@precisa-saude/fhir 0.19.0 → 0.20.1

package/dist/{chunk-EXG2IU2O.js → chunk-YYANW65U.js}

@@ -1,7 +1,14 @@
 import {
-  getDefinitionByLoinc,
-  loincToCode
-} from "./chunk-MTWOF55H.js";
+  BIOMARKER_CODE_SYSTEM,
+  LOINC_SYSTEM
+} from "./chunk-A6HR4XDK.js";
+import {
+  codeToLoinc,
+  getDefinitionByCode,
+  isValidCode,
+  loincToCode,
+  normalizeCode
+} from "./chunk-3KIJIRCI.js";
 import {
   validateFHIRImportBundle
 } from "./chunk-N3ZCOLG2.js";
@@ -9,10 +16,30 @@ import {
 // src/importer.ts
 var MAX_OBSERVATIONS = 5e3;
 var MAX_FILE_SIZE = 15 * 1024 * 1024;
-function extractLoincCode(observation) {
-  if (!observation.code?.coding) return void 0;
-  const loincCoding = observation.code.coding.find((c) => c.system === "http://loinc.org");
-  return loincCoding?.code;
+function resolveBiomarkerCode(observation) {
+  const coding = observation.code?.coding ?? [];
+  const loincCode = coding.find((c) => c.system === LOINC_SYSTEM)?.code;
+  const declaredCode = coding.find((c) => c.system === BIOMARKER_CODE_SYSTEM)?.code;
+  const seenCodes = [
+    ...loincCode ? [`LOINC ${loincCode}`] : [],
+    ...declaredCode ? [`biomarker code ${declaredCode}`] : []
+  ];
+  let reason;
+  if (seenCodes.length > 0) {
+    reason = `Unknown code: ${seenCodes.join(", ")}`;
+  } else if (coding.length > 0) {
+    const systems = [...new Set(coding.map((c) => c.system ?? "(sem system)"))];
+    reason = `No code in a supported system (found: ${systems.join(", ")})`;
+  } else {
+    reason = "No code found in observation coding";
+  }
+  const fromLoinc = loincCode ? loincToCode(loincCode) : void 0;
+  if (fromLoinc) return { internalCode: fromLoinc, loincCode, reason };
+  if (declaredCode && isValidCode(declaredCode)) {
+    const canonical = normalizeCode(declaredCode);
+    return { internalCode: canonical, loincCode: codeToLoinc(canonical), reason };
+  }
+  return { loincCode, reason };
 }
 function extractFlag(observation) {
   const code = observation.interpretation?.[0]?.coding?.[0]?.code;
@@ -41,28 +68,13 @@ function extractObservationsFromBundle(bundle) {
   return { observations, skipped };
 }
 function mapFHIRObservationToInternal(observation, index) {
-  const loincCode = extractLoincCode(observation);
-  if (!loincCode) {
-    return {
-      skipped: {
-        index,
-        reason: "No LOINC code found in observation coding",
-        resourceType: "Observation"
-      }
-    };
-  }
-  const internalCode = loincToCode(loincCode);
+  const { internalCode, loincCode, reason } = resolveBiomarkerCode(observation);
   if (!internalCode) {
     return {
-      skipped: {
-        index,
-        loincCode,
-        reason: `Unknown LOINC code: ${loincCode}`,
-        resourceType: "Observation"
-      }
+      skipped: { index, loincCode, reason, resourceType: "Observation" }
     };
   }
-  const definition = getDefinitionByLoinc(loincCode);
+  const definition = getDefinitionByCode(internalCode);
   let value;
   let unit = "";
   let isQualitative = false;
@@ -150,4 +162,4 @@ export {
   mapFHIRObservationToInternal,
   processImportBundle
 };
-//# sourceMappingURL=chunk-EXG2IU2O.js.map
+//# sourceMappingURL=chunk-YYANW65U.js.map

