ezmedicationinput 0.1.42 → 0.1.44

package/dist/format.js

@@ -1,7 +1,10 @@
 "use strict";
 Object.defineProperty(exports, "__esModule", { value: true });
+exports.formatCanonicalClause = formatCanonicalClause;
 exports.formatInternal = formatInternal;
+const prn_1 = require("./prn");
 const types_1 = require("./types");
+const timing_summary_1 = require("./timing-summary");
 const ROUTE_SHORT = {
     [types_1.RouteCode["Oral route"]]: "PO",
     [types_1.RouteCode["Sublingual route"]]: "SL",
@@ -56,9 +59,17 @@ const DAY_NAMES = {
     sat: "Saturday",
     sun: "Sunday"
 };
+const EN_TIMES_PER_DAY = {
+    1: "once daily",
+    2: "twice daily",
+    3: "three times daily",
+    4: "four times daily"
+};
+const SLOWLY_QUALIFIER_CODE = "419443000";
+const EMPTY_STOMACH_QUALIFIER_CODE = "717154004";
 const DEFAULT_ROUTE_GRAMMAR = { verb: "Use" };
 const ROUTE_GRAMMAR = {
-    [types_1.RouteCode["Oral route"]]: { verb: "Take", routePhrase: "by mouth" },
+    [types_1.RouteCode["Oral route"]]: { verb: "Take", routePhrase: "orally" },
     [types_1.RouteCode["Ophthalmic route"]]: {
         verb: "Instill",
         routePhrase: ({ hasSite }) => (hasSite ? undefined : "in the eye"),
@@ -74,6 +85,11 @@ const ROUTE_GRAMMAR = {
         routePhrase: ({ hasSite }) => (hasSite ? undefined : "rectally"),
         sitePreposition: "into"
     },
+    [types_1.RouteCode["Per vagina"]]: {
+        verb: "Insert",
+        routePhrase: ({ hasSite }) => (hasSite ? undefined : "vaginally"),
+        sitePreposition: "into"
+    },
     [types_1.RouteCode["Topical route"]]: {
         verb: "Apply",
         routePhrase: ({ hasSite }) => (hasSite ? undefined : "topically"),
@@ -110,6 +126,10 @@ const ROUTE_GRAMMAR = {
         sitePreposition: "into"
     }
 };
+function scheduleOf(clause) {
+    var _a;
+    return (_a = clause.schedule) !== null && _a !== void 0 ? _a : {};
+}
 function grammarFromRouteText(text) {
     if (!text) {
         return undefined;
@@ -145,6 +165,9 @@ function grammarFromRouteText(text) {
     if (normalized.includes("rectal") || normalized.includes("rectum")) {
         return ROUTE_GRAMMAR[types_1.RouteCode["Per rectum"]];
     }
+    if (normalized.includes("vagin")) {
+        return ROUTE_GRAMMAR[types_1.RouteCode["Per vagina"]];
+    }
     if (normalized.includes("nasal")) {
         return ROUTE_GRAMMAR[types_1.RouteCode["Nasal route"]];
     }
@@ -153,41 +176,89 @@ function grammarFromRouteText(text) {
     }
     return undefined;
 }
-function resolveRouteGrammar(internal) {
+function resolveRouteGrammar(clause) {
+    var _a, _b, _c, _d;
+    const routeCode = (_a = clause.route) === null || _a === void 0 ? void 0 : _a.code;
+    if (routeCode && ROUTE_GRAMMAR[routeCode]) {
+        return (_b = ROUTE_GRAMMAR[routeCode]) !== null && _b !== void 0 ? _b : DEFAULT_ROUTE_GRAMMAR;
+    }
+    return (_d = grammarFromRouteText((_c = clause.route) === null || _c === void 0 ? void 0 : _c.text)) !== null && _d !== void 0 ? _d : DEFAULT_ROUTE_GRAMMAR;
+}
+function resolveMethodVerb(clause, grammar) {
     var _a, _b;
-    if (internal.routeCode && ROUTE_GRAMMAR[internal.routeCode]) {
-        return (_a = ROUTE_GRAMMAR[internal.routeCode]) !== null && _a !== void 0 ? _a : DEFAULT_ROUTE_GRAMMAR;
+    const methodText = (_b = (_a = clause.method) === null || _a === void 0 ? void 0 : _a.text) === null || _b === void 0 ? void 0 : _b.trim();
+    if (methodText) {
+        return methodText;
     }
-    return (_b = grammarFromRouteText(internal.routeText)) !== null && _b !== void 0 ? _b : DEFAULT_ROUTE_GRAMMAR;
+    return grammar.verb;
 }
 function pluralize(unit, value) {
     if (Math.abs(value) === 1) {
-        if (unit === "tab")
-            return "tablet";
-        if (unit === "cap")
-            return "capsule";
+        switch (unit) {
+            case "tab":
+                return "tablet";
+            case "cap":
+                return "capsule";
+            default:
+                return unit;
+        }
+    }
+    if (unit.endsWith(" ribbon")) {
         return unit;
     }
-    if (unit === "tab" || unit === "tablet")
-        return "tablets";
-    if (unit === "cap" || unit === "capsule")
-        return "capsules";
-    if (unit === "mL")
-        return "mL";
-    if (unit === "mg")
-        return "mg";
-    if (unit === "puff")
-        return value === 1 ? "puff" : "puffs";
-    if (unit === "patch")
-        return value === 1 ? "patch" : "patches";
-    if (unit === "drop")
-        return value === 1 ? "drop" : "drops";
-    if (unit === "suppository")
-        return value === 1 ? "suppository" : "suppositories";
-    return unit;
+    switch (unit) {
+        case "tab":
+        case "tablet":
+            return "tablets";
+        case "cap":
+        case "capsule":
+            return "capsules";
+        case "mL":
+        case "mg":
+            return unit;
+        case "puff":
+            return "puffs";
+        case "patch":
+            return "patches";
+        case "drop":
+            return "drops";
+        case "suppository":
+            return "suppositories";
+        case "pump":
+            return "pumps";
+        case "squeeze":
+            return "squeezes";
+        case "applicatorful":
+            return "applicatorfuls";
+        case "capful":
+            return "capfuls";
+        case "scoop":
+            return "scoops";
+        case "application":
