@imranq2/fhirpatientsummary 1.0.31 → 1.0.33

package/dist/index.cjs

@@ -197,7 +197,8 @@ var IPSSectionSummaryCompositionFilter = {
   ["HistoryOfProceduresSection" /* PROCEDURES */]: (resource) => resource.resourceType === "Composition" && resource.type?.coding?.some((c) => codingMatches(c, "procedure_summary_document", IPS_SUMMARY_COMPOSITION_TYPE_SYSTEM))
 };
 var IPSSectionSummaryIPSCompositionFilter = {
-  ["VitalSignsSection" /* VITAL_SIGNS */]: (resource) => resource.resourceType === "Composition" && resource.type?.coding?.some((c) => c.system === IPS_SUMMARY_COMPOSITION_TYPE_SYSTEM && c.code === "ips_vital_summary_document")
+  ["Patient" /* PATIENT */]: (resource) => resource.resourceType === "Composition" && resource.type?.coding?.some((c) => codingMatches(c, "ips_patient_summary_document", IPS_SUMMARY_COMPOSITION_TYPE_SYSTEM)),
+  ["VitalSignsSection" /* VITAL_SIGNS */]: (resource) => resource.resourceType === "Composition" && resource.type?.coding?.some((c) => codingMatches(c, "ips_vital_summary_document", IPS_SUMMARY_COMPOSITION_TYPE_SYSTEM))
 };
 var IPSSectionResourceHelper = class {
   static getResourceFilterForSection(section) {
@@ -912,18 +913,6 @@ var TemplateUtilities = class {
     }
     return "";
   }
-  /**
-   * Returns the owner tag from the resource meta.security array.
-   * @param resource - FHIR resource with meta tag
-   * @returns The owner code if found, otherwise undefined
-   */
-  getOwnerTag(resource) {
-    if (!resource?.meta?.security) return "";
-    const ownerEntry = resource.meta.security.find(
-      (sec) => sec.system === "https://www.icanbwell.com/owner" && !!sec.code
-    );
-    return ownerEntry?.code;
-  }
   /**
    * Public method to render plain text as HTML, escaping special characters and replacing newlines with <br />.
    * This method should be used whenever displaying user-supplied or FHIR resource text in HTML to prevent XSS vulnerabilities
@@ -938,6 +927,23 @@ var TemplateUtilities = class {
     const escapedText = text.replace(/</g, "&lt;").replace(/>/g, "&gt;");
     return escapedText.replace(/\n/g, "<br />");
   }
+  capitalizeFirstLetter(text) {
+    if (!text || text.length === 0) {
+      return "";
+    }
+    return text.charAt(0).toUpperCase() + text.slice(1);
+  }
+  renderListSectionData(sectionData) {
+    if (!sectionData || !Array.isArray(sectionData) || sectionData.length === 0) {
+      return "";
+    }
+    const items = [];
+    for (const section of sectionData) {
+      items.push(this.renderTextAsHtml(section.text?.div || ""));
+    }
+    const listString = Array.from(items).map((item) => `<li>${item}</li>`).join("");
+    return `<ul>${listString}</ul>`;
+  }
   /**
    * Renders note elements from a FHIR resource in a standardized format
    * Can render as simple comma-separated text or as styled HTML with timestamps
@@ -1425,6 +1431,60 @@ var PatientTemplate = class _PatientTemplate {
   generateNarrative(resources, timezone) {
     return _PatientTemplate.generateStaticNarrative(resources, timezone);
   }
+  /**
+   * Generate HTML narrative for Patient resources using summary
+   * @param resources - FHIR Composition resources
+   * @param timezone - Optional timezone to use for date formatting (e.g., 'America/New_York', 'Europe/London')
+   * @returns HTML string for rendering
+   */
+  // eslint-disable-next-line @typescript-eslint/no-unused-vars
+  generateSummaryNarrative(resources, timezone) {
+    const templateUtilities = new TemplateUtilities(resources);
+    const compositionResources = resources[0];
+    const data = {};
+    for (const rowData of compositionResources.section ?? []) {
+      for (const columnData of rowData.section ?? []) {
+        switch (columnData.title) {
+          case "Name":
+          case "Address":
+          case "Communication":
+            data[columnData.title] = templateUtilities.renderListSectionData(columnData.section ?? []);
+            break;
+          case "Telecom": {
+            const telecomStringParts = [];
+            for (const telecomData of columnData.section ?? []) {
+              const telecomSystem = telecomData?.title;
+              const telecomValue = templateUtilities.renderListSectionData(telecomData.section ?? []);
+              if (telecomSystem && telecomValue) {
+                telecomStringParts.push(`<li><strong>${telecomSystem}:</strong>${telecomValue}</li>`);
+              }
+            }
+            data["Telecom"] = `<ul>${telecomStringParts.join("")}</ul>`;
+            break;
+          }
+          default:
+            if (columnData.title) {
+              data[columnData.title] = templateUtilities.renderTextAsHtml(columnData.text?.div ?? "");
+            }
+            break;
+        }
+      }
+    }
+    let html = `<p>This section merges all Patient resources into a single combined patient record, preferring non-empty values for each field.</p>`;
+    html += `<div>
+      <ul>
+        <li><strong>Name(s):</strong>${data["Name"] || ""}</li>
+        <li><strong>Gender:</strong>${data["Gender"] || ""}</li>
+        <li><strong>Date of Birth:</strong>${data["Date of Birth"] || ""}</li>
+        <li><strong>Telecom:</strong>${data["Telecom"] || ""}</li>
+        <li><strong>Address(es):</strong>${data["Address"] || ""}</li>
+        <li><strong>Marital Status:</strong> ${data["Marital Status"] || ""}</li>
+        <li><strong>Deceased:</strong>${data["Deceased"] || ""}</li>
+        <li><strong>Language(s):</strong>${data["Communication"] || ""}</li>
+      </ul>
+    </div>`;
+    return html;
+  }
   /**
    * Internal static implementation that actually generates the narrative
    * @param resources - FHIR Patient resources
@@ -1518,7 +1578,8 @@ var PatientTemplate = class _PatientTemplate {
         }
       }
     });
-    return Array.from(uniqueNames).map((nameText) => `<ul><li>${nameText}</li></ul>`).join("");
+    const namesHtml = Array.from(uniqueNames).map((nameText) => `<li>${nameText}</li>`).join("");
+    return `<ul>${namesHtml}</ul>`;
   }
   /**
    * Renders patient telecom information grouped by system
@@ -1622,7 +1683,8 @@ var PatientTemplate = class _PatientTemplate {
       }
     });
     const deduplicatedAddresses = this.deduplicateSimilarAddresses(Array.from(uniqueAddresses));
-    return deduplicatedAddresses.map((addressText) => `<ul><li>${addressText}</li></ul>`).join("");
+    const addressesHtml = deduplicatedAddresses.map((addressText) => `<li>${addressText}</li>`).join("");
+    return `<ul>${addressesHtml}</ul>`;