package/dist/chunk-YYANW65U.js.map

@@ -0,0 +1 @@
+{"version":3,"sources":["../src/importer.ts"],"sourcesContent":["/**\n * FHIR Importer\n *\n * Parses FHIR R4 Bundles and extracts Observation resources with known LOINC codes,\n * mapping them to internal biomarker codes for storage as lab results.\n */\n\nimport {\n  codeToLoinc,\n  getDefinitionByCode,\n  isValidCode,\n  loincToCode,\n  normalizeCode,\n} from './biomarkers';\nimport { BIOMARKER_CODE_SYSTEM, LOINC_SYSTEM } from './code-systems';\nimport type { FHIRBundle, FHIRObservation } from './fhir-types';\nimport { validateFHIRImportBundle } from './validators';\n\nexport interface ImportedObservation {\n  biomarkerCode: string;\n  biomarkerName: string;\n  collectionDate: string;\n  flag: 'H' | 'L' | '';\n  isQualitative: boolean;\n  /** Ausente nos biomarcadores sem LOINC publicado, como composição corporal. */\n  loincCode?: string;\n  referenceMax?: number;\n  referenceMin?: number;\n  unit: string;\n  value: number | string;\n}\n\nexport interface SkippedEntry {\n  index: number;\n  loincCode?: string;\n  reason: string;\n  resourceType?: string;\n}\n\nexport interface ImportError {\n  details: string;\n  field: string;\n}\n\nexport interface FHIRImportResult {\n  errors: ImportError[];\n  imported: ImportedObservation[];\n  skipped: SkippedEntry[];\n  totalProcessed: number;\n}\n\n/**\n * Limites de importação.\n *\n * Uma Observation exportada ocupa cerca de 1,25KB em JSON compacto e 2,75KB\n * quando o arquivo vem indentado, medido sobre um histórico real de 998\n * Observations em 61 laudos. Nesse tamanho, 5000 Observations dão 6,0MB\n * compactos ou 13,1MB indentados, e por isso o teto de arquivo é 15MB: cobre\n * as duas formas com folga.\n *\n * Na densidade desse mesmo histórico (16 Observations por laudo), 5000\n * equivalem a cerca de 300 laudos.\n */\nconst MAX_OBSERVATIONS = 5000;\nconst MAX_FILE_SIZE = 15 * 1024 * 1024; // 15MB\n\n/**\n * Resolve o código interno do biomarcador a partir do `code.coding`.\n *\n * LOINC primeiro, que é o vocabulário que arquivos de terceiros usam. Quando\n * não resolve, cai para o coding de códigos internos, presente nos arquivos\n * exportados pela própria plataforma.\n *\n * O fallback cobre dois casos: biomarcadores sem LOINC publicado (composição\n * corporal, densidade óssea, escore de cálcio) e arquivos antigos, exportados\n * quando esses biomarcadores saíam com o placeholder `99999-9`, que não\n * resolve para nada.\n */\nfunction resolveBiomarkerCode(observation: FHIRObservation): {\n  internalCode?: string;\n  loincCode?: string;\n  reason: string;\n} {\n  const coding = observation.code?.coding ?? [];\n  const loincCode = coding.find((c) => c.system === LOINC_SYSTEM)?.code;\n  const declaredCode = coding.find((c) => c.system === BIOMARKER_CODE_SYSTEM)?.code;\n\n  const seenCodes = [\n    ...(loincCode ? [`LOINC ${loincCode}`] : []),\n    ...(declaredCode ? [`biomarker code ${declaredCode}`] : []),\n  ];\n\n  // Três motivos distintos de descarte, que antes se confundiam num só. Sem\n  // essa separação, um arquivo em SNOMED relatava \"nenhum código encontrado\",\n  // sugerindo `coding` vazio quando na verdade o código existia e estava num\n  // system que não tratamos. Para importação de terceiros, é a diferença entre\n  // um diagnóstico acionável e um enigma.\n  let reason: string;\n  if (seenCodes.length > 0) {\n    reason = `Unknown code: ${seenCodes.join(', ')}`;\n  } else if (coding.length > 0) {\n    const systems = [...new Set(coding.map((c) => c.system ?? '(sem system)'))];\n    reason = `No code in a supported system (found: ${systems.join(', ')})`;\n  } else {\n    reason = 'No code found in observation coding';\n  }\n\n  const fromLoinc = loincCode ? loincToCode(loincCode) : undefined;\n  if (fromLoinc) return { internalCode: fromLoinc, loincCode, reason };\n\n  if (declaredCode && isValidCode(declaredCode)) {\n    // `isValidCode` aceita alias, mas alias não serve como código armazenado:\n    // 49 definições têm um, e tanto `codeToLoinc` quanto as faixas de\n    // referência são indexadas só pelo canônico. Sem normalizar, `VLDL_Cholesterol`\n    // entraria no lugar de `VLDL` e perderia o LOINC 13458-5 que ele tem.\n    // Importar um Bundle é fronteira de dados, que é onde `normalizeCode` deve\n    // ser aplicado.\n    const canonical = normalizeCode(declaredCode);\n\n    // `codeToLoinc` devolve undefined para quem não tem LOINC, que é o caso\n    // esperado aqui. O campo fica de fora em vez de receber um valor inventado.\n    return { internalCode: canonical, loincCode: codeToLoinc(canonical), reason };\n  }\n\n  return { loincCode, reason };\n}\n\n/**\n * Extract interpretation flag from Observation\n */\nfunction extractFlag(observation: FHIRObservation): 'H' | 'L' | '' {\n  const code = observation.interpretation?.[0]?.coding?.[0]?.code;\n  if (code === 'H' || code === 'HH') return 'H';\n  if (code === 'L' || code === 'LL') return 'L';\n  return '';\n}\n\n/**\n * Extract Observation resources from a FHIR Bundle\n */\nexport function extractObservationsFromBundle(bundle: FHIRBundle): {\n  observations: FHIRObservation[];\n  skipped: SkippedEntry[];\n} {\n  const observations: FHIRObservation[] = [];\n  const skipped: SkippedEntry[] = [];\n\n  for (let i = 0; i < bundle.entry.length; i++) {\n    const entry = bundle.entry[i]!;\n    if (!entry.resource) {\n      skipped.push({ index: i, reason: 'Entry has no resource' });\n      continue;\n    }\n\n    if (entry.resource.resourceType !== 'Observation') {\n      // Non-observation resources are silently skipped (Patient, DiagnosticReport, etc.)\n      continue;\n    }\n\n    if (observations.length >= MAX_OBSERVATIONS) {\n      skipped.push({ index: i, reason: `Maximum of ${MAX_OBSERVATIONS} observations exceeded` });\n      continue;\n    }\n\n    observations.push(entry.resource as FHIRObservation);\n  }\n\n  return { observations, skipped };\n}\n\n/**\n * Map a FHIR Observation to internal format using LOINC→biomarker code lookup\n */\nexport function mapFHIRObservationToInternal(\n  observation: FHIRObservation,\n  index: number,\n): { observation: ImportedObservation } | { skipped: SkippedEntry } {\n  const { internalCode, loincCode, reason } = resolveBiomarkerCode(observation);\n\n  if (!internalCode) {\n    return {\n      skipped: { index, loincCode, reason, resourceType: 'Observation' },\n    };\n  }\n\n  const definition = getDefinitionByCode(internalCode);\n\n  // Extract value\n  let value: number | string;\n  let unit = '';\n  let isQualitative = false;\n\n  if (observation.valueQuantity?.value !