+            return "applications";
+        case "fingertip unit":
+            return "fingertip units";
+        case "finger length":
+            return "finger lengths";
+        default:
+            return unit;
+    }
+}
+function formatPatientInstructionSentence(text) {
+    const trimmed = text === null || text === void 0 ? void 0 : text.trim();
+    if (!trimmed) {
+        return undefined;
+    }
+    const sentence = /^[.!?]$/.test(trimmed.slice(-1)) ? trimmed : `${trimmed}.`;
+    return sentence.charAt(0).toUpperCase() + sentence.slice(1);
 }
-function describeFrequency(internal) {
-    const { frequency, frequencyMax, period, periodMax, periodUnit, timingCode } = internal;
+function describeFrequency(schedule) {
+    const frequency = schedule === null || schedule === void 0 ? void 0 : schedule.frequency;
+    const frequencyMax = schedule === null || schedule === void 0 ? void 0 : schedule.frequencyMax;
+    const period = schedule === null || schedule === void 0 ? void 0 : schedule.period;
+    const periodMax = schedule === null || schedule === void 0 ? void 0 : schedule.periodMax;
+    const periodUnit = schedule === null || schedule === void 0 ? void 0 : schedule.periodUnit;
+    const timingCode = schedule === null || schedule === void 0 ? void 0 : schedule.timingCode;
     if (frequency !== undefined &&
         frequencyMax !== undefined &&
         periodUnit === types_1.FhirPeriodUnit.Day &&
@@ -201,16 +272,18 @@ function describeFrequency(internal) {
         return `${stripTrailingZero(frequency)} to ${stripTrailingZero(frequencyMax)} times daily`;
     }
     if (frequency && periodUnit === types_1.FhirPeriodUnit.Day && (!period || period === 1)) {
-        if (frequency === 1)
-            return "once daily";
-        if (frequency === 2)
-            return "twice daily";
-        if (frequency === 3)
-            return "three times daily";
-        if (frequency === 4)
-            return "four times daily";
+        const dailyText = EN_TIMES_PER_DAY[frequency];
+        if (dailyText) {
+            return dailyText;
+        }
         return `${stripTrailingZero(frequency)} times daily`;
     }
+    if (periodUnit === types_1.FhirPeriodUnit.Minute && period) {
+        if (periodMax && periodMax !== period) {
+            return `every ${stripTrailingZero(period)} to ${stripTrailingZero(periodMax)} minutes`;
+        }
+        return `every ${stripTrailingZero(period)} minute${period === 1 ? "" : "s"}`;
+    }
     if (periodUnit === types_1.FhirPeriodUnit.Hour && period) {
         if (periodMax && periodMax !== period) {
             return `every ${stripTrailingZero(period)} to ${stripTrailingZero(periodMax)} hours`;
@@ -244,6 +317,15 @@ function describeFrequency(internal) {
         }
         return `every ${stripTrailingZero(period)} months`;
     }
+    if (periodUnit === types_1.FhirPeriodUnit.Year && period) {
+        if (period === 1 && (!periodMax || periodMax === 1)) {
+            return "once yearly";
+        }
+        if (periodMax && periodMax !== period) {
+            return `every ${stripTrailingZero(period)} to ${stripTrailingZero(periodMax)} years`;
+        }
+        return `every ${stripTrailingZero(period)} years`;
+    }
     if (timingCode) {
         if (timingCode === "WK") {
             return "once weekly";
@@ -265,81 +347,200 @@ function describeFrequency(internal) {
         }
     }
     if (frequency && periodUnit === undefined && period === undefined) {
-        if (frequency === 1)
+        if (frequency === 1) {
             return "once";
+        }
         return `${stripTrailingZero(frequency)} times`;
     }
     return undefined;
 }
-function formatDoseShort(internal) {
-    if (internal.doseRange) {
-        const { low, high } = internal.doseRange;
-        const base = `${stripTrailingZero(low)}-${stripTrailingZero(high)}`;
-        if (internal.unit) {
-            return `${base} ${internal.unit}`;
+function describeFrequencyCount(count) {
+    if (!count || count <= 0) {
+        return undefined;
+    }
+    const dailyText = EN_TIMES_PER_DAY[count];
+    if (dailyText) {
+        return dailyText;
+    }
+    return `${stripTrailingZero(count)} times daily`;
+}
+function describeStandaloneOccurrenceCount(schedule) {
+    var _a, _b, _c;
+    const count = schedule === null || schedule === void 0 ? void 0 : schedule.count;
+    if (!count || count <= 0) {
+        return undefined;
+    }
+    if ((schedule === null || schedule === void 0 ? void 0 : schedule.frequency) !== undefined ||
+        (schedule === null || schedule === void 0 ? void 0 : schedule.frequencyMax) !== undefined ||
+        (schedule === null || schedule === void 0 ? void 0 : schedule.period) !== undefined ||
+        (schedule === null || schedule === void 0 ? void 0 : schedule.periodMax) !== undefined ||
+        (schedule === null || schedule === void 0 ? void 0 : schedule.periodUnit) !== undefined ||
+        ((_a = schedule === null || schedule === void 0 ? void 0 : schedule.dayOfWeek) === null || _a === void 0 ? void 0 : _a.length) ||
+        ((_b = schedule === null || schedule === void 0 ? void 0 : schedule.when) === null || _b === void 0 ? void 0 : _b.length) ||
+        ((_c = schedule === null || schedule === void 0 ? void 0 : schedule.timeOfDay) === null || _c === void 0 ? void 0 : _c.length) ||
+        (schedule === null || schedule === void 0 ? void 0 : schedule.duration) !== undefined ||
+        (schedule === null || schedule === void 0 ? void 0 : schedule.durationMax) !== undefined ||
+        (schedule === null || schedule === void 0 ? void 0 : schedule.durationUnit) !== undefined ||
+        (schedule === null || schedule === void 0 ? void 0 : schedule.timingCode)) {
+        return undefined;
+    }
+    switch (count) {
+        case 1:
+            return "once";
+        case 2:
+            return "twice";
+        default:
+            return `${stripTrailingZero(count)} times`;
+    }
+}
+function formatDoseShort(dose) {
+    if (!dose) {
+        return undefined;
+    }
+    if (dose.range) {
+        if (dose.range.low !== undefined && dose.range.high !== undefined) {
+            const base = `${stripTrailingZero(dose.range.low)}-${stripTrailingZero(dose.range.high)}`;
+            if (dose.unit) {
+                return `${base} ${dose.unit}`;
+            }
+            return base;
+        }
+        if (dose.range.low !== undefined) {
+            const base = `>=${stripTrailingZero(dose.range.low)}`;
+            if (dose.unit) {
+                return `${base} ${dose.unit}`;
+            }
+            return base;
+        }
+        if (dose.range.high !== undefined) {
+            const base = `<=${stripTrailingZero(dose.range.high)}`;
+            if (dose.unit) {
+                return `${base} ${dose.unit}`;
+            }
+            return base;
         }
-        return base;
     }
-    if (internal.dose !== undefined) {
-        const dosePart = internal.unit
-            ? `${stripTrailingZero(internal.dose)} ${internal.unit}`
-            : `${stripTrailingZero(internal.dose)}`;
-        return dosePart.trim();
+    if (dose.value !== undefined) {
+        if (dose.unit) {
+            return `${stripTrailingZero(dose.value)} ${dose.unit}`;
+        }
+        return `${stripTrailingZero(dose.value)}`;
     }
     return undefined;
 }
-function formatDoseLong(internal) {
-    if (internal.doseRange) {
-        const { low, high } = internal.doseRange;
-        if (internal.unit) {
-            return `${stripTrailingZero(low)} to ${stripTrailingZero(high)} ${pluralize(internal.unit, high)}`;
+function formatDoseLong(dose) {
+    if (!dose) {
+        return undefined;
+    }
+    if (dose.range) {
+        if (dose.range.low !== undefined && dose.range.high !== undefined) {
+            if (dose.unit) {
+                return `${stripTrailingZero(dose.range.low)} to ${stripTrailingZero(dose.range.high)} ${pluralize(dose.unit, dose.range.high)}`;
+            }
+            return `${stripTrailingZero(dose.range.low)} to ${stripTrailingZero(dose.range.high)}`;
+        }
+        if (dose.range.low !== undefined) {
+            if (dose.unit) {
+                return `at least ${stripTrailingZero(dose.range.low)} ${pluralize(dose.unit, dose.range.low)}`;
+            }
+            return `at least ${stripTrailingZero(dose.range.low)}`;
+        }
+        if (dose.range.high !== undefined) {
+            if (dose.unit) {
+                return `up to ${stripTrailingZero(dose.range.high)} ${pluralize(dose.unit, dose.range.high)}`;
+            }
+            return `up to ${stripTrailingZero(dose.range.high)}`;
         }
-        return `${stripTrailingZero(low)} to ${stripTrailingZero(high)}`;
     }
-    if (internal.dose !== undefined) {
-        if (internal.unit) {
-            return `${stripTrailingZero(internal.dose)} ${pluralize(internal.unit, internal.dose)}`;
+    if (dose.value !== undefined) {
+        if (dose.unit) {
+            return `${stripTrailingZero(dose.value)} ${pluralize(dose.unit, dose.value)}`;
         }
-        return `${stripTrailingZero(internal.dose)}`;
+        return `${stripTrailingZero(dose.value)}`;
     }
     return undefined;
 }
-function collectWhenPhrases(internal) {
-    if (!internal.when.length) {
+function summarizeMealTimingGroup(group) {
+    let relationText = "with";
+    if (group.relation === "before") {
+        relationText = "before";
+    }
+    else if (group.relation === "after") {
+        relationText = "after";
+    }
+    return `${relationText} ${joinWithAnd(group.meals)}`;
+}
+function collectWhenPhrases(schedule, options) {
+    var _a, _b, _c;
+    const when = (_a = schedule === null || schedule === void 0 ? void 0 : schedule.when) !== null && _a !== void 0 ? _a : [];
+    if (!when.length) {
         return [];
     }
     const unique = [];
     const seen = new Set();
-    for (const code of internal.when) {
+    let hasSpecificAfter = false;
+    let hasSpecificBefore = false;
+    let hasSpecificWith = false;
+    for (const code of when) {
         if (!seen.has(code)) {
             seen.add(code);
             unique.push(code);
+            if (code === types_1.EventTiming["After Breakfast"] ||
+                code === types_1.EventTiming["After Lunch"] ||
+                code === types_1.EventTiming["After Dinner"]) {
+                hasSpecificAfter = true;
+            }
+            if (code === types_1.EventTiming["Before Breakfast"] ||
+                code === types_1.EventTiming["Before Lunch"] ||
+                code === types_1.EventTiming["Before Dinner"]) {
+                hasSpecificBefore = true;
+            }
+            if (code === types_1.EventTiming.Breakfast || code === types_1.EventTiming.Lunch || code === types_1.EventTiming.Dinner) {
+                hasSpecificWith = true;
+            }
         }
     }
-    const hasSpecificAfter = unique.some((code) => code === types_1.EventTiming["After Breakfast"] ||
-        code === types_1.EventTiming["After Lunch"] ||
-        code === types_1.EventTiming["After Dinner"]);
-    const hasSpecificBefore = unique.some((code) => code === types_1.EventTiming["Before Breakfast"] ||
-        code === types_1.EventTiming["Before Lunch"] ||
-        code === types_1.EventTiming["Before Dinner"]);
-    const hasSpecificWith = unique.some((code) => code === types_1.EventTiming.Breakfast ||
-        code === types_1.EventTiming.Lunch ||
-        code === types_1.EventTiming.Dinner);
-    return unique
-        .filter((code) => {
+    const filtered = [];
+    for (const code of unique) {
         if (code === types_1.EventTiming["After Meal"] && hasSpecificAfter) {
-            return false;
+            continue;
         }
         if (code === types_1.EventTiming["Before Meal"] && hasSpecificBefore) {
-            return false;
+            continue;
         }
         if (code === types_1.EventTiming.Meal && hasSpecificWith) {
-            return false;
+            continue;
         }
-        return true;
-    })
-        .map((code) => { var _a; return (_a = WHEN_TEXT[code]) !== null && _a !== void 0 ? _a : code; })
-        .filter((text) => Boolean(text));
+        filtered.push(code);
+    }
+    const mealGroup = (0, timing_summary_1.getMealTimingGroup)(filtered, options);
+    if (!mealGroup) {
+        const phrases = [];
+        for (const code of filtered) {
+            const text = (_b = WHEN_TEXT[code]) !== null && _b !== void 0 ? _b : code;
+            if (text) {
+                phrases.push(text);
+            }
+        }
+        return phrases;
+    }
+    const groupedCodes = new Set(mealGroup.codes);
+    const phrases = [];
+    let insertedGroup = false;
+    for (const code of filtered) {
+        if (groupedCodes.has(code)) {
+            if (!insertedGroup) {
+                phrases.push(summarizeMealTimingGroup(mealGroup));
+                insertedGroup = true;
+            }
+            continue;
+        }
+        const text = (_c = WHEN_TEXT[code]) !== null && _c !== void 0 ? _c : code;
+        if (text) {
+            phrases.push(text);
+        }
+    }
+    return phrases;
 }
 function joinWithAnd(parts) {
     if (!parts.length) {
@@ -365,21 +566,23 @@ function combineFrequencyAndEvents(frequency, events) {
     }
     if (events.length === 1 && events[0] === "at bedtime") {
         const lowerFrequency = frequency.toLowerCase();
-        if (lowerFrequency === "twice daily" || lowerFrequency === "three times daily" || lowerFrequency === "four times daily") {
+        if (lowerFrequency === "twice daily" ||
+            lowerFrequency === "three times daily" ||
+            lowerFrequency === "four times daily") {
             return { frequency: `${frequency} and ${events[0]}` };
         }
     }
     return { frequency, event: joinWithAnd(events) };
 }
-function buildRoutePhrase(internal, grammar, hasSite) {
-    var _a;
+function buildRoutePhrase(clause, grammar, hasSite) {
+    var _a, _b;
     if (typeof grammar.routePhrase === "function") {
-        return grammar.routePhrase({ hasSite, internal });
+        return grammar.routePhrase({ hasSite, clause });
     }
     if (typeof grammar.routePhrase === "string") {
         return grammar.routePhrase;
     }
-    const text = (_a = internal.routeText) === null || _a === void 0 ? void 0 : _a.trim();
+    const text = (_b = (_a = clause.route) === null || _a === void 0 ? void 0 : _a.text) === null || _b === void 0 ? void 0 : _b.trim();
     if (!text) {
         return undefined;
     }
@@ -388,7 +591,7 @@ function buildRoutePhrase(internal, grammar, hasSite) {
         return text;
     }
     if (normalized === "oral") {
-        return "by mouth";
+        return "orally";
     }
     if (normalized === "intravenous") {
         return "intravenously";
@@ -413,17 +616,34 @@ function buildRoutePhrase(internal, grammar, hasSite) {
     }
     return `via ${text}`;
 }
-function formatSite(internal, grammar) {
-    var _a;
-    const text = (_a = internal.siteText) === null || _a === void 0 ? void 0 : _a.trim();
+function formatSite(clause, grammar) {
+    var _a, _b, _c, _d, _e, _f, _g, _h, _j, _k, _l, _m;
+    let text = (_b = (_a = clause.site) === null || _a === void 0 ? void 0 : _a.text) === null || _b === void 0 ? void 0 : _b.trim();
+    if (!text) {
+        const display = (_e = (_d = (_c = clause.site) === null || _c === void 0 ? void 0 : _c.coding) === null || _d === void 0 ? void 0 : _d.display) === null || _e === void 0 ? void 0 : _e.trim();
+        if (display) {
+            text = display.charAt(0).toLowerCase() + display.slice(1);
+        }
+        else {
+            text = (_h = (_g = (_f = clause.site) === null || _f === void 0 ? void 0 : _f.coding) === null || _g === void 0 ? void 0 : _g.code) === null || _h === void 0 ? void 0 : _h.trim();
+        }
+    }
     if (!text) {
         return undefined;
     }
     const lower = text.toLowerCase();
-    if (internal.routeCode === types_1.RouteCode["Per rectum"]) {
-        if (lower === "rectum" || lower === "rectal") {
-            return undefined;
-        }
+    const routeText = (_k = (_j = clause.route) === null || _j === void 0 ? void 0 : _j.text) === null || _k === void 0 ? void 0 : _k.trim().toLowerCase();
+    const isRectalRoute = ((_l = clause.route) === null || _l === void 0 ? void 0 : _l.code) === types_1.RouteCode["Per rectum"] ||
+        routeText === "rectum" ||
+        routeText === "rectal";
+    const isVaginalRoute = ((_m = clause.route) === null || _m === void 0 ? void 0 : _m.code) === types_1.RouteCode["Per vagina"] ||
+        routeText === "vagina" ||
+        routeText === "vaginal";
+    if (isRectalRoute && (lower === "rectum" || lower === "rectal")) {
+        return undefined;
+    }
+    if (isVaginalRoute && (lower === "vagina" || lower === "vaginal")) {
+        return undefined;
     }
     let preposition = grammar.sitePreposition;
     if (!preposition) {
@@ -439,7 +659,7 @@ function formatSite(internal, grammar) {
         else if (lower.includes("ear")) {
             preposition = "in";
         }
-        else if (/(skin|arm|leg|thigh|abdomen|shoulder|hand|foot|cheek|forearm|back|buttock|hip|face|hair|scalp|forehead|chin|neck)/.test(lower)) {
+        else if (/(skin|head|temple|arm|leg|thigh|abdomen|shoulder|elbow|wrist|ankle|knee|hand|foot|cheek|forearm|back|chest|breast|axilla|armpit|groin|lip|buttock|hip|face|hair|scalp|forehead|eyelid|chin|neck)/.test(lower)) {
             preposition = "to";
         }
         else {
@@ -452,15 +672,7 @@ function formatSite(internal, grammar) {
 function formatSiteNoun(site, preposition) {
     const trimmed = site.trim();
     const lower = trimmed.toLowerCase();
-    const skipArticlePrefixes = [
-        "the ",
-        "both ",
-        "each ",
-        "either ",
-        "every ",
-        "all ",
-        "bilateral ",
-    ];
+    const skipArticlePrefixes = ["the ", "both ", "each ", "either ", "every ", "all ", "bilateral "];
     for (const prefix of skipArticlePrefixes) {
         if (lower.startsWith(prefix)) {
             return trimmed;
@@ -470,107 +682,157 @@ function formatSiteNoun(site, preposition) {
     if (needsArticle || preposition === "at") {
         return `the ${trimmed}`;
     }
-    if (/(eye|nostril|ear|arm|leg|thigh|abdomen|hand|foot|cheek|skin|back)/.test(lower)) {
-        return `the ${trimmed}`;
-    }
     return `the ${trimmed}`;
 }
-function describeDayOfWeek(internal) {
-    if (!internal.dayOfWeek.length) {
+function describeDayOfWeek(schedule) {
+    var _a, _b;
+    const dayOfWeek = (_a = schedule === null || schedule === void 0 ? void 0 : schedule.dayOfWeek) !== null && _a !== void 0 ? _a : [];
+    if (!dayOfWeek.length) {
         return undefined;
     }
-    const days = internal.dayOfWeek.map((d) => { var _a; return (_a = DAY_NAMES[d]) !== null && _a !== void 0 ? _a : d; });
-    if (!days.length) {
+    const days = [];
+    for (const day of dayOfWeek) {
+        days.push((_b = DAY_NAMES[day]) !== null && _b !== void 0 ? _b : day);
+    }
+    return days.length ? `on ${joinWithAnd(days)}` : undefined;
+}
+function formatDurationShort(schedule) {
+    if (schedule.duration === undefined || !schedule.durationUnit) {
         return undefined;
     }
-    return `on ${joinWithAnd(days)}`;
+    const base = stripTrailingZero(schedule.duration);
+    const qualifier = schedule.durationMax !== undefined && schedule.durationMax !== schedule.duration
+        ? `${base}-${stripTrailingZero(schedule.durationMax)}`
+        : base;
+    return `x${qualifier}${schedule.durationUnit}`;
 }
-function formatInternal(internal, style, localization) {
-    const defaults = {
-        short: formatShort(internal),
-        long: formatLong(internal)
-    };
-    if (!localization) {
-        return defaults[style];
+function describeDuration(schedule) {
+    if (!schedule || schedule.duration === undefined || !schedule.durationUnit) {
+        return undefined;
     }
-    const formatDefault = (target) => defaults[target];
-    if (style === "short" && localization.formatShort) {
-        const context = {
-            style: "short",
-            internal,
-            defaultText: defaults.short,
-            formatDefault
-        };
-        return localization.formatShort(context);
+    const unit = schedule.durationUnit;
+    const label = (value) => {
+        switch (unit) {
+            case types_1.FhirPeriodUnit.Minute:
+                return value === 1 ? "minute" : "minutes";
+            case types_1.FhirPeriodUnit.Hour:
+                return value === 1 ? "hour" : "hours";
+            case types_1.FhirPeriodUnit.Day:
+                return value === 1 ? "day" : "days";
+            case types_1.FhirPeriodUnit.Week:
+                return value === 1 ? "week" : "weeks";
+            case types_1.FhirPeriodUnit.Month:
+                return value === 1 ? "month" : "months";
+            case types_1.FhirPeriodUnit.Year:
+                return value === 1 ? "year" : "years";
+            default:
+                return value === 1 ? "unit" : "units";
+        }
+    };
+    if (schedule.durationMax !== undefined && schedule.durationMax !== schedule.duration) {
+        return `for ${stripTrailingZero(schedule.duration)} to ${stripTrailingZero(schedule.durationMax)} ${label(schedule.durationMax)}`;
     }
-    if (style === "long" && localization.formatLong) {
-        const context = {
-            style: "long",
-            internal,
-            defaultText: defaults.long,
-            formatDefault
-        };
-        return localization.formatLong(context);
+    return `for ${stripTrailingZero(schedule.duration)} ${label(schedule.duration)}`;
+}
+function shouldUseGenericMedicationObject(clause) {
+    var _a, _b;
+    const methodText = (_b = (_a = clause.method) === null || _a === void 0 ? void 0 : _a.text) === null || _b === void 0 ? void 0 : _b.trim();
+    switch (methodText) {
+        case "Apply sunscreen":
+        case "Reapply sunscreen":
+        case "Use shampoo":
+            return false;
+        default:
+            return true;
     }
-    return defaults[style];
 }
-function formatShort(internal) {
+function shouldSuppressRoutePhrase(clause, grammar, verb) {
     var _a;
+    if (((_a = clause.route) === null || _a === void 0 ? void 0 : _a.code) !== types_1.RouteCode["Oral route"]) {
+        return false;
+    }
+    if (grammar.routePhrase !== "orally") {
+        return false;
+    }
+    switch (verb) {
+        case "Drink":
+        case "Swallow":
+            return true;
+        default:
+            return false;
+    }
+}
+function formatShort(clause) {
+    var _a, _b, _c, _d, _e, _f;
+    const schedule = scheduleOf(clause);
     const parts = [];
-    const dosePart = formatDoseShort(internal);
+    const dosePart = formatDoseShort(clause.dose);
     if (dosePart) {
         parts.push(dosePart);
     }
-    if (internal.routeCode) {
-        const short = ROUTE_SHORT[internal.routeCode];
+    const routeCode = (_a = clause.route) === null || _a === void 0 ? void 0 : _a.code;
+    const routeText = (_b = clause.route) === null || _b === void 0 ? void 0 : _b.text;
+    if (routeCode) {
+        const short = ROUTE_SHORT[routeCode];
         if (short) {
             parts.push(short);
         }
-        else if (internal.routeText) {
-            parts.push(internal.routeText);
+        else if (routeText) {
+            parts.push(routeText);
         }
     }
-    else if (internal.routeText) {
-        parts.push(internal.routeText);
+    else if (routeText) {
+        parts.push(routeText);
     }
-    if (internal.timingCode) {
-        parts.push(internal.timingCode);
+    if (schedule.timingCode) {
+        parts.push(schedule.timingCode);
     }
-    else if (internal.frequency !== undefined &&
-        internal.frequencyMax !== undefined &&
-        internal.periodUnit === types_1.FhirPeriodUnit.Day &&
-        (!internal.period || internal.period === 1)) {
-        parts.push(`${stripTrailingZero(internal.frequency)}-${stripTrailingZero(internal.frequencyMax)}x/d`);
+    else if (schedule.frequency !== undefined &&
+        schedule.frequencyMax !== undefined &&
+        schedule.periodUnit === types_1.FhirPeriodUnit.Day &&
+        (!schedule.period || schedule.period === 1)) {
+        parts.push(`${stripTrailingZero(schedule.frequency)}-${stripTrailingZero(schedule.frequencyMax)}x/d`);
     }
-    else if (internal.frequency &&
-        internal.periodUnit === types_1.FhirPeriodUnit.Day &&
-        (!internal.period || internal.period === 1)) {
-        parts.push(`${stripTrailingZero(internal.frequency)}x/d`);
+    else if (schedule.frequency &&
+        schedule.periodUnit === types_1.FhirPeriodUnit.Day &&
+        (!schedule.period || schedule.period === 1)) {
+        parts.push(`${stripTrailingZero(schedule.frequency)}x/d`);
     }
-    else if (internal.period && internal.periodUnit) {
-        const base = stripTrailingZero(internal.period);
-        const qualifier = internal.periodMax && internal.periodMax !== internal.period
-            ? `${base}-${stripTrailingZero(internal.periodMax)}`
+    else if (schedule.period && schedule.periodUnit) {
+        const base = stripTrailingZero(schedule.period);
+        const qualifier = schedule.periodMax && schedule.periodMax !== schedule.period
+            ? `${base}-${stripTrailingZero(schedule.periodMax)}`
             : base;
-        parts.push(`Q${qualifier}${internal.periodUnit.toUpperCase()}`);
+        parts.push(`Q${qualifier}${schedule.periodUnit.toUpperCase()}`);
+    }
+    if ((_c = schedule.when) === null || _c === void 0 ? void 0 : _c.length) {
+        parts.push(schedule.when.join(" "));
     }
-    if (internal.when.length) {
-        parts.push(internal.when.join(" "));
+    if ((_d = schedule.dayOfWeek) === null || _d === void 0 ? void 0 : _d.length) {
+        const days = [];
+        for (const day of schedule.dayOfWeek) {
+            days.push(day.charAt(0).toUpperCase() + day.slice(1, 3));
+        }
+        parts.push(days.join(","));
     }
-    if (internal.dayOfWeek.length) {
-        parts.push(internal.dayOfWeek
-            .map((d) => d.charAt(0).toUpperCase() + d.slice(1, 3))
-            .join(","));
+    if ((_e = schedule.timeOfDay) === null || _e === void 0 ? void 0 : _e.length) {
+        const times = [];
+        for (const time of schedule.timeOfDay) {
+            times.push(time.slice(0, 5));
+        }
+        parts.push(times.join(","));
     }
-    if ((_a = internal.timeOfDay) === null || _a === void 0 ? void 0 : _a.length) {
-        parts.push(internal.timeOfDay.map(t => t.slice(0, 5)).join(","));
+    if (schedule.count !== undefined) {
+        parts.push(`x${stripTrailingZero(schedule.count)}`);
     }
-    if (internal.count !== undefined) {
-        parts.push(`x${stripTrailingZero(internal.count)}`);
+    const durationShort = formatDurationShort(schedule);
+    if (durationShort) {
+        parts.push(durationShort);
     }
-    if (internal.asNeeded) {
-        if (internal.asNeededReason) {
-            parts.push(`PRN ${internal.asNeededReason}`);
+    if ((_f = clause.prn) === null || _f === void 0 ? void 0 : _f.enabled) {
+        const reason = (0, prn_1.getPreferredCanonicalPrnReasonText)(clause.prn.reason, clause.prn.reasons);
+        if (reason) {
+            parts.push(`PRN ${reason}`);
         }
         else {
             parts.push("PRN");
@@ -578,40 +840,50 @@ function formatShort(internal) {
     }
     return parts.filter(Boolean).join(" ");
 }
-function formatLong(internal) {
-    var _a, _b;
-    const grammar = resolveRouteGrammar(internal);
-    const dosePart = (_a = formatDoseLong(internal)) !== null && _a !== void 0 ? _a : "the medication";
-    const sitePart = formatSite(internal, grammar);
-    const routePart = buildRoutePhrase(internal, grammar, Boolean(sitePart));
-    const frequencyPart = describeFrequency(internal);
-    const eventParts = collectWhenPhrases(internal);
-    if ((_b = internal.timeOfDay) === null || _b === void 0 ? void 0 : _b.length) {
+function formatLong(clause, options) {
+    var _a, _b, _c, _d, _e, _f;
+    const schedule = scheduleOf(clause);
+    const grammar = resolveRouteGrammar(clause);
+    const verb = resolveMethodVerb(clause, grammar);
+    const explicitDosePart = formatDoseLong(clause.dose);
+    const dosePart = explicitDosePart !== null && explicitDosePart !== void 0 ? explicitDosePart : (shouldUseGenericMedicationObject(clause) ? "the medication" : undefined);
+    const sitePart = formatSite(clause, grammar);
+    const routePart = shouldSuppressRoutePhrase(clause, grammar, verb)
+        ? undefined
+        : buildRoutePhrase(clause, grammar, Boolean(sitePart));
+    const standaloneOccurrenceCount = describeStandaloneOccurrenceCount(schedule);
+    const frequencyPart = (_b = (_a = describeFrequency(schedule)) !== null && _a !== void 0 ? _a : standaloneOccurrenceCount) !== null && _b !== void 0 ? _b : describeFrequencyCount((0, timing_summary_1.inferDailyOccurrenceCount)(schedule, options));
+    const eventParts = collectWhenPhrases(schedule, options);
+    if ((_c = schedule.timeOfDay) === null || _c === void 0 ? void 0 : _c.length) {
         const timeStrings = [];
-        for (const time of internal.timeOfDay) {
+        for (const time of schedule.timeOfDay) {
             const parts = time.split(":");
-            const h = parseInt(parts[0], 10);
-            const m = parseInt(parts[1], 10);
-            const isAm = h < 12;
-            const displayH = h % 12 || 12;
-            const displayM = m < 10 ? `0${m}` : `${m}`;
-            timeStrings.push(`${displayH}:${displayM}${isAm ? " am" : " pm"}`);
-        }
-        if (timeStrings.length > 0) {
+            const hours = Number(parts[0]);
+            const minutes = Number(parts[1]);
+            if (!Number.isFinite(hours) || !Number.isFinite(minutes)) {
+                continue;
+            }
+            const isAm = hours < 12;
+            const displayHours = hours % 12 || 12;
+            const displayMinutes = minutes < 10 ? `0${minutes}` : `${minutes}`;
+            timeStrings.push(`${displayHours}:${displayMinutes}${isAm ? " am" : " pm"}`);
+        }
+        if (timeStrings.length) {
             eventParts.push(`at ${timeStrings.join(", ")}`);
         }
     }
     const timing = combineFrequencyAndEvents(frequencyPart, eventParts);
-    const dayPart = describeDayOfWeek(internal);
-    const countPart = internal.count
-        ? `for ${stripTrailingZero(internal.count)} ${internal.count === 1 ? "dose" : "doses"}`
+    const dayPart = describeDayOfWeek(schedule);
+    const countPart = schedule.count !== undefined && !standaloneOccurrenceCount
+        ? `for ${stripTrailingZero(schedule.count)} ${schedule.count === 1 ? "dose" : "doses"}`
         : undefined;
-    const asNeededPart = internal.asNeeded
-        ? internal.asNeededReason
-            ? `as needed for ${internal.asNeededReason}`
-            : "as needed"
-        : undefined;
-    const segments = [dosePart];
+    const durationPart = describeDuration(schedule);
+    const reason = (0, prn_1.getPreferredCanonicalPrnReasonText)((_d = clause.prn) === null || _d === void 0 ? void 0 : _d.reason, (_e = clause.prn) === null || _e === void 0 ? void 0 : _e.reasons);
+    const asNeededPart = ((_f = clause.prn) === null || _f === void 0 ? void 0 : _f.enabled) ? (reason ? `as needed for ${reason}` : "as needed") : undefined;
+    const segments = [];
+    if (dosePart) {
+        segments.push(dosePart);
+    }
     if (routePart) {
         segments.push(routePart);
     }
@@ -627,6 +899,9 @@ function formatLong(internal) {
     if (countPart) {
         segments.push(countPart);
     }
+    if (durationPart) {
+        segments.push(durationPart);
+    }
     if (asNeededPart) {
         segments.push(asNeededPart);
     }
@@ -634,34 +909,121 @@ function formatLong(internal) {
         segments.push(sitePart);
     }
     const body = segments.filter(Boolean).join(" ").replace(/\s+/g, " ").trim();
+    const instructionPhrases = [];
+    const instructionText = formatAdditionalInstructions(clause);
+    if (instructionText) {
+        instructionPhrases.push(instructionText);
+    }
+    const patientInstruction = formatPatientInstructionSentence(clause.patientInstruction);
+    if (patientInstruction) {
+        instructionPhrases.push(patientInstruction);
+    }
+    const trailingInstructionText = instructionPhrases.join(" ").trim() || undefined;
     if (!body) {
-        const instructionText = formatAdditionalInstructions(internal);
-        if (!instructionText) {
-            return `${grammar.verb}.`;
+        if (!trailingInstructionText) {
+            return `${verb}.`;
         }
-        return `${grammar.verb}. ${instructionText}`.trim();
+        return `${verb}. ${trailingInstructionText}`.trim();
     }
-    const instructionText = formatAdditionalInstructions(internal);
-    const baseSentence = `${grammar.verb} ${body}.`;
-    return instructionText ? `${baseSentence} ${instructionText}` : baseSentence;
+    const baseSentence = `${verb} ${body}.`;
+    return trailingInstructionText ? `${baseSentence} ${trailingInstructionText}` : baseSentence;
 }
-function formatAdditionalInstructions(internal) {
-    var _a;
-    if (!((_a = internal.additionalInstructions) === null || _a === void 0 ? void 0 : _a.length)) {
+function formatAdditionalInstructions(clause) {
+    var _a, _b, _c, _d, _e, _f;
+    const instructions = (_a = clause.additionalInstructions) !== null && _a !== void 0 ? _a : [];
+    if (!instructions.length) {
         return undefined;
     }
-    const phrases = internal.additionalInstructions
-        .map((instruction) => { var _a; return instruction.text || ((_a = instruction.coding) === null || _a === void 0 ? void 0 : _a.display); })
-        .filter((text) => Boolean(text))
-        .map((text) => text.trim())
-        .filter((text) => text.length > 0);
+    const phrases = [];
+    const grammar = resolveRouteGrammar(clause);
+    const verb = resolveMethodVerb(clause, grammar);
+    for (const instruction of instructions) {
+        if (((_b = instruction.coding) === null || _b === void 0 ? void 0 : _b.code) === SLOWLY_QUALIFIER_CODE) {
+            const contextual = verb ? `${verb} slowly` : "Slowly";
+            phrases.push(contextual);
+            continue;
+        }
+        if (((_c = instruction.coding) === null || _c === void 0 ? void 0 : _c.code) === EMPTY_STOMACH_QUALIFIER_CODE ||
+            ((_d = instruction.frames) === null || _d === void 0 ? void 0 : _d.some((frame) => frame.relation === types_1.AdviceRelation.On &&
+                frame.args.some((arg) => arg.role === types_1.AdviceArgumentRole.MealState &&
+                    arg.conceptId === "empty_stomach")))) {
+            phrases.push("On an empty stomach");
+            continue;
+        }
+        const text = (_e = instruction.text) !== null && _e !== void 0 ? _e : (_f = instruction.coding) === null || _f === void 0 ? void 0 : _f.display;
+        if (!text) {
+            continue;
+        }
+        const trimmed = text.trim();
+        if (trimmed) {
+            phrases.push(trimmed);
+        }
+    }
     if (!phrases.length) {
         return undefined;
     }
-    return phrases
-        .map((phrase) => (/[.!?]$/.test(phrase) ? phrase : `${phrase}.`))
-        .join(" ")
-        .trim();
+    return phrases.map((phrase) => (/[.!?]$/.test(phrase) ? phrase : `${phrase}.`)).join(" ").trim();
+}
+function firstCanonicalClause(internal) {
+    const clauses = internal.clauses;
+    if (clauses.length > 0) {
+        return clauses[0];
+    }
+    return {
+        kind: "administration",
+        rawText: internal.input,
+        raw: { start: 0, end: internal.input.length, text: internal.input },
+        leftovers: [],
+        evidence: [],
+        confidence: 0
+    };
+}
+function formatCanonicalClause(clause, style, localization, options) {
+    let shortDefault;
+    let longDefault;
+    const formatDefault = (target) => {
+        switch (target) {
+            case "short":
+                if (shortDefault === undefined) {
+                    shortDefault = formatShort(clause);
+                }
+                return shortDefault;
+            case "long":
+                if (longDefault === undefined) {
+                    longDefault = formatLong(clause, options);
+                }
+                return longDefault;
+        }
+    };
+    if (!localization) {
+        return formatDefault(style);
+    }
+    if (style === "short" && localization.formatShort) {
+        const context = {
+            style: "short",
+            clause,
+            defaultText: formatDefault("short"),
+            groupMealTimingsByRelation: Boolean(options === null || options === void 0 ? void 0 : options.groupMealTimingsByRelation),
+            includeTimesPerDaySummary: Boolean(options === null || options === void 0 ? void 0 : options.includeTimesPerDaySummary),
+            formatDefault
+        };
+        return localization.formatShort(context);
+    }
+    if (style === "long" && localization.formatLong) {
+        const context = {
+            style: "long",
+            clause,
+            defaultText: formatDefault("long"),
+            groupMealTimingsByRelation: Boolean(options === null || options === void 0 ? void 0 : options.groupMealTimingsByRelation),
+            includeTimesPerDaySummary: Boolean(options === null || options === void 0 ? void 0 : options.includeTimesPerDaySummary),
+            formatDefault
+        };
+        return localization.formatLong(context);
+    }
+    return formatDefault(style);
+}
+function formatInternal(internal, style, localization, options) {
+    return formatCanonicalClause(firstCanonicalClause(internal), