@murphai/murph 1.2.0 → 1.2.3

package/node_modules/@murphai/importers/dist/clinical-records/index.js

@@ -0,0 +1,1523 @@
+import { createHash } from "node:crypto";
+import { readFile, stat } from "node:fs/promises";
+import { CLINICAL_IMPORT_PLAN_MAX_DECISIONS, CLINICAL_RAW_MANIFEST_MAX_BYTES, CLINICAL_RAW_RESOURCE_FILES_MAX_TOTAL_BYTES, CLINICAL_RAW_RESOURCE_FILE_MAX_BYTES, clinicalFacetSlug, clinicalFhirManifestPathSchema, clinicalImportRetractDecisionSchema, clinicalImportPlanSchema, clinicalImportReviewDecisionSchema, clinicalImportUpsertDecisionSchema, clinicalRawManifestSchema, externalRefForFhir, hashClinicalFhirPageUrl, hashClinicalFhirPatientId, hasWholeFamilyClinicalFhirRetrievalScope, isClinicalFhirUrlWithinBase, normalizeClinicalFhirPatientReference, rawRefForClinicalManifestFile, } from "@murphai/clinical-records";
+import { eventImportDecisionSchema, eventImportRetractionDecisionSchema, isWritableIsoDateTime, } from "@murphai/contracts";
+import { resolveVaultPathOnDisk } from "@murphai/core";
+const VITAL_LOINC_BY_CODE = new Map([
+    ["8480-6", { facet: "bp-systolic", metric: "systolic-blood-pressure", title: "Systolic blood pressure", unit: "mmHg" }],
+    ["8462-4", { facet: "bp-diastolic", metric: "diastolic-blood-pressure", title: "Diastolic blood pressure", unit: "mmHg" }],
+    ["8867-4", { facet: "heart-rate", metric: "heart-rate", title: "Heart rate", unit: "bpm" }],
+    ["9279-1", { facet: "respiratory-rate", metric: "respiratory-rate", title: "Respiratory rate", unit: "breaths/min" }],
+    ["59408-5", { facet: "spo2", metric: "spo2", title: "Oxygen saturation", unit: "percent" }],
+    ["8310-5", { facet: "temperature", metric: "temperature", title: "Body temperature", unit: "Cel" }],
+    ["29463-7", { facet: "body-weight", metric: "body-weight", title: "Body weight", unit: "kg" }],
+]);
+const CANONICAL_BASE64_TEXT = /^(?:[A-Za-z0-9+/]{4})*(?:[A-Za-z0-9+/]{2}==|[A-Za-z0-9+/]{3}=)?$/u;
+const DOCUMENT_REFERENCE_TEXT_DECODER = new TextDecoder("utf-8", { fatal: true });
+const NO_KNOWN_ALLERGY_CODES = new Set(["716186003"]);
+const ALLERGY_CONFLICT_RESOURCE_TYPES = new Set(["AllergyIntolerance", "Condition"]);
+const NO_KNOWN_ALLERGY_TEXTS = new Set([
+    "no known allergy",
+    "no known allergy situation",
+    "no known allergies",
+    "no known allergies situation",
+]);
+const FHIR_SYSTEM_ALLERGY_CLINICAL_STATUS = "http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical";
+const FHIR_SYSTEM_ALLERGY_VERIFICATION_STATUS = "http://terminology.hl7.org/CodeSystem/allergyintolerance-verification";
+const FHIR_SYSTEM_LOINC = "http://loinc.org";
+const FHIR_SYSTEM_OBSERVATION_CATEGORY = "http://terminology.hl7.org/CodeSystem/observation-category";
+const FHIR_SYSTEM_OBSERVATION_INTERPRETATION = "http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation";
+const FHIR_SYSTEM_SNOMED_CT = "http://snomed.info/sct";
+const FHIR_SYSTEM_UCUM = "http://unitsofmeasure.org";
+const LABORATORY_CATEGORY_CODES = new Set(["laboratory"]);
+const RESULT_STATUS_NORMAL_CODES = new Set(["n"]);
+const RESULT_STATUS_ABNORMAL_CODES = new Set(["a", "aa", "h", "hh", "l", "ll"]);
+const VITAL_LOINC_CODES = new Set(VITAL_LOINC_BY_CODE.keys());
+const CLINICAL_NOTE_MAX_LENGTH = 4_000;
+const DIAGNOSTIC_SUMMARY_MAX_LENGTH = 1_000;
+const LAB_RESULT_TEXT_MAX_LENGTH = 160;
+const LAB_RESULT_MAX_COUNT = 500;
+const FHIR_VITAL_UNIT_ALIASES_BY_FACET = new Map([
+    ["body-weight", new Map([["[lb_av]", "lb"], ["lb", "lb"]])],
+    ["bp-diastolic", new Map([["mm[hg]", "mmHg"], ["mmhg", "mmHg"]])],
+    ["bp-systolic", new Map([["mm[hg]", "mmHg"], ["mmhg", "mmHg"]])],
+    ["heart-rate", new Map([
+            ["/min", "bpm"],
+            ["beats per minute", "bpm"],
+            ["beats/min", "bpm"],
+            ["beats/minute", "bpm"],
+            ["bpm", "bpm"],
+        ])],
+    ["respiratory-rate", new Map([
+            ["/min", "breaths/min"],
+            ["breaths per minute", "breaths/min"],
+            ["breaths/min", "breaths/min"],
+            ["breaths/minute", "breaths/min"],
+        ])],
+    ["spo2", new Map([["%", "percent"], ["percent", "percent"]])],
+    ["temperature", new Map([["cel", "Cel"]])],
+]);
+const IMPORTABLE_OBSERVATION_STATUSES = new Set(["amended", "corrected", "final"]);
+const IMPORTABLE_DIAGNOSTIC_REPORT_STATUSES = new Set(["amended", "appended", "corrected", "final"]);
+const IMPORTABLE_DOCUMENT_REFERENCE_STATUSES = new Set(["current"]);
+const IMPORTABLE_DOCUMENT_REFERENCE_DOC_STATUSES = new Set(["amended", "appended", "corrected", "final"]);
+const IMPORTABLE_ALLERGY_CLINICAL_STATUS_CODES = new Set(["active"]);
+const IMPORTABLE_ALLERGY_VERIFICATION_STATUS_CODES = new Set(["confirmed"]);
+const RETRACTED_ALLERGY_VERIFICATION_STATUS_CODES = new Set(["entered-in-error", "refuted"]);
+const REVIEW_HOLD_RESOURCE_TYPES = new Set([
+    "DiagnosticReport",
+    "DocumentReference",
+    "Observation",
+]);
+export async function buildClinicalImportPlan(input) {
+    const manifestPath = clinicalFhirManifestPathSchema.parse(input.manifestPath);
+    const manifest = clinicalRawManifestSchema.parse(JSON.parse(await readVaultRelativeText(input.vaultRoot, manifestPath, {
+        maxBytes: CLINICAL_RAW_MANIFEST_MAX_BYTES,
+    })));
+    assertClinicalRawManifestPathIdentity({ manifest, manifestPath });
+    await assertRawResourceFileByteBounds({
+        manifest,
+        manifestPath,
+        vaultRoot: input.vaultRoot,
+    });
+    const pages = [];
+    for (const resourceFile of manifest.resourceFiles) {
+        const rawRef = rawRefForClinicalManifestFile({
+            manifestPath,
+            resourceFile,
+        });
+        pages.push({
+            content: await readVaultRelativeText(input.vaultRoot, rawRef, {
+                maxBytes: CLINICAL_RAW_RESOURCE_FILE_MAX_BYTES,
+            }),
+            relativePath: resourceFile.relativePath,
+        });
+    }
+    return buildClinicalImportPlanFromSnapshot({
+        manifest,
+        manifestPath,
+        pages,
+    });
+}
+export function buildClinicalImportPlanFromSnapshot(input) {
+    const manifestPath = clinicalFhirManifestPathSchema.parse(input.manifestPath);
+    const manifest = clinicalRawManifestSchema.parse(input.manifest);
+    assertClinicalRawManifestPathIdentity({ manifest, manifestPath });
+    const pageContents = indexClinicalImportSnapshotPages({ manifest, pages: input.pages });
+    assertClinicalImportSnapshotPageByteBounds({ manifest, manifestPath, pageContents });
+    const decisions = [];
+    const resourcePages = [];
+    for (const resourceFile of manifest.resourceFiles) {
+        const pageText = pageContents.get(resourceFile.relativePath);
+        if (pageText === undefined) {
+            throw new Error(`Clinical FHIR snapshot is missing ${resourceFile.relativePath}.`);
+        }
+        const page = parseClinicalResourcePage({
+            manifest,
+            manifestPath,
+            pageText,
+            resourceFile,
+        });
+        resourcePages.push(page);
+    }
+    assertResolvedFhirPagination(resourcePages);
+    const resourceContexts = resourcePages.flatMap((page) => page.resources.map((resource) => ({
+        manifest,
+        rawRef: page.rawRef,
+        resource,
+    })));
+    for (const context of resourceContexts) {
+        if (decisions.length >= CLINICAL_IMPORT_PLAN_MAX_DECISIONS) {
+            throw new Error(`Clinical FHIR import plan decision count exceeds ${CLINICAL_IMPORT_PLAN_MAX_DECISIONS}.`);
+        }
+        decisions.push(mapFhirResource(context));
+    }
+    const allergySnapshotDecision = buildAllergySnapshotDecision({
+        manifest,
+        manifestPath,
+        resourceContexts,
+    });
+    if (allergySnapshotDecision) {
+        if (decisions.length >= CLINICAL_IMPORT_PLAN_MAX_DECISIONS) {
+            throw new Error(`Clinical FHIR import plan decision count exceeds ${CLINICAL_IMPORT_PLAN_MAX_DECISIONS}.`);
+        }
+        decisions.push(allergySnapshotDecision);
+    }
+    return clinicalImportPlanSchema.parse({
+        schemaVersion: "murph.clinical-import-plan.v1",
+        source: {