== undefined) {\n    value = observation.valueQuantity.value;\n    unit = observation.valueQuantity.unit || observation.valueQuantity.code || '';\n  } else if (observation.valueString) {\n    value = observation.valueString;\n    isQualitative = true;\n  } else {\n    return {\n      skipped: {\n        index,\n        loincCode,\n        reason: 'Observation has no value (valueQuantity or valueString)',\n        resourceType: 'Observation',\n      },\n    };\n  }\n\n  // Extract collection date (effectiveDateTime or effectivePeriod.start)\n  const collectionDate = observation.effectiveDateTime || observation.effectivePeriod?.start || '';\n  if (!collectionDate) {\n    return {\n      skipped: {\n        index,\n        loincCode,\n        reason: 'Observation has no effectiveDateTime or effectivePeriod.start',\n        resourceType: 'Observation',\n      },\n    };\n  }\n\n  // Extract reference ranges\n  let referenceMin: number | undefined;\n  let referenceMax: number | undefined;\n  if (observation.referenceRange?.[0]) {\n    referenceMin = observation.referenceRange[0].low?.value;\n    referenceMax = observation.referenceRange[0].high?.value;\n  }\n\n  const imported: ImportedObservation = {\n    biomarkerCode: internalCode,\n    biomarkerName:\n      definition?.names.pt[0] || definition?.names.en[0] || observation.code.text || internalCode,\n    collectionDate,\n    flag: extractFlag(observation),\n    isQualitative,\n    loincCode,\n    referenceMax,\n    referenceMin,\n    unit: unit || definition?.unit || '',\n    value,\n  };\n\n  return { observation: imported };\n}\n\n/**\n * Process a complete FHIR Bundle for import\n */\nexport function processImportBundle(data: unknown): FHIRImportResult {\n  // Structural validation\n  const validationErrors = validateFHIRImportBundle(data);\n  if (validationErrors.length > 0) {\n    return {\n      errors: validationErrors,\n      imported: [],\n      skipped: [],\n      totalProcessed: 0,\n    };\n  }\n\n  const bundle = data as FHIRBundle;\n\n  // Extract observations\n  const { observations, skipped } = extractObservationsFromBundle(bundle);\n\n  // Map each observation to internal format\n  const imported: ImportedObservation[] = [];\n  const allSkipped: SkippedEntry[] = [...skipped];\n\n  for (let i = 0; i < observations.length; i++) {\n    const result = mapFHIRObservationToInternal(observations[i]!, i);\n\n    if ('observation' in result) {\n      imported.push(result.observation);\n    } else {\n      allSkipped.push(result.skipped);\n    }\n  }\n\n  return {\n    errors: [],\n    imported,\n    skipped: allSkipped,\n    totalProcessed: observations.length,\n  };\n}\n\nexport { MAX_FILE_SIZE, MAX_OBSERVATIONS };\n"],"mappings":";;;;;;;;;;;;;;;;AA+DA,IAAM,mBAAmB;AACzB,IAAM,gBAAgB,KAAK,OAAO;AAclC,SAAS,qBAAqB,aAI5B;AACA,QAAM,SAAS,YAAY,MAAM,UAAU,CAAC;AAC5C,QAAM,YAAY,OAAO,KAAK,CAAC,MAAM,EAAE,WAAW,YAAY,GAAG;AACjE,QAAM,eAAe,OAAO,KAAK,CAAC,MAAM,EAAE,WAAW,qBAAqB,GAAG;AAE7E,QAAM,YAAY;AAAA,IAChB,GAAI,YAAY,CAAC,SAAS,SAAS,EAAE,IAAI,CAAC;AAAA,IAC1C,GAAI,eAAe,CAAC,kBAAkB,YAAY,EAAE,IAAI,CAAC;AAAA,EAC3D;AAOA,MAAI;AACJ,MAAI,UAAU,SAAS,GAAG;AACxB,aAAS,iBAAiB,UAAU,KAAK,IAAI,CAAC;AAAA,EAChD,WAAW,OAAO,SAAS,GAAG;AAC5B,UAAM,UAAU,CAAC,GAAG,IAAI,IAAI,OAAO,IAAI,CAAC,MAAM,EAAE,UAAU,cAAc,CAAC,CAAC;AAC1E,aAAS,yCAAyC,QAAQ,KAAK,IAAI,CAAC;AAAA,EACtE,OAAO;AACL,aAAS;AAAA,EACX;AAEA,QAAM,YAAY,YAAY,YAAY,SAAS,IAAI;AACvD,MAAI,UAAW,QAAO,EAAE,cAAc,WAAW,WAAW,OAAO;AAEnE,MAAI,gBAAgB,YAAY,YAAY,GAAG;AAO7C,UAAM,YAAY,cAAc,YAAY;AAI5C,WAAO,EAAE,cAAc,WAAW,WAAW,YAAY,SAAS,GAAG,OAAO;AAAA,EAC9E;AAEA,SAAO,EAAE,WAAW,OAAO;AAC7B;AAKA,SAAS,YAAY,aAA8C;AACjE,QAAM,OAAO,YAAY,iBAAiB,CAAC,GAAG,SAAS,CAAC,GAAG;AAC3D,MAAI,SAAS,OAAO,SAAS,KAAM,QAAO;AAC1C,MAAI,SAAS,OAAO,SAAS,KAAM,QAAO;AAC1C,SAAO;AACT;AAKO,SAAS,8BAA8B,QAG5C;AACA,QAAM,eAAkC,CAAC;AACzC,QAAM,UAA0B,CAAC;AAEjC,WAAS,IAAI,GAAG,IAAI,OAAO,MAAM,QAAQ,KAAK;AAC5C,UAAM,QAAQ,OAAO,MAAM,CAAC;AAC5B,QAAI,CAAC,MAAM,UAAU;AACnB,cAAQ,KAAK,EAAE,OAAO,GAAG,QAAQ,wBAAwB,CAAC;AAC1D;AAAA,IACF;AAEA,QAAI,MAAM,SAAS,iBAAiB,eAAe;AAEjD;AAAA,IACF;AAEA,QAAI,aAAa,UAAU,kBAAkB;AAC3C,cAAQ,KAAK,EAAE,OAAO,GAAG,QAAQ,cAAc,gBAAgB,yBAAyB,CAAC;AACzF;AAAA,IACF;AAEA,iBAAa,KAAK,MAAM,QAA2B;AAAA,EACrD;AAEA,SAAO,EAAE,cAAc,QAAQ;AACjC;AAKO,SAAS,6BACd,aACA,OACkE;AAClE,QAAM,EAAE,cAAc,WAAW,OAAO,IAAI,qBAAqB,WAAW;AAE5E,MAAI,CAAC,cAAc;AACjB,WAAO;AAAA,MACL,SAAS,EAAE,OAAO,WAAW,QAAQ,cAAc,cAAc;AAAA,IACnE;AAAA,EACF;AAEA,QAAM,aAAa,oBAAoB,YAAY;AAGnD,MAAI;AACJ,MAAI,OAAO;AACX,MAAI,gBAAgB;AAEpB,MAAI,YAAY,eAAe,UAAU,QAAW;AAClD,YAAQ,YAAY,cAAc;AAClC,WAAO,YAAY,cAAc,QAAQ,YAAY,cAAc,QAAQ;AAAA,EAC7E,WAAW,YAAY,aAAa;AAClC,YAAQ,YAAY;AACpB,oBAAgB;AAAA,EAClB,OAAO;AACL,WAAO;AAAA,MACL,SAAS;AAAA,QACP;AAAA,QACA;AAAA,QACA,QAAQ;AAAA,QACR,cAAc;AAAA,MAChB;AAAA,IACF;AAAA,EACF;AAGA,QAAM,iBAAiB,YAAY,qBAAqB,YAAY,iBAAiB,SAAS;AAC9F,MAAI,CAAC,gBAAgB;AACnB,WAAO;AAAA,MACL,SAAS;AAAA,QACP;AAAA,QACA;AAAA,QACA,QAAQ;AAAA,QACR,cAAc;AAAA,MAChB;AAAA,IACF;AAAA,EACF;AAGA,MAAI;AACJ,MAAI;AACJ,MAAI,YAAY,iBAAiB,CAAC,GAAG;AACnC,mBAAe,YAAY,eAAe,CAAC,EAAE,KAAK;AAClD,mBAAe,YAAY,eAAe,CAAC,EAAE,MAAM;AAAA,EACrD;AAEA,QAAM,WAAgC;AAAA,IACpC,eAAe;AAAA,IACf,eACE,YAAY,MAAM,GAAG,CAAC,KAAK,YAAY,MAAM,GAAG,CAAC,KAAK,YAAY,KAAK,QAAQ;AAAA,IACjF;AAAA,IACA,MAAM,YAAY,WAAW;AAAA,IAC7B;AAAA,IACA;AAAA,IACA;AAAA,IACA;AAAA,IACA,MAAM,QAAQ,YAAY,QAAQ;AAAA,IAClC;AAAA,EACF;AAEA,SAAO,EAAE,aAAa,SAAS;AACjC;AAKO,SAAS,oBAAoB,MAAiC;AAEnE,QAAM,mBAAmB,yBAAyB,IAAI;AACtD,MAAI,iBAAiB,SAAS,GAAG;AAC/B,WAAO;AAAA,MACL,QAAQ;AAAA,MACR,UAAU,CAAC;AAAA,MACX,SAAS,CAAC;AAAA,MACV,gBAAgB;AAAA,IAClB;AAAA,EACF;AAEA,QAAM,SAAS;AAGf,QAAM,EAAE,cAAc,QAAQ,IAAI,8BAA8B,MAAM;AAGtE,QAAM,WAAkC,CAAC;AACzC,QAAM,aAA6B,CAAC,GAAG,OAAO;AAE9C,WAAS,IAAI,GAAG,IAAI,aAAa,QAAQ,KAAK;AAC5C,UAAM,SAAS,6BAA6B,aAAa,CAAC,GAAI,CAAC;AAE/D,QAAI,iBAAiB,QAAQ;AAC3B,eAAS,KAAK,OAAO,WAAW;AAAA,IAClC,OAAO;AACL,iBAAW,KAAK,OAAO,OAAO;AAAA,IAChC;AAAA,EACF;AAEA,SAAO;AAAA,IACL,QAAQ,CAAC;AAAA,IACT;AAAA,IACA,SAAS;AAAA,IACT,gBAAgB,aAAa;AAAA,EAC/B;AACF;","names":[]}

