@cosyte/synth 0.1.5 → 0.1.7

package/dist/deid/index.cjs

@@ -1,18 +1,15 @@
 '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');
+var module$1 = require('module');
+var url = require('url');
 
-// src/deid/index.ts
+var _documentCurrentScript = typeof document !== 'undefined' ? document.currentScript : null;
+var __require = /* @__PURE__ */ ((x) => typeof require !== "undefined" ? require : typeof Proxy !== "undefined" ? new Proxy(x, {
+  get: (a, b) => (typeof require !== "undefined" ? require : a)[b]
+}) : x)(function(x) {
+  if (typeof require !== "undefined") return require.apply(this, arguments);
+  throw Error('Dynamic require of "' + x + '" is not supported');
+});
 
 // src/rng/splitmix32.ts
 function splitmix32(seed) {
@@ -452,6 +449,40 @@ var safe = Object.freeze({
   npi,
   dea
 });
+function defaultHost() {
+  if (typeof undefined !== "function") return { require: __require, resolve: void 0 };
+  return { require: module$1.createRequire((typeof document === 'undefined' ? require('u' + 'rl').pathToFileURL(__filename).href : (_documentCurrentScript && _documentCurrentScript.tagName.toUpperCase() === 'SCRIPT' && _documentCurrentScript.src || new URL('index.cjs', document.baseURI).href))), resolve: (s) => undefined(s) };
+}
+function isRequireEsmRefusal(error) {
+  return error?.code === "ERR_REQUIRE_ESM";
+}
+function loadPeer(specifier, host) {
+  if (host.resolve === void 0) return host.require(specifier);
+  const entry = url.fileURLToPath(host.resolve(specifier));
+  try {
+    return host.require(entry);
+  } catch (error) {
+    if (!isRequireEsmRefusal(error)) throw error;
+    return host.require(specifier);
+  }
+}
+function lazyPeer(specifier, host) {
+  let loaded;
+  return () => loaded ??= loadPeer(specifier, defaultHost());
+}
+
+// src/peers.ts
+var hl7Peer = lazyPeer("@cosyte/hl7");
+var fhirPeer = lazyPeer("@cosyte/fhir");
+var ccdaPeer = lazyPeer("@cosyte/ccda");
+var x12Peer = lazyPeer("@cosyte/x12");
+var ncpdpTelecomPeer = lazyPeer("@cosyte/ncpdp/telecom");
+var deidPeer = lazyPeer("@cosyte/deid");
+var deidHl7Peer = lazyPeer("@cosyte/deid/hl7");
+var deidFhirPeer = lazyPeer("@cosyte/deid/fhir");
+var deidX12Peer = lazyPeer("@cosyte/deid/x12");
+var deidNcpdpPeer = lazyPeer("@cosyte/deid/ncpdp");
+var deidCcdaPeer = lazyPeer("@cosyte/deid/ccda");
 
 // src/hl7/common.ts
 function seededTimestamp(rng) {
@@ -464,7 +495,7 @@ function seededTimestamp(rng) {
 function mshScaffold(rng, type) {
   const timestamp = seededTimestamp(rng);
   const controlId = `SYNTH${rng.digits(10)}`;
-  const message = hl7$1.buildMessage({
+  const message = hl7Peer().buildMessage({
     type,
     sendingApp: "COSYTE-SYNTH",
     sendingFacility: "SYNTH-FAC",
@@ -915,36 +946,36 @@ function prop(name2, value) {
   return { name: name2, value };
 }
 function str(value) {
-  return fhir.primitive(value);
+  return fhirPeer().primitive(value);
 }
 function dec(raw) {
-  return fhir.primitive(fhir.decimal(raw));
+  return fhirPeer().primitive(fhirPeer().decimal(raw));
 }
 function bool(value) {
-  return fhir.primitive(value);
+  return fhirPeer().primitive(value);
 }
 function coding(concept) {
-  return fhir.complex([
+  return fhirPeer().complex([
     prop("system", str(concept.system)),
     prop("code", str(concept.code)),
     prop("display", str(concept.display))
   ]);
 }
 function codeableConcept(concept) {
-  return fhir.complex([prop("coding", fhir.list([coding(concept)]))]);
+  return fhirPeer().complex([prop("coding", fhirPeer().list([coding(concept)]))]);
 }
 function reference(ref) {
-  return fhir.complex([prop("reference", str(ref))]);
+  return fhirPeer().complex([prop("reference", str(ref))]);