   }
   /**
    * Calculates the similarity between two strings using Levenshtein distance
@@ -1740,7 +1802,8 @@ var PatientTemplate = class _PatientTemplate {
         uniqueLanguages.add(language);
       }
     });
-    return Array.from(uniqueLanguages).map((language) => `<ul><li>${language}${preferredLanguages.has(language) ? " (preferred)" : ""}</li></ul>`).join("");
+    const languagesHtml = Array.from(uniqueLanguages).map((language) => `<li>${language}${preferredLanguages.has(language) ? " (preferred)" : ""}</li>`).join("");
+    return `<ul>${languagesHtml}</ul>`;
   }
   /**
    * Capitalizes first letter of a string
@@ -1784,7 +1847,6 @@ var AllergyIntoleranceTemplate = class _AllergyIntoleranceTemplate {
               <th>Code (System)</th>
               <th>Criticality</th>
               <th>Recorded Date</th>
-              <th>Source</th>
             </tr>
           </thead>
           <tbody>`;
@@ -1804,21 +1866,20 @@ var AllergyIntoleranceTemplate = class _AllergyIntoleranceTemplate {
             case "Recorded Date":
               data["recordedDate"] = templateUtilities.renderTextAsHtml(columnData.text?.div ?? "");
               break;
-            case "Source":
-              data["source"] = templateUtilities.renderTextAsHtml(columnData.text?.div ?? "");
-              break;
             default:
               break;
           }
         }
+        if (data["allergen"]?.toLowerCase() === "unknown") {
+          continue;
+        }
         isSummaryCreated = true;
         html += `
             <tr>
-              <td>${data["allergen"] ?? ""}</td>
+              <td>${templateUtilities.capitalizeFirstLetter(data["allergen"] ?? "")}</td>
                <td>${data["codeSystem"] ?? ""}</td>
               <td>${data["criticality"] ?? ""}</td>
               <td>${templateUtilities.renderTime(data["recordedDate"], timezone) ?? ""}</td>
-              <td>${data["source"] ?? ""}</td>
             </tr>`;
       }
     }
@@ -1872,7 +1933,6 @@ var AllergyIntoleranceTemplate = class _AllergyIntoleranceTemplate {
               <th>Reaction</th>
               <th>Onset Date</th>
               <th>Comments</th>
-              <th>Source</th>
             </tr>
           </thead>
           <tbody>`;
@@ -1902,7 +1962,6 @@ var AllergyIntoleranceTemplate = class _AllergyIntoleranceTemplate {
               <th>Onset Date</th>
               <th>Comments</th>
               <th>Resolved Date</th>
-              <th>Source</th>
             </tr>
           </thead>
           <tbody>`;
@@ -1931,16 +1990,19 @@ var AllergyIntoleranceTemplate = class _AllergyIntoleranceTemplate {
   static generateAllergyRows(allergies, templateUtilities, timezone, includeResolved = false) {
     let html = "";
     for (const allergy of allergies) {
+      const allergenName = templateUtilities.codeableConceptDisplay(allergy.code);
+      if (allergenName?.toLowerCase() === "unknown") {
+        continue;
+      }
       html += `
-        <tr id="${templateUtilities.narrativeLinkId(allergy.extension)}">
-          <td class="Name"><span class="AllergenName">${templateUtilities.renderTextAsHtml(templateUtilities.codeableConceptDisplay(allergy.code))}</span></td>
+        <tr>
+          <td class="Name"><span class="AllergenName">${templateUtilities.capitalizeFirstLetter(templateUtilities.renderTextAsHtml(allergenName))}</span></td>
           <td class="Status">${templateUtilities.renderTextAsHtml(templateUtilities.codeableConceptDisplay(allergy.clinicalStatus)) || ""}</td>
           <td class="CodeSystem">${templateUtilities.codeableConceptCoding(allergy.code)}</td>
           <td class="Category">${templateUtilities.renderTextAsHtml(templateUtilities.safeConcat(allergy.category)) || ""}</td>
           <td class="Reaction">${templateUtilities.renderTextAsHtml(templateUtilities.concatReactionManifestation(allergy.reaction)) || ""}</td>
           <td class="OnsetDate">${templateUtilities.renderTextAsHtml(templateUtilities.renderTime(allergy.onsetDateTime, timezone)) || ""}</td>
-          <td class="Comments">${templateUtilities.renderNotes(allergy.note, timezone, { styled: true, warning: true })}</td>
-           <td class="Source">${templateUtilities.getOwnerTag(allergy)}</td>`;
+          <td class="Comments">${templateUtilities.renderNotes(allergy.note, timezone, { styled: true, warning: true })}</td>`;
       if (includeResolved) {
         let endDate = "";
         if (allergy.extension && Array.isArray(allergy.extension)) {
@@ -1995,9 +2057,7 @@ var MedicationSummaryTemplate = class _MedicationSummaryTemplate {
                 <th>Status</th>
                 <th>Sig</th>
                 <th>Days of Supply</th>
-                <th>Refills</th>
                 <th>Start Date</th>
-                <th>Source</th>
                 </tr>
             </thead>
             <tbody>`;
@@ -2023,15 +2083,9 @@ var MedicationSummaryTemplate = class _MedicationSummaryTemplate {
             case "Days Of Supply":
               data["daysOfSupply"] = templateUtilities.renderTextAsHtml(columnData.text?.div ?? "");
               break;
-            case "Refills Remaining":
-              data["refills"] = templateUtilities.renderTextAsHtml(columnData.text?.div ?? "");
-              break;
             case "Authored On Date":
               data["startDate"] = templateUtilities.renderTextAsHtml(columnData.text?.div ?? "");
               break;
-            case "Source":
-              data["source"] = templateUtilities.renderTextAsHtml(columnData.text?.div ?? "");
-              break;
             default:
               break;
           }
@@ -2047,17 +2101,18 @@ var MedicationSummaryTemplate = class _MedicationSummaryTemplate {
           skippedMedications++;
         }
         if (data["status"] === "active" || startDateObj && startDateObj >= twoYearsAgo) {
+          if (data["medication"]?.toLowerCase() === "unknown") {
+            continue;
+          }
           isSummaryCreated = true;
           html += `
                             <tr>
-                                <td>${templateUtilities.renderTextAsHtml(data["medication"])}</td>
+                                <td>${templateUtilities.capitalizeFirstLetter(templateUtilities.renderTextAsHtml(data["medication"]))}</td>
                                 <td>${templateUtilities.codeableConceptCoding(sectionCodeableConcept)}</td>
                                 <td>${templateUtilities.renderTextAsHtml(data["status"])}</td>