+            kind: "fhir",
+            rawManifestPath: manifestPath,
+            sourceSystem: manifest.sourceSystem,
+            connectionId: manifest.connectionId,
+            retrievalJobId: manifest.retrievalJobId,
+        },
+        decisions,
+    });
+}
+function indexClinicalImportSnapshotPages(input) {
+    if (input.pages.length !== input.manifest.resourceFiles.length) {
+        throw new Error("Clinical FHIR snapshot pages do not match the manifest resource files.");
+    }
+    const pageContents = new Map();
+    for (const page of input.pages) {
+        if (pageContents.has(page.relativePath)) {
+            throw new Error(`Clinical FHIR snapshot has duplicate page content for ${page.relativePath}.`);
+        }
+        pageContents.set(page.relativePath, page.content);
+    }
+    for (const resourceFile of input.manifest.resourceFiles) {
+        if (!pageContents.has(resourceFile.relativePath)) {
+            throw new Error(`Clinical FHIR snapshot is missing ${resourceFile.relativePath}.`);
+        }
+    }
+    return pageContents;
+}
+function assertClinicalRawManifestPathIdentity(input) {
+    const manifestPathParts = input.manifestPath.split("/");
+    if (manifestPathParts[3] !== input.manifest.connectionId
+        || manifestPathParts[4] !== input.manifest.retrievalJobId) {
+        throw new Error("Clinical FHIR raw manifest path does not match manifest identity.");
+    }
+}
+function assertClinicalImportSnapshotPageByteBounds(input) {
+    let totalBytes = 0;
+    for (const resourceFile of input.manifest.resourceFiles) {
+        const rawRef = rawRefForClinicalManifestFile({
+            manifestPath: input.manifestPath,
+            resourceFile,
+        });
+        const content = input.pageContents.get(resourceFile.relativePath);
+        if (content === undefined) {
+            throw new Error(`Clinical FHIR snapshot is missing ${resourceFile.relativePath}.`);
+        }
+        const byteSize = Buffer.byteLength(content, "utf8");
+        if (byteSize > CLINICAL_RAW_RESOURCE_FILE_MAX_BYTES) {
+            throw new Error(`Clinical FHIR raw resource file exceeds ${CLINICAL_RAW_RESOURCE_FILE_MAX_BYTES} bytes for ${rawRef}.`);
+        }
+        totalBytes += byteSize;
+        if (totalBytes > CLINICAL_RAW_RESOURCE_FILES_MAX_TOTAL_BYTES) {
+            throw new Error(`Clinical FHIR raw resource files exceed ${CLINICAL_RAW_RESOURCE_FILES_MAX_TOTAL_BYTES} total bytes.`);
+        }
+    }
+}
+export function clinicalPlanToEventImportDecisions(input) {
+    const plan = clinicalImportPlanSchema.parse(input);
+    return plan.decisions.flatMap((decision) => {
+        if (decision.action !== "review") {
+            return [eventImportDecisionSchema.parse(decision)];
+        }
+        if (!REVIEW_HOLD_RESOURCE_TYPES.has(decision.resourceType)) {
+            return [];
+        }
+        if (!decision.externalRef) {
+            if (decision.resourceId) {
+                throw new Error(`Clinical review for ${decision.resourceType}/${decision.resourceId} has no comparable source revision.`);
+            }
+            return [];
+        }
+        return [eventImportRetractionDecisionSchema.parse({
+                action: "retract",
+                externalRef: decision.externalRef,
+                reason: decision.reason,
+                evidence: decision.evidence,
+            })];
+    });
+}
+function buildAllergySnapshotDecision(input) {
+    if (!hasCompleteAllergyEvidence(input.manifest)
+        || input.resourceContexts.some(({ resource }) => isAllergyEvidenceUncertain(resource))) {
+        return null;
+    }
+    const noKnownAllergyContexts = input.resourceContexts.filter((context) => isAllergyIntolerance(context.resource)
+        && isImportableNoKnownAllergySnapshotEvidence(context.resource));
+    const hasConflict = input.resourceContexts.some(({ resource }) => isAllergyConflictEvidence(resource));
+    const evidence = allergySnapshotEvidence(input);
+    const externalRef = externalRefForFhir({
+        fhirBaseUrlHash: input.manifest.fhirBaseUrlHash,
+        patientIdHash: input.manifest.patientIdHash,
+        sourceSystem: input.manifest.sourceSystem,
+        resourceType: "AllergyEvidenceSummary",
+        resourceId: "global",
+        version: input.manifest.fetchedAt,
+    });
+    const assertionContext = [...noKnownAllergyContexts].sort((left, right) => (readResourceId(left.resource) ?? "").localeCompare(readResourceId(right.resource) ?? "")
+        || left.rawRef.localeCompare(right.rawRef))[0];
+    if (assertionContext && !hasConflict) {
+        const recordedDate = readString(assertionContext.resource.recordedDate);
+        const occurredAt = readIsoDateTime(recordedDate);
+        if (!recordedDate || !occurredAt) {
+            throw new Error("Clinical no-known-allergy snapshot evidence lost its admitted timestamp.");
+        }
+        return clinicalImportUpsertDecisionSchema.parse({
+            action: "upsert",
+            payload: {
+                kind: "clinical_assertion",
+                occurredAt,
+                source: "import",
+                title: "No known allergies",
+                assertion: "no_known_allergies",
+                domain: "allergy",
+                polarity: "absent",
+                subject: "allergies",
+                assertedOn: recordedDate.slice(0, 10),
+                sourceLabel: "FHIR allergy evidence snapshot",
+                evidence,
+                externalRef,
+            },
+        });
+    }
+    return clinicalImportRetractDecisionSchema.parse({
+        action: "retract",
+        externalRef,
+        reason: hasConflict
+            ? "FHIR allergy snapshot conflicts with no-known-allergies"
+            : "FHIR allergy snapshot has no explicit no-known-allergies assertion",
+        evidence,
+    });
+}
+function allergySnapshotEvidence(input) {
+    const resourceEvidence = input.resourceContexts
+        .filter(({ resource }) => ALLERGY_CONFLICT_RESOURCE_TYPES.has(resource.resourceType))
+        .map((context) => evidenceForResource(context, readResourceId(context.resource)))
+        .sort((left, right) => left.rawRef.localeCompare(right.rawRef)
+        || left.sourceLabel.localeCompare(right.sourceLabel));
+    return [
+        { rawRef: input.manifestPath, sourceLabel: "FHIR allergy snapshot manifest" },
+        ...resourceEvidence.slice(0, 49),
+    ];
+}
+function hasCompleteAllergyEvidence(manifest) {
+    const completedResourceTypes = new Set(manifest.completedResourceTypes);
+    return [...ALLERGY_CONFLICT_RESOURCE_TYPES].every((resourceType) => completedResourceTypes.has(resourceType)
+        && hasWholeFamilyClinicalFhirRetrievalScope(manifest, resourceType)
+        && hasGrantedFhirReadScope(manifest, resourceType)
+        && manifest.errors?.some((error) => error.resourceType === undefined || error.resourceType === resourceType) !== true);
+}
+function hasGrantedFhirReadScope(manifest, resourceType) {
+    for (const scopeGroup of manifest.grantedScopes) {
+        for (const scope of scopeGroup.split(/\s+/u)) {
+            const match = /^(?:patient|system|user)\/([^\s.]+)\.([a-z]+)$/u.exec(scope);
+            const scopedResourceType = match?.[1];
+            const permissions = match?.[2];
+            if ((scopedResourceType === "*" || scopedResourceType === resourceType)
+                && (permissions === "read"
+                    || (/^c?r?u?d?s?$/u.test(permissions ?? "") && permissions?.includes("r") === true))) {
+                return true;
+            }
+        }
+    }
+    return false;
+}
+async function assertRawResourceFileByteBounds(input) {
+    let totalBytes = 0;
+    for (const resourceFile of input.manifest.resourceFiles) {
+        const rawRef = rawRefForClinicalManifestFile({
+            manifestPath: input.manifestPath,
+            resourceFile,
+        });
+        const byteSize = await readVaultRelativeFileSize(input.vaultRoot, rawRef);
+        if (byteSize > CLINICAL_RAW_RESOURCE_FILE_MAX_BYTES) {
+            throw new Error(`Clinical FHIR raw resource file exceeds ${CLINICAL_RAW_RESOURCE_FILE_MAX_BYTES} bytes for ${rawRef}.`);