 }
 function narrative(text) {
   const escaped = text.replace(/&/g, "&amp;").replace(/</g, "&lt;").replace(/>/g, "&gt;");
-  return fhir.complex([
+  return fhirPeer().complex([
     prop("status", str("generated")),
     prop("div", str(`<div xmlns="http://www.w3.org/1999/xhtml"><p>${escaped}</p></div>`))
   ]);
 }
 function meta(profiles) {
-  return fhir.complex([prop("profile", fhir.list(profiles.map((p) => str(p))))]);
+  return fhirPeer().complex([prop("profile", fhirPeer().list(profiles.map((p) => str(p))))]);
 }
 function toFhirDate(ymd) {
   return `${ymd.slice(0, 4)}-${ymd.slice(4, 6)}-${ymd.slice(6, 8)}`;
@@ -961,13 +992,13 @@ function fhirPatientIdentity(rng) {
   return { id, person, mrn, birthDate, gender, address: address2, phone: phone2, email: email2 };
 }
 function mrnIdentifier(mrn) {
-  return fhir.complex([
+  return fhirPeer().complex([
     prop(
       "type",
-      fhir.complex([
+      fhirPeer().complex([
         prop(
           "coding",
-          fhir.list([
+          fhirPeer().list([
             coding({
               system: SYSTEM.IDENTIFIER_TYPE,
               code: "MR",
@@ -1252,13 +1283,16 @@ var EXAMPLE_ENCOUNTER_CLASSES = Object.freeze([
 // src/fhir/patient.ts
 var PATIENT_PROFILES = Object.freeze(["base", "us-core"]);
 function ombExtension(url, category) {
-  return fhir.complex([
+  return fhirPeer().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))])
+      fhirPeer().list([
+        fhirPeer().complex([
+          prop("url", str("ombCategory")),
+          prop("valueCoding", coding(category))
+        ]),
+        fhirPeer().complex([prop("url", str("text")), prop("valueString", str(category.display))])
       ])
     )
   ]);
@@ -1289,24 +1323,27 @@ function generatePatient(options = {}) {
     props.push(
       prop(
         "extension",
-        fhir.list([
+        fhirPeer().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))])
+          fhirPeer().complex([
+            prop("url", str(US_CORE_BIRTHSEX_EXTENSION)),
+            prop("valueCode", str(birthsex))
+          ])
         ])
       )
     );
   }
-  props.push(prop("identifier", fhir.list([mrnIdentifier(id.mrn)])));
+  props.push(prop("identifier", fhirPeer().list([mrnIdentifier(id.mrn)])));
   props.push(prop("active", bool(true)));
   props.push(
     prop(
       "name",
-      fhir.list([
-        fhir.complex([
+      fhirPeer().list([
+        fhirPeer().complex([
           prop("use", str("official")),
           prop("family", str(id.person.family)),
-          prop("given", fhir.list([str(id.person.given)]))
+          prop("given", fhirPeer().list([str(id.person.given)]))
         ])
       ])
     )
@@ -1314,13 +1351,13 @@ function generatePatient(options = {}) {
   props.push(
     prop(
       "telecom",
-      fhir.list([
-        fhir.complex([
+      fhirPeer().list([
+        fhirPeer().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))])
+        fhirPeer().complex([prop("system", str("email")), prop("value", str(id.email))])
       ])
     )
   );
@@ -1329,10 +1366,10 @@ function generatePatient(options = {}) {
   props.push(
     prop(
       "address",
-      fhir.list([
-        fhir.complex([
+      fhirPeer().list([
+        fhirPeer().complex([
           prop("use", str("home")),
-          prop("line", fhir.list([str(id.address.street)])),
+          prop("line", fhirPeer().list([str(id.address.street)])),
           prop("city", str(id.address.city)),
           prop("state", str(id.address.state)),
           prop("postalCode", str(id.address.zip))
@@ -1340,8 +1377,10 @@ function generatePatient(options = {}) {
       ])
     )