                                 <td>${templateUtilities.renderTextAsHtml(data["sig-prescriber"] || data["sig-pharmacy"])}</td>
                                 <td>${templateUtilities.renderTextAsHtml(data["daysOfSupply"])}</td>
-                                <td>${templateUtilities.renderTextAsHtml(data["refills"])}</td>
                                 <td>${templateUtilities.renderTime(data["startDate"], timezone)}</td>
-                                <td>${templateUtilities.renderTextAsHtml(data["source"])}</td>
                             </tr>`;
         }
       }
@@ -2097,8 +2152,8 @@ var MedicationSummaryTemplate = class _MedicationSummaryTemplate {
   static generateStaticNarrative(resources, timezone, now) {
     const templateUtilities = new TemplateUtilities(resources);
     let html = "";
-    const medicationRequests = this.getMedicationRequests(templateUtilities, resources);
-    const medicationStatements = this.getMedicationStatements(templateUtilities, resources);
+    const medicationRequests = resources.filter((entry) => entry.resourceType === "MedicationRequest");
+    const medicationStatements = resources.filter((entry) => entry.resourceType === "MedicationStatement");
     const allActiveMedications = [];
     const currentDate = now || /* @__PURE__ */ new Date();
     const twoYearsAgo = new Date(currentDate);
@@ -2106,10 +2161,10 @@ var MedicationSummaryTemplate = class _MedicationSummaryTemplate {
     let skippedMedications = 0;
     const allMedications = [];
     medicationRequests.forEach((mr) => {
-      allMedications.push({ type: "request", resource: mr.resource, extension: mr.extension });
+      allMedications.push({ type: "request", resource: mr });
     });
     medicationStatements.forEach((ms) => {
-      allMedications.push({ type: "statement", resource: ms.resource, extension: ms.extension });
+      allMedications.push({ type: "statement", resource: ms });
     });
     for (const med of allMedications) {
       let dateString;
@@ -2166,36 +2221,6 @@ var MedicationSummaryTemplate = class _MedicationSummaryTemplate {
     }
     return "";
   }
-  /**
-   * Extract MedicationRequest resources
-   * @param templateUtilities - Instance of TemplateUtilities for utility functions
-   * @param resources - FHIR Medication resources
-   * @returns Array of MedicationRequest resources
-   */
-  static getMedicationRequests(templateUtilities, resources) {
-    if (resources.length === 0) {
-      return [];
-    }
-    return resources.filter((entry) => entry.resourceType === "MedicationRequest").map((entry) => ({
-      resource: entry,
-      extension: templateUtilities.narrativeLinkExtension(entry)
-    }));
-  }
-  /**
-   * Extract MedicationStatement resources
-   * @param templateUtilities - Instance of TemplateUtilities for utility functions
-   * @param resources - FHIR Medication resources
-   * @returns Array of MedicationStatement resources
-   */
-  static getMedicationStatements(templateUtilities, resources) {
-    if (resources.length === 0) {
-      return [];
-    }
-    return resources.filter((entry) => entry.resourceType === "MedicationStatement").map((entry) => ({
-      resource: entry,
-      extension: templateUtilities.narrativeLinkExtension(entry)
-    }));
-  }
   /**
    * Render HTML table for combined MedicationRequest and MedicationStatement resources
    * @param templateUtilities - Instance of TemplateUtilities for utility functions
@@ -2212,19 +2237,15 @@ var MedicationSummaryTemplate = class _MedicationSummaryTemplate {
             <th>Code (System)</th>
             <th>Sig</th>
             <th>Dispense Quantity</th>
-            <th>Refills</th>
             <th>Start Date</th>
-            <th>Source</th>
           </tr>
         </thead>
         <tbody>`;
     for (const medication of medications) {
-      const narrativeLinkId = templateUtilities.narrativeLinkId(medication.extension);
       let type;
       let medicationName;
       let sig;
       let dispenseQuantity = "";
-      let refills = "";
       let startDate = "";
       let codeSystemDisplay = "";
       if (medication.type === "request") {
@@ -2240,7 +2261,6 @@ var MedicationSummaryTemplate = class _MedicationSummaryTemplate {
             dispenseQuantity = `${quantity.value} ${quantity.unit || quantity.code || ""}`.trim();
           }
         }
-        refills = mr.dispenseRequest?.numberOfRepeatsAllowed?.toString() || "";
         if (mr.dispenseRequest?.validityPeriod) {
           startDate = mr.dispenseRequest.validityPeriod.start || "";
         } else {
@@ -2265,16 +2285,17 @@ var MedicationSummaryTemplate = class _MedicationSummaryTemplate {
           codeSystemDisplay = templateUtilities.codeableConceptCoding(ms.medicationCodeableConcept);
         }
       }
+      if (medicationName?.toLowerCase() === "unknown") {
+        continue;
+      }
       html += `
-        <tr${narrativeLinkId ? ` id="${narrativeLinkId}"` : ""}>
+        <tr>
           <td>${type}</td>
-          <td>${medicationName}<ul></ul></td>
+          <td>${templateUtilities.capitalizeFirstLetter(medicationName)}</td>
           <td>${codeSystemDisplay}</td>
           <td>${sig}</td>
           <td>${dispenseQuantity}</td>
-          <td>${refills}</td>
           <td>${startDate}</td>
-           <td>${templateUtilities.getOwnerTag(medication.resource)}</td>
         </tr>`;
     }
     html += `
@@ -2319,7 +2340,6 @@ var ImmunizationsTemplate = class _ImmunizationsTemplate {
               <th>Code (System)</th>
               <th>Status</th>
               <th>Date</th>
-              <th>Source</th>
             </tr>
           </thead>
           <tbody>`;
@@ -2339,22 +2359,21 @@ var ImmunizationsTemplate = class _ImmunizationsTemplate {
             case "occurrenceDateTime":
               data["occurrenceDateTime"] = templateUtilities.renderTextAsHtml(columnData.text?.div ?? "");
               break;
-            case "Source":
-              data["source"] = templateUtilities.renderTextAsHtml(columnData.text?.div ?? "");
-              break;
             default:
               break;
           }
         }
         if (data["status"] === "completed") {
+          if (data["immunization"]?.toLowerCase() === "unknown") {
+            continue;
+          }
           isSummaryCreated = true;
           html += `
               <tr>
-                <td>${data["immunization"] ?? ""}</td>
+                <td>${templateUtilities.capitalizeFirstLetter(data["immunization"] ?? "")}</td>
