "3718001", display: "Cow's milk (substance)" })
+]);
+var EXAMPLE_ALLERGY_MANIFESTATIONS = Object.freeze([
+  Object.freeze({ system: SYSTEM.SNOMED, code: "247472004", display: "Wheal (finding)" }),
+  Object.freeze({ system: SYSTEM.SNOMED, code: "126485001", display: "Urticaria (disorder)" }),
+  Object.freeze({
+    system: SYSTEM.SNOMED,
+    code: "271807003",
+    display: "Eruption of skin (disorder)"
+  }),
+  Object.freeze({ system: SYSTEM.SNOMED, code: "267036007", display: "Dyspnea (finding)" }),
+  Object.freeze({ system: SYSTEM.SNOMED, code: "422587007", display: "Nausea (finding)" })
+]);
+var EXAMPLE_PROCEDURES = Object.freeze([
+  Object.freeze({
+    system: SYSTEM.SNOMED,
+    code: "80146002",
+    display: "Excision of appendix (procedure)"
+  }),
+  Object.freeze({ system: SYSTEM.SNOMED, code: "73761001", display: "Colonoscopy (procedure)" }),
+  Object.freeze({
+    system: SYSTEM.SNOMED,
+    code: "5880005",
+    display: "Physical examination procedure (procedure)"
+  }),
+  Object.freeze({
+    system: SYSTEM.SNOMED,
+    code: "108252007",
+    display: "Laboratory procedure (procedure)"
+  }),
+  Object.freeze({ system: SYSTEM.SNOMED, code: "71651007", display: "Mammography (procedure)" })
+]);
+var EXAMPLE_DIAGNOSTIC_REPORTS = Object.freeze([
+  Object.freeze({
+    system: SYSTEM.LOINC,
+    code: "24323-8",
+    display: "Comprehensive metabolic 2000 panel - Serum or Plasma"
+  }),
+  Object.freeze({
+    system: SYSTEM.LOINC,
+    code: "58410-2",
+    display: "CBC panel - Blood by Automated count"
+  }),
+  Object.freeze({
+    system: SYSTEM.LOINC,
+    code: "24357-6",
+    display: "Urinalysis complete panel - Urine"
+  }),
+  Object.freeze({
+    system: SYSTEM.LOINC,
+    code: "24331-1",
+    display: "Lipid 1996 panel - Serum or Plasma"
+  }),
+  Object.freeze({
+    system: SYSTEM.LOINC,
+    code: "24321-2",
+    display: "Basic metabolic 1998 panel - Serum or Plasma"
+  })
+]);
+var EXAMPLE_ENCOUNTER_TYPES = Object.freeze([
+  Object.freeze({
+    system: SYSTEM.SNOMED,
+    code: "308335008",
+    display: "Patient encounter procedure (procedure)"
+  }),
+  Object.freeze({
+    system: SYSTEM.SNOMED,
+    code: "185349003",
+    display: "Encounter for check up (procedure)"
+  }),
+  Object.freeze({
+    system: SYSTEM.SNOMED,
+    code: "185347001",
+    display: "Encounter for problem (procedure)"
+  }),
+  Object.freeze({
+    system: SYSTEM.SNOMED,
+    code: "390906007",
+    display: "Follow-up encounter (procedure)"
+  })
+]);
+var EXAMPLE_ENCOUNTER_CLASSES = Object.freeze([
+  Object.freeze({ system: SYSTEM.V3_ACT_CODE, code: "AMB", display: "ambulatory" }),
+  Object.freeze({ system: SYSTEM.V3_ACT_CODE, code: "EMER", display: "emergency" }),
+  Object.freeze({ system: SYSTEM.V3_ACT_CODE, code: "IMP", display: "inpatient encounter" })
+]);
+
+// src/fhir/patient.ts
+function ombExtension(url, category) {
+  return fhir.complex([
+    prop("url", str(url)),
+    prop(
+      "extension",
+      fhir.list([
+        fhir.complex([prop("url", str("ombCategory")), prop("valueCoding", coding(category))]),
+        fhir.complex([prop("url", str("text")), prop("valueString", str(category.display))])
+      ])
+    )
+  ]);
+}
+function generatePatient(options = {}) {
+  const { seed = 0, profile = "base" } = options;
+  const rng = createRng(seed);
+  const id = fhirPatientIdentity(rng);
+  const usCore = profile === "us-core";
+  const props = [
+    prop("resourceType", str("Patient")),
+    prop("id", str(`syn-patient-${id.id}`))
+  ];
+  if (usCore) props.push(prop("meta", meta([US_CORE_PROFILE.PATIENT])));
+  props.push(
+    prop(
+      "text",
+      narrative(
+        `Synthetic patient ${id.person.given} ${id.person.family} (${id.gender}, born ${id.birthDate}).`
+      )
+    )
+  );
+  if (usCore) {
+    const race = rng.pick(EXAMPLE_RACE_CATEGORIES);
+    const ethnicity = rng.pick(EXAMPLE_ETHNICITY_CATEGORIES);
+    const birthsex = id.gender === "male" ? "M" : "F";
+    props.push(
+      prop(
+        "extension",
+        fhir.list([
+          ombExtension(US_CORE_RACE_EXTENSION, race),
+          ombExtension(US_CORE_ETHNICITY_EXTENSION, ethnicity),
+          fhir.complex([prop("url", str(US_CORE_BIRTHSEX_EXTENSION)), prop("valueCode", str(birthsex))])
+        ])
+      )
+    );
+  }
+  props.push(prop("identifier", fhir.list([mrnIdentifier(id.mrn)])));
+  props.push(prop("active", bool(true)));
+  props.push(
+    prop(
+      "name",
+      fhir.list([
+        fhir.complex([
+          prop("use", str("official")),
+          prop("family", str(id.person.family)),
+          prop("given", fhir.list([str(id.person.given)]))
+        ])
+      ])
+    )
+  );
+  props.push(
+    prop(
+      "telecom",
+      fhir.list([
+        fhir.complex([
+          prop("system", str("phone")),
+          prop("value", str(id.phone)),
+          prop("use", str("home"))
+        ]),
+        fhir.complex([prop("system", str("email")), prop("value", str(id.email))])
+      ])
+    )
+  );
+  props.push(prop("gender", str(id.gender)));
+  props.push(prop("birthDate", str(id.birthDate)));
+  props.push(
+    prop(
+      "address",
+      fhir.list([
+        fhir.complex([
+          prop("use", str("home")),
+          prop("line", fhir.list([str(id.address.street)])),
+          prop("city", str(id.address.city)),
+          prop("state", str(id.address.state)),
+          prop("postalCode", str(id.address.zip))
+        ])
+      ])
+    )
+  );
+  return fhir.complex(props);
+}
+function generateCondition(options = {}) {
+  const { seed = 0, subject = "Patient/syn-patient-1", usCore = true } = options;
+  const rng = createRng(seed);
+  const code = rng.pick(EXAMPLE_CONDITIONS);
+  const props = [
+    prop("resourceType", str("Condition")),
+    prop("id", str(`syn-cond-${rng.digits(8)}`))
+  ];
+  if (usCore) props.push(prop("meta", meta([US_CORE_PROFILE.CONDITION])));
+  props.push(prop("text", narrative(`Synthetic condition: ${code.display}.`)));
+  props.push(
+    prop(
+      "clinicalStatus",
+      codeableConcept({ system: SYSTEM.CONDITION_CLINICAL, code: "active", display: "Active" })
+    )
+  );
+  props.push(
+    prop(
+      "verificationStatus",
+      codeableConcept({
+        system: SYSTEM.CONDITION_VER_STATUS,
+        code: "confirmed",
+        display: "Confirmed"
+      })
+    )
+  );
+  props.push(
+    prop(
+      "category",
+      fhir.list([
+        codeableConcept({
+          system: SYSTEM.CONDITION_CATEGORY,
+          code: "problem-list-item",
+          display: "Problem List Item"
+        })
+      ])
+    )
+  );
+  props.push(prop("code", codeableConcept(code)));
+  props.push(prop("subject", reference(subject)));
+  return fhir.complex(props);
+}
+function drawValue(rng, concept) {
+  const span = concept.high - concept.low;
+  const raw = concept.low + rng.float() * span;
+  return raw.toFixed(concept.decimals);
+}
+function valueQuantity(rng, concept) {
+  return fhir.complex([
+    prop("value", dec(drawValue(rng, concept))),
+    prop("unit", str(concept.unit)),
+    prop("system", str(SYSTEM.UCUM)),
+    prop("code", str(concept.unit))
+  ]);
+}
+function buildObservation(seed, subject, usCore, profileUrl, category, pool, effective) {
+  const rng = createRng(seed);
+  const concept = rng.pick(pool);
+  const props = [
+    prop("resourceType", str("Observation")),
+    prop("id", str(`syn-obs-${rng.digits(8)}`))
+  ];
+  if (usCore) props.push(prop("meta", meta([profileUrl])));
+  props.push(
+    prop("text", narrative(`Synthetic ${category.display.toLowerCase()}: ${concept.display}.`))
+  );
+  props.push(prop("status", str("final")));
+  props.push(
+    prop(
+      "category",
+      fhir.list([