+        }
+        totalBytes += byteSize;
+        if (totalBytes > CLINICAL_RAW_RESOURCE_FILES_MAX_TOTAL_BYTES) {
+            throw new Error(`Clinical FHIR raw resource files exceed ${CLINICAL_RAW_RESOURCE_FILES_MAX_TOTAL_BYTES} total bytes.`);
+        }
+    }
+}
+function parseClinicalResourcePage(input) {
+    const rawRef = rawRefForClinicalManifestFile({
+        manifestPath: input.manifestPath,
+        resourceFile: input.resourceFile,
+    });
+    assertRawResourceFileHash({ rawRef, resourceFile: input.resourceFile, text: input.pageText });
+    const page = JSON.parse(input.pageText);
+    const resources = extractFhirResources(page, {
+        maxResources: input.resourceFile.count,
+        rawRef,
+    });
+    assertRawResourceFileCount({ actualCount: resources.length, rawRef, resourceFile: input.resourceFile });
+    assertDeclaredResourceFamily({ rawRef, resourceFile: input.resourceFile, resources });
+    assertManifestPatientBinding({ manifest: input.manifest, rawRef, resources });
+    const nextPageUrlHash = readFhirNextPageUrlHash({
+        fhirBaseUrlHash: input.manifest.fhirBaseUrlHash,
+        page,
+        rawRef,
+        resourceFile: input.resourceFile,
+    });
+    return {
+        ...(nextPageUrlHash ? { nextPageUrlHash } : {}),
+        rawRef,
+        resourceFile: input.resourceFile,
+        resources,
+    };
+}
+function assertDeclaredResourceFamily(input) {
+    if (input.resources.some((resource) => resource.resourceType !== input.resourceFile.resourceType)) {
+        throw new Error(`Clinical FHIR raw resource does not match declared resource type for ${input.rawRef}.`);
+    }
+}
+function assertManifestPatientBinding(input) {
+    for (const resource of input.resources) {
+        const patientReferences = patientReferencesForResource(resource);
+        if (patientReferences.length === 0) {
+            throw new Error(`Clinical FHIR raw resource is missing its manifest patient reference for ${input.rawRef}.`);
+        }
+        for (const patientReference of patientReferences) {
+            const patientId = resource.resourceType === "Patient"
+                ? patientReference
+                : normalizeClinicalFhirPatientReference({
+                    fhirBaseUrlHash: input.manifest.fhirBaseUrlHash,
+                    reference: patientReference,
+                });
+            if (!patientId) {
+                throw new Error(`Clinical FHIR raw resource has an invalid manifest patient reference for ${input.rawRef}.`);
+            }
+            const patientIdHash = hashClinicalFhirPatientId(patientId);
+            if (patientIdHash !== input.manifest.patientIdHash) {
+                throw new Error(`Clinical FHIR raw resource does not match manifest patient for ${input.rawRef}.`);
+            }
+        }
+    }
+}
+function patientReferencesForResource(resource) {
+    if (resource.resourceType === "Patient") {
+        const patientId = readResourceId(resource);
+        return patientId ? [patientId] : [];
+    }
+    const patientField = resource.resourceType === "AllergyIntolerance" || resource.resourceType === "Immunization"
+        ? "patient"
+        : "subject";
+    if (!isRecord(resource)) {
+        return [];
+    }
+    const record = resource;
+    const expectedReference = readReferenceValue(record[patientField]);
+    if (!expectedReference) {
+        return [];
+    }
+    const alternateField = patientField === "patient" ? "subject" : "patient";
+    const alternateValue = record[alternateField];
+    if (alternateValue === undefined) {
+        return [expectedReference];
+    }
+    const alternateReference = readReferenceValue(alternateValue);
+    return alternateReference ? [expectedReference, alternateReference] : [];
+}
+function readReferenceValue(value) {
+    return isRecord(value) ? readString(value.reference) : undefined;
+}
+function readFhirNextPageUrlHash(input) {
+    let rawNextPageUrlHash;
+    if (isFhirBundle(input.page) && input.page.link !== undefined) {
+        if (!Array.isArray(input.page.link)) {
+            throw new Error(`Clinical FHIR raw Bundle pagination links are invalid for ${input.rawRef}.`);
+        }
+        const nextUrls = new Set();
+        for (const link of input.page.link) {
+            if (readString(link?.relation)?.toLowerCase() !== "next") {
+                continue;
+            }
+            const nextUrl = readString(link.url);
+            if (!nextUrl) {
+                throw new Error(`Clinical FHIR raw Bundle next link is invalid for ${input.rawRef}.`);
+            }
+            nextUrls.add(nextUrl);
+        }
+        if (nextUrls.size > 1) {
+            throw new Error(`Clinical FHIR raw Bundle has ambiguous next links for ${input.rawRef}.`);
+        }
+        const nextUrl = nextUrls.values().next().value;
+        if (nextUrl !== undefined) {
+            if (!isClinicalFhirUrlWithinBase({
+                fhirBaseUrlHash: input.fhirBaseUrlHash,
+                url: nextUrl,
+            })) {
+                throw new Error(`Clinical FHIR raw Bundle next link is outside the manifest FHIR base for ${input.rawRef}.`);
+            }
+            rawNextPageUrlHash = hashClinicalFhirPageUrl(nextUrl);
+        }
+    }
+    const declaredNextPageUrlHash = input.resourceFile.nextPageUrlHash;
+    if (rawNextPageUrlHash
+        && declaredNextPageUrlHash
+        && rawNextPageUrlHash !== declaredNextPageUrlHash) {
+        throw new Error(`Clinical FHIR raw Bundle next link does not match its manifest hash for ${input.rawRef}.`);
+    }
+    return declaredNextPageUrlHash ?? rawNextPageUrlHash;
+}
+function assertResolvedFhirPagination(resourcePages) {
+    const pagesByResourceTypeAndUrl = new Map();
+    for (const page of resourcePages) {
+        const pageUrlHash = page.resourceFile.pageUrlHash;
+        if (!pageUrlHash) {
+            continue;
+        }
+        const pagesByUrl = pagesByResourceTypeAndUrl.get(page.resourceFile.resourceType) ?? new Map();
+        if (pagesByUrl.has(pageUrlHash)) {
+            throw new Error(`Clinical FHIR raw manifest has duplicate page URL hashes for ${page.resourceFile.resourceType}.`);
+        }
+        pagesByUrl.set(pageUrlHash, page);
+        pagesByResourceTypeAndUrl.set(page.resourceFile.resourceType, pagesByUrl);
+    }
+    const nextPageByRawRef = new Map();
+    const targetedRawRefs = new Set();
+    for (const page of resourcePages) {
+        if (!page.nextPageUrlHash) {
+            continue;
+        }
+        const nextPage = pagesByResourceTypeAndUrl
+            .get(page.resourceFile.resourceType)
+            ?.get(page.nextPageUrlHash);
+        if (!nextPage) {
+            throw new Error(`Clinical FHIR raw manifest has unresolved pagination for ${page.rawRef}.`);
+        }
+        nextPageByRawRef.set(page.rawRef, nextPage);
+        targetedRawRefs.add(nextPage.rawRef);
+    }
+    for (const page of resourcePages) {
+        if (page.resourceFile.pageUrlHash && !targetedRawRefs.has(page.rawRef)) {
+            throw new Error(`Clinical FHIR raw manifest has unreachable pagination for ${page.rawRef}.`);
+        }
+    }
+    for (const page of resourcePages) {
+        const seenRawRefs = new Set();
+        let currentPage = page;
+        while (currentPage) {
+            if (seenRawRefs.has(currentPage.rawRef)) {
+                throw new Error(`Clinical FHIR raw manifest has cyclic pagination for ${currentPage.rawRef}.`);
+            }
+            seenRawRefs.add(currentPage.rawRef);
+            currentPage = nextPageByRawRef.get(currentPage.rawRef);
+        }
+    }
+}
+async function readVaultRelativeText(vaultRoot, relativePath, options) {
+    const { absolutePath } = await resolveVaultPathOnDisk(vaultRoot, relativePath);
+    if (options?.maxBytes !== undefined) {
+        const byteSize = (await stat(absolutePath)).size;
+        if (byteSize > options.maxBytes) {
+            throw new Error(`Clinical FHIR raw file exceeds ${options.maxBytes} bytes for ${relativePath}.`);
+        }
+    }
+    return readFile(absolutePath, "utf8");