package/dist/cli.js

@@ -2252,8 +2252,9 @@ var BIOMARKER_DEFINITIONS = [
   // múltiplas formulações: "total body water" não devolve nada, "body water"
   // devolve os dois códigos abaixo.
   //
-  // As 12 entradas sem código, e o motivo de cada uma:
+  // As 13 entradas sem código, e o motivo de cada uma:
   //
+  //   MuscleMassIndex       corte publicado é sobre massa apendicular, não total
   //   VisceralFatLevel      índice de 1 a 20; 73707-2 é área, outra grandeza
   //   ResidualMass          conceito de fracionamento antropométrico, não LOINC
   //   BasalMetabolicRate    candidatos são índice ou RMR medido, ver nota local
@@ -2303,6 +2304,35 @@ var BIOMARKER_DEFINITIONS = [
     },
     unit: "kg"
   },
+  // Derivado, não extraído: `MuscleMass / altura²`, calculado pelo
+  // `calculadoras-clinicas` a partir da altura que o usuário informa no
+  // cadastro. Mesmo ajuste que o IMC faz com o peso, e serve para a medida
+  // ser comparável entre estaturas diferentes e ao longo do tempo.
+  //
+  // Sem `loinc` e sem faixa, e agora com fonte para a decisão em vez de só
+  // cautela. O EWGSOP2 (Age and Ageing, 2019, DOI 10.1093/ageing/afy169)
+  // separa explicitamente "total body Skeletal Muscle Mass (SMM)" de
+  // "Appendicular Skeletal Muscle Mass (ASM)", e os cortes publicados são
+  // sobre ASM. `MuscleMass` aqui é total, então o corte não se aplica.
+  //
+  // O mesmo consenso ainda diz, sobre ajustar por tamanho corporal: "The
+  // authors make no recommendation to adjust for body size, but adjustment
+  // can be made if data are available for a relevant normative population."
+  // Não temos população normativa brasileira para bioimpedância, e o
+  // consenso registra que a equação de Sergi, padrão do método, foi
+  // derivada em europeus idosos.
+  //
+  // Por isso o índice existe para acompanhar a própria evolução, e não para
+  // classificar.
+  {
+    category: "composicao-corporal",
+    code: "MuscleMassIndex",
+    names: {
+      en: ["Muscle Mass Index", "Skeletal Muscle Mass Index", "SMI", "SMMI"],
+      pt: ["\xCDndice de Massa Muscular", "IMM", "\xCDndice de Massa Muscular Esquel\xE9tica"]
+    },
+    unit: "kg/m2"
+  },
   {
     category: "composicao-corporal",
     code: "PhaseAngle",
@@ -2404,6 +2434,18 @@ var BIOMARKER_DEFINITIONS = [
     },
     unit: "cm"
   },
+  // O EWGSOP2 usa a panturrilha como proxy de massa muscular onde não há
+  // outro método disponível, o que a torna útil em consulta sem aparelho.
+  {
+    category: "composicao-corporal",
+    code: "CalfCircumference",
+    loinc: "107112-5",
+    names: {
+      en: ["Calf Circumference", "Calf Girth"],
+      pt: ["Circunfer\xEAncia da Panturrilha", "Per\xEDmetro da Panturrilha", "Panturrilha"]
+    },
+    unit: "cm"
+  },
   {
     category: "composicao-corporal",
     code: "WaistToHeightRatio",
@@ -2984,6 +3026,12 @@ function loincToCode(loinc) {
 function codeToLoinc(code) {
   return codeToLoincMap.get(code);
 }
+function isValidCode(code) {
+  return validCodeSet.has(code);
+}
+function normalizeCode(code) {
+  return codeAliasToCanonicalMap.get(code) ?? code;
+}
 function getDefinitionByCode(code) {
   return codeToDefinitionMap.get(code);
 }
@@ -3048,6 +3096,10 @@ async function categories(_args, json) {
   outputText(lines.join("\n"));
 }
 
+// src/code-systems.ts
+var LOINC_SYSTEM = "http://loinc.org";
+var BIOMARKER_CODE_SYSTEM = "http://fhir-brasil.dev/biomarker-codes";
+
 // src/units.ts
 var UNIT_TO_UCUM = {
   // Dimensionless / special measurements
@@ -3918,7 +3970,7 @@ function interpretationDisplay(flag) {
   }
 }
 function labObservationToFHIR(observation, patientId, laboratoryName) {
-  const loincCode = codeToLoinc(observation.biomarkerCode) || "99999-9";
+  const loincCode = codeToLoinc(observation.biomarkerCode);
   const sourceUnit = observation.unit || getDefaultUnit(observation.biomarkerCode) || observation.unit;
   const ucumUnit = unitToUCUM(sourceUnit);
   const isQualitative = observation.isQualitative || typeof observation.value === "string";
@@ -3935,16 +3987,23 @@ function labObservationToFHIR(observation, patientId, laboratoryName) {
       }
     ],
     code: {
+      // Sem LOINC, o coding LOINC simplesmente não sai. Antes ia `99999-9`,
+      // que não é código LOINC nenhum: publicava sob `http://loinc.org` uma
+      // afirmação falsa, e quem consumisse o bundle confiando no system
+      // trataria aquilo como código de verdade. Composição corporal, densidade
+      // óssea e escore de cálcio não têm LOINC, e o certo é a lacuna explícita.
       coding: [
-        {
-          code: loincCode,
-          display: observation.biomarkerName,
-          system: "http://loinc.org"
-        },
+        ...loincCode ? [
+          {
+            code: loincCode,
+            display: observation.biomarkerName,
+            system: LOINC_SYSTEM
+          }
+        ] : [],
         {
           code: observation.biomarkerCode,
           display: observation.biomarkerName,
-          system: "http://fhir-brasil.dev/biomarker-codes"
+          system: BIOMARKER_CODE_SYSTEM
         }
       ],
       text: observation.biomarkerName
@@ -4175,10 +4234,30 @@ function validateFHIRImportBundle(data) {
 // src/importer.ts
 var MAX_OBSERVATIONS = 5e3;
 var MAX_FILE_SIZE = 15 * 1024 * 1024;
-function extractLoincCode(observation) {
-  if (!observation.code?.coding) return void 0;
-  const loincCoding = observation.code.coding.find((c) => c.system === "http://loinc.org");
-  return loincCoding?.code;
+function resolveBiomarkerCode(observation) {
+  const coding = observation.code?.coding ?? [];
+  const loincCode = coding.find((c) => c.system === LOINC_SYSTEM)?.code;
+  const declaredCode = coding.find((c) => c.system === BIOMARKER_CODE_SYSTEM)?.code;
+  const seenCodes = [
+    ...loincCode ? [`LOINC ${loincCode}`] : [],
+    ...declaredCode ? [`biomarker code ${declaredCode}`] : []
+  ];
+  let reason;
+  if (seenCodes.length > 0) {
+    reason = `Unknown code: ${seenCodes.join(", ")}`;
+  } else if (coding.length > 0) {
+    const systems = [...new Set(coding.map((c) => c.system ?? "(sem system)"))];
+    reason = `No code in a supported system (found: ${systems.join(", ")})`;
+  } else {
+    reason = "No code found in observation coding";
+  }
+  const fromLoinc = loincCode ? loincToCode(loincCode) : void 0;
+  if (fromLoinc) return { internalCode: fromLoinc, loincCode, reason };
+  if (declaredCode && isValidCode(declaredCode)) {
+    const canonical = normalizeCode(declaredCode);
+    return { internalCode: canonical, loincCode: codeToLoinc(canonical), reason };
+  }
+  return { loincCode, reason };
 }
 function extractFlag(observation) {
   const code = observation.interpretation?.[0]?.coding?.[0]?.code;
@@ -4207,28 +4286,13 @@ function extractObservationsFromBundle(bundle) {
   return { observations, skipped };
 }
 function mapFHIRObservationToInternal(observation, index) {
-  const loincCode = extractLoincCode(observation);
-  if (!loincCode) {
-    return {
-      skipped: {
-        index,
-        reason: "No LOINC code found in observation coding",
-        resourceType: "Observation"
-      }
-    };
-  }
-  const internalCode = loincToCode(loincCode);
+  const { internalCode, loincCode, reason } = resolveBiomarkerCode(observation);
   if (!internalCode) {
     return {
-      skipped: {
-        index,
-        loincCode,
-        reason: `Unknown LOINC code: ${loincCode}`,
-        resourceType: "Observation"
-      }
+      skipped: { index, loincCode, reason, resourceType: "Observation" }
     };
   }
-  const definition = getDefinitionByLoinc(loincCode);
+  const definition = getDefinitionByCode(internalCode);
   let value;
   let unit = "";
   let isQualitative = false;
@@ -5935,6 +5999,53 @@ var biomarkerRangeDefinitions = {
   // Só `max`. O limite inferior não entra porque a revisão não estabelece
   // piso, e inventar um transformaria em alteração um valor que a fonte não
   // classifica.
+  // O EWGSOP2 traz um único corte, <31 cm, e o enuncia restrito: "Calf
+  // circumference has been shown to predict performance and survival in
+  // older people (cut-off point <31 cm)". Por isso entra como variante por
+  // idade, e não como padrão para todo adulto — estender o número para
+  // gente de 30 anos seria ir além do que a fonte diz.
+  //
+  // O padrão fica sem `min` de propósito: não há corte publicado para
+  // adulto jovem, e o consumidor lê a medida sem zona em vez de ler uma
+  // zona inventada.
+  //
+  // Como interpretar, por faixa etária:
+  //
+  //   60+   a medida tem corte e classifica: abaixo de 31 cm é sinal de
+  //         alerta para perda de massa muscular.
+  //   <60   a medida é válida e comparável com ela mesma ao longo do tempo,
+  //         mas não classifica. Uma queda consistente entre exames importa
+  //         mais do que o valor absoluto num único dia, e é assim que o
+  //         conteúdo do marcador orienta o usuário.
+  //
+  // A ausência de zona abaixo dos 60 não é lacuna a preencher com o número
+  // dos idosos: massa muscular tem trajetória própria por idade, e o
+  // consenso deriva o corte justamente na faixa em que a perda vira
+  // desfecho.
+  //
+  // Recência conferida em 28/08/2026. Existe consenso mais novo, o GLIS
+  // 2024 (Age and Ageing, DOI 10.1093/ageing/afae052), primeiro global
+  // sobre sarcopenia, com Cruz-Jentoft e Chen entre os autores — ou seja,
+  // os líderes do EWGSOP2 e do AWGS. Ele **não** substitui este corte: é
+  // conceitual, e o próprio texto diz que servirá "to develop an
+  // operational definition for clinical and research settings". Enquanto a
+  // definição operacional não sai, o EWGSOP2 segue sendo a referência de
+  // ponto de corte.
+  //
+  // Nota: o consenso asiático (AWGS 2019) usa 34 cm para homens e 33 para
+  // mulheres, em outra população e como triagem, não como corte de massa.
+  // Os números não são intercambiáveis.
+  CalfCircumference: {
+    default: { unit: "cm" },
+    direction: "higher-better",
+    source: "ewgsop2-2019",
+    // O corte não é específico por sexo na fonte; as duas variantes existem
+    // porque `RangeVariant` exige o campo, e carregam o mesmo número.
+    variants: [
+      { ageMin: 60, range: { min: 31, unit: "cm" }, sex: "F" },
+      { ageMin: 60, range: { min: 31, unit: "cm" }, sex: "M" }
+    ]
+  },
   WaistToHeightRatio: {
     default: { max: 0.5, unit: "" },
     direction: "lower-better",
@@ -6489,7 +6600,7 @@ async function main() {
     strict: false
   });
   if (values.version) {
-    process.stdout.write(`${"0.19.0"}
+    process.stdout.write(`${"0.20.1"}
 `);
     return;
   }

package/dist/converter.cjs

@@ -3,13 +3,14 @@
 
 
 
-var _chunkJ3QVVVVHcjs = require('./chunk-J3QVVVVH.cjs');
-require('./chunk-Z5VH5QGC.cjs');
+var _chunkQJF5BZ3Jcjs = require('./chunk-QJF5BZ3J.cjs');
+require('./chunk-OR67NJDZ.cjs');
+require('./chunk-NXOTXKVB.cjs');
 require('./chunk-MJ254F5K.cjs');
 
 
 
 
 
-exports.labObservationToFHIR = _chunkJ3QVVVVHcjs.labObservationToFHIR; exports.labReportToFHIR = _chunkJ3QVVVVHcjs.labReportToFHIR; exports.labResultToFHIRBundle = _chunkJ3QVVVVHcjs.labResultToFHIRBundle; exports.userProfileToFHIR = _chunkJ3QVVVVHcjs.userProfileToFHIR;
+exports.labObservationToFHIR = _chunkQJF5BZ3Jcjs.labObservationToFHIR; exports.labReportToFHIR = _chunkQJF5BZ3Jcjs.labReportToFHIR; exports.labResultToFHIRBundle = _chunkQJF5BZ3Jcjs.labResultToFHIRBundle; exports.userProfileToFHIR = _chunkQJF5BZ3Jcjs.userProfileToFHIR;
 //# sourceMappingURL=converter.cjs.map

package/dist/converter.cjs.map

@@ -1 +1 @@
-{"version":3,"sources":["/home/runner/work/fhir-brasil/fhir-brasil/packages/core/dist/converter.cjs"],"names":[],"mappings":"AAAA;AACE;AACA;AACA;AACA;AACF,wDAA6B;AAC7B,gCAA6B;AAC7B,gCAA6B;AAC7B;AACE;AACA;AACA;AACA;AACF,6QAAC","file":"/home/runner/work/fhir-brasil/fhir-brasil/packages/core/dist/converter.cjs"}
+{"version":3,"sources":["/home/runner/work/fhir-brasil/fhir-brasil/packages/core/dist/converter.cjs"],"names":[],"mappings":"AAAA;AACE;AACA;AACA;AACA;AACF,wDAA6B;AAC7B,gCAA6B;AAC7B,gCAA6B;AAC7B,gCAA6B;AAC7B;AACE;AACA;AACA;AACA;AACF,6QAAC","file":"/home/runner/work/fhir-brasil/fhir-brasil/packages/core/dist/converter.cjs"}

package/dist/converter.js

@@ -3,8 +3,9 @@ import {
   labReportToFHIR,
   labResultToFHIRBundle,
   userProfileToFHIR
-} from "./chunk-LCXTQE2B.js";
-import "./chunk-MTWOF55H.js";
+} from "./chunk-SN5ZJHWS.js";
+import "./chunk-A6HR4XDK.js";
+import "./chunk-3KIJIRCI.js";
 import "./chunk-R4MUCMO3.js";
 export {
   labObservationToFHIR,

package/dist/importer.cjs

@@ -4,8 +4,9 @@
 
 
 
-var _chunk6HKQY6VOcjs = require('./chunk-6HKQY6VO.cjs');
-require('./chunk-Z5VH5QGC.cjs');
+var _chunkETZXOGABcjs = require('./chunk-ETZXOGAB.cjs');
+require('./chunk-OR67NJDZ.cjs');
+require('./chunk-NXOTXKVB.cjs');
 require('./chunk-3ILBFLVQ.cjs');
 
 
@@ -13,5 +14,5 @@ require('./chunk-3ILBFLVQ.cjs');
 
 
 
-exports.MAX_FILE_SIZE = _chunk6HKQY6VOcjs.MAX_FILE_SIZE; exports.MAX_OBSERVATIONS = _chunk6HKQY6VOcjs.MAX_OBSERVATIONS; exports.extractObservationsFromBundle = _chunk6HKQY6VOcjs.extractObservationsFromBundle; exports.mapFHIRObservationToInternal = _chunk6HKQY6VOcjs.mapFHIRObservationToInternal; exports.processImportBundle = _chunk6HKQY6VOcjs.processImportBundle;
+exports.MAX_FILE_SIZE = _chunkETZXOGABcjs.MAX_FILE_SIZE; exports.MAX_OBSERVATIONS = _chunkETZXOGABcjs.MAX_OBSERVATIONS; exports.extractObservationsFromBundle = _chunkETZXOGABcjs.extractObservationsFromBundle; exports.mapFHIRObservationToInternal = _chunkETZXOGABcjs.mapFHIRObservationToInternal; exports.processImportBundle = _chunkETZXOGABcjs.processImportBundle;
 //# sourceMappingURL=importer.cjs.map

package/dist/importer.cjs.map

@@ -1 +1 @@
-{"version":3,"sources":["/home/runner/work/fhir-brasil/fhir-brasil/packages/core/dist/importer.cjs"],"names":[],"mappings":"AAAA;AACE;AACA;AACA;AACA;AACA;AACF,wDAA6B;AAC7B,gCAA6B;AAC7B,gCAA6B;AAC7B;AACE;AACA;AACA;AACA;AACA;AACF,4WAAC","file":"/home/runner/work/fhir-brasil/fhir-brasil/packages/core/dist/importer.cjs"}
+{"version":3,"sources":["/home/runner/work/fhir-brasil/fhir-brasil/packages/core/dist/importer.cjs"],"names":[],"mappings":"AAAA;AACE;AACA;AACA;AACA;AACA;AACF,wDAA6B;AAC7B,gCAA6B;AAC7B,gCAA6B;AAC7B,gCAA6B;AAC7B;AACE;AACA;AACA;AACA;AACA;AACF,4WAAC","file":"/home/runner/work/fhir-brasil/fhir-brasil/packages/core/dist/importer.cjs"}

package/dist/importer.d.cts

@@ -13,7 +13,8 @@ interface ImportedObservation {
     collectionDate: string;
     flag: 'H' | 'L' | '';
     isQualitative: boolean;
-    loincCode: string;
+    /** Ausente nos biomarcadores sem LOINC publicado, como composição corporal. */
+    loincCode?: string;
     referenceMax?: number;
     referenceMin?: number;
     unit: string;

package/dist/importer.d.ts

@@ -13,7 +13,8 @@ interface ImportedObservation {
     collectionDate: string;
     flag: 'H' | 'L' | '';
     isQualitative: boolean;
-    loincCode: string;
+    /** Ausente nos biomarcadores sem LOINC publicado, como composição corporal. */
+    loincCode?: string;
     referenceMax?: number;
     referenceMin?: number;
     unit: string;

package/dist/importer.js

@@ -4,8 +4,9 @@ import {
   extractObservationsFromBundle,
   mapFHIRObservationToInternal,
   processImportBundle
-} from "./chunk-EXG2IU2O.js";
-import "./chunk-MTWOF55H.js";
+} from "./chunk-YYANW65U.js";
+import "./chunk-A6HR4XDK.js";
+import "./chunk-3KIJIRCI.js";
 import "./chunk-N3ZCOLG2.js";
 export {
   MAX_FILE_SIZE,

package/dist/index.cjs

@@ -3,17 +3,18 @@
 
 
 
-var _chunkJ3QVVVVHcjs = require('./chunk-J3QVVVVH.cjs');
+var _chunkQJF5BZ3Jcjs = require('./chunk-QJF5BZ3J.cjs');
 
 
 
 
 
 
-var _chunk6HKQY6VOcjs = require('./chunk-6HKQY6VO.cjs');
+var _chunkETZXOGABcjs = require('./chunk-ETZXOGAB.cjs');
 
 
 
+var _chunkOR67NJDZcjs = require('./chunk-OR67NJDZ.cjs');
 
 
 
@@ -43,15 +44,18 @@ var _chunk6HKQY6VOcjs = require('./chunk-6HKQY6VO.cjs');
 
 
 
-var _chunkZ5VH5QGCcjs = require('./chunk-Z5VH5QGC.cjs');
 
 
 
+var _chunkNXOTXKVBcjs = require('./chunk-NXOTXKVB.cjs');
 
 
 
 
-var _chunkMMO356YHcjs = require('./chunk-MMO356YH.cjs');
+
+
+
+var _chunkERALICUKcjs = require('./chunk-ERALICUK.cjs');
 
 
 
@@ -228,7 +232,7 @@ function interventionToFHIRObservation(intervention, patientId) {
 }
 function interventionsToFHIRBundle(interventions, userProfile) {
   const patientId = userProfile.userId;
-  const fhirPatient = _chunkJ3QVVVVHcjs.userProfileToFHIR.call(void 0, userProfile);
+  const fhirPatient = _chunkQJF5BZ3Jcjs.userProfileToFHIR.call(void 0, userProfile);
   const entries = interventions.map((intervention) => {
     const isMedication = intervention.type === "medication" || intervention.type === "supplement";
     const resource = isMedication ? interventionToFHIRMedicationStatement(intervention, patientId) : interventionToFHIRObservation(intervention, patientId);
@@ -691,5 +695,7 @@ function cnsToFHIRIdentifier(cns) {
 
 
 
-exports.AGE_BRACKETS = AGE_BRACKETS; exports.BIOMARKER_DEFAULT_UNIT = _chunkMJ254F5Kcjs.BIOMARKER_DEFAULT_UNIT; exports.BIOMARKER_DEFINITIONS = _chunkZ5VH5QGCcjs.BIOMARKER_DEFINITIONS; exports.BIOMARKER_UNITS = _chunkMJ254F5Kcjs.BIOMARKER_UNITS; exports.BODY_FAT_ZONES = BODY_FAT_ZONES; exports.CAC_INDICATOR_CODES = _chunkZ5VH5QGCcjs.CAC_INDICATOR_CODES; exports.CATEGORY_GROUPS = CATEGORY_GROUPS; exports.CATEGORY_SCREENING_INTERVALS = CATEGORY_SCREENING_INTERVALS; exports.DEXA_CATEGORIES = _chunkZ5VH5QGCcjs.DEXA_CATEGORIES; exports.DEXA_INDICATOR_CODES = _chunkZ5VH5QGCcjs.DEXA_INDICATOR_CODES; exports.MAX_FILE_SIZE = _chunk6HKQY6VOcjs.MAX_FILE_SIZE; exports.MAX_OBSERVATIONS = _chunk6HKQY6VOcjs.MAX_OBSERVATIONS; exports.T_SCORE_ZONES = T_SCORE_ZONES; exports.UNIT_TO_UCUM = _chunkMJ254F5Kcjs.UNIT_TO_UCUM; exports.ZONE_DEFS = ZONE_DEFS; exports.applyFallbackReferenceRanges = _chunkMMO356YHcjs.applyFallbackReferenceRanges; exports.biomarkerRangeDefinitions = _chunkMMO356YHcjs.biomarkerRangeDefinitions; exports.calculateNextScreeningDate = calculateNextScreeningDate; exports.cnsToFHIRIdentifier = cnsToFHIRIdentifier; exports.codeToLoinc = _chunkZ5VH5QGCcjs.codeToLoinc; exports.convertUnit = _chunkMJ254F5Kcjs.convertUnit; exports.cpfToFHIRIdentifier = cpfToFHIRIdentifier; exports.defaultReferenceRanges = _chunkMMO356YHcjs.defaultReferenceRanges; exports.extractObservationsFromBundle = _chunk6HKQY6VOcjs.extractObservationsFromBundle; exports.filterVisibleBiomarkers = _chunkZ5VH5QGCcjs.filterVisibleBiomarkers; exports.findCodeByName = _chunkZ5VH5QGCcjs.findCodeByName; exports.formatCNS = formatCNS; exports.formatCPF = formatCPF; exports.generateCacFullReference = _chunkZ5VH5QGCcjs.generateCacFullReference; exports.generateDexaFullReference = _chunkZ5VH5QGCcjs.generateDexaFullReference; exports.generateFilteredLLMReference = _chunkZ5VH5QGCcjs.generateFilteredLLMReference; exports.generateLLMReference = _chunkZ5VH5QGCcjs.generateLLMReference; exports.getAllCodes = _chunkZ5VH5QGCcjs.getAllCodes; exports.getAllDefinitions = _chunkZ5VH5QGCcjs.getAllDefinitions; exports.getAllLoincCodes = _chunkZ5VH5QGCcjs.getAllLoincCodes; exports.getAllSearchPatterns = _chunkZ5VH5QGCcjs.getAllSearchPatterns; exports.getBiomarkersByCategory = _chunkZ5VH5QGCcjs.getBiomarkersByCategory; exports.getBiomarkersForCategories = _chunkZ5VH5QGCcjs.getBiomarkersForCategories; exports.getCanonicalUnit = _chunkMJ254F5Kcjs.getCanonicalUnit; exports.getCategoriesByInterval = getCategoriesByInterval; exports.getCategoryGroup = getCategoryGroup; exports.getDaysUntilScreening = getDaysUntilScreening; exports.getDefaultUnit = _chunkMJ254F5Kcjs.getDefaultUnit; exports.getDefinitionByCode = _chunkZ5VH5QGCcjs.getDefinitionByCode; exports.getDefinitionByLoinc = _chunkZ5VH5QGCcjs.getDefinitionByLoinc; exports.getDefinitionsBySex = _chunkZ5VH5QGCcjs.getDefinitionsBySex; exports.getDueCategories = getDueCategories; exports.getFallbackReferenceRange = _chunkMMO356YHcjs.getFallbackReferenceRange; exports.getRangeDirection = _chunkMMO356YHcjs.getRangeDirection; exports.getReferenceRange = _chunkMMO356YHcjs.getReferenceRange; exports.getSIUnit = _chunkMJ254F5Kcjs.getSIUnit; exports.getScreeningInterval = getScreeningInterval; exports.getSexForCode = _chunkZ5VH5QGCcjs.getSexForCode; exports.getVisibleDefinitions = _chunkZ5VH5QGCcjs.getVisibleDefinitions; exports.interventionToFHIRMedicationStatement = interventionToFHIRMedicationStatement; exports.interventionToFHIRObservation = interventionToFHIRObservation; exports.interventionsToFHIRBundle = interventionsToFHIRBundle; exports.isBiomarkerVisible = _chunkZ5VH5QGCcjs.isBiomarkerVisible; exports.isCacDocument = _chunkZ5VH5QGCcjs.isCacDocument; exports.isDexaDocument = _chunkZ5VH5QGCcjs.isDexaDocument; exports.isScreeningDue = isScreeningDue; exports.isValidCode = _chunkZ5VH5QGCcjs.isValidCode; exports.isValidLoinc = _chunkZ5VH5QGCcjs.isValidLoinc; exports.labObservationToFHIR = _chunkJ3QVVVVHcjs.labObservationToFHIR; exports.labReportToFHIR = _chunkJ3QVVVVHcjs.labReportToFHIR; exports.labResultToFHIRBundle = _chunkJ3QVVVVHcjs.labResultToFHIRBundle; exports.listMappedSubcategories = listMappedSubcategories; exports.loincToCode = _chunkZ5VH5QGCcjs.loincToCode; exports.mapFHIRObservationToInternal = _chunk6HKQY6VOcjs.mapFHIRObservationToInternal; exports.normalizeCode = _chunkZ5VH5QGCcjs.normalizeCode; exports.plural = plural; exports.pluralCount = pluralCount; exports.pluralPhrase = pluralPhrase; exports.pluralPhraseCount = pluralPhraseCount; exports.processImportBundle = _chunk6HKQY6VOcjs.processImportBundle; exports.toBiomarkerTests = _chunkZ5VH5QGCcjs.toBiomarkerTests; exports.unitToUCUM = _chunkMJ254F5Kcjs.unitToUCUM; exports.userProfileToFHIR = _chunkJ3QVVVVHcjs.userProfileToFHIR; exports.validateCNS = validateCNS; exports.validateCPF = validateCPF; exports.validateFHIRDiagnosticReport = _chunk3ILBFLVQcjs.validateFHIRDiagnosticReport; exports.validateFHIRImportBundle = _chunk3ILBFLVQcjs.validateFHIRImportBundle; exports.validateFHIRObservation = _chunk3ILBFLVQcjs.validateFHIRObservation; exports.validateLoincNameMatch = _chunkZ5VH5QGCcjs.validateLoincNameMatch;
+
+
+exports.AGE_BRACKETS = AGE_BRACKETS; exports.BIOMARKER_CODE_SYSTEM = _chunkOR67NJDZcjs.BIOMARKER_CODE_SYSTEM; exports.BIOMARKER_DEFAULT_UNIT = _chunkMJ254F5Kcjs.BIOMARKER_DEFAULT_UNIT; exports.BIOMARKER_DEFINITIONS = _chunkNXOTXKVBcjs.BIOMARKER_DEFINITIONS; exports.BIOMARKER_UNITS = _chunkMJ254F5Kcjs.BIOMARKER_UNITS; exports.BODY_FAT_ZONES = BODY_FAT_ZONES; exports.CAC_INDICATOR_CODES = _chunkNXOTXKVBcjs.CAC_INDICATOR_CODES; exports.CATEGORY_GROUPS = CATEGORY_GROUPS; exports.CATEGORY_SCREENING_INTERVALS = CATEGORY_SCREENING_INTERVALS; exports.DEXA_CATEGORIES = _chunkNXOTXKVBcjs.DEXA_CATEGORIES; exports.DEXA_INDICATOR_CODES = _chunkNXOTXKVBcjs.DEXA_INDICATOR_CODES; exports.LOINC_SYSTEM = _chunkOR67NJDZcjs.LOINC_SYSTEM; exports.MAX_FILE_SIZE = _chunkETZXOGABcjs.MAX_FILE_SIZE; exports.MAX_OBSERVATIONS = _chunkETZXOGABcjs.MAX_OBSERVATIONS; exports.T_SCORE_ZONES = T_SCORE_ZONES; exports.UNIT_TO_UCUM = _chunkMJ254F5Kcjs.UNIT_TO_UCUM; exports.ZONE_DEFS = ZONE_DEFS; exports.applyFallbackReferenceRanges = _chunkERALICUKcjs.applyFallbackReferenceRanges; exports.biomarkerRangeDefinitions = _chunkERALICUKcjs.biomarkerRangeDefinitions; exports.calculateNextScreeningDate = calculateNextScreeningDate; exports.cnsToFHIRIdentifier = cnsToFHIRIdentifier; exports.codeToLoinc = _chunkNXOTXKVBcjs.codeToLoinc; exports.convertUnit = _chunkMJ254F5Kcjs.convertUnit; exports.cpfToFHIRIdentifier = cpfToFHIRIdentifier; exports.defaultReferenceRanges = _chunkERALICUKcjs.defaultReferenceRanges; exports.extractObservationsFromBundle = _chunkETZXOGABcjs.extractObservationsFromBundle; exports.filterVisibleBiomarkers = _chunkNXOTXKVBcjs.filterVisibleBiomarkers; exports.findCodeByName = _chunkNXOTXKVBcjs.findCodeByName; exports.formatCNS = formatCNS; exports.formatCPF = formatCPF; exports.generateCacFullReference = _chunkNXOTXKVBcjs.generateCacFullReference; exports.generateDexaFullReference = _chunkNXOTXKVBcjs.generateDexaFullReference; exports.generateFilteredLLMReference = _chunkNXOTXKVBcjs.generateFilteredLLMReference; exports.generateLLMReference = _chunkNXOTXKVBcjs.generateLLMReference; exports.getAllCodes = _chunkNXOTXKVBcjs.getAllCodes; exports.getAllDefinitions = _chunkNXOTXKVBcjs.getAllDefinitions; exports.getAllLoincCodes = _chunkNXOTXKVBcjs.getAllLoincCodes; exports.getAllSearchPatterns = _chunkNXOTXKVBcjs.getAllSearchPatterns; exports.getBiomarkersByCategory = _chunkNXOTXKVBcjs.getBiomarkersByCategory; exports.getBiomarkersForCategories = _chunkNXOTXKVBcjs.getBiomarkersForCategories; exports.getCanonicalUnit = _chunkMJ254F5Kcjs.getCanonicalUnit; exports.getCategoriesByInterval = getCategoriesByInterval; exports.getCategoryGroup = getCategoryGroup; exports.getDaysUntilScreening = getDaysUntilScreening; exports.getDefaultUnit = _chunkMJ254F5Kcjs.getDefaultUnit; exports.getDefinitionByCode = _chunkNXOTXKVBcjs.getDefinitionByCode; exports.getDefinitionByLoinc = _chunkNXOTXKVBcjs.getDefinitionByLoinc; exports.getDefinitionsBySex = _chunkNXOTXKVBcjs.getDefinitionsBySex; exports.getDueCategories = getDueCategories; exports.getFallbackReferenceRange = _chunkERALICUKcjs.getFallbackReferenceRange; exports.getRangeDirection = _chunkERALICUKcjs.getRangeDirection; exports.getReferenceRange = _chunkERALICUKcjs.getReferenceRange; exports.getSIUnit = _chunkMJ254F5Kcjs.getSIUnit; exports.getScreeningInterval = getScreeningInterval; exports.getSexForCode = _chunkNXOTXKVBcjs.getSexForCode; exports.getVisibleDefinitions = _chunkNXOTXKVBcjs.getVisibleDefinitions; exports.interventionToFHIRMedicationStatement = interventionToFHIRMedicationStatement; exports.interventionToFHIRObservation = interventionToFHIRObservation; exports.interventionsToFHIRBundle = interventionsToFHIRBundle; exports.isBiomarkerVisible = _chunkNXOTXKVBcjs.isBiomarkerVisible; exports.isCacDocument = _chunkNXOTXKVBcjs.isCacDocument; exports.isDexaDocument = _chunkNXOTXKVBcjs.isDexaDocument; exports.isScreeningDue = isScreeningDue; exports.isValidCode = _chunkNXOTXKVBcjs.isValidCode; exports.isValidLoinc = _chunkNXOTXKVBcjs.isValidLoinc; exports.labObservationToFHIR = _chunkQJF5BZ3Jcjs.labObservationToFHIR; exports.labReportToFHIR = _chunkQJF5BZ3Jcjs.labReportToFHIR; exports.labResultToFHIRBundle = _chunkQJF5BZ3Jcjs.labResultToFHIRBundle; exports.listMappedSubcategories = listMappedSubcategories; exports.loincToCode = _chunkNXOTXKVBcjs.loincToCode; exports.mapFHIRObservationToInternal = _chunkETZXOGABcjs.mapFHIRObservationToInternal; exports.normalizeCode = _chunkNXOTXKVBcjs.normalizeCode; exports.plural = plural; exports.pluralCount = pluralCount; exports.pluralPhrase = pluralPhrase; exports.pluralPhraseCount = pluralPhraseCount; exports.processImportBundle = _chunkETZXOGABcjs.processImportBundle; exports.toBiomarkerTests = _chunkNXOTXKVBcjs.toBiomarkerTests; exports.unitToUCUM = _chunkMJ254F5Kcjs.unitToUCUM; exports.userProfileToFHIR = _chunkQJF5BZ3Jcjs.userProfileToFHIR; exports.validateCNS = validateCNS; exports.validateCPF = validateCPF; exports.validateFHIRDiagnosticReport = _chunk3ILBFLVQcjs.validateFHIRDiagnosticReport; exports.validateFHIRImportBundle = _chunk3ILBFLVQcjs.validateFHIRImportBundle; exports.validateFHIRObservation = _chunk3ILBFLVQcjs.validateFHIRObservation; exports.validateLoincNameMatch = _chunkNXOTXKVBcjs.validateLoincNameMatch;
 //# sourceMappingURL=index.cjs.map