+        codeableConcept({
+          system: SYSTEM.OBSERVATION_CATEGORY,
+          code: category.code,
+          display: category.display
+        })
+      ])
+    )
+  );
+  props.push(prop("code", codeableConcept(concept)));
+  props.push(prop("subject", reference(subject)));
+  const y = rng.int(2020, 2025);
+  const m = String(rng.int(1, 12)).padStart(2, "0");
+  const d = String(rng.int(1, 28)).padStart(2, "0");
+  if (effective) props.push(prop("effectiveDateTime", str(`${String(y)}-${m}-${d}`)));
+  props.push(prop("valueQuantity", valueQuantity(rng, concept)));
+  return fhir.complex(props);
+}
+function generateObservationLab(options = {}) {
+  const { seed = 0, subject = "Patient/syn-patient-1", usCore = true } = options;
+  return buildObservation(
+    seed,
+    subject,
+    usCore,
+    US_CORE_PROFILE.OBSERVATION_LAB,
+    { code: "laboratory", display: "Laboratory" },
+    EXAMPLE_LAB_OBSERVATIONS2,
+    false
+  );
+}
+function generateVitalSign(options = {}) {
+  const { seed = 0, subject = "Patient/syn-patient-1", usCore = true } = options;
+  return buildObservation(
+    seed,
+    subject,
+    usCore,
+    US_CORE_PROFILE.VITAL_SIGNS,
+    { code: "vital-signs", display: "Vital Signs" },
+    EXAMPLE_VITAL_SIGNS,
+    true
+  );
+}
+function generateMedicationRequest(options = {}) {
+  const {
+    seed = 0,
+    subject = "Patient/syn-patient-1",
+    requester = "Practitioner/syn-practitioner-1",
+    usCore = true
+  } = options;
+  const rng = createRng(seed);
+  const med = rng.pick(EXAMPLE_MEDICATIONS);
+  const y = rng.int(2020, 2025);
+  const m = String(rng.int(1, 12)).padStart(2, "0");
+  const d = String(rng.int(1, 28)).padStart(2, "0");
+  const props = [
+    prop("resourceType", str("MedicationRequest")),
+    prop("id", str(`syn-medreq-${rng.digits(8)}`))
+  ];
+  if (usCore) props.push(prop("meta", meta([US_CORE_PROFILE.MEDICATION_REQUEST])));
+  props.push(prop("text", narrative(`Synthetic medication order: ${med.display}.`)));
+  props.push(prop("status", str("active")));
+  props.push(prop("intent", str("order")));
+  props.push(prop("medicationCodeableConcept", codeableConcept(med)));
+  props.push(prop("subject", reference(subject)));
+  props.push(prop("authoredOn", str(`${String(y)}-${m}-${d}`)));
+  props.push(prop("requester", reference(requester)));
+  return fhir.complex(props);
+}
+function generateEncounter(options = {}) {
+  const { seed = 0, subject = "Patient/syn-patient-1", usCore = true } = options;
+  const rng = createRng(seed);
+  const cls = rng.pick(EXAMPLE_ENCOUNTER_CLASSES);
+  const type = rng.pick(EXAMPLE_ENCOUNTER_TYPES);
+  const id = safe.identifier(rng, "AN");
+  const start = toFhirDate(safe.dateYmd(rng, 2018, 2024));
+  const props = [
+    prop("resourceType", str("Encounter")),
+    prop("id", str(`syn-enc-${rng.digits(8)}`))
+  ];
+  if (usCore) props.push(prop("meta", meta([US_CORE_PROFILE.ENCOUNTER])));
+  props.push(prop("text", narrative(`Synthetic encounter: ${type.display}.`)));
+  props.push(
+    prop(
+      "identifier",
+      fhir.list([
+        fhir.complex([
+          prop("system", str(`urn:oid:${id.assigningAuthorityOid}`)),
+          prop("value", str(id.value))
+        ])
+      ])
+    )
+  );
+  props.push(prop("status", str("finished")));
+  props.push(prop("class", coding(cls)));
+  props.push(prop("type", fhir.list([codeableConcept(type)])));
+  props.push(prop("subject", reference(subject)));
+  props.push(prop("period", fhir.complex([prop("start", str(`${start}T09:00:00Z`))])));
+  return fhir.complex(props);
+}
+function generateImmunization(options = {}) {
+  const { seed = 0, patient = "Patient/syn-patient-1", usCore = true } = options;
+  const rng = createRng(seed);
+  const vaccine = rng.pick(EXAMPLE_VACCINES2);
+  const occurrence = toFhirDate(safe.dateYmd(rng, 2015, 2024));
+  const props = [
+    prop("resourceType", str("Immunization")),
+    prop("id", str(`syn-imm-${rng.digits(8)}`))
+  ];
+  if (usCore) props.push(prop("meta", meta([US_CORE_PROFILE.IMMUNIZATION])));
+  props.push(prop("text", narrative(`Synthetic immunization: ${vaccine.display}.`)));
+  props.push(prop("status", str("completed")));
+  props.push(prop("vaccineCode", codeableConcept(vaccine)));
+  props.push(prop("patient", reference(patient)));
+  props.push(prop("occurrenceDateTime", str(occurrence)));
+  props.push(prop("primarySource", bool(true)));
+  return fhir.complex(props);
+}
+function generateAllergyIntolerance(options = {}) {
+  const { seed = 0, patient = "Patient/syn-patient-1", usCore = true } = options;
+  const rng = createRng(seed);
+  const allergen = rng.pick(EXAMPLE_ALLERGENS);
+  const manifestation = rng.pick(EXAMPLE_ALLERGY_MANIFESTATIONS);
+  const props = [
+    prop("resourceType", str("AllergyIntolerance")),
+    prop("id", str(`syn-allergy-${rng.digits(8)}`))
+  ];
+  if (usCore) props.push(prop("meta", meta([US_CORE_PROFILE.ALLERGY_INTOLERANCE])));
+  props.push(prop("text", narrative(`Synthetic allergy: ${allergen.display}.`)));
+  props.push(
+    prop(
+      "clinicalStatus",
+      codeableConcept({ system: SYSTEM.ALLERGY_CLINICAL, code: "active", display: "Active" })
+    )
+  );
+  props.push(
+    prop(
+      "verificationStatus",
+      codeableConcept({
+        system: SYSTEM.ALLERGY_VERIFICATION,
+        code: "confirmed",
+        display: "Confirmed"
+      })
+    )
+  );
+  props.push(prop("code", codeableConcept(allergen)));
+  props.push(prop("patient", reference(patient)));
+  props.push(
+    prop(
+      "reaction",
+      fhir.list([fhir.complex([prop("manifestation", fhir.list([codeableConcept(manifestation)]))])])
+    )
+  );
+  return fhir.complex(props);
+}
+function generateProcedure(options = {}) {
+  const { seed = 0, subject = "Patient/syn-patient-1", usCore = true } = options;
+  const rng = createRng(seed);
+  const code = rng.pick(EXAMPLE_PROCEDURES);
+  const performed = toFhirDate(safe.dateYmd(rng, 2018, 2024));
+  const props = [
+    prop("resourceType", str("Procedure")),
+    prop("id", str(`syn-proc-${rng.digits(8)}`))
+  ];
+  if (usCore) props.push(prop("meta", meta([US_CORE_PROFILE.PROCEDURE])));
+  props.push(prop("text", narrative(`Synthetic procedure: ${code.display}.`)));
+  props.push(prop("status", str("completed")));
+  props.push(prop("code", codeableConcept(code)));
+  props.push(prop("subject", reference(subject)));
+  props.push(prop("performedDateTime", str(`${performed}T10:00:00Z`)));
+  return fhir.complex(props);
+}
+function generateDiagnosticReport(options = {}) {
+  const { seed = 0, subject = "Patient/syn-patient-1", results = [], usCore = true } = options;
+  const rng = createRng(seed);
+  const code = rng.pick(EXAMPLE_DIAGNOSTIC_REPORTS);
+  const day = toFhirDate(safe.dateYmd(rng, 2018, 2024));
+  const props = [
+    prop("resourceType", str("DiagnosticReport")),
+    prop("id", str(`syn-dr-${rng.digits(8)}`))
+  ];
+  if (usCore) props.push(prop("meta", meta([US_CORE_PROFILE.DIAGNOSTIC_REPORT_LAB])));
+  props.push(prop("text", narrative(`Synthetic laboratory report: ${code.display}.`)));
+  props.push(prop("status", str("final")));
+  props.push(
+    prop(
+      "category",
+      fhir.list([
+        codeableConcept({
+          system: SYSTEM.DIAGNOSTIC_SERVICE_SECTION,
+          code: "LAB",
+          display: "Laboratory"
+        })
+      ])
+    )
+  );
+  props.push(prop("code", codeableConcept(code)));
+  props.push(prop("subject", reference(subject)));
+  props.push(prop("effectiveDateTime", str(`${day}T08:30:00Z`)));
+  props.push(prop("issued", str(`${day}T09:00:00.000Z`)));
+  if (results.length > 0) {
+    props.push(prop("result", fhir.list(results.map((r) => reference(r)))));
+  }
+  return fhir.complex(props);
+}
+function section(sec) {
+  return fhir.complex([
+    prop("title", str(sec.title)),
+    prop("code", codeableConcept({ system: SYSTEM.LOINC, code: sec.code, display: sec.title })),
+    prop("entry", fhir.list(sec.entries.map((e) => reference(e))))
+  ]);
+}
+function buildComposition(rng, input) {
+  const props = [
+    prop("resourceType", str("Composition")),
+    prop("id", str(`syn-comp-${rng.digits(8)}`)),
+    prop("text", narrative("Synthetic continuity-of-care document summary.")),
+    prop("status", str("final")),
+    prop(
+      "type",
+      codeableConcept({
+        system: SYSTEM.LOINC,
+        code: "34133-9",
+        display: "Summarization of Episode Note"
+      })
+    ),
+    prop("subject", reference(input.subject)),
+    prop("date", str(`${input.date}T09:00:00Z`)),
+    prop("author", fhir.list([reference(input.organization)])),
+    prop("title", str("Synthetic Continuity of Care Document")),
+    prop("custodian", reference(input.organization)),
+    prop("section", fhir.list(input.sections.map((s) => section(s))))
+  ];
+  return fhir.complex(props);
+}
+
+// src/fhir/bundle.ts
+function resourceTypeOf(resource) {
+  const rt = resource.properties.find((p) => p.name === "resourceType");
+  return rt !== void 0 && rt.value.kind === "primitive" ? String(rt.value.value) : "Resource";
+}
+function buildOrganization(rng) {
+  const id = safe.identifier(rng, "AN");
+  return fhir.complex([
+    prop("resourceType", str("Organization")),
+    prop("id", str(`syn-org-${rng.digits(8)}`)),
+    prop("text", narrative("Synthetic health organization.")),
+    prop(
+      "identifier",
+      fhir.list([
+        fhir.complex([
+          prop("system", str(`urn:oid:${id.assigningAuthorityOid}`)),
+          prop("value", str(id.value))
+        ])
+      ])
+    ),
+    prop("active", bool(true)),
+    prop("name", str("Synthetic Health Organization"))
+  ]);
+}
+function buildSpine(rng) {
+  const patientUrl = `urn:uuid:${safe.uuid(rng)}`;
+  const orgUrl = `urn:uuid:${safe.uuid(rng)}`;
+  const date = toFhirDate(safe.dateYmd(rng, 2018, 2024));
+  const patient = {
+    fullUrl: patientUrl,
+    resource: generatePatient({ seed: rng.nextUint32(), profile: "us-core" })
+  };
+  const org = { fullUrl: orgUrl, resource: buildOrganization(rng) };
+  const condUrl = `urn:uuid:${safe.uuid(rng)}`;
+  const cond = generateCondition({ seed: rng.nextUint32(), subject: patientUrl });
+  const labUrl = `urn:uuid:${safe.uuid(rng)}`;
+  const lab = generateObservationLab({ seed: rng.nextUint32(), subject: patientUrl });
+  const vitalUrl = `urn:uuid:${safe.uuid(rng)}`;
+  const vital = generateVitalSign({ seed: rng.nextUint32(), subject: patientUrl });
+  const medUrl = `urn:uuid:${safe.uuid(rng)}`;
+  const med = generateMedicationRequest({
+    seed: rng.nextUint32(),
+    subject: patientUrl,
+    requester: orgUrl
+  });
+  const encUrl = `urn:uuid:${safe.uuid(rng)}`;
+  const enc = generateEncounter({ seed: rng.nextUint32(), subject: patientUrl });
+  const immUrl = `urn:uuid:${safe.uuid(rng)}`;
+  const imm = generateImmunization({ seed: rng.nextUint32(), patient: patientUrl });
+  const allergyUrl = `urn:uuid:${safe.uuid(rng)}`;
+  const allergy = generateAllergyIntolerance({ seed: rng.nextUint32(), patient: patientUrl });
+  const procUrl = `urn:uuid:${safe.uuid(rng)}`;
+  const proc = generateProcedure({ seed: rng.nextUint32(), subject: patientUrl });
+  const drUrl = `urn:uuid:${safe.uuid(rng)}`;
+  const dr = generateDiagnosticReport({
+    seed: rng.nextUint32(),
+    subject: patientUrl,
+    results: [labUrl]
+  });
+  const entries = [
+    patient,
+    org,
+    { fullUrl: condUrl, resource: cond },
+    { fullUrl: labUrl, resource: lab },
+    { fullUrl: vitalUrl, resource: vital },
+    { fullUrl: medUrl, resource: med },
+    { fullUrl: encUrl, resource: enc },
+    { fullUrl: immUrl, resource: imm },
+    { fullUrl: allergyUrl, resource: allergy },
+    { fullUrl: procUrl, resource: proc },
+    { fullUrl: drUrl, resource: dr }
+  ];
+  const urls = {
+    condition: condUrl,
+    lab: labUrl,
+    vital: vitalUrl,
+    medication: medUrl,
+    encounter: encUrl,
+    immunization: immUrl,
+    allergy: allergyUrl,
+    procedure: procUrl,
+    diagnosticReport: drUrl
+  };
+  return { patientUrl, orgUrl, date, urls, entries };
+}
+function documentSections(urls) {
+  const at = (k) => urls[k] !== void 0 ? [urls[k]] : [];
+  return [
+    { code: "11450-4", title: "Problem List", entries: at("condition") },
+    {
+      code: "30954-2",
+      title: "Relevant Diagnostic Tests/Laboratory Data",
+      entries: [...at("diagnosticReport"), ...at("lab"), ...at("vital")]
+    },
+    { code: "10160-0", title: "History of Medication Use", entries: at("medication") },
+    { code: "48765-2", title: "Allergies and Adverse Reactions", entries: at("allergy") },
+    { code: "11369-6", title: "History of Immunizations", entries: at("immunization") },
+    { code: "47519-4", title: "History of Procedures", entries: at("procedure") },
+    { code: "46240-8", title: "History of Encounters", entries: at("encounter") }
+  ];
+}
+function generateBundle(options = {}) {
+  const { seed = 0, type = "collection" } = options;
+  const rng = createRng(seed);
+  const spine = buildSpine(rng);
+  const members = type === "document" ? [
+    {
+      fullUrl: `urn:uuid:${safe.uuid(rng)}`,
+      resource: buildComposition(rng, {
+        subject: spine.patientUrl,
+        organization: spine.orgUrl,
+        date: spine.date,
+        sections: documentSections(spine.urls)
+      })
+    },
+    ...spine.entries
+  ] : [...spine.entries];
+  const entries = members.map((member) => {
+    const entryProps = [
+      prop("fullUrl", str(member.fullUrl)),
+      prop("resource", member.resource)
+    ];
+    if (type === "transaction") {
+      entryProps.push(
+        prop(
+          "request",
+          fhir.complex([prop("method", str("POST")), prop("url", str(resourceTypeOf(member.resource)))])
+        )
+      );
+    }
+    return fhir.complex(entryProps);
+  });
+  const props = [
+    prop("resourceType", str("Bundle")),
+    prop("id", str(`syn-bundle-${rng.digits(8)}`))
+  ];
+  if (type === "document") {
+    const id = safe.identifier(rng, "AN");
+    props.push(
+      prop(
+        "identifier",
+        fhir.complex([
+          prop("system", str(`urn:oid:${id.assigningAuthorityOid}`)),
+          prop("value", str(`urn:uuid:${safe.uuid(rng)}`))
+        ])
+      )
+    );
+  }
+  props.push(prop("type", str(type)));
+  if (type === "document") props.push(prop("timestamp", str(`${spine.date}T09:00:00.000Z`)));
+  props.push(prop("entry", fhir.list(entries)));
+  return fhir.complex(props);
+}
+function dec2(value) {
+  const d = x12.X12Decimal.fromString(value);
+  if (d === void 0) throw new Error(`invalid synthetic decimal: ${value}`);
+  return d;
+}
+function money(n) {
+  return `${String(n)}.00`;
+}
+
+// src/x12/identity.ts
+var SYNTHETIC_ORG_NAMES = Object.freeze([
+  "SYNTH BILLING GROUP",
+  "FIXTURE CLINIC INC",
+  "PLACEHOLDER MEDICAL CTR",
+  "SAMPLE HEALTH PARTNERS",
+  "MOCK CARE ASSOCIATES",
+  "PROTOTYPE PHYSICIANS LLC"
+]);
+var SYNTHETIC_PAYER_NAMES = Object.freeze([
+  "SYNTHCARE HEALTH PLAN",
+  "FIXTURE MUTUAL INSURANCE",
+  "PLACEHOLDER BENEFIT ADMIN",
+  "SAMPLE STATE MEDICAID",
+  "MOCK NATIONAL INSURER"
+]);
+function x12Person(rng) {
+  const person = safe.name(rng);
+  const memberId = `MBR${safe.identifier(rng, "MB").value}`;
+  const dob = safe.dateYmd(rng, 1935, 2010);
+  const sex = rng.pick(["M", "F"]);
+  const address2 = safe.address(rng);
+  return { person, memberId, dob, sex, address: address2 };
+}