+}
+async function readVaultRelativeFileSize(vaultRoot, relativePath) {
+    const { absolutePath } = await resolveVaultPathOnDisk(vaultRoot, relativePath);
+    const fileStat = await stat(absolutePath);
+    return fileStat.size;
+}
+function assertRawResourceFileHash(input) {
+    const actualSha256 = sha256Hex(input.text);
+    if (actualSha256 !== input.resourceFile.sha256) {
+        throw new Error(`Clinical FHIR raw resource file hash mismatch for ${input.rawRef}.`);
+    }
+}
+function assertRawResourceFileCount(input) {
+    if (input.actualCount !== input.resourceFile.count) {
+        throw new Error(`Clinical FHIR raw resource count mismatch for ${input.rawRef}.`);
+    }
+}
+function sha256Hex(value) {
+    return createHash("sha256").update(value, "utf8").digest("hex");
+}
+function mapFhirResource(context) {
+    if (hasMalformedFhirContained(context.resource)) {
+        return reviewOnly(context, "FHIR contained resources are invalid");
+    }
+    if (hasUnsupportedFhirModifier(context.resource)) {
+        return reviewOnly(context, "FHIR modifier semantics are not importable");
+    }
+    if ((isObservation(context.resource)
+        || isDiagnosticReport(context.resource)
+        || isDocumentReference(context.resource)
+        || isAllergyIntolerance(context.resource))
+        && !readResourceUpdatedAt(context.resource)) {
+        return reviewOnly(context, "FHIR resource lastUpdated is missing");
+    }
+    const retractionReason = authoritativeRetractionReason(context.resource);
+    if (retractionReason) {
+        const resourceId = readResourceId(context.resource);
+        return resourceId
+            ? retractionDecision(context, resourceId, retractionReason)
+            : reviewOnly(context, "FHIR resource id is missing");
+    }
+    if (isObservation(context.resource)) {
+        return mapObservation(resourceContext(context, context.resource));
+    }
+    if (isDiagnosticReport(context.resource)) {
+        return mapDiagnosticReport(resourceContext(context, context.resource));
+    }
+    if (isDocumentReference(context.resource)) {
+        return mapDocumentReference(resourceContext(context, context.resource));
+    }
+    if (isAllergyIntolerance(context.resource)) {
+        return mapAllergyIntolerance(resourceContext(context, context.resource));
+    }
+    switch (readString(context.resource.resourceType)) {
+        case "Condition":
+            return reviewOnly(context, "condition registry import not implemented");
+        case "MedicationRequest":
+        case "MedicationStatement":
+            return reviewOnly(context, "medication history import not implemented");
+        case "Encounter":
+            return reviewOnly(context, "externalRef-idempotent encounter import not implemented");
+        case "Procedure":
+            return reviewOnly(context, "procedure import not implemented");
+        case "Immunization":
+            return reviewOnly(context, "externalRef-idempotent immunization import not implemented");
+        default:
+            return reviewOnly(context, "FHIR resource type is raw evidence only in v1");
+    }
+}
+function resourceContext(context, resource) {
+    return {
+        manifest: context.manifest,
+        rawRef: context.rawRef,
+        resource,
+    };
+}
+function reviewOnly(context, reason) {
+    const resourceId = readResourceId(context.resource);
+    const externalRef = resourceId && readResourceUpdatedAt(context.resource)
+        ? externalRefForResource(context, context.resource.resourceType, resourceId)
+        : undefined;
+    return clinicalImportReviewDecisionSchema.parse({
+        action: "review",
+        resourceType: context.resource.resourceType,
+        resourceId,
+        ...(externalRef ? { externalRef } : {}),
+        reason,
+        evidence: [evidenceForResource(context, resourceId)],
+    });
+}
+function upsertOrReview(context, payload, reviewReason) {
+    const parsedDecision = clinicalImportUpsertDecisionSchema.safeParse({ action: "upsert", payload });
+    if (!parsedDecision.success) {
+        return reviewOnly(context, reviewReason);
+    }
+    return parsedDecision.data;
+}
+function retractionDecision(context, resourceId, reason) {
+    return clinicalImportRetractDecisionSchema.parse({
+        action: "retract",
+        externalRef: externalRefForResource(context, context.resource.resourceType, resourceId),
+        reason,
+        evidence: [evidenceForResource(context, resourceId)],
+    });
+}
+function authoritativeRetractionReason(resource) {
+    if (isObservation(resource) || isDiagnosticReport(resource)) {
+        const status = readString(resource.status)?.toLowerCase();
+        if (status === "cancelled" || status === "entered-in-error") {
+            return `FHIR ${resource.resourceType} status ${status}`;
+        }
+    }
+    if (isDocumentReference(resource)) {
+        const status = readString(resource.status)?.toLowerCase();
+        const docStatus = readString(resource.docStatus)?.toLowerCase();
+        if (status === "entered-in-error" || status === "superseded") {
+            return `FHIR DocumentReference status ${status}`;
+        }
+        if (docStatus === "entered-in-error") {
+            return "FHIR DocumentReference docStatus entered-in-error";
+        }
+    }
+    return null;
+}
+function mapObservation(context) {
+    const resourceId = readResourceId(context.resource);
+    if (!resourceId) {
+        return reviewOnly(context, "FHIR resource id is missing");
+    }
+    if (!hasImportableStatus(context.resource.status, IMPORTABLE_OBSERVATION_STATUSES)) {
+        return reviewOnly(context, "observation status is not importable");
+    }
+    const occurredAt = readClinicalOccurredAt(context.resource);
+    if (isLaboratoryObservation(context.resource)) {
+        return mapLaboratoryObservation(context, resourceId);
+    }
+    const components = readFhirArray(context.resource.component);
+    const emittedVitalFacets = new Set();
+    const vitalMeasurements = [];
+    let hasUnmatchedVitalComponent = false;
+    for (const component of components) {
+        const vitalDecision = vitalDecisionForCodeableConcept(component.code);
+        if (vitalDecision.status === "ambiguous") {
+            return reviewOnly(context, "vital code is ambiguous");
+        }
+        const vital = vitalDecision.status === "matched" ? vitalDecision.vital : null;
+        if (!vital && codeableConceptHasCodeWithUnexpectedSystem(component.code, FHIR_SYSTEM_LOINC, VITAL_LOINC_CODES)) {
+            return reviewOnly(context, "vital coding system is not importable");
+        }
+        if (!vital) {
+            hasUnmatchedVitalComponent = true;
+            continue;
+        }
+        if (!hasOnlyFhirValue(component, "valueQuantity")) {
+            return reviewOnly(context, "vital quantity is not importable");
+        }
+        const value = readQuantityValue(component.valueQuantity);
+        if (!value) {
+            return reviewOnly(context, "vital quantity is not importable");
+        }
+        if (!occurredAt) {
+            return reviewOnly(context, "clinical timestamp is missing");
+        }
+        if (value.comparator) {
+            return reviewOnly(context, "vital quantity comparator is not importable");
+        }
+        const unit = normalizeVitalUnit(value, vital);
+        if (!unit) {
+            return reviewOnly(context, "vital quantity unit is not importable");
+        }
+        if (emittedVitalFacets.has(vital.facet)) {
+            return reviewOnly(context, "duplicate vital facet in FHIR observation");
+        }
+        emittedVitalFacets.add(vital.facet);
+        vitalMeasurements.push({
+            metric: vital.metric,
+            unit,
+            value: value.value,
+        });
+    }
+    if (vitalMeasurements.length > 0) {
+        if (hasUnmatchedVitalComponent) {
+            return reviewOnly(context, "vital component code is not importable");
+        }
+        if (hasOwnFhirValue(context.resource)) {
+            return reviewOnly(context, "vital observation mixes component and top-level values");