   );
-  return fhir.complex(props);
+  return fhirPeer().complex(props);
 }
+
+// src/fhir/condition.ts
 function generateCondition(options = {}) {
   const { seed = 0, subject = "Patient/syn-patient-1", usCore = true } = options;
   const rng = createRng(seed);
@@ -1371,7 +1410,7 @@ function generateCondition(options = {}) {
   props.push(
     prop(
       "category",
-      fhir.list([
+      fhirPeer().list([
         codeableConcept({
           system: SYSTEM.CONDITION_CATEGORY,
           code: "problem-list-item",
@@ -1382,15 +1421,17 @@ function generateCondition(options = {}) {
   );
   props.push(prop("code", codeableConcept(code)));
   props.push(prop("subject", reference(subject)));
-  return fhir.complex(props);
+  return fhirPeer().complex(props);
 }
+
+// src/fhir/observation.ts
 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([
+  return fhirPeer().complex([
     prop("value", dec(drawValue(rng, concept))),
     prop("unit", str(concept.unit)),
     prop("system", str(SYSTEM.UCUM)),
@@ -1412,7 +1453,7 @@ function buildObservation(seed, subject, usCore, profileUrl, category, pool, eff
   props.push(
     prop(
       "category",
-      fhir.list([
+      fhirPeer().list([
         codeableConcept({
           system: SYSTEM.OBSERVATION_CATEGORY,
           code: category.code,
@@ -1428,7 +1469,7 @@ function buildObservation(seed, subject, usCore, profileUrl, category, pool, eff
   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);
+  return fhirPeer().complex(props);
 }
 function generateObservationLab(options = {}) {
   const { seed = 0, subject = "Patient/syn-patient-1", usCore = true } = options;
@@ -1454,6 +1495,8 @@ function generateVitalSign(options = {}) {
     true
   );
 }
+
+// src/fhir/medication-request.ts
 function generateMedicationRequest(options = {}) {
   const {
     seed = 0,
@@ -1478,8 +1521,10 @@ function generateMedicationRequest(options = {}) {
   props.push(prop("subject", reference(subject)));
   props.push(prop("authoredOn", str(`${String(y)}-${m}-${d}`)));
   props.push(prop("requester", reference(requester)));
-  return fhir.complex(props);
+  return fhirPeer().complex(props);
 }
+
+// src/fhir/encounter.ts
 function generateEncounter(options = {}) {
   const { seed = 0, subject = "Patient/syn-patient-1", usCore = true } = options;
   const rng = createRng(seed);
@@ -1496,8 +1541,8 @@ function generateEncounter(options = {}) {
   props.push(
     prop(
       "identifier",
-      fhir.list([
-        fhir.complex([
+      fhirPeer().list([
+        fhirPeer().complex([
           prop("system", str(`urn:oid:${id.assigningAuthorityOid}`)),
           prop("value", str(id.value))
         ])
@@ -1506,11 +1551,13 @@ function generateEncounter(options = {}) {
   );
   props.push(prop("status", str("finished")));
   props.push(prop("class", coding(cls)));
-  props.push(prop("type", fhir.list([codeableConcept(type)])));
+  props.push(prop("type", fhirPeer().list([codeableConcept(type)])));
   props.push(prop("subject", reference(subject)));
-  props.push(prop("period", fhir.complex([prop("start", str(`${start}T09:00:00Z`))])));
-  return fhir.complex(props);
+  props.push(prop("period", fhirPeer().complex([prop("start", str(`${start}T09:00:00Z`))])));
+  return fhirPeer().complex(props);
 }
+
+// src/fhir/immunization.ts
 function generateImmunization(options = {}) {
   const { seed = 0, patient = "Patient/syn-patient-1", usCore = true } = options;
   const rng = createRng(seed);
@@ -1527,8 +1574,10 @@ function generateImmunization(options = {}) {
   props.push(prop("patient", reference(patient)));
   props.push(prop("occurrenceDateTime", str(occurrence)));