+function x12Organization(rng) {
+  const name2 = rng.pick(SYNTHETIC_ORG_NAMES);
+  const npiValue = safe.npi(rng);
+  const taxIdSsn = safe.ssn(rng).replace(/\D/g, "");
+  const address2 = safe.address(rng);
+  return { name: name2, npi: npiValue, taxIdSsn, address: address2 };
+}
+function x12ProviderPerson(rng) {
+  const person = safe.name(rng);
+  const npiValue = safe.npi(rng);
+  return { person, npi: npiValue };
+}
+function x12Payer(rng) {
+  const name2 = rng.pick(SYNTHETIC_PAYER_NAMES);
+  const payerId = `SYN${rng.digits(5)}`;
+  return { name: name2, payerId };
+}
+function x12TradingPartners(rng) {
+  return { senderId: `SYNSUB${rng.digits(3)}`, receiverId: `SYNRCV${rng.digits(3)}` };
+}
+function x12EnvelopeTiming(rng) {
+  const serviceDate2 = safe.dateYmd(rng, 2024, 2026);
+  const yy = serviceDate2.slice(2, 4);
+  const mmdd = serviceDate2.slice(4, 8);
+  const hh = String(rng.int(0, 23)).padStart(2, "0");
+  const mi = String(rng.int(0, 59)).padStart(2, "0");
+  return {
+    interchangeDate: `${yy}${mmdd}`,
+    interchangeTime: `${hh}${mi}`,
+    interchangeControlNumber: rng.digits(9),
+    groupControlNumber: String(rng.int(1, 99999)),
+    transactionSetControlNumber: rng.digits(4),
+    serviceDate: serviceDate2
+  };
+}
+
+// src/x12/example-codes.ts
+var PROFESSIONAL_PROCEDURES = Object.freeze([
+  { code: "99213", label: "office/outpatient visit, established patient" },
+  { code: "99214", label: "office/outpatient visit, established patient, moderate" },
+  { code: "99203", label: "office/outpatient visit, new patient" },
+  { code: "85025", label: "complete blood count with differential" },
+  { code: "80053", label: "comprehensive metabolic panel" },
+  { code: "93000", label: "electrocardiogram, routine" }
+]);
+var PROCEDURE_MODIFIERS = Object.freeze(["25", "59", "76", "GT"]);
+var PLACES_OF_SERVICE = Object.freeze(["11", "22", "21", "12", "49"]);
+var DIAGNOSES = Object.freeze([
+  { code: "J20.9", label: "acute bronchitis, unspecified" },
+  { code: "E11.9", label: "type 2 diabetes mellitus without complications" },
+  { code: "I10", label: "essential (primary) hypertension" },
+  { code: "M54.5", label: "low back pain" },
+  { code: "R07.9", label: "chest pain, unspecified" },
+  { code: "Z00.00", label: "general adult medical exam without abnormal findings" }
+]);
+var REVENUE_CODES = Object.freeze([
+  { code: "0120", label: "room & board, semi-private" },
+  { code: "0300", label: "laboratory, general" },
+  { code: "0450", label: "emergency room, general" },
+  { code: "0636", label: "drugs requiring detailed coding" }
+]);
+var INSTITUTIONAL_PROCEDURES = Object.freeze([
+  { code: "99221", label: "initial hospital care, per day" },
+  { code: "99231", label: "subsequent hospital care, per day" }
+]);
+var DENTAL_PROCEDURES = Object.freeze([
+  { code: "D2391", label: "resin-based composite, one surface, posterior" },
+  { code: "D1110", label: "prophylaxis, adult" },
+  { code: "D0120", label: "periodic oral evaluation" }
+]);
+var TOOTH_CODES = Object.freeze(["14", "3", "19", "30"]);
+var TOOTH_SURFACES = Object.freeze(["M", "O", "D", "B", "L"]);
+var SERVICE_TYPE_CODES = Object.freeze(["30", "1", "35", "88", "98"]);
+
+// src/x12/claim-837.ts
+function serviceDtp(serviceDate2) {
+  return { qualifier: "472", formatQualifier: "D8", value: serviceDate2 };
+}
+function envelopeOf(partners, timing) {
+  return {
+    senderId: partners.senderId,
+    receiverId: partners.receiverId,
+    interchangeDate: timing.interchangeDate,
+    interchangeTime: timing.interchangeTime,
+    interchangeControlNumber: timing.interchangeControlNumber,
+    groupControlNumber: timing.groupControlNumber,
+    transactionSetControlNumber: timing.transactionSetControlNumber,
+    usageIndicator: "T"
+  };
+}
+function professionalLine(rng, serviceDate2) {
+  const charge = dec2(`${String(rng.int(75, 400))}.00`);
+  const line = {
+    variant: "P",
+    procedureQualifier: "HC",
+    procedureCode: rng.pick(PROFESSIONAL_PROCEDURES).code,
+    ...rng.bool(0.4) ? { modifiers: [rng.pick(PROCEDURE_MODIFIERS)] } : {},
+    charge,
+    unitOfMeasure: "UN",
+    units: dec2("1"),
+    placeOfServiceCode: rng.pick(PLACES_OF_SERVICE),
+    diagnosisPointers: ["1"],
+    dates: [serviceDtp(serviceDate2)]
+  };
+  return { line, charge };
+}
+function institutionalLine(rng, serviceDate2) {
+  const charge = dec2(`${String(rng.int(500, 5e3))}.00`);
+  const line = {
+    variant: "I",
+    revenueCode: rng.pick(REVENUE_CODES).code,
+    procedureQualifier: "HC",
+    procedureCode: rng.pick(INSTITUTIONAL_PROCEDURES).code,
+    charge,
+    unitOfMeasure: "UN",
+    units: dec2("1"),
+    dates: [serviceDtp(serviceDate2)]
+  };
+  return { line, charge };
+}
+function dentalLine(rng, serviceDate2) {
+  const charge = dec2(`${String(rng.int(80, 900))}.00`);
+  const line = {
+    variant: "D",
+    procedureQualifier: "AD",
+    procedureCode: rng.pick(DENTAL_PROCEDURES).code,
+    charge,
+    units: dec2("1"),
+    placeOfServiceCode: "11",
+    toothInformation: [
+      { qualifier: "JP", toothCode: rng.pick(TOOTH_CODES), surfaces: [rng.pick(TOOTH_SURFACES)] }
+    ],
+    dates: [serviceDtp(serviceDate2)]
+  };
+  return { line, charge };
+}
+function claimOf(rng, variant, serviceDate2) {
+  const lineCount = rng.int(1, 2);
+  const built = Array.from({ length: lineCount }, () => {
+    if (variant === "P") return professionalLine(rng, serviceDate2);
+    if (variant === "I") return institutionalLine(rng, serviceDate2);
+    return dentalLine(rng, serviceDate2);
+  });
+  const total = built.reduce((acc, b) => acc.add(b.charge), dec2("0"));
+  const diagnosis = rng.pick(DIAGNOSES).code;
+  const secondary = rng.pick(DIAGNOSES).code;
+  return {
+    claimId: `PTACCT${rng.digits(6)}`,
+    totalCharge: total,
+    placeOfServiceCode: variant === "P" ? rng.pick(PLACES_OF_SERVICE) : "11",
+    facilityCodeQualifier: "B",
+    claimFrequencyCode: "1",
+    providerSignatureOnFile: "Y",
+    providerAcceptAssignment: "A",
+    benefitsAssignment: "Y",
+    releaseOfInformationCode: "Y",
+    diagnoses: [
+      { qualifier: "ABK", code: diagnosis },
+      { qualifier: "ABF", code: secondary }
+    ],
+    dates: [{ qualifier: "431", formatQualifier: "D8", value: serviceDate2 }],
+    serviceLines: built.map((b) => b.line)
+  };
+}
+function specOf(rng, variant) {
+  const partners = x12TradingPartners(rng);
+  const timing = x12EnvelopeTiming(rng);
+  const envelope = envelopeOf(partners, timing);
+  const org = x12Organization(rng);
+  const subscriberPerson = x12Person(rng);
+  const rendering = x12ProviderPerson(rng);
+  const payer = x12Payer(rng);
+  const claim = claimOf(rng, variant, timing.serviceDate);
+  const subscriber = {
+    info: {
+      payerResponsibilityCode: "P",
+      individualRelationshipCode: "18",
+      // self
+      groupNumber: `GRP${rng.digits(5)}`,
+      claimFilingIndicator: "MB"
+    },
+    subscriber: {
+      entityIdentifierCode: "IL",
+      entityTypeQualifier: "1",
+      name: subscriberPerson.person.family,
+      firstName: subscriberPerson.person.given,
+      idQualifier: "MI",
+      idCode: subscriberPerson.memberId,
+      address: {
+        lines: [subscriberPerson.address.street],
+        city: subscriberPerson.address.city,
+        state: subscriberPerson.address.state,
+        postalCode: subscriberPerson.address.zip
+      }
+    },
+    payer: {
+      entityIdentifierCode: "PR",
+      entityTypeQualifier: "2",
+      name: payer.name,
+      idQualifier: "PI",
+      idCode: payer.payerId
+    },
+    claims: [
+      {
+        ...claim,
+        // Rendering provider (Loop 2310B, NM1 fields round-trip) — a person with an invalid-Luhn NPI.