+        }
+        if (!occurredAt) {
+            return reviewOnly(context, "clinical timestamp is missing");
+        }
+        return upsertOrReview(context, buildVitalsPayload(context, {
+            occurredAt,
+            resourceId,
+            title: textForCodeableConcept(context.resource.code) ?? "FHIR vitals",
+            measurements: vitalMeasurements,
+        }), "clinical upsert exceeds supported import bounds");
+    }
+    const vitalDecision = vitalDecisionForCodeableConcept(context.resource.code);
+    if (vitalDecision.status === "ambiguous") {
+        return reviewOnly(context, "vital code is ambiguous");
+    }
+    const vital = vitalDecision.status === "matched" ? vitalDecision.vital : null;
+    if (!vital && codeableConceptHasCodeWithUnexpectedSystem(context.resource.code, FHIR_SYSTEM_LOINC, VITAL_LOINC_CODES)) {
+        return reviewOnly(context, "vital coding system is not importable");
+    }
+    if (vital && components.length > 0) {
+        return reviewOnly(context, "vital component code is not importable");
+    }
+    if (vital && !hasOnlyFhirValue(context.resource, "valueQuantity")) {
+        return reviewOnly(context, "vital quantity is not importable");
+    }
+    const quantity = readQuantityValue(context.resource.valueQuantity);
+    if (vital && !quantity) {
+        return reviewOnly(context, "vital quantity is not importable");
+    }
+    if (vital && quantity) {
+        if (!occurredAt) {
+            return reviewOnly(context, "clinical timestamp is missing");
+        }
+        if (quantity.comparator) {
+            return reviewOnly(context, "vital quantity comparator is not importable");
+        }
+        const unit = normalizeVitalUnit(quantity, vital);
+        if (!unit) {
+            return reviewOnly(context, "vital quantity unit is not importable");
+        }
+        return upsertOrReview(context, buildVitalsPayload(context, {
+            occurredAt,
+            resourceId,
+            title: vital.title,
+            measurements: [{
+                    metric: vital.metric,
+                    unit,
+                    value: quantity.value,
+                }],
+        }), "clinical upsert exceeds supported import bounds");
+    }
+    return reviewOnly(context, "observation code is not importable");
+}
+function mapLaboratoryObservation(context, resourceId) {
+    const occurredAt = readClinicalOccurredAt(context.resource);
+    const components = readFhirArray(context.resource.component);
+    const results = [];
+    for (const component of components) {
+        const componentInterpretation = resultInterpretationFromInterpretation(component.interpretation);
+        if (componentInterpretation.status === "ambiguous") {
+            return reviewOnly(context, "clinical result interpretation is ambiguous");
+        }
+        const componentResult = buildBloodTestResult(component, componentInterpretation.flag);
+        if (!componentResult) {
+            return reviewOnly(context, "laboratory observation component result is not importable");
+        }
+        results.push(componentResult);
+    }
+    const topLevelInterpretation = resultInterpretationFromInterpretation(context.resource.interpretation);
+    if (topLevelInterpretation.status === "ambiguous") {
+        return reviewOnly(context, "clinical result interpretation is ambiguous");
+    }
+    const singleResult = buildBloodTestResult(context.resource, topLevelInterpretation.flag);
+    if (singleResult) {
+        results.unshift(singleResult);
+    }
+    else if (hasOwnFhirValue(context.resource)) {
+        return reviewOnly(context, "laboratory observation result is not importable");
+    }
+    if (results.length === 0) {
+        return reviewOnly(context, "laboratory observation result is not importable");
+    }
+    if (results.length > LAB_RESULT_MAX_COUNT) {
+        return reviewOnly(context, "laboratory observation result count exceeds supported import bounds");
+    }
+    if (!occurredAt) {
+        return reviewOnly(context, "clinical timestamp is missing");
+    }
+    const testName = textForCodeableConcept(context.resource.code) ?? "FHIR laboratory observation";
+    const emittedResultStatus = resultStatusFromBloodTestResults(results);
+    if (topLevelInterpretation.status !== "unknown"
+        && emittedResultStatus !== "unknown"
+        && topLevelInterpretation.status !== emittedResultStatus) {
+        return reviewOnly(context, "clinical result interpretation is ambiguous");
+    }
+    let resultStatus = emittedResultStatus;
+    if (topLevelInterpretation.status === "abnormal" && emittedResultStatus === "unknown") {
+        resultStatus = "abnormal";
+    }
+    return upsertOrReview(context, {
+        kind: "test",
+        occurredAt,
+        source: "import",
+        title: testName,
+        testName,
+        resultStatus,
+        testCategory: "laboratory",
+        collectedAt: occurredAt,
+        reportedAt: readIsoDateTime(context.resource.issued),
+        results,
+        evidence: [evidenceForResource(context, resourceId)],
+        externalRef: externalRefForResource(context, "Observation", resourceId),
+    }, "clinical upsert exceeds supported import bounds");
+}
+function mapDiagnosticReport(context) {
+    const resourceId = readResourceId(context.resource);
+    if (!resourceId) {
+        return reviewOnly(context, "FHIR resource id is missing");
+    }
+    if (!hasImportableStatus(context.resource.status, IMPORTABLE_DIAGNOSTIC_REPORT_STATUSES)) {
+        return reviewOnly(context, "diagnostic report status is not importable");
+    }
+    const occurredAt = readClinicalOccurredAt(context.resource);
+    const testName = textForCodeableConcept(context.resource.code) ?? "FHIR diagnostic report";
+    const conclusion = readText(context.resource.conclusion);
+    const narrativeText = textFromNarrative(context.resource.text);
+    if (conclusion || narrativeText) {
+        if (!occurredAt) {
+            return reviewOnly(context, "clinical timestamp is missing");
+        }
+        const summary = conclusion ?? narrativeText ?? "";
+        if (summary.length > DIAGNOSTIC_SUMMARY_MAX_LENGTH) {
+            return reviewOnly(context, "diagnostic report summary exceeds supported import bounds");
+        }
+        const resultInterpretation = resultInterpretationFromInterpretation(context.resource.conclusionCode);
+        if (resultInterpretation.status === "ambiguous") {
+            return reviewOnly(context, "clinical result interpretation is ambiguous");
+        }
+        const resultStatus = resultInterpretation.status;
+        return upsertOrReview(context, {
+            kind: "test",
+            occurredAt,
+            source: "import",
+            title: testName,
+            testName,
+            resultStatus,
+            summary,
+            testCategory: "diagnostic-report",
+            reportedAt: readIsoDateTime(context.resource.issued),
+            evidence: [evidenceForResource(context, resourceId)],
+            externalRef: externalRefForResource(context, "DiagnosticReport", resourceId),
+        }, "clinical upsert exceeds supported import bounds");
+    }
+    return reviewOnly(context, "diagnostic report summary is not available in raw FHIR page");
+}
+function mapDocumentReference(context) {
+    const resourceId = readResourceId(context.resource);
+    if (!resourceId) {
+        return reviewOnly(context, "FHIR resource id is missing");
+    }
+    if (!hasImportableStatus(context.resource.status, IMPORTABLE_DOCUMENT_REFERENCE_STATUSES)) {
+        return reviewOnly(context, "document reference status is not importable");
+    }
+    if (!hasImportableOptionalStatus(context.resource.docStatus, IMPORTABLE_DOCUMENT_REFERENCE_DOC_STATUSES)) {
+        return reviewOnly(context, "document reference docStatus is not importable");
+    }
+    const noteDecision = decideDocumentReferenceText(context.resource);
+    if (noteDecision.status === "ambiguous") {
+        return reviewOnly(context, "document reference has multiple inline text attachments");
+    }