   props.push(prop("primarySource", bool(true)));
-  return fhir.complex(props);
+  return fhirPeer().complex(props);
 }
+
+// src/fhir/allergy-intolerance.ts
 function generateAllergyIntolerance(options = {}) {
   const { seed = 0, patient = "Patient/syn-patient-1", usCore = true } = options;
   const rng = createRng(seed);
@@ -1561,11 +1610,17 @@ function generateAllergyIntolerance(options = {}) {
   props.push(
     prop(
       "reaction",
-      fhir.list([fhir.complex([prop("manifestation", fhir.list([codeableConcept(manifestation)]))])])
+      fhirPeer().list([
+        fhirPeer().complex([
+          prop("manifestation", fhirPeer().list([codeableConcept(manifestation)]))
+        ])
+      ])
     )
   );
-  return fhir.complex(props);
+  return fhirPeer().complex(props);
 }
+
+// src/fhir/procedure.ts
 function generateProcedure(options = {}) {
   const { seed = 0, subject = "Patient/syn-patient-1", usCore = true } = options;
   const rng = createRng(seed);
@@ -1581,8 +1636,10 @@ function generateProcedure(options = {}) {
   props.push(prop("code", codeableConcept(code)));
   props.push(prop("subject", reference(subject)));
   props.push(prop("performedDateTime", str(`${performed}T10:00:00Z`)));
-  return fhir.complex(props);
+  return fhirPeer().complex(props);
 }
+
+// src/fhir/diagnostic-report.ts
 function generateDiagnosticReport(options = {}) {
   const { seed = 0, subject = "Patient/syn-patient-1", results = [], usCore = true } = options;
   const rng = createRng(seed);
@@ -1598,7 +1655,7 @@ function generateDiagnosticReport(options = {}) {
   props.push(
     prop(
       "category",
-      fhir.list([
+      fhirPeer().list([
         codeableConcept({
           system: SYSTEM.DIAGNOSTIC_SERVICE_SECTION,
           code: "LAB",
@@ -1612,15 +1669,17 @@ function generateDiagnosticReport(options = {}) {
   props.push(prop("effectiveDateTime", str(`${day}T08:30:00Z`)));
   props.push(prop("issued", str(`${day}T09:00:00.000Z`)));
   if (results.length > 0) {
-    props.push(prop("result", fhir.list(results.map((r) => reference(r)))));
+    props.push(prop("result", fhirPeer().list(results.map((r) => reference(r)))));
   }
-  return fhir.complex(props);
+  return fhirPeer().complex(props);
 }
+
+// src/fhir/composition.ts
 function section(sec) {
-  return fhir.complex([
+  return fhirPeer().complex([
     prop("title", str(sec.title)),
     prop("code", codeableConcept({ system: SYSTEM.LOINC, code: sec.code, display: sec.title })),
-    prop("entry", fhir.list(sec.entries.map((e) => reference(e))))
+    prop("entry", fhirPeer().list(sec.entries.map((e) => reference(e))))
   ]);
 }
 function buildComposition(rng, input) {
@@ -1639,12 +1698,12 @@ function buildComposition(rng, input) {
     ),
     prop("subject", reference(input.subject)),
     prop("date", str(`${input.date}T09:00:00Z`)),
-    prop("author", fhir.list([reference(input.organization)])),
+    prop("author", fhirPeer().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))))
+    prop("section", fhirPeer().list(input.sections.map((s) => section(s))))
   ];
-  return fhir.complex(props);
+  return fhirPeer().complex(props);
 }
 
 // src/fhir/bundle.ts
@@ -1659,14 +1718,14 @@ function resourceTypeOf(resource) {
 }
 function buildOrganization(rng) {
   const id = safe.identifier(rng, "AN");
-  return fhir.complex([
+  return fhirPeer().complex([
     prop("resourceType", str("Organization")),
     prop("id", str(`syn-org-${rng.digits(8)}`)),
     prop("text", narrative("Synthetic health organization.")),
     prop(
       "identifier",
-      fhir.list([
-        fhir.complex([
+      fhirPeer().list([
+        fhirPeer().complex([