+        providers: [
+          {
+            entityIdentifierCode: "82",
+            entityTypeQualifier: "1",
+            name: rendering.person.family,
+            firstName: rendering.person.given,
+            idQualifier: "XX",
+            idCode: rendering.npi
+          }
+        ]
+      }
+    ]
+  };
+  const billingProvider = {
+    provider: {
+      entityIdentifierCode: "85",
+      entityTypeQualifier: "2",
+      name: org.name,
+      idQualifier: "XX",
+      idCode: org.npi,
+      address: {
+        lines: [org.address.street],
+        city: org.address.city,
+        state: org.address.state,
+        postalCode: org.address.zip
+      },
+      // Provider tax id as a never-issued (900-range) SSN at REF*SY — provably synthetic (roadmap §4.1).
+      references: [{ qualifier: "SY", value: org.taxIdSsn }]
+    },
+    subscribers: [subscriber]
+  };
+  return {
+    envelope,
+    submitter: {
+      entityIdentifierCode: "41",
+      entityTypeQualifier: "2",
+      name: org.name,
+      idQualifier: "46",
+      idCode: envelope.senderId
+    },
+    receiver: {
+      entityIdentifierCode: "40",
+      entityTypeQualifier: "2",
+      name: payer.name,
+      idQualifier: "46",
+      idCode: envelope.receiverId
+    },
+    billingProviders: [billingProvider]
+  };
+}
+function generate837(variant, options) {
+  const rng = createRng(options.seed);
+  const spec = specOf(rng, variant);
+  if (variant === "P") return x12.build837P(spec);
+  if (variant === "I") return x12.build837I(spec);
+  return x12.build837D(spec);
+}
+function generate837P(options) {
+  return generate837("P", options);
+}
+function generate837I(options) {
+  return generate837("I", options);
+}
+function generate837D(options) {
+  return generate837("D", options);
+}
+function generate835(options) {
+  const rng = createRng(options.seed);
+  const partners = x12TradingPartners(rng);
+  const timing = x12EnvelopeTiming(rng);
+  const patient = x12Person(rng);
+  const org = x12Organization(rng);
+  const payer = x12Payer(rng);
+  const chargeN = rng.int(200, 2e3);
+  const patientRespN = rng.int(10, Math.min(chargeN - 1, 150));
+  const paymentN = chargeN - patientRespN;
+  const casReason = rng.pick(["1", "2", "3"]);
+  const line = {
+    productServiceIdQualifier: "HC",
+    productServiceId: rng.pick(PROFESSIONAL_PROCEDURES).code,
+    ...rng.bool(0.4) ? { modifiers: [rng.pick(PROCEDURE_MODIFIERS)] } : {},
+    chargeAmount: dec2(money(chargeN)),
+    paymentAmount: dec2(money(paymentN)),
+    serviceDateStart: timing.serviceDate,
+    serviceDateEnd: timing.serviceDate,
+    adjustments: [{ groupCode: "PR", reasonCode: casReason, amount: dec2(money(patientRespN)) }],
+    amounts: [{ qualifier: "B6", amount: dec2(money(paymentN)) }]
+  };
+  const claim = {
+    patientControlNumber: `PTACCT${rng.digits(6)}`,
+    claimStatusCode: "1",
+    // processed as primary
+    totalChargeAmount: dec2(money(chargeN)),
+    totalPaymentAmount: dec2(money(paymentN)),
+    patientResponsibilityAmount: dec2(money(patientRespN)),
+    claimFilingIndicatorCode: "MB",
+    payerClaimControlNumber: `ICN${rng.digits(9)}`,
+    facilityTypeCode: "11",
+    claimFrequencyCode: "1",
+    patient: {
+      entityIdentifierCode: "QC",
+      lastName: patient.person.family,
+      firstName: patient.person.given,
+      idQualifier: "MI",
+      idCode: patient.memberId
+    },
+    serviceProvider: {
+      entityIdentifierCode: "82",
+      name: org.name,
+      idQualifier: "XX",
+      idCode: org.npi
+    },
+    servicePeriodStart: timing.serviceDate,
+    servicePeriodEnd: timing.serviceDate,
+    serviceLines: [line]
+  };
+  const spec = {
+    envelope: {
+      senderId: partners.senderId,
+      receiverId: partners.receiverId,
+      interchangeDate: timing.interchangeDate,
+      interchangeTime: timing.interchangeTime,
+      interchangeControlNumber: timing.interchangeControlNumber,
+      groupControlNumber: timing.groupControlNumber,
+      transactionSetControlNumber: timing.transactionSetControlNumber,
+      usageIndicator: "T"
+    },
+    payment: {
+      transactionHandlingCode: "I",
+      totalActualPayment: dec2(money(paymentN)),
+      creditDebitFlag: "C",
+      method: "ACH",
+      paymentDate: timing.serviceDate
+    },
+    traces: [
+      {
+        traceTypeCode: "1",
+        referenceId: rng.digits(7),
+        originatingCompanyId: `1${rng.digits(9)}`
+      }
+    ],
+    payer: {
+      entityIdentifierCode: "PR",
+      name: payer.name,
+      address: {
+        lines: [org.address.street],
+        city: org.address.city,
+        state: org.address.state,
+        postalCode: org.address.zip
+      },
+      additionalIdentifiers: [{ qualifier: "2U", value: payer.payerId }]
+    },
+    payee: {
+      entityIdentifierCode: "PE",
+      name: org.name,
+      idQualifier: "XX",
+      idCode: org.npi,
+      address: {
+        lines: [org.address.street],
+        city: org.address.city,
+        state: org.address.state,
+        postalCode: org.address.zip
+      }
+    },
+    claims: [claim]
+  };
+  return x12.build835(spec);
+}
+function generate271(options) {
+  const rng = createRng(options.seed);
+  const partners = x12TradingPartners(rng);
+  const timing = x12EnvelopeTiming(rng);
+  const subscriber = x12Person(rng);
+  const providerOrg = x12Organization(rng);
+  const payer = x12Payer(rng);
+  const serviceTypes = [
+    { code: rng.pick(SERVICE_TYPE_CODES) },
+    { code: rng.pick(SERVICE_TYPE_CODES) }
+  ];
+  const spec = {
+    envelope: {
+      senderId: partners.senderId,
+      receiverId: partners.receiverId,
+      interchangeDate: timing.interchangeDate,
+      interchangeTime: timing.interchangeTime,
+      interchangeControlNumber: timing.interchangeControlNumber,
+      groupControlNumber: timing.groupControlNumber,
+      transactionSetControlNumber: timing.transactionSetControlNumber,
+      usageIndicator: "T"
+    },
+    informationSources: [
+      {
+        entity: {
+          entityIdentifierCode: "PR",
+          entityTypeQualifier: "2",
+          name: payer.name,
+          idQualifier: "PI",
+          idCode: payer.payerId
+        },
+        receivers: [
+          {
+            entity: {
+              entityIdentifierCode: "1P",
+              entityTypeQualifier: "2",
+              name: providerOrg.name,
+              idQualifier: "XX",
+              idCode: providerOrg.npi
+            },
+            subscribers: [
+              {
+                traces: [{ traceTypeCode: "2", referenceId: `ELIG${rng.digits(10)}` }],
+                name: {
+                  entityIdentifierCode: "IL",
+                  entityTypeQualifier: "1",
+                  lastName: subscriber.person.family,
+                  firstName: subscriber.person.given,
+                  idQualifier: "MI",
+                  idCode: subscriber.memberId,
+                  address: {
+                    lines: [subscriber.address.street],
+                    city: subscriber.address.city,
+                    state: subscriber.address.state,
+                    postalCode: subscriber.address.zip
+                  },
+                  dateOfBirth: subscriber.dob,
+                  genderCode: subscriber.sex
+                },
+                references: [{ qualifier: "6P", value: `GRP${rng.digits(5)}` }],
+                dates: [{ qualifier: "307", formatQualifier: "D8", value: timing.serviceDate }],
+                benefits: [
+                  {