                 <td>${data["codeSystem"] ?? ""}</td>
                 <td>${data["status"] ?? ""}</td>
                 <td>${templateUtilities.renderTime(data["occurrenceDateTime"], timezone) ?? ""}</td>
-                <td>${data["source"] ?? ""}</td>
               </tr>`;
         }
       }
@@ -2385,7 +2404,6 @@ var ImmunizationsTemplate = class _ImmunizationsTemplate {
             <th>Lot Number</th>
             <th>Comments</th>
             <th>Date</th>
-            <th>Source</th>
           </tr>
         </thead>
         <tbody>`;
@@ -2393,9 +2411,13 @@ var ImmunizationsTemplate = class _ImmunizationsTemplate {
     if (immunizations.length > 0) {
       for (const resourceItem of immunizations) {
         const imm = resourceItem;
+        const immunizationName = templateUtilities.codeableConceptDisplay(imm.vaccineCode);
+        if (immunizationName?.toLowerCase() === "unknown") {
+          continue;
+        }
         html += `
           <tr>
-            <td>${templateUtilities.renderTextAsHtml(templateUtilities.codeableConceptDisplay(imm.vaccineCode))}</td>
+            <td>${templateUtilities.capitalizeFirstLetter(templateUtilities.renderTextAsHtml(immunizationName))}</td>
             <td>${templateUtilities.codeableConceptCoding(imm.vaccineCode)}</td>
             <td>${imm.status || ""}</td>
             <td>${templateUtilities.concatDoseNumber(imm.protocolApplied)}</td>
@@ -2403,7 +2425,6 @@ var ImmunizationsTemplate = class _ImmunizationsTemplate {
             <td>${imm.lotNumber || ""}</td>
             <td>${templateUtilities.renderNotes(imm.note, timezone)}</td>
             <td>${templateUtilities.renderTime(imm.occurrenceDateTime, timezone)}</td>
-            <td>${templateUtilities.getOwnerTag(imm)}</td>
           </tr>`;
       }
     }
@@ -2453,7 +2474,6 @@ var ProblemListTemplate = class _ProblemListTemplate {
               <th>Code (System)</th>
               <th>Onset Date</th>
               <th>Recorded Date</th>
-              <th>Source</th>
             </tr>
           </thead>
           <tbody>`;
@@ -2464,13 +2484,15 @@ var ProblemListTemplate = class _ProblemListTemplate {
       if (codeAndSystem && seenCodeAndSystems.has(codeAndSystem)) {
         continue;
       }
+      if (conditionDisplay?.toLowerCase() === "unknown") {
+        continue;
+      }
       seenCodeAndSystems.add(codeAndSystem);
       html += `<tr>
-          <td class="Name">${conditionDisplay}</td>
+          <td class="Name">${templateUtilities.capitalizeFirstLetter(conditionDisplay)}</td>
           <td class="CodeSystem">${codeAndSystem}</td>
           <td class="OnsetDate">${templateUtilities.renderDate(cond.onsetDateTime)}</td>
           <td class="RecordedDate">${templateUtilities.renderDate(cond.recordedDate)}</td>
-          <td class="Source">${templateUtilities.getOwnerTag(cond)}</td>
         </tr>`;
     }
     html += `</tbody>
@@ -2510,7 +2532,6 @@ var VitalSignsTemplate = class _VitalSignsTemplate {
               <th>Code (System)</th>
               <th>Result</th>
               <th>Date</th>
-              <th>Source</th>
             </tr>
           </thead>
           <tbody>`;
@@ -2543,14 +2564,16 @@ var VitalSignsTemplate = class _VitalSignsTemplate {
             data[columnTitle] = templateUtilities.renderTextAsHtml(columnData.text?.div ?? "");
           }
         }
+        if (data["Vital Name"]?.toLowerCase() === "unknown") {
+          continue;
+        }
         isSummaryCreated = true;
         html += `
           <tr>
-            <td>${data["Vital Name"] ?? ""}</td>
+            <td>${templateUtilities.capitalizeFirstLetter(data["Vital Name"] ?? "")}</td>
             <td>${data["codeSystem"] ?? ""}</td>
             <td>${templateUtilities.extractObservationSummaryValue(data, timezone) ?? ""}</td>
             <td>${templateUtilities.extractObservationSummaryEffectiveTime(data, timezone) ?? ""}</td>
-            <td>${data["Source"] ?? ""}</td>
           </tr>`;
       }
     }
@@ -2588,14 +2611,17 @@ var VitalSignsTemplate = class _VitalSignsTemplate {
             <th>Component(s)</th>
             <th>Comments</th>
             <th>Date</th>
-            <th>Source</th>
           </tr>
         </thead>
         <tbody>`;
     for (const obs of observations) {
+      const vitalName = templateUtilities.codeableConceptDisplay(obs.code, "display");
+      if (vitalName?.toLowerCase() === "unknown") {
+        continue;
+      }
       html += `
           <tr>
-            <td>${templateUtilities.renderTextAsHtml(templateUtilities.codeableConceptDisplay(obs.code, "display"))}</td>
+            <td>${templateUtilities.capitalizeFirstLetter(templateUtilities.renderTextAsHtml(vitalName))}</td>
             <td>${templateUtilities.codeableConceptCoding(obs.code)}</td>
             <td>${templateUtilities.extractObservationValue(obs)}</td>
             <td>${templateUtilities.extractObservationValueUnit(obs)}</td>
@@ -2603,7 +2629,6 @@ var VitalSignsTemplate = class _VitalSignsTemplate {
             <td>${templateUtilities.renderComponent(obs.component)}</td>
             <td>${templateUtilities.renderNotes(obs.note, timezone)}</td>
             <td>${obs.effectiveDateTime ? templateUtilities.renderTime(obs.effectiveDateTime, timezone) : obs.effectivePeriod ? templateUtilities.renderPeriod(obs.effectivePeriod, timezone) : ""}</td>
-            <td>${templateUtilities.getOwnerTag(obs)}</td>
           </tr>`;
     }
     html += `
@@ -2648,10 +2673,16 @@ var MedicalDevicesTemplate = class _MedicalDevicesTemplate {
       const dateB = b.recordedOn;
       return typeof dateA === "string" && typeof dateB === "string" ? new Date(dateB).getTime() - new Date(dateA).getTime() : 0;
     });
+    let isDeviceAdded = false;
     for (const dus of deviceStatements) {
+      const deviceName = templateUtilities.renderTextAsHtml(templateUtilities.renderDevice(dus.device));
+      if (deviceName?.toLowerCase() === "unknown") {
+        continue;
+      }
+      isDeviceAdded = true;
       html += `
         <tr>
-          <td>${templateUtilities.renderTextAsHtml(templateUtilities.renderDevice(dus.device))}</td>
+          <td>${templateUtilities.capitalizeFirstLetter(deviceName)}</td>
           <td>${templateUtilities.renderTextAsHtml(dus.status || "")}</td>
           <td>${templateUtilities.renderNotes(dus.note, timezone)}</td>
           <td>${templateUtilities.renderTextAsHtml(templateUtilities.renderRecorded(dus.recordedOn, timezone))}</td>