           prop("system", str(`urn:oid:${id.assigningAuthorityOid}`)),
           prop("value", str(id.value))
         ])
@@ -1779,11 +1838,14 @@ function generateBundle(options = {}) {
       entryProps.push(
         prop(
           "request",
-          fhir.complex([prop("method", str("POST")), prop("url", str(resourceTypeOf(member.resource)))])
+          fhirPeer().complex([
+            prop("method", str("POST")),
+            prop("url", str(resourceTypeOf(member.resource)))
+          ])
         )
       );
     }
-    return fhir.complex(entryProps);
+    return fhirPeer().complex(entryProps);
   });
   const props = [
     prop("resourceType", str("Bundle")),
@@ -1794,7 +1856,7 @@ function generateBundle(options = {}) {
     props.push(
       prop(
         "identifier",
-        fhir.complex([
+        fhirPeer().complex([
           prop("system", str(`urn:oid:${id.assigningAuthorityOid}`)),
           prop("value", str(`urn:uuid:${safe.uuid(rng)}`))
         ])
@@ -1803,11 +1865,13 @@ function generateBundle(options = {}) {
   }
   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);
+  props.push(prop("entry", fhirPeer().list(entries)));
+  return fhirPeer().complex(props);
 }
+
+// src/x12/money.ts
 function dec2(value) {
-  const d = x12.X12Decimal.fromString(value);
+  const d = x12Peer().X12Decimal.fromString(value);
   if (d === void 0) throw new SynthError(SYNTH_FATAL_CODES.SYNTH_INVALID_DECIMAL);
   return d;
 }
@@ -1890,12 +1954,12 @@ 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: "J209", label: "acute bronchitis, unspecified" },
+    { code: "E119", 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" }
+    { code: "M545", label: "low back pain" },
+    { code: "R079", label: "chest pain, unspecified" },
+    { code: "Z0000", label: "general adult medical exam without abnormal findings" }
   ].map((entry) => Object.freeze(entry))
 );
 var REVENUE_CODES = Object.freeze(
@@ -2112,11 +2176,11 @@ function generate837(variant, options) {
   const spec = specOf(rng, resolved);
   switch (resolved) {
     case "P":
-      return x12.build837P(spec);
+      return x12Peer().build837P(spec);
     case "I":
-      return x12.build837I(spec);
+      return x12Peer().build837I(spec);
     case "D":
-      return x12.build837D(spec);
+      return x12Peer().build837D(spec);
   }
 }
 function generate837P(options) {
@@ -2128,6 +2192,8 @@ function generate837I(options) {
 function generate837D(options) {
   return generate837("D", options);
 }
+
+// src/x12/remit-835.ts
 function generate835(options) {
   const rng = createRng(options.seed);
   const partners = x12TradingPartners(rng);
@@ -2228,8 +2294,10 @@ function generate835(options) {
     },
     claims: [claim]
   };
-  return x12.build835(spec);
+  return x12Peer().build835(spec);
 }
+
+// src/x12/eligibility-271.ts
 function generate271(options) {
   const rng = createRng(options.seed);
   const partners = x12TradingPartners(rng);
@@ -2299,7 +2367,8 @@ function generate271(options) {
                     serviceTypeCodes: serviceTypes,
                     inPlanNetwork: "Y",
                     monetaryAmount: dec2(money(rng.int(500, 5e3))),
-                    percent: dec2(String(rng.pick([80, 90, 100])))
+                    percent: dec2(rng.pick([".8", ".9", "1"]))
+                    // EB-08 is a decimal fraction
                   }
                 ]
               }
@@ -2309,7 +2378,7 @@ function generate271(options) {
       }
     ]
   };
-  return x12.build271(spec);
+  return x12Peer().build271(spec);
 }
 
 // src/ncpdp/identity.ts
@@ -2365,6 +2434,8 @@ var EXAMPLE_DRUGS = Object.freeze(
   ].map((entry) => Object.freeze(entry))
 );
 var DAW_CODES = Object.freeze(["0", "1", "2"]);
+
+// src/ncpdp/telecom.ts
 var SYNTHETIC_BIN = "999999";
 function digitsOnly(value) {
   return value.replace(/\D/g, "");
@@ -2448,7 +2519,8 @@ function claimSegment(rng, minimal) {
       field("E1", "03"),
       // 03 = NDC
       field("D7", drug.ndc),
-      field("E7", String(rng.int(30, 90))),
+      field("E7", String(rng.int(30, 90) * 1e3)),
+      // 442-E7 carries three implied decimals
       field("D5", String(rng.pick([30, 60, 90]))),
       field("D8", rng.pick(DAW_CODES))
     ]
@@ -2464,7 +2536,9 @@ function generateTelecom(code, options) {
     prescriberSegment(rng),
     claimSegment(rng, false)
   ];
-  return telecom.serializeTelecom(telecom.buildTelecomRequest({ header: head, segments }));
+  return ncpdpTelecomPeer().serializeTelecom(
+    ncpdpTelecomPeer().buildTelecomRequest({ header: head, segments })
+  );
 }
 function generateB1(options) {
   return generateTelecom("B1", options);
@@ -2475,11 +2549,23 @@ function generateB2(options) {
 function generateB3(options) {
   return generateTelecom("B3", options);
 }
+
+// src/ccda/example-codes.ts
+var LOINC_OID = "2.16.840.1.113883.6.1";
+var SNOMED_CT_OID = "2.16.840.1.113883.6.96";
+var RXNORM_OID = "2.16.840.1.113883.6.88";
+var CVX_OID = "2.16.840.1.113883.12.292";
+var NCI_ROUTE_OID = "2.16.840.1.113883.3.26.1.1";
+var LOINC = LOINC_OID;
+var SNOMED_CT = SNOMED_CT_OID;
+var RXNORM = RXNORM_OID;
+var CVX = CVX_OID;
+var NCI_ROUTE = NCI_ROUTE_OID;
 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
+  "http://loinc.org": LOINC,
+  "http://snomed.info/sct": SNOMED_CT,
+  "http://www.nlm.nih.gov/research/umls/rxnorm": RXNORM,
+  "http://hl7.org/fhir/sid/cvx": CVX
 });
 function toBuildCode(concept) {
   const codeSystem = URI_TO_OID[concept.system];
@@ -2503,24 +2589,24 @@ 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: "266919005", codeSystem: SNOMED_CT, displayName: "Never smoker" }),
+  Object.freeze({ code: "8517006", codeSystem: SNOMED_CT, displayName: "Former smoker" }),
   Object.freeze({
     code: "449868002",
-    codeSystem: ccda.SNOMED_CT,
+    codeSystem: SNOMED_CT,
     displayName: "Current every day smoker"
   }),
   Object.freeze({
     code: "428041000124106",
-    codeSystem: ccda.SNOMED_CT,
+    codeSystem: 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" })
+  Object.freeze({ code: "C38288", codeSystem: NCI_ROUTE, displayName: "Oral" }),
+  Object.freeze({ code: "C28161", codeSystem: NCI_ROUTE, displayName: "Intramuscular" }),
+  Object.freeze({ code: "C38276", codeSystem: NCI_ROUTE, displayName: "Intravenous" }),
+  Object.freeze({ code: "C38299", codeSystem: NCI_ROUTE, displayName: "Subcutaneous" })
 ]);
 
 // src/ccda/identity.ts
@@ -2628,16 +2714,18 @@ function generateCcda(options = {}) {
   const { seed = 0 } = options;
   const documentType = resolveKind(CCDA_DOCUMENT_TYPES, options.documentType ?? "ccd");
   const rng = createRng(seed);
-  return ccda.buildCcda(buildInit(rng, documentType));
+  return ccdaPeer().buildCcda(buildInit(rng, documentType));
 }
+
+// src/deid/loop.ts
 var DEID_LOOP_POLICY_NAME = "synth-deid-loop-removal";
 function deidLoopPolicy() {
-  return deid.defineDeidPolicy({
+  return deidPeer().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"
+      [deidPeer().SAFE_HARBOR_CATEGORIES.MRN]: "redact",
+      [deidPeer().SAFE_HARBOR_CATEGORIES.HEALTH_PLAN_BENEFICIARY]: "redact",
+      [deidPeer().SAFE_HARBOR_CATEGORIES.ACCOUNT]: "redact"
     }
   });
 }
@@ -2774,7 +2862,8 @@ var DEID_LOOP_SKIPPED = Object.freeze([
     reason: "@cosyte/synth does not generate DICOM, so there is nothing to pair."
   })
 ]);
-var POLICY = deidLoopPolicy();
+var policy;
+var loopPolicy = () => policy ??= deidLoopPolicy();
 function residue(loci) {
   return loci.map((l) => l.value).join("\n");
 }
@@ -2799,8 +2888,8 @@ function hl7DeidLoop(options = {}) {
   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 planted = identifierSentinels(deidHl7Peer().extractHl7Loci(message).loci, original);
+  const deidDoc = deidHl7Peer().deidentifyHl7(message, { policy: loopPolicy() }).document;
   const deidentified = deidDoc.toString();
   return assembleVerdict({
     format: "hl7",
@@ -2809,17 +2898,17 @@ function hl7DeidLoop(options = {}) {
     planted,
     original,
     deidentified,
-    phiResidue: residue(hl7.extractHl7Loci(deidDoc).loci),
+    phiResidue: residue(deidHl7Peer().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);
+  const original = fhirPeer().serializeResource(bundle);
+  const planted = identifierSentinels(deidFhirPeer().extractFhirLoci(bundle).loci, original);
+  const deidDoc = deidFhirPeer().deidentifyFhir(bundle, { policy: loopPolicy() }).document;
+  const deidentified = fhirPeer().serializeResource(deidDoc);
   return assembleVerdict({
     format: "fhir",
     artifact: "Bundle",
@@ -2827,7 +2916,7 @@ function fhirDeidLoop(options = {}) {
     planted,
     original,
     deidentified,
-    phiResidue: residue(fhir$1.extractFhirLoci(deidDoc).loci),
+    phiResidue: residue(deidFhirPeer().extractFhirLoci(deidDoc).loci),
     clinicalCodes: FHIR_CLINICAL
   });
 }
@@ -2849,9 +2938,9 @@ 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;
+  const original = x12Peer().serializeX12(interchange);
+  const planted = identifierSentinels(deidX12Peer().extractX12Loci(interchange).loci, original);
+  const deidentified = deidX12Peer().deidentifyX12(interchange, { policy: loopPolicy() }).x12;
   return assembleVerdict({
     format: "x12",
     artifact: variant,
@@ -2859,7 +2948,7 @@ function x12DeidLoop(options = {}) {
     planted,
     original,
     deidentified,
-    phiResidue: residue(x12$1.extractX12Loci(x12.parseX12(deidentified)).loci),
+    phiResidue: residue(deidX12Peer().extractX12Loci(x12Peer().parseX12(deidentified)).loci),
     clinicalCodes: X12_CLINICAL
   });
 }
@@ -2877,9 +2966,9 @@ 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;
+  const tx = ncpdpTelecomPeer().parseTelecom(original);
+  const planted = identifierSentinels(deidNcpdpPeer().extractTelecomLoci(tx).loci, original);
+  const deidentified = deidNcpdpPeer().deidentifyTelecom(tx, { policy: loopPolicy() }).telecom;
   return assembleVerdict({
     format: "ncpdp-telecom",
     artifact: transaction,
@@ -2887,7 +2976,9 @@ function ncpdpTelecomDeidLoop(options = {}) {
     planted,
     original,
     deidentified,
-    phiResidue: residue(ncpdp.extractTelecomLoci(telecom.parseTelecom(deidentified)).loci),
+    phiResidue: residue(
+      deidNcpdpPeer().extractTelecomLoci(ncpdpTelecomPeer().parseTelecom(deidentified)).loci
+    ),
     clinicalCodes: NCPDP_CLINICAL
   });
 }
@@ -2895,9 +2986,9 @@ 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 original = ccdaPeer().serializeCcda(doc);
   const planted = recordTargetSentinels(original);
-  const deidentified = ccda$1.deidentifyCcda(doc, { policy: POLICY }).document.toString();
+  const deidentified = deidCcdaPeer().deidentifyCcda(doc, { policy: loopPolicy() }).document.toString();
   return assembleVerdict({
     format: "ccda",
     artifact: documentType === "ccd" ? "CCD" : "ReferralNote",
@@ -2912,9 +3003,9 @@ function ccdaDeidLoop(options = {}) {
 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 list = byFormatMap.get(r.format) ?? [];
+    list.push(r);
+    byFormatMap.set(r.format, list);
   }
   const byFormat = [];
   for (const [format, runs] of byFormatMap) {