+                    eligibilityCode: "1",
+                    // active coverage
+                    coverageLevelCode: "IND",
+                    serviceTypeCodes: serviceTypes,
+                    inPlanNetwork: "Y",
+                    monetaryAmount: dec2(money(rng.int(500, 5e3))),
+                    percent: dec2(String(rng.pick([80, 90, 100])))
+                  }
+                ]
+              }
+            ]
+          }
+        ]
+      }
+    ]
+  };
+  return x12.build271(spec);
+}
+
+// src/ncpdp/identity.ts
+var SYNTHETIC_PHARMACY_NAMES = Object.freeze([
+  "SYNTH COMMUNITY PHARMACY",
+  "FIXTURE DRUG MART",
+  "PLACEHOLDER RX SERVICES",
+  "SAMPLE APOTHECARY LLC",
+  "MOCK PHARMACY GROUP"
+]);
+function ncpdpPatient(rng) {
+  const person = safe.name(rng);
+  const dob = safe.dateYmd(rng, 1935, 2010);
+  const gender = rng.pick(["1", "2"]);
+  const patientId = `MBR${safe.identifier(rng, "MR").value}`;
+  const phone2 = safe.phone(rng);
+  const address2 = safe.address(rng);
+  return { person, dob, gender, patientId, phone: phone2, address: address2 };
+}
+function ncpdpPrescriber(rng) {
+  const person = safe.name(rng);
+  const npi2 = safe.npi(rng);
+  const dea2 = safe.dea(rng, person);
+  return { person, npi: npi2, dea: dea2 };
+}
+function ncpdpPharmacy(rng) {
+  const businessName = rng.pick(SYNTHETIC_PHARMACY_NAMES);
+  const npi2 = safe.npi(rng);
+  const ncpdpId = rng.digits(7);
+  return { businessName, npi: npi2, ncpdpId };
+}
+function ncpdpCardholder(rng) {
+  const person = safe.name(rng);
+  const cardholderId = `MBR${safe.identifier(rng, "MB").value}`;
+  const groupId = `GRP${rng.digits(5)}`;
+  const personCode = rng.pick(["01", "02", "03"]);
+  return { person, cardholderId, groupId, personCode };
+}
+
+// src/ncpdp/example-codes.ts
+var EXAMPLE_DRUGS = Object.freeze([
+  { description: "Amoxicillin 500 MG Oral Capsule", ndc: "00000010101", form: "EA" },
+  { description: "Lisinopril 10 MG Oral Tablet", ndc: "00000020202", form: "EA" },
+  { description: "Atorvastatin 20 MG Oral Tablet", ndc: "00000030303", form: "EA" },
+  { description: "Metformin 500 MG Oral Tablet", ndc: "00000040404", form: "EA" },
+  { description: "Amlodipine 5 MG Oral Tablet", ndc: "00000050505", form: "EA" },
+  { description: "Omeprazole 20 MG Delayed Release Capsule", ndc: "00000060606", form: "EA" },
+  { description: "Levothyroxine 50 MCG Oral Tablet", ndc: "00000070707", form: "EA" },
+  { description: "Azithromycin 250 MG Oral Tablet", ndc: "00000080808", form: "EA" },
+  { description: "Sertraline 50 MG Oral Tablet", ndc: "00000090909", form: "EA" },
+  { description: "Albuterol 90 MCG Metered Dose Inhaler", ndc: "00000101010", form: "EA" }
+]);
+var DAW_CODES = Object.freeze(["0", "1", "2"]);
+var SYNTHETIC_BIN = "999999";
+function digitsOnly(value) {
+  return value.replace(/\D/g, "");
+}
+function header(rng, transactionCode, pharmacyNpi) {
+  const date = serviceDate(rng);
+  return {
+    binNumber: SYNTHETIC_BIN,
+    versionRelease: "D0",
+    transactionCode,
+    processorControlNumber: `SYN${rng.digits(4)}`,
+    transactionCount: "1",
+    serviceProviderIdQualifier: "01",
+    // 01 = NPI
+    serviceProviderId: pharmacyNpi,
+    dateOfService: date,
+    softwareCertificationId: `SW${rng.digits(6)}`
+  };
+}
+function serviceDate(rng) {
+  const year = rng.int(2024, 2026);
+  const month = rng.int(1, 12);
+  const day = rng.int(1, 28);
+  return `${String(year)}${String(month).padStart(2, "0")}${String(day).padStart(2, "0")}`;
+}
+function field(id, value) {
+  return { id, value };
+}
+function patientSegment(rng) {
+  const p = ncpdpPatient(rng);
+  return {
+    segmentId: "01",
+    fields: [
+      field("C4", p.dob),
+      field("C5", p.gender),
+      field("CA", p.person.given),
+      field("CB", p.person.family),
+      field("CM", p.address.street),
+      field("CQ", digitsOnly(p.phone)),
+      field("CY", p.patientId)
+    ]
+  };
+}
+function insuranceSegment(rng) {
+  const c = ncpdpCardholder(rng);
+  return {
+    segmentId: "04",
+    fields: [
+      field("C2", c.cardholderId),
+      field("C1", c.groupId),
+      field("C3", c.personCode),
+      field("CC", c.person.given),
+      field("CD", c.person.family)
+    ]
+  };
+}
+function prescriberSegment(rng) {
+  const dr = ncpdpPrescriber(rng);
+  return {
+    segmentId: "03",
+    fields: [field("EZ", "01"), field("DB", dr.npi)]
+  };
+}
+function claimSegment(rng, minimal) {
+  const drug = rng.pick(EXAMPLE_DRUGS);
+  const rxRef = `RX${rng.digits(7)}`;
+  const fill = String(rng.int(0, 5));
+  if (minimal) {
+    return {
+      segmentId: "07",
+      fields: [field("EM", "1"), field("D2", rxRef), field("D3", fill)]
+    };
+  }
+  return {
+    segmentId: "07",
+    fields: [
+      field("EM", "1"),
+      // 1 = Rx Billing
+      field("D2", rxRef),
+      field("D3", fill),
+      field("E1", "03"),
+      // 03 = NDC
+      field("D7", drug.ndc),
+      field("E7", String(rng.int(30, 90))),
+      field("D5", String(rng.pick([30, 60, 90]))),
+      field("D8", rng.pick(DAW_CODES))
+    ]
+  };
+}
+function generateTelecom(code, options) {
+  const rng = createRng(options.seed);
+  const pharmacy = ncpdpPharmacy(rng);
+  const head = header(rng, code, pharmacy.npi);
+  const segments = code === "B2" ? [insuranceSegment(rng), claimSegment(rng, true)] : [
+    patientSegment(rng),
+    insuranceSegment(rng),
+    prescriberSegment(rng),
+    claimSegment(rng, false)
+  ];
+  return telecom.serializeTelecom(telecom.buildTelecomRequest({ header: head, segments }));
+}
+function generateB1(options) {
+  return generateTelecom("B1", options);
+}
+function generateB2(options) {
+  return generateTelecom("B2", options);
+}
+function generateB3(options) {
+  return generateTelecom("B3", options);
+}
+var URI_TO_OID = Object.freeze({
+  "http://loinc.org": ccda.LOINC,
+  "http://snomed.info/sct": ccda.SNOMED_CT,
+  "http://www.nlm.nih.gov/research/umls/rxnorm": ccda.RXNORM,
+  "http://hl7.org/fhir/sid/cvx": ccda.CVX
+});
+function toBuildCode(concept) {
+  const codeSystem = URI_TO_OID[concept.system];
+  if (codeSystem === void 0) {
+    throw new Error(`ccda example-codes: no OID mapping for code system "${concept.system}"`);
+  }
+  return { code: concept.code, codeSystem, displayName: concept.display };
+}
+function quantityFor(rng, concept) {
+  const scale = 10 ** concept.decimals;
+  const value = rng.int(concept.low * scale, concept.high * scale) / scale;
+  return { value, unit: concept.unit };
+}
+var PROBLEMS = EXAMPLE_CONDITIONS;
+var ALLERGENS = EXAMPLE_ALLERGENS;
+var ALLERGY_REACTIONS = EXAMPLE_ALLERGY_MANIFESTATIONS;
+var MEDICATIONS = EXAMPLE_MEDICATIONS;
+var LAB_RESULTS = EXAMPLE_LAB_OBSERVATIONS2;
+var RESULT_PANELS = EXAMPLE_DIAGNOSTIC_REPORTS;
+var VITAL_SIGNS = EXAMPLE_VITAL_SIGNS;
+var VACCINES = EXAMPLE_VACCINES2;
+var PROCEDURES = EXAMPLE_PROCEDURES;
+var SMOKING_STATUSES = Object.freeze([
+  Object.freeze({ code: "266919005", codeSystem: ccda.SNOMED_CT, displayName: "Never smoker" }),
+  Object.freeze({ code: "8517006", codeSystem: ccda.SNOMED_CT, displayName: "Former smoker" }),
+  Object.freeze({
+    code: "449868002",
+    codeSystem: ccda.SNOMED_CT,
+    displayName: "Current every day smoker"
+  }),
+  Object.freeze({
+    code: "428041000124106",
+    codeSystem: ccda.SNOMED_CT,
+    displayName: "Current some day smoker"
+  })
+]);
+var ROUTES = Object.freeze([
+  Object.freeze({ code: "C38288", codeSystem: ccda.NCI_ROUTE, displayName: "Oral" }),
+  Object.freeze({ code: "C28161", codeSystem: ccda.NCI_ROUTE, displayName: "Intramuscular" }),
+  Object.freeze({ code: "C38276", codeSystem: ccda.NCI_ROUTE, displayName: "Intravenous" }),
+  Object.freeze({ code: "C38299", codeSystem: ccda.NCI_ROUTE, displayName: "Subcutaneous" })
+]);
+
+// src/ccda/identity.ts
+function ccdaPatientIdentity(rng) {
+  const person = safe.name(rng);
+  const mrn = safe.identifier(rng, "MR");
+  const birthTime = safe.dateYmd(rng, 1930, 2010);
+  const gender = rng.pick(["M", "F"]);
+  const patient = {
+    mrn: mrn.value,
+    mrnRoot: mrn.assigningAuthorityOid,
+    mrnAssigningAuthority: mrn.assigningAuthority,
+    given: [person.given],
+    family: person.family,
+    gender,
+    birthTime
+  };
+  return { patient, person, mrn };
+}
+
+// src/ccda/ccd.ts
+function pickN(rng, pool, n) {
+  const take = Math.min(n, pool.length);
+  const indices = pool.map((_v, i) => i);
+  const out = [];
+  for (let i = 0; i < take; i += 1) {
+    const j = rng.int(0, indices.length - 1);
+    const idx = indices[j];
+    indices.splice(j, 1);
+    out.push(pool[idx]);
+  }
+  return out;
+}
+function buildInit(rng, documentType) {
+  const effectiveTime = safe.dateYmd(rng, 2020, 2025);
+  const { patient, person } = ccdaPatientIdentity(rng);
+  const problems = pickN(rng, PROBLEMS, rng.int(1, 3)).map((c) => ({
+    problem: toBuildCode(c),
+    status: "active",
+    onset: safe.dateYmd(rng, 2010, 2019)
+  }));
+  const allergen = rng.pick(ALLERGENS);
+  const reaction = rng.pick(ALLERGY_REACTIONS);
+  const allergies = [{ allergen: toBuildCode(allergen), reaction: toBuildCode(reaction) }];
+  const medications = pickN(rng, MEDICATIONS, rng.int(1, 2)).map((c) => ({
+    drug: toBuildCode(c),
+    dose: { value: 1, unit: "{tablet}" },
+    route: rng.pick(ROUTES),
+    frequency: { value: rng.pick([8, 12, 24]), unit: "h" }
+  }));
+  const panel = rng.pick(RESULT_PANELS);
+  const resultMembers = pickN(rng, LAB_RESULTS, 2).map((q) => ({
+    test: toBuildCode(q),
+    quantity: quantityFor(rng, q),
+    effectiveTime
+  }));
+  const results = [{ code: toBuildCode(panel), effectiveTime, results: resultMembers }];
+  const vitalMembers = pickN(rng, VITAL_SIGNS, 2).map((q) => ({
+    code: toBuildCode(q),
+    quantity: quantityFor(rng, q)
+  }));
+  const vitalSigns = [{ effectiveTime, vitals: vitalMembers }];
+  const vaccine = rng.pick(VACCINES);
+  const immunizations = [
+    {
+      vaccine: toBuildCode(vaccine),
+      dose: { value: 0.5, unit: "mL" },
+      route: rng.pick(ROUTES),
+      effectiveTime: safe.dateYmd(rng, 2018, 2024)
+    }
+  ];
+  const procedure = rng.pick(PROCEDURES);
+  const procedures = [
+    {
+      code: toBuildCode(procedure),
+      disposition: "performed",
+      effectiveTime: safe.dateYmd(rng, 2015, 2023)
+    }
+  ];
+  const smokingStatus = [{ value: rng.pick(SMOKING_STATUSES), effectiveTime }];
+  const base = {
+    documentType,
+    effectiveTime,
+    patient,
+    problems,
+    allergies,
+    medications,
+    results,
+    vitalSigns,
+    immunizations,
+    procedures,
+    smokingStatus
+  };
+  if (documentType === "referralNote") {
+    return {
+      ...base,
+      reasonForReferral: `Synthetic referral for evaluation of ${person.given} ${person.family}.`,
+      assessment: "Synthetic assessment narrative. Not a real clinical assessment."
+    };
+  }
+  return base;
+}
+function generateCcda(options = {}) {
+  const { seed = 0, documentType = "ccd" } = options;
+  const rng = createRng(seed);
+  return ccda.buildCcda(buildInit(rng, documentType));
+}
+var DEID_LOOP_POLICY_NAME = "synth-deid-loop-removal";
+function deidLoopPolicy() {
+  return deid.defineDeidPolicy({
+    name: DEID_LOOP_POLICY_NAME,
+    transforms: {
+      [deid.SAFE_HARBOR_CATEGORIES.MRN]: "redact",
+      [deid.SAFE_HARBOR_CATEGORIES.HEALTH_PLAN_BENEFICIARY]: "redact",
+      [deid.SAFE_HARBOR_CATEGORIES.ACCOUNT]: "redact"
+    }
+  });
+}
+var STOPWORDS = /* @__PURE__ */ new Set([
+  "official",
+  "usual",
+  "temp",
+  "old",
+  "anonymous",
+  "maiden",
+  "nickname",
+  "home",
+  "work",
+  "mobile",
+  "phone",
+  "email",
+  "fax",
+  "sms",
+  "pager",
+  "other",
+  "use",
+  "street",
+  "road",
+  "avenue",
+  "court",
+  "lane",
+  "drive",
+  "boulevard",
+  "place",
+  "way",
+  "suite",
+  "apt",
+  "unit",
+  "null",
+  "undefined"
+]);
+function tokenize(value) {
+  return value.split(/[\s^~&|,()/\\]+/).map((t) => t.trim()).filter((t) => t.length > 0);
+}
+function isDistinctive(token) {
+  if (token.length < 4) return false;
+  if (STOPWORDS.has(token.toLowerCase())) return false;
+  if (/^\d+$/.test(token) && token.length < 5) return false;
+  return true;
+}
+function identifierSentinels(loci, original) {
+  const out = [];
+  const seen = /* @__PURE__ */ new Set();
+  for (const locus of loci) {
+    if (locus.kind !== "identifier" || locus.value.length === 0) continue;
+    for (const token of tokenize(locus.value)) {
+      if (!isDistinctive(token)) continue;
+      if (!original.includes(token)) continue;
+      if (seen.has(token)) continue;
+      seen.add(token);
+      out.push({
+        token,
+        locus: locus.path,
+        ...locus.category !== void 0 ? { category: locus.category } : {}
+      });
+    }
+  }
+  return out;
+}
+function recordTargetSentinels(xml) {
+  const block = /<recordTarget[\s\S]*?<\/recordTarget>/i.exec(xml);
+  if (block === null) return [];
+  const scope = block[0];
+  const out = [];
+  const seen = /* @__PURE__ */ new Set();
+  const add = (token, locus) => {
+    const trimmed = token.trim();
+    if (!isDistinctive(trimmed) || seen.has(trimmed)) return;
+    seen.add(trimmed);
+    out.push({ token: trimmed, locus, category: "names" });
+  };
+  for (const m of scope.matchAll(/<given>([^<]+)<\/given>/g)) add(m[1] ?? "", "recordTarget/given");
+  for (const m of scope.matchAll(/<family>([^<]+)<\/family>/g))
+    add(m[1] ?? "", "recordTarget/family");
+  for (const m of scope.matchAll(/<id\b[^>]*\bextension="([^"]+)"/g))
+    add(m[1] ?? "", "recordTarget/id");
+  return out;
+}
+function sweepSurvivors(phiResidue, sentinels) {
+  return sentinels.filter((s) => phiResidue.includes(s.token));
+}
+function clinicalRetention(original, deidentified, clinicalCodes) {
+  const probed = [...new Set(clinicalCodes.filter((c) => c.length >= 4 && original.includes(c)))];
+  const scrubbed = probed.filter((c) => !deidentified.includes(c));
+  return { probed, scrubbed };
+}
+function assembleVerdict(parts) {
+  const survivors = sweepSurvivors(parts.phiResidue ?? parts.deidentified, parts.planted);
+  const { probed, scrubbed } = clinicalRetention(
+    parts.original,
+    parts.deidentified,
+    parts.clinicalCodes
+  );
+  const pass = parts.planted.length > 0 && survivors.length === 0 && scrubbed.length === 0;
+  return Object.freeze({
+    format: parts.format,
+    artifact: parts.artifact,
+    seed: parts.seed,
+    planted: Object.freeze([...parts.planted]),
+    survivors: Object.freeze(survivors),
+    clinicalProbed: Object.freeze(probed),
+    clinicalScrubbed: Object.freeze(scrubbed),
+    original: parts.original,
+    deidentified: parts.deidentified,
+    pass
+  });
+}
+
+// src/deid/index.ts
+var DEID_LOOP_COVERED_FORMATS = Object.freeze([
+  "hl7",
+  "fhir",
+  "ccda",
+  "x12",
+  "ncpdp-telecom"
+]);
+var DEID_LOOP_SKIPPED = Object.freeze([
+  Object.freeze({
+    format: "ncpdp-script",
+    reason: "@cosyte/deid ships no NCPDP SCRIPT locus map; synth generates SCRIPT but the loop cannot pair it."
+  }),
+  Object.freeze({
+    format: "astm",
+    reason: "@cosyte/deid ships no ASTM adapter; synth generates ASTM but the loop cannot pair it."
+  }),
+  Object.freeze({
+    format: "dicom",
+    reason: "@cosyte/synth does not generate DICOM, so there is nothing to pair."
+  })
+]);
+var POLICY = deidLoopPolicy();
+function residue(loci) {
+  return loci.map((l) => l.value).join("\n");
+}
+function recordTargetResidue(xml) {
+  return /<recordTarget[\s\S]*?<\/recordTarget>/i.exec(xml)?.[0] ?? "";
+}
+var HL7_CLINICAL = [...EXAMPLE_LAB_OBSERVATIONS, ...EXAMPLE_ORDER_SERVICES, ...EXAMPLE_VACCINES].map(
+  (c) => c.code
+);
+var FHIR_CLINICAL = [
+  ...EXAMPLE_LAB_OBSERVATIONS2,
+  ...EXAMPLE_VITAL_SIGNS,
+  ...EXAMPLE_CONDITIONS,
+  ...EXAMPLE_MEDICATIONS
+].map((c) => c.code);
+var X12_CLINICAL = [...PROFESSIONAL_PROCEDURES, ...INSTITUTIONAL_PROCEDURES, ...DIAGNOSES].map(
+  (c) => c.code
+);
+var NCPDP_CLINICAL = EXAMPLE_DRUGS.map((d) => d.ndc);
+function hl7DeidLoop(options = {}) {
+  const seed = options.seed ?? 0;
+  const kind = options.kind ?? "ORU^R01";
+  const message = generateHl7(kind, seed);
+  const original = message.toString();
+  const planted = identifierSentinels(hl7.extractHl7Loci(message).loci, original);
+  const deidDoc = hl7.deidentifyHl7(message, { policy: POLICY }).document;
+  const deidentified = deidDoc.toString();
+  return assembleVerdict({
+    format: "hl7",
+    artifact: kind,
+    seed,
+    planted,
+    original,
+    deidentified,
+    phiResidue: residue(hl7.extractHl7Loci(deidDoc).loci),
+    clinicalCodes: HL7_CLINICAL
+  });
+}
+function fhirDeidLoop(options = {}) {
+  const seed = options.seed ?? 0;
+  const bundle = generateBundle({ seed });
+  const original = fhir.serializeResource(bundle);
+  const planted = identifierSentinels(fhir$1.extractFhirLoci(bundle).loci, original);
+  const deidDoc = fhir$1.deidentifyFhir(bundle, { policy: POLICY }).document;
+  const deidentified = fhir.serializeResource(deidDoc);
+  return assembleVerdict({
+    format: "fhir",
+    artifact: "Bundle",
+    seed,
+    planted,
+    original,
+    deidentified,
+    phiResidue: residue(fhir$1.extractFhirLoci(deidDoc).loci),
+    clinicalCodes: FHIR_CLINICAL
+  });
+}
+function generateX12(variant, seed) {
+  switch (variant) {
+    case "837P":
+      return generate837P({ seed });
+    case "837I":
+      return generate837I({ seed });
+    case "837D":
+      return generate837D({ seed });
+    case "271":
+      return generate271({ seed });
+    case "835":
+      return generate835({ seed });
+  }
+}
+function x12DeidLoop(options = {}) {
+  const seed = options.seed ?? 0;
+  const variant = options.variant ?? "837P";
+  const interchange = generateX12(variant, seed);
+  const original = x12.serializeX12(interchange);
+  const planted = identifierSentinels(x12$1.extractX12Loci(interchange).loci, original);
+  const deidentified = x12$1.deidentifyX12(interchange, { policy: POLICY }).x12;
+  return assembleVerdict({
+    format: "x12",
+    artifact: variant,
+    seed,
+    planted,
+    original,
+    deidentified,
+    phiResidue: residue(x12$1.extractX12Loci(x12.parseX12(deidentified)).loci),
+    clinicalCodes: X12_CLINICAL
+  });
+}
+function generateTelecomWire(transaction, seed) {
+  switch (transaction) {
+    case "B1":
+      return generateB1({ seed });
+    case "B2":
+      return generateB2({ seed });
+    case "B3":
+      return generateB3({ seed });
+  }
+}
+function ncpdpTelecomDeidLoop(options = {}) {
+  const seed = options.seed ?? 0;
+  const transaction = options.transaction ?? "B1";
+  const original = generateTelecomWire(transaction, seed);
+  const tx = telecom.parseTelecom(original);
+  const planted = identifierSentinels(ncpdp.extractTelecomLoci(tx).loci, original);
+  const deidentified = ncpdp.deidentifyTelecom(tx, { policy: POLICY }).telecom;
+  return assembleVerdict({
+    format: "ncpdp-telecom",
+    artifact: transaction,
+    seed,
+    planted,
+    original,
+    deidentified,
+    phiResidue: residue(ncpdp.extractTelecomLoci(telecom.parseTelecom(deidentified)).loci),
+    clinicalCodes: NCPDP_CLINICAL
+  });
+}
+function ccdaDeidLoop(options = {}) {
+  const seed = options.seed ?? 0;
+  const documentType = options.documentType ?? "ccd";
+  const doc = generateCcda({ seed, documentType: documentType === "ccd" ? "ccd" : "referralNote" });
+  const original = ccda.serializeCcda(doc);
+  const planted = recordTargetSentinels(original);
+  const deidentified = ccda$1.deidentifyCcda(doc, { policy: POLICY }).document.toString();
+  return assembleVerdict({
+    format: "ccda",
+    artifact: documentType === "ccd" ? "CCD" : "ReferralNote",
+    seed,
+    planted,
+    original,
+    deidentified,
+    phiResidue: recordTargetResidue(deidentified),
+    clinicalCodes: [...EXAMPLE_CONDITIONS, ...EXAMPLE_MEDICATIONS].map((c) => c.code)
+  });
+}
+function summarizeDeidCoverage(results) {
+  const byFormatMap = /* @__PURE__ */ new Map();
+  for (const r of results) {
+    const list10 = byFormatMap.get(r.format) ?? [];
+    list10.push(r);
+    byFormatMap.set(r.format, list10);
+  }
+  const byFormat = [];
+  for (const [format, runs] of byFormatMap) {
+    byFormat.push({
+      format,
+      artifacts: runs.map((r) => r.artifact),
+      planted: runs.reduce((n, r) => n + r.planted.length, 0),
+      survivors: runs.reduce((n, r) => n + r.survivors.length, 0),
+      clinicalProbed: runs.reduce((n, r) => n + r.clinicalProbed.length, 0),
+      clinicalScrubbed: runs.reduce((n, r) => n + r.clinicalScrubbed.length, 0),
+      pass: runs.every((r) => r.pass)
+    });
+  }
+  return {
+    byFormat,
+    totalPlanted: results.reduce((n, r) => n + r.planted.length, 0),
+    totalSurvivors: results.reduce((n, r) => n + r.survivors.length, 0),
+    totalClinicalScrubbed: results.reduce((n, r) => n + r.clinicalScrubbed.length, 0),
+    allPass: results.every((r) => r.pass),
+    skipped: DEID_LOOP_SKIPPED
+  };
+}
+
+exports.DEID_LOOP_COVERED_FORMATS = DEID_LOOP_COVERED_FORMATS;
+exports.DEID_LOOP_POLICY_NAME = DEID_LOOP_POLICY_NAME;
+exports.DEID_LOOP_SKIPPED = DEID_LOOP_SKIPPED;
+exports.assembleVerdict = assembleVerdict;
+exports.ccdaDeidLoop = ccdaDeidLoop;
+exports.clinicalRetention = clinicalRetention;
+exports.deidLoopPolicy = deidLoopPolicy;
+exports.fhirDeidLoop = fhirDeidLoop;
+exports.hl7DeidLoop = hl7DeidLoop;
+exports.identifierSentinels = identifierSentinels;
+exports.ncpdpTelecomDeidLoop = ncpdpTelecomDeidLoop;
+exports.recordTargetSentinels = recordTargetSentinels;
+exports.summarizeDeidCoverage = summarizeDeidCoverage;
+exports.sweepSurvivors = sweepSurvivors;
+exports.x12DeidLoop = x12DeidLoop;
+//# sourceMappingURL=index.cjs.map
+//# sourceMappingURL=index.cjs.map