+    if (noteDecision.status === "unavailable") {
+        return reviewOnly(context, "document reference text is not available in raw FHIR page");
+    }
+    const note = noteDecision.text;
+    if (note.length > CLINICAL_NOTE_MAX_LENGTH) {
+        return reviewOnly(context, "document reference text exceeds supported import bounds");
+    }
+    const occurredAt = readClinicalOccurredAt(context.resource);
+    if (!occurredAt) {
+        return reviewOnly(context, "clinical timestamp is missing");
+    }
+    const title = readText(context.resource.description)
+        ?? textForCodeableConcept(context.resource.type)
+        ?? "FHIR document reference";
+    return upsertOrReview(context, {
+        kind: "note",
+        occurredAt,
+        source: "import",
+        title,
+        note,
+        noteType: "fhir_document_reference",
+        authoredAt: readIsoDateTime(context.resource.date),
+        evidence: [evidenceForResource(context, resourceId)],
+        externalRef: externalRefForResource(context, "DocumentReference", resourceId),
+    }, "clinical upsert exceeds supported import bounds");
+}
+function mapAllergyIntolerance(context) {
+    const resourceId = readResourceId(context.resource);
+    if (!resourceId) {
+        return reviewOnly(context, "FHIR resource id is missing");
+    }
+    if (codeableConceptHasCodeWithUnexpectedSystem(context.resource.code, FHIR_SYSTEM_SNOMED_CT, NO_KNOWN_ALLERGY_CODES)) {
+        return reviewOnly(context, "no-known allergy code system is not importable");
+    }
+    if (hasTrustedNoKnownAllergyCode(context.resource) && !isNoKnownAllergy(context.resource)) {
+        return reviewOnly(context, "no-known allergy code is ambiguous");
+    }
+    if (!isNoKnownAllergy(context.resource)) {
+        return reviewOnly(context, "allergy registry import not implemented");
+    }
+    if (!hasImportableAllergyStatus(context.resource)) {
+        return reviewOnly(context, "allergy status is not importable");
+    }
+    if (!isImportableGlobalNoKnownAllergyAssertion(context.resource)) {
+        return reviewOnly(context, "no-known allergy conflicts with allergy evidence");
+    }
+    const recordedDate = readString(context.resource.recordedDate);
+    if (!recordedDate || !readIsoDateTime(recordedDate)) {
+        return reviewOnly(context, "clinical timestamp is missing");
+    }
+    return reviewOnly(context, "no-known allergy evidence is resolved at snapshot scope");
+}
+function buildVitalsPayload(context, input) {
+    return {
+        kind: "measurement",
+        occurredAt: input.occurredAt,
+        source: "import",
+        title: input.title,
+        measurements: input.measurements,
+        evidence: [evidenceForResource(context, input.resourceId)],
+        externalRef: externalRefForResource(context, "Observation", input.resourceId),
+    };
+}
+function normalizeVitalUnit(quantity, vital) {
+    if (quantity.system !== undefined && quantity.system !== FHIR_SYSTEM_UCUM) {
+        return null;
+    }
+    if (quantity.unitSource === "code" && quantity.system !== FHIR_SYSTEM_UCUM) {
+        return null;
+    }
+    const trimmedUnit = quantity.unit?.trim();
+    if (!trimmedUnit) {
+        return null;
+    }
+    const alias = FHIR_VITAL_UNIT_ALIASES_BY_FACET.get(vital.facet)?.get(trimmedUnit.toLowerCase());
+    const unit = alias ?? trimmedUnit;
+    return unit === vital.unit || alias !== undefined ? unit : null;
+}
+function buildBloodTestResult(resource, flag) {
+    if (fhirValueKeys(resource).length !== 1) {
+        return null;
+    }
+    const analyte = textForCodeableConcept(resource.code);
+    if (!analyte || analyte.length > LAB_RESULT_TEXT_MAX_LENGTH) {
+        return null;
+    }
+    const quantity = readQuantityValue(resource.valueQuantity);
+    const slugFields = clinicalSlugFields(analyte);
+    if (quantity) {
+        return {
+            analyte,
+            ...slugFields,
+            comparator: quantity.comparator,
+            ...(flag ? { flag } : {}),
+            unit: quantity.unit,
+            value: quantity.value,
+        };
+    }
+    const textValue = readObservationTextValue(resource);
+    if (textValue) {
+        if (textValue.length > LAB_RESULT_TEXT_MAX_LENGTH) {
+            return null;
+        }
+        return {
+            analyte,
+            ...slugFields,
+            ...(flag ? { flag } : {}),
+            textValue,
+        };
+    }
+    return null;
+}
+function clinicalSlugFields(value) {
+    const slug = clinicalFacetSlug(value);
+    if (!slug) {
+        return {};
+    }
+    return { biomarkerSlug: slug, slug };
+}
+function externalRefForResource(context, resourceType, resourceId) {
+    const version = readResourceUpdatedAt(context.resource);
+    if (!version) {
+        throw new Error("Clinical FHIR source revision is missing after admission.");
+    }
+    return externalRefForFhir({
+        fhirBaseUrlHash: context.manifest.fhirBaseUrlHash,
+        patientIdHash: context.manifest.patientIdHash,
+        sourceSystem: context.manifest.sourceSystem,
+        resourceType,
+        resourceId,
+        version,
+    });
+}
+function evidenceForResource(context, resourceId) {
+    const resourceType = readString(context.resource.resourceType) ?? "FHIR";
+    return {
+        rawRef: context.rawRef,
+        sourceLabel: resourceId ? `${resourceType}/${resourceId}` : resourceType,
+    };
+}
+function extractFhirResources(value, input) {
+    const resources = [];
+    const appendResource = (resource) => {
+        if (!isFhirResource(resource)) {
+            throw new Error(`Clinical FHIR raw page contains an invalid resource for ${input.rawRef}.`);
+        }
+        resources.push(resource);
+        if (resources.length > input.maxResources) {
+            throw new Error(`Clinical FHIR raw resource count exceeds declared count for ${input.rawRef}.`);
+        }
+    };
+    if (Array.isArray(value)) {
+        for (const resource of value) {
+            appendResource(resource);
+        }
+        return resources;
+    }
+    if (isFhirResource(value) && !isFhirBundle(value)) {
+        appendResource(value);
+        return resources;
+    }
+    if (!isFhirBundle(value)) {
+        throw new Error(`Clinical FHIR raw page has an invalid shape for ${input.rawRef}.`);
+    }
+    if (hasUnsupportedFhirBundleEnvelopeModifier(value)) {
+        throw new Error(`Clinical FHIR raw Bundle has unsupported modifier semantics for ${input.rawRef}.`);
+    }
+    if (value.entry === undefined) {
+        return resources;
+    }
+    if (!Array.isArray(value.entry)) {
+        throw new Error(`Clinical FHIR raw Bundle entries are invalid for ${input.rawRef}.`);
+    }
+    for (const entry of value.entry) {
+        appendResource(isRecord(entry) ? entry.resource : undefined);
+    }
+    return resources;
+}
+function vitalDecisionForCodeableConcept(value) {
+    const vitalDefinitionsByFacet = new Map();
+    for (const coding of codingsForCodeableConcept(value)) {
+        const code = coding.code?.toLowerCase();
+        const vital = coding.system === FHIR_SYSTEM_LOINC && code ? VITAL_LOINC_BY_CODE.get(code) : undefined;
+        if (vital) {
+            vitalDefinitionsByFacet.set(vital.facet, vital);
+        }
+    }
+    if (vitalDefinitionsByFacet.size === 0) {
+        return { status: "unmatched" };
+    }
+    if (vitalDefinitionsByFacet.size > 1) {
+        return { status: "ambiguous" };
+    }
+    const vital = vitalDefinitionsByFacet.values().next().value;
+    return vital === undefined ? { status: "unmatched" } : { status: "matched", vital };
+}
+function isLaboratoryObservation(resource) {
+    return readFhirArray(resource.category).some((category) => codeableConceptHasSystemCode(category, FHIR_SYSTEM_OBSERVATION_CATEGORY, LABORATORY_CATEGORY_CODES));
+}
+function isNoKnownAllergy(resource) {
+    return hasTrustedNoKnownAllergyCode(resource) && isUnambiguousNoKnownAllergy(resource);
+}
+function isImportableGlobalNoKnownAllergyAssertion(resource) {
+    return (isNoKnownAllergy(resource)
+        && hasImportableAllergyStatus(resource)
+        && !hasScopedOrContradictoryAllergyDetail(resource));