@@ -2660,7 +2691,7 @@ var MedicalDevicesTemplate = class _MedicalDevicesTemplate {
     html += `
         </tbody>
       </table>`;
-    return html;
+    return isDeviceAdded ? html : void 0;
   }
 };
 
@@ -3025,7 +3056,6 @@ var DiagnosticResultsTemplate = class _DiagnosticResultsTemplate {
               <th>Result</th>
               <th>Reference Range</th>
               <th>Date</th>
-              <th>Source</th>
             </tr>
           </thead>
           <tbody>`;
@@ -3039,7 +3069,6 @@ var DiagnosticResultsTemplate = class _DiagnosticResultsTemplate {
               <th>Report</th>
               <th>Performer</th>
               <th>Issued</th>
-              <th>Source</th>
             </tr>
           </thead>
           <tbody>`;
@@ -3086,8 +3115,6 @@ var DiagnosticResultsTemplate = class _DiagnosticResultsTemplate {
               case "Status":
                 data["status"] = templateUtilities.renderTextAsHtml(columnData.text?.div ?? "");
                 break;
-              case "Source":
-                data["source"] = templateUtilities.renderTextAsHtml(columnData.text?.div ?? "");
                 break;
               default:
                 break;
@@ -3113,16 +3140,18 @@ var DiagnosticResultsTemplate = class _DiagnosticResultsTemplate {
             for (const component of components) {
               const componentCode = `${groupName}${component["code"] ?? ""}`;
               if (componentCode && !observationAdded.has(componentCode)) {
+                if (component["code"]?.toLowerCase() === "unknown") {
+                  continue;
+                }
                 observationAdded.add(componentCode);
                 this.formatSummaryObservationData(component);
                 observationhtml += `
                   <tr>
-                    <td>${componentCode}</td>
+                    <td>${templateUtilities.capitalizeFirstLetter(componentCode)}</td>
                     <td></td>
                     <td>${templateUtilities.renderTextAsHtml(component["formattedValue"]) ?? ""}</td>
                     <td>${templateUtilities.renderTextAsHtml(component["referenceRange"])?.trim() ?? ""}</td>
                     <td>${date ?? ""}</td>
-                    <td>${data["source"] ?? ""}</td>
                   </tr>`;
               }
             }
@@ -3130,16 +3159,18 @@ var DiagnosticResultsTemplate = class _DiagnosticResultsTemplate {
             if (obsDate && obsDate >= twoYearsAgo) {
               const code = data["code"] ?? "";
               if (code && !observationAdded.has(code)) {
+                if (code.toLowerCase() === "unknown") {
+                  continue;
+                }
                 observationAdded.add(code);
                 this.formatSummaryObservationData(data);
                 observationhtml += `
                   <tr>
-                    <td>${data["code"] ?? ""}</td>
+                    <td>${templateUtilities.capitalizeFirstLetter(data["code"] ?? "")}</td>
                     <td>${templateUtilities.codeableConceptCoding(sectionCodeableConcept)}</td>
                     <td>${templateUtilities.renderTextAsHtml(data["formattedValue"]) ?? ""}</td>
                     <td>${templateUtilities.renderTextAsHtml(data["referenceRange"])?.trim() ?? ""}</td>
                     <td>${date ?? ""}</td>
-                    <td>${data["source"] ?? ""}</td>
                   </tr>`;
               }
             }
@@ -3152,13 +3183,15 @@ var DiagnosticResultsTemplate = class _DiagnosticResultsTemplate {
           if (data["status"] === "final" && issuedDate && issuedDate >= twoYearsAgo) {
             const reportName = data["report"] ?? "";
             if (reportName && !diagnosticReportAdded.has(reportName)) {
+              if (reportName.toLowerCase() === "unknown") {
+                continue;
+              }
               diagnosticReportAdded.add(reportName);
               diagnosticReporthtml += `
                     <tr>
-                      <td>${data["report"] ?? ""}</td>
+                      <td>${templateUtilities.capitalizeFirstLetter(data["report"] ?? "")}</td>
                       <td>${data["performer"] ?? ""}</td>
                       <td>${templateUtilities.renderTime(data["issued"], timezone) ?? ""}</td>
-                        <td>${data["source"] ?? ""}</td>
                     </tr>`;
             }
           }
@@ -3343,7 +3376,6 @@ var DiagnosticResultsTemplate = class _DiagnosticResultsTemplate {
             <th>Result</th>
             <th>Reference Range</th>
             <th>Date</th>
-            <th>Source</th>
           </tr>
         </thead>
         <tbody>`;
@@ -3352,16 +3384,18 @@ var DiagnosticResultsTemplate = class _DiagnosticResultsTemplate {
       const obsCodeDisplay = templateUtilities.renderTextAsHtml(templateUtilities.codeableConceptDisplay(obs.code));
       const obsCodeAndSystem = templateUtilities.codeableConceptCoding(obs.code);
       if (!observationAdded.has(obsCodeDisplay) && !observationAdded.has(obsCodeAndSystem)) {
+        if (obsCodeDisplay?.toLowerCase() === "unknown") {
+          continue;
+        }
         observationAdded.add(obsCodeDisplay);
         observationAdded.add(obsCodeAndSystem);
         html += `
-          <tr id="${templateUtilities.narrativeLinkId(obs)}">
-            <td>${obsCodeDisplay}</td>
+          <tr>
+            <td>${templateUtilities.capitalizeFirstLetter(obsCodeDisplay)}</td>
             <td>${templateUtilities.codeableConceptCoding(obs.code)}</td>
             <td>${templateUtilities.extractObservationValue(obs)}</td>
             <td>${templateUtilities.concatReferenceRange(obs.referenceRange)}</td>
             <td>${obs.effectiveDateTime ? templateUtilities.renderTime(obs.effectiveDateTime, timezone) : obs.effectivePeriod ? templateUtilities.renderPeriod(obs.effectivePeriod, timezone) : ""}</td>
-            <td>${templateUtilities.getOwnerTag(obs)}</td>
           </tr>`;
       }
     }
@@ -3388,7 +3422,6 @@ var DiagnosticResultsTemplate = class _DiagnosticResultsTemplate {
             <th>Category</th>
             <th>Result</th>
             <th>Issued</th>
-            <th>Source</th>
           </tr>
         </thead>
         <tbody>`;
@@ -3397,6 +3430,9 @@ var DiagnosticResultsTemplate = class _DiagnosticResultsTemplate {
       const reportName = templateUtilities.renderTextAsHtml(templateUtilities.codeableConceptDisplay(report.code));
       const codeAndSystem = templateUtilities.codeableConceptCoding(report.code);
       if (!diagnosticReportAdded.has(reportName) && !diagnosticReportAdded.has(codeAndSystem)) {
+        if (reportName?.toLowerCase() === "unknown") {
+          continue;
+        }
         diagnosticReportAdded.add(reportName);
         diagnosticReportAdded.add(codeAndSystem);
         let resultCount = "";
@@ -3404,13 +3440,12 @@ var DiagnosticResultsTemplate = class _DiagnosticResultsTemplate {
           resultCount = `${report.result.length} result${report.result.length !== 1 ? "s" : ""}`;
         }
         html += `
-          <tr id="${templateUtilities.narrativeLinkId(report)}">
-            <td>${reportName}</td>
+          <tr>
+            <td>${templateUtilities.capitalizeFirstLetter(reportName)}</td>
             <td>${codeAndSystem}</td>
             <td>${templateUtilities.firstFromCodeableConceptList(report.category)}</td>
             <td>${resultCount}</td>
             <td>${report.issued ? templateUtilities.renderTime(report.issued, timezone) : ""}</td>
-            <td>${templateUtilities.getOwnerTag(report)}</td>
           </tr>`;
       }
     }
@@ -3477,7 +3512,6 @@ var HistoryOfProceduresTemplate = class _HistoryOfProceduresTemplate {
               <th>Code (System)</th>
               <th>Performer</th>
               <th>Date</th>
-              <th>Source</th>
             </tr>
           </thead>
           <tbody>`;
@@ -3497,21 +3531,21 @@ var HistoryOfProceduresTemplate = class _HistoryOfProceduresTemplate {
             case "Performed Date":
               data["date"] = columnData.text?.div ?? "";
               break;
-            case "Source":
-              data["source"] = templateUtilities.renderTextAsHtml(columnData.text?.div ?? "");
               break;
             default:
               break;
           }
         }
+        if (data["procedure"]?.toLowerCase() === "unknown") {
+          continue;
+        }
         isSummaryCreated = true;
         html += `
             <tr>
-              <td>${data["procedure"] ?? ""}</td>
+              <td>${templateUtilities.capitalizeFirstLetter(data["procedure"] ?? "")}</td>
                <td>${data["codeSystem"] ?? ""}</td>
               <td>${data["performer"] ?? ""}</td>
               <td>${templateUtilities.renderTime(data["date"], timezone) ?? ""}</td>
-                <td>${data["source"] ?? ""}</td>
             </tr>`;
       }
     }
@@ -3539,19 +3573,21 @@ var HistoryOfProceduresTemplate = class _HistoryOfProceduresTemplate {
             <th>Code (System)</th>
             <th>Comments</th>
             <th>Date</th>
-            <th>Source</th>
           </tr>
         </thead>
         <tbody>`;
     for (const resourceItem of resources) {
       const proc = resourceItem;
+      const procedureName = templateUtilities.codeableConceptDisplay(proc.code, "display");
+      if (procedureName?.toLowerCase() === "unknown") {
+        continue;
+      }
       html += `
         <tr>
-          <td>${templateUtilities.renderTextAsHtml(templateUtilities.codeableConceptDisplay(proc.code, "display"))}</td>
+          <td>${templateUtilities.capitalizeFirstLetter(templateUtilities.renderTextAsHtml(procedureName))}</td>
           <td>${templateUtilities.codeableConceptCoding(proc.code)}</td>
           <td>${templateUtilities.renderNotes(proc.note, timezone)}</td>
           <td>${templateUtilities.renderTime(proc.performedDateTime || proc.performedPeriod?.start, timezone)}</td>
-          <td>${templateUtilities.getOwnerTag(proc)}</td>
         </tr>`;
     }
     html += `
@@ -3598,21 +3634,27 @@ var SocialHistoryTemplate = class _SocialHistoryTemplate {
             <th>Unit</th>
             <th>Comments</th>
             <th>Date</th>
-            <th>Source</th>
           </tr>
         </thead>
         <tbody>`;
+    const addedObservations = /* @__PURE__ */ new Set();
     for (const obs of observations) {
-      html += `
-          <tr>
-            <td>${templateUtilities.renderTextAsHtml(templateUtilities.codeableConceptDisplay(obs.code))}</td>
-            <td>${templateUtilities.codeableConceptCoding(obs.code)}</td>
-            <td>${templateUtilities.extractObservationValue(obs)}</td>
-            <td>${templateUtilities.extractObservationValueUnit(obs)}</td>
-            <td>${templateUtilities.renderNotes(obs.note, timezone)}</td>
-            <td>${obs.effectiveDateTime ? templateUtilities.renderTime(obs.effectiveDateTime, timezone) : obs.effectivePeriod ? templateUtilities.renderPeriod(obs.effectivePeriod, timezone) : ""}</td>
-            <td>${templateUtilities.getOwnerTag(obs)}</td>
-          </tr>`;
+      const obsName = templateUtilities.renderTextAsHtml(templateUtilities.codeableConceptDisplay(obs.code));
+      if (!addedObservations.has(obsName)) {
+        if (obsName?.toLowerCase() === "unknown") {
+          continue;
+        }
+        addedObservations.add(obsName);
+        html += `
+            <tr>
+              <td>${templateUtilities.capitalizeFirstLetter(obsName)}</td>
+              <td>${templateUtilities.codeableConceptCoding(obs.code)}</td>
+              <td>${templateUtilities.extractObservationValue(obs)}</td>
+              <td>${templateUtilities.extractObservationValueUnit(obs)}</td>
+              <td>${templateUtilities.renderNotes(obs.note, timezone)}</td>
+              <td>${obs.effectiveDateTime ? templateUtilities.renderTime(obs.effectiveDateTime, timezone) : obs.effectivePeriod ? templateUtilities.renderPeriod(obs.effectivePeriod, timezone) : ""}</td>
+            </tr>`;
+      }
     }
     html += `
         </tbody>
@@ -3661,7 +3703,6 @@ var PastHistoryOfIllnessTemplate = class {
               <th>Onset Date</th>
               <th>Recorded Date</th>
               <th>Resolved Date</th>
-              <th>Source</th>
             </tr>
           </thead>
           <tbody>`;
@@ -3669,14 +3710,16 @@ var PastHistoryOfIllnessTemplate = class {
     for (const cond of filteredConditions) {
       const conditionCode = templateUtilities.renderTextAsHtml(templateUtilities.codeableConceptDisplay(cond.code));
       if (!addedConditionCodes.has(conditionCode)) {
+        if (conditionCode?.toLowerCase() === "unknown") {
+          continue;
+        }
         addedConditionCodes.add(conditionCode);
         html += `<tr>
-            <td class="Name">${conditionCode}</td>
+            <td class="Name">${templateUtilities.capitalizeFirstLetter(conditionCode)}</td>
             <td class="CodeSystem">${templateUtilities.codeableConceptCoding(cond.code)}</td>
             <td class="OnsetDate">${templateUtilities.renderDate(cond.onsetDateTime)}</td>
             <td class="RecordedDate">${templateUtilities.renderDate(cond.recordedDate)}</td>
             <td class="ResolvedDate">${templateUtilities.renderDate(cond.abatementDateTime)}</td>
-            <td class="Source">${templateUtilities.getOwnerTag(cond)}</td>
           </tr>`;
       }
     }
@@ -3717,19 +3760,21 @@ var PlanOfCareTemplate = class {
             <th>Comments</th>
             <th>Planned Start</th>
             <th>Planned End</th>
-            <th>Source</th>
           </tr>
         </thead>
         <tbody>`;
     for (const cp of carePlans) {
+      const carePlanName = cp.description || cp.title || "";
+      if (carePlanName.toLowerCase() === "unknown") {
+        continue;
+      }
       html += `
-          <tr id="${templateUtilities.narrativeLinkId(cp)}">
-            <td>${cp.description || cp.title || ""}</td>
+          <tr>
+            <td>${templateUtilities.capitalizeFirstLetter(carePlanName)}</td>
             <td>${cp.intent || ""}</td>
             <td>${templateUtilities.concat(cp.note, "text")}</td>
             <td>${cp.period?.start ? templateUtilities.renderTime(cp.period?.start, timezone) : ""}</td>
             <td>${cp.period?.end ? templateUtilities.renderTime(cp.period?.end, timezone) : ""}</td>
-            <td>${templateUtilities.getOwnerTag(cp)}</td>
           </tr>`;
     }
     html += `
@@ -3757,7 +3802,6 @@ var PlanOfCareTemplate = class {
               <th>Created</th>
               <th>Planned Start</th>
               <th>Planned End</th>
-              <th>Source</th>
             </tr>
           </thead>
           <tbody>`;
@@ -3772,14 +3816,16 @@ var PlanOfCareTemplate = class {
         if (data["status"] !== "active") {
           continue;
         }
+        if (data["CarePlan Name"]?.toLowerCase() === "unknown") {
+          continue;
+        }
         isSummaryCreated = true;
         html += `
             <tr>
-              <td>${data["CarePlan Name"] ?? ""}</td>
+              <td>${templateUtilities.capitalizeFirstLetter(data["CarePlan Name"] ?? "")}</td>
               <td>${templateUtilities.renderTime(data["created"], timezone) ?? ""}</td>
               <td>${templateUtilities.renderTime(data["period.start"], timezone) ?? ""}</td>
               <td>${templateUtilities.renderTime(data["period.end"], timezone) ?? ""}</td>
-                <td>${data["source"] ?? ""}</td>
             </tr>`;
       }
     }
@@ -3836,12 +3882,15 @@ var FunctionalStatusTemplate = class _FunctionalStatusTemplate {
       for (const obs of functionalObservations) {
         const observation = obs;
         const obsName = templateUtilities.codeableConceptDisplay(observation.code);
+        if (obsName?.toLowerCase() === "unknown") {
+          continue;
+        }
         const value = templateUtilities.extractObservationValue(observation);
         const date = observation.effectiveDateTime ? templateUtilities.renderDate(observation.effectiveDateTime) : observation.issued ? templateUtilities.renderDate(observation.issued) : "";
         const interpretation = observation.interpretation ? templateUtilities.codeableConceptDisplay(observation.interpretation[0]) : "";
         const comments = observation.comment || observation.note?.map((n) => n.text).join("; ") || "";
-        html += `<tr id="${templateUtilities.narrativeLinkId(observation)}">
-          <td>${obsName}</td>
+        html += `<tr>
+          <td>${templateUtilities.capitalizeFirstLetter(obsName)}</td>
           <td>${value ?? ""}</td>
           <td>${date}</td>
           <td>${interpretation}</td>
@@ -3871,7 +3920,7 @@ var FunctionalStatusTemplate = class _FunctionalStatusTemplate {
           }
           findingsHtml += "</ul>";
         }
-        html += `<tr id="${templateUtilities.narrativeLinkId(impression)}">
+        html += `<tr>
           <td>${formattedDate}</td>
           <td>${impression.status || ""}</td>
           <td>${impression.description || ""}</td>
@@ -3943,18 +3992,19 @@ var PregnancyTemplate = class _PregnancyTemplate {
                   <th>Code (System)</th>
                   <th>Comments</th>
                   <th>Date</th>
-                  <th>Source</th>
                 </tr>
               </thead>
               <tbody>`;
-    function renderRow({ id, result, comments, date, codeSystem, owner }) {
+    function renderRow({ result, comments, date, codeSystem }) {
+      if (result?.toLowerCase() === "unknown") {
+        return;
+      }
       html += `
-                <tr id="${id}">
-                  <td class="Result">${result}</td>
+                <tr>
+                  <td class="Result">${templateUtilities.capitalizeFirstLetter(result)}</td>
                   <td class="CodeSystem">${codeSystem}</td>
                   <td class="Comments">${comments}</td>
                   <td class="Date">${date}</td>
-                  <td class="Source">${owner}</td>
                 </tr>`;
     }
     const rowResources = [];
@@ -3981,9 +4031,9 @@ var PregnancyTemplate = class _PregnancyTemplate {
       if (!b.date) return -1;
       return new Date(b.date).getTime() - new Date(a.date).getTime();
     });
+    const addedRows = /* @__PURE__ */ new Set();
     for (const { resource, date, type } of rowResources) {
       let result = "", comments = "", dateStr = "", codeSystem = "";
-      const id = templateUtilities.narrativeLinkId(resource);
       if (type === "status") {
         result = templateUtilities.renderTextAsHtml(templateUtilities.extractPregnancyStatus(resource));
         comments = templateUtilities.renderNotes(resource.note, timezone);
@@ -4005,8 +4055,11 @@ var PregnancyTemplate = class _PregnancyTemplate {
         dateStr = date ? templateUtilities.renderTextAsHtml(templateUtilities.renderTime(date, timezone)) : "";
         codeSystem = templateUtilities.renderTextAsHtml(templateUtilities.codeableConceptCoding(resource.code));
       }
-      const owner = templateUtilities.getOwnerTag(resource);
-      renderRow({ id, result, comments, date: dateStr, codeSystem, owner });
+      const rowKey = `${result}|${codeSystem}`;
+      if (!addedRows.has(rowKey)) {
+        addedRows.add(rowKey);
+        renderRow({ result, comments, date: dateStr, codeSystem });
+      }
     }
     html += `
               </tbody>
@@ -4052,11 +4105,17 @@ var AdvanceDirectivesTemplate = class _AdvanceDirectivesTemplate {
           </tr>
         </thead>
         <tbody>`;
+    let isConsentAdded = false;
     for (const resourceItem of resources) {
       const consent = resourceItem;
+      const consentScope = templateUtilities.capitalizeFirstLetter(templateUtilities.renderTextAsHtml(templateUtilities.codeableConceptDisplay(consent.scope, "display")));
+      if (!consentScope || consentScope.toLowerCase() === "unknown") {
+        continue;
+      }
+      isConsentAdded = true;
       html += `
         <tr>
-          <td>${templateUtilities.renderTextAsHtml(templateUtilities.codeableConceptDisplay(consent.scope, "display"))}</td>
+          <td>${consentScope}</td>
           <td>${consent.status || ""}</td>
           <td>${consent.provision?.action ? templateUtilities.concatCodeableConcept(consent.provision.action) : ""}</td>
           <td>${consent.dateTime || ""}</td>
@@ -4065,7 +4124,7 @@ var AdvanceDirectivesTemplate = class _AdvanceDirectivesTemplate {
     html += `
         </tbody>
       </table>`;
-    return html;
+    return isConsentAdded ? html : void 0;
   }
 };
 
@@ -4260,6 +4319,10 @@ var ComprehensiveIPSCompositionBuilder = class {
    * @param validResources - Array of domain resources
    */
   addSectionAsync(narrative, sectionType, validResources) {
+    if (sectionType === "Patient" /* PATIENT */) {
+      this.patientSummary = narrative;
+      return this;
+    }
     const sectionEntry = {
       title: IPS_SECTION_DISPLAY_NAMES[sectionType] || sectionType,
       code: {
@@ -4289,26 +4352,24 @@ var ComprehensiveIPSCompositionBuilder = class {
     for (const resource of validResources) {
       this.resources.add(resource);
     }
-    if (sectionType !== "Patient" /* PATIENT */) {
-      let narrative = void 0;
-      if (validResources.length > 0) {
-        narrative = await NarrativeGenerator.generateNarrativeAsync(
-          sectionType,
-          validResources,
-          timezone,
-          true
-        );
-      }
-      if (!narrative && sectionType in IPSMandatorySections) {
-        narrative = await NarrativeGenerator.createNarrativeAsync(
-          IPSMissingMandatorySectionContent[sectionType]
-        );
-      }
-      if (!narrative) {
-        return this;
-      }
-      this.addSectionAsync(narrative, sectionType, validResources);
+    let narrative = void 0;
+    if (validResources.length > 0) {
+      narrative = await NarrativeGenerator.generateNarrativeAsync(
+        sectionType,
+        validResources,
+        timezone,
+        true
+      );
+    }
+    if (!narrative && sectionType in IPSMandatorySections) {
+      narrative = await NarrativeGenerator.createNarrativeAsync(
+        IPSMissingMandatorySectionContent[sectionType]
+      );
     }
+    if (!narrative) {
+      return this;
+    }
+    this.addSectionAsync(narrative, sectionType, validResources);
     return this;
   }
   async makeSectionFromSummaryAsync(sectionType, summaryCompositions, resources, timezone) {
@@ -4346,17 +4407,18 @@ var ComprehensiveIPSCompositionBuilder = class {
    * @param timezone - Optional timezone to use for date formatting
    * @param useSummaryCompositions - Whether to use summary compositions (default: false)
    */
-  async readBundleAsync(bundle, timezone, useSummaryCompositions = false) {
+  async readBundleAsync(bundle, timezone, useSummaryCompositions = false, consoleLogger = console) {
     if (!bundle.entry) {
       return this;
     }
     const patientEntries = [];
     const resources = [];
     bundle.entry.forEach((e) => {
-      if (e.resource?.resourceType === "Patient") {
-        patientEntries.push(e.resource);
-        this.resources.add(e.resource);
-      } else if (e.resource) {
+      if (e.resource) {
+        if (e.resource.resourceType === "Patient") {
+          patientEntries.push(e.resource);
+          this.resources.add(e.resource);
+        }
         resources.push(e.resource);
       }
     });
@@ -4365,20 +4427,20 @@ var ComprehensiveIPSCompositionBuilder = class {
     }
     this.patients = patientEntries;
     for (const sectionType of Object.values(IPSSections)) {
-      if (sectionType === "Patient" /* PATIENT */) {
-        continue;
-      }
       const summaryIPSCompositionFilter = useSummaryCompositions ? IPSSectionResourceHelper.getSummaryIPSCompositionFilterForSection(sectionType) : void 0;
       const sectionIPSSummary = summaryIPSCompositionFilter ? resources.filter((resource) => summaryIPSCompositionFilter(resource)) : [];
       if (sectionIPSSummary.length > 0) {
+        consoleLogger.info(`Using IPS summary composition for section: ${sectionType}`);
         await this.makeSectionFromSummaryAsync(sectionType, sectionIPSSummary, resources, timezone);
         continue;
       }
       const summaryCompositionFilter = useSummaryCompositions ? IPSSectionResourceHelper.getSummaryCompositionFilterForSection(sectionType) : void 0;
       const sectionSummary = summaryCompositionFilter ? resources.filter((resource) => summaryCompositionFilter(resource)) : [];
       if (sectionSummary.length > 0) {
+        consoleLogger.info(`Using summary composition for section: ${sectionType}`);
         await this.makeSectionFromSummaryAsync(sectionType, sectionSummary, resources, timezone);
       } else {
+        consoleLogger.info(`Using individual resources for section: ${sectionType}`);
         const sectionFilter = IPSSectionResourceHelper.getResourceFilterForSection(sectionType);
         const sectionResources = resources.filter((resource) => sectionFilter(resource));
         await this.makeSectionAsync(sectionType, sectionResources, timezone);
@@ -4402,6 +4464,9 @@ var ComprehensiveIPSCompositionBuilder = class {
     if (!this.patients) {
       throw new Error("Patient resource must be set before building the bundle");
     }
+    if (!this.patientSummary) {
+      throw new Error("Patient summary narrative must be set before building the bundle");
+    }
     const primaryPatientId = patientId ?? this.patients[0].id;
     const composition = {
       id: `Composition-${primaryPatientId}`,
@@ -4425,14 +4490,7 @@ var ComprehensiveIPSCompositionBuilder = class {
       date: (now || /* @__PURE__ */ new Date()).toISOString(),
       title: "International Patient Summary",
       section: this.sections,
-      text: await NarrativeGenerator.generateNarrativeAsync(
-        "Patient" /* PATIENT */,
-        this.patients,
-        timezone,
-        true,
-        false,
-        now
-      )
+      text: this.patientSummary
     };
     const bundle = {
       resourceType: "Bundle",