+}
+function isImportableNoKnownAllergySnapshotEvidence(resource) {
+    const recordedDate = readString(resource.recordedDate);
+    return isImportableGlobalNoKnownAllergyAssertion(resource)
+        && readResourceId(resource) !== undefined
+        && readResourceUpdatedAt(resource) !== undefined
+        && recordedDate !== undefined
+        && readIsoDateTime(recordedDate) !== undefined;
+}
+function isRetractedNoKnownAllergy(resource) {
+    return isNoKnownAllergy(resource)
+        && codeableConceptHasOnlyImportableCodings(resource.verificationStatus, FHIR_SYSTEM_ALLERGY_VERIFICATION_STATUS, RETRACTED_ALLERGY_VERIFICATION_STATUS_CODES);
+}
+function hasTrustedNoKnownAllergyCode(resource) {
+    return codeableConceptHasSystemCode(resource.code, FHIR_SYSTEM_SNOMED_CT, NO_KNOWN_ALLERGY_CODES);
+}
+function isUnambiguousNoKnownAllergy(resource) {
+    for (const coding of codingsForCodeableConcept(resource.code)) {
+        const code = coding.code?.toLowerCase();
+        if (coding.system !== FHIR_SYSTEM_SNOMED_CT || code === undefined || !NO_KNOWN_ALLERGY_CODES.has(code)) {
+            return false;
+        }
+        if (!isNoKnownAllergyConceptText(coding.display)) {
+            return false;
+        }
+    }
+    return isNoKnownAllergyConceptText(resource.code?.text);
+}
+function isAllergyEvidenceUncertain(resource) {
+    if (hasMalformedFhirContained(resource)) {
+        return true;
+    }
+    if (isRecord(resource)
+        && Object.hasOwn(resource, "contained")
+        && readUnknownArray(resource.contained).length > 0) {
+        return true;
+    }
+    if (!ALLERGY_CONFLICT_RESOURCE_TYPES.has(resource.resourceType)) {
+        return false;
+    }
+    if (hasUnsupportedFhirModifier(resource)) {
+        return true;
+    }
+    if (!isAllergyIntolerance(resource)) {
+        return false;
+    }
+    if (codeableConceptHasCodeWithUnexpectedSystem(resource.code, FHIR_SYSTEM_SNOMED_CT, NO_KNOWN_ALLERGY_CODES)
+        || (hasTrustedNoKnownAllergyCode(resource) && !isNoKnownAllergy(resource))) {
+        return true;
+    }
+    if (isNoKnownAllergy(resource) && !isRetractedNoKnownAllergy(resource)) {
+        return !isImportableNoKnownAllergySnapshotEvidence(resource);
+    }
+    return false;
+}
+function isAllergyConflictEvidence(resource) {
+    if (!ALLERGY_CONFLICT_RESOURCE_TYPES.has(resource.resourceType)
+        || isAllergyEvidenceUncertain(resource)) {
+        return false;
+    }
+    if (isAllergyIntolerance(resource)) {
+        return !isImportableGlobalNoKnownAllergyAssertion(resource);
+    }
+    return resource.resourceType === "Condition";
+}
+function hasMalformedFhirContained(resource) {
+    if (!isRecord(resource) || !Object.hasOwn(resource, "contained")) {
+        return false;
+    }
+    return !Array.isArray(resource.contained) || resource.contained.some((contained) => !isRecord(contained)
+        || typeof contained.resourceType !== "string"
+        || contained.resourceType !== contained.resourceType.trim()
+        || !/^[A-Z][A-Za-z0-9]+$/u.test(contained.resourceType));
+}
+function hasUnsupportedFhirModifier(value) {
+    const pending = [value];
+    while (pending.length > 0) {
+        const current = pending.pop();
+        if (Array.isArray(current)) {
+            for (const nested of current) {
+                pending.push(nested);
+            }
+            continue;
+        }
+        if (!isRecord(current)) {
+            continue;
+        }
+        if (hasUnsupportedFhirModifierFields(current)) {
+            return true;
+        }
+        for (const nested of Object.values(current)) {
+            pending.push(nested);
+        }
+    }
+    return false;
+}
+function hasUnsupportedFhirBundleEnvelopeModifier(bundle) {
+    const pending = [bundle];
+    while (pending.length > 0) {
+        const current = pending.pop();
+        if (Array.isArray(current)) {
+            for (const nested of current) {
+                pending.push(nested);
+            }
+            continue;
+        }
+        if (!isRecord(current)) {
+            continue;
+        }
+        if (hasUnsupportedFhirModifierFields(current)) {
+            return true;
+        }
+        for (const [key, nested] of Object.entries(current)) {
+            if (key !== "resource") {
+                pending.push(nested);
+            }
+        }
+    }
+    return false;
+}
+function hasUnsupportedFhirModifierFields(value) {
+    if (Object.hasOwn(value, "implicitRules")) {
+        return true;
+    }
+    if (!Object.hasOwn(value, "modifierExtension")) {
+        return false;
+    }
+    return !Array.isArray(value.modifierExtension) || value.modifierExtension.length > 0;
+}
+function isNoKnownAllergyConceptText(value) {
+    if (value === undefined) {
+        return true;
+    }
+    return NO_KNOWN_ALLERGY_TEXTS.has(value.trim().toLowerCase().replace(/[^a-z0-9]+/g, " ").trim());
+}
+function hasImportableAllergyStatus(resource) {
+    return (codeableConceptHasOnlyImportableCodings(resource.clinicalStatus, FHIR_SYSTEM_ALLERGY_CLINICAL_STATUS, IMPORTABLE_ALLERGY_CLINICAL_STATUS_CODES)
+        && codeableConceptHasOnlyImportableCodings(resource.verificationStatus, FHIR_SYSTEM_ALLERGY_VERIFICATION_STATUS, IMPORTABLE_ALLERGY_VERIFICATION_STATUS_CODES));
+}
+function hasScopedOrContradictoryAllergyDetail(resource) {
+    return (hasFhirArrayContentOrInvalidShape(resource.category)
+        || hasFhirArrayContentOrInvalidShape(resource.reaction)
+        || hasFhirArrayContentOrInvalidShape(resource.note)
+        || resource.lastOccurrence !== undefined
+        || Object.keys(resource).some((key) => key.startsWith("onset")));
+}
+function hasImportableStatus(value, importableStatuses) {
+    const status = readString(value)?.toLowerCase();
+    return status !== undefined && importableStatuses.has(status);
+}
+function hasImportableOptionalStatus(value, importableStatuses) {
+    const status = readString(value)?.toLowerCase();
+    return status === undefined || importableStatuses.has(status);
+}
+function codeableConceptHasSystemCode(value, system, codes) {
+    return codingsForCodeableConcept(value).some((coding) => {
+        const code = coding.code?.toLowerCase();
+        return coding.system === system && code !== undefined && codes.has(code);
+    });
+}
+function codeableConceptHasOnlyImportableCodings(value, system, codes) {
+    const codings = codingsForCodeableConcept(value);
+    return codings.length > 0 && codings.every((coding) => {
+        const code = coding.code?.toLowerCase();
+        return coding.system === system && code !== undefined && codes.has(code);
+    });
+}
+function codeableConceptHasCodeWithUnexpectedSystem(value, expectedSystem, codes) {
+    if (codeableConceptHasSystemCode(value, expectedSystem, codes)) {
+        return false;
+    }
+    return codingsForCodeableConcept(value).some((coding) => {
+        const code = coding.code?.toLowerCase();
+        return code !== undefined && codes.has(code) && coding.system !== expectedSystem;
+    });
+}
+function resultInterpretationFromInterpretation(value) {
+    let hasAbnormal = false;
+    let hasNormal = false;
+    let flag;
+    for (const interpretation of readFhirArray(value)) {
+        for (const coding of codingsForCodeableConcept(interpretation)) {
+            if (coding.system !== FHIR_SYSTEM_OBSERVATION_INTERPRETATION) {
+                continue;
+            }
+            const code = coding.code?.toLowerCase();
+            if (code && RESULT_STATUS_ABNORMAL_CODES.has(code)) {
+                hasAbnormal = true;
+                flag = combineResultFlags(flag, flagForInterpretationCode(code));
+            }
+            if (code && RESULT_STATUS_NORMAL_CODES.has(code)) {
+                hasNormal = true;
+            }
+        }
+    }
+    if (hasAbnormal && hasNormal) {
+        return { status: "ambiguous" };
+    }
+    if (hasAbnormal) {
+        return { flag: flag ?? "abnormal", status: "abnormal" };
+    }
+    if (hasNormal) {
+        return { flag: "normal", status: "normal" };
+    }
+    return { status: "unknown" };
+}
+function flagForInterpretationCode(code) {
+    switch (code) {
+        case "aa":
+        case "hh":
+        case "ll":
+            return "critical";
+        case "h":
+            return "high";
+        case "l":
+            return "low";
+        default:
+            return "abnormal";
+    }
+}
+function combineResultFlags(current, next) {
+    if (current === "critical" || next === "critical") {
+        return "critical";
+    }
+    if (current === "high" && next === "low") {
+        return "abnormal";
+    }
+    if (current === "low" && next === "high") {
+        return "abnormal";
+    }
+    return current ?? next;
+}
+function resultStatusFromBloodTestResults(results) {
+    let allResultsAreKnownNormal = results.length > 0;
+    for (const result of results) {
+        const flag = result.flag;
+        if (flag === "normal") {
+            continue;
+        }
+        allResultsAreKnownNormal = false;
+        if (flag !== undefined && flag !== "unknown") {
+            return "abnormal";
+        }
+    }
+    return allResultsAreKnownNormal ? "normal" : "unknown";
+}
+function readClinicalOccurredAt(resource) {
+    if ("effectiveDateTime" in resource || "effectivePeriod" in resource) {
+        return readEffectiveOccurredAt(resource);
+    }
+    if (resource.resourceType === "Observation") {
+        return undefined;
+    }
+    return readIsoDateTime("issued" in resource ? resource.issued : undefined)
+        ?? readIsoDateTime("date" in resource ? resource.date : undefined)
+        ?? readIsoDateTime("recordedDate" in resource ? resource.recordedDate : undefined);
+}
+function readEffectiveOccurredAt(resource) {
+    const effectiveDateTime = readString(resource.effectiveDateTime);
+    if (effectiveDateTime) {
+        return readIsoDateTime(effectiveDateTime);
+    }
+    if (resource.effectivePeriod !== undefined) {
+        return readIsoDateTime(readPeriodStart(resource.effectivePeriod));
+    }
+    return undefined;
+}
+function readPeriodStart(period) {
+    return readString(period?.start);
+}
+function readIsoDateTime(value) {
+    const text = readString(value);
+    if (!text) {
+        return undefined;
+    }
+    if (isWritableIsoDateTime(text)) {
+        return new Date(text).toISOString();
+    }
+    return undefined;
+}
+function readResourceId(resource) {
+    const resourceId = readString(resource.id);
+    return resourceId && resourceId.length <= 64 ? resourceId : undefined;
+}
+function readResourceUpdatedAt(resource) {
+    const text = readString(resource.meta?.lastUpdated);
+    return text && text.length <= 200 && isWritableIsoDateTime(text) ? text : undefined;
+}
+function readQuantityValue(quantity) {
+    if (!quantity) {
+        return null;
+    }
+    const numericValue = readNumber(quantity.value);
+    if (numericValue === undefined) {
+        return null;
+    }
+    const rawComparator = readString(quantity.comparator);
+    const comparator = readQuantityComparator(rawComparator);
+    if (rawComparator && !comparator) {
+        return null;
+    }
+    const system = readString(quantity.system);
+    const code = system === FHIR_SYSTEM_UCUM ? readString(quantity.code) : undefined;
+    const unit = readString(quantity.unit);
+    return {
+        comparator,
+        system,
+        unit: code ?? unit,
+        unitSource: code ? "code" : unit ? "unit" : undefined,
+        value: numericValue,
+    };
+}
+function readQuantityComparator(comparator) {
+    switch (comparator) {
+        case "<":
+        case "<=":
+        case ">":
+        case ">=":
+            return comparator;
+        default:
+            return undefined;
+    }
+}
+function readObservationTextValue(resource) {
+    return (readText(resource.valueString)
+        ?? readString(resource.valueInteger)
+        ?? readString(resource.valueBoolean)
+        ?? textForCodeableConcept(resource.valueCodeableConcept)
+        ?? null);
+}
+function textForCodeableConcept(value) {
+    if (!value) {
+        return undefined;
+    }
+    return (readText(value.text)
+        ?? codingsForCodeableConcept(value)
+            .map((coding) => coding.display)
+            .find((display) => display !== undefined));
+}
+function codingsForCodeableConcept(value) {
+    if (!value) {
+        return [];
+    }
+    return readUnknownArray(value.coding)
+        .filter(isRecord)
+        .map((coding) => ({
+        code: readString(coding.code),
+        display: readText(coding.display),
+        system: readString(coding.system),
+    }));
+}
+function decideDocumentReferenceText(resource) {
+    const textData = [];
+    for (const content of readUnknownArray(resource.content)) {
+        const attachment = isRecord(content) && isRecord(content.attachment) ? content.attachment : null;
+        const contentType = readText(attachment?.contentType)?.toLowerCase() ?? "";
+        if (contentType.startsWith("text/")) {
+            textData.push(readStrictString(attachment?.data));
+        }
+    }
+    if (textData.length > 1) {
+        return { status: "ambiguous" };
+    }
+    const data = textData[0];
+    const text = data ? decodeDocumentReferenceTextData(data)?.trim() : null;
+    return text ? { status: "available", text } : { status: "unavailable" };
+}
+function decodeDocumentReferenceTextData(value) {
+    const normalized = value.replace(/\s+/gu, "");
+    if (normalized.length === 0 || !CANONICAL_BASE64_TEXT.test(normalized)) {
+        return null;
+    }
+    const bytes = Buffer.from(normalized, "base64");
+    if (bytes.toString("base64") !== normalized) {
+        return null;
+    }
+    try {
+        return DOCUMENT_REFERENCE_TEXT_DECODER.decode(bytes);
+    }
+    catch {
+        return null;
+    }
+}
+function textFromNarrative(value) {
+    const div = readText(value?.div);
+    if (!div) {
+        return null;
+    }
+    const text = div
+        .replace(/<[^>]+>/gu, " ")
+        .replace(/\s+/gu, " ")
+        .trim();
+    return text.length > 0 ? text : null;
+}
+function isObservation(resource) {
+    return resource.resourceType === "Observation";
+}
+function isDiagnosticReport(resource) {
+    return resource.resourceType === "DiagnosticReport";
+}
+function isDocumentReference(resource) {
+    return resource.resourceType === "DocumentReference";
+}
+function isAllergyIntolerance(resource) {
+    return resource.resourceType === "AllergyIntolerance";
+}
+function isFhirBundle(value) {
+    return isFhirResource(value) && value.resourceType === "Bundle";
+}
+function isFhirResource(value) {
+    return isRecord(value) && typeof value.resourceType === "string" && value.resourceType.length > 0;
+}
+function isRecord(value) {
+    return typeof value === "object" && value !== null && !Array.isArray(value);
+}
+function readUnknownArray(value) {
+    return Array.isArray(value) ? value : [];
+}
+function readFhirArray(value) {
+    return Array.isArray(value) ? value : [];
+}
+function hasFhirArrayContentOrInvalidShape(value) {
+    return value !== undefined && (!Array.isArray(value) || value.length > 0);
+}
+function fhirValueKeys(value) {
+    return Object.keys(value).filter((key) => key.startsWith("value"));
+}
+function hasOwnFhirValue(value) {
+    return fhirValueKeys(value).length > 0;
+}
+function hasOnlyFhirValue(value, expectedKey) {
+    const keys = fhirValueKeys(value);
+    return keys.length === 1 && keys[0] === expectedKey;
+}
+function readText(value) {
+    if (typeof value !== "string") {
+        return undefined;
+    }
+    const text = value.trim();
+    return text.length > 0 ? text : undefined;
+}
+function readStrictString(value) {
+    return typeof value === "string" && value.length > 0 ? value : undefined;
+}
+function readString(value) {
+    if (typeof value === "string" && value.length > 0) {
+        return value;
+    }
+    if (typeof value === "number" || typeof value === "boolean") {
+        return String(value);
+    }
+    return undefined;
+}
+function readNumber(value) {
+    return typeof value === "number" && Number.isFinite(value) ? value : undefined;
+}
+//# sourceMappingURL=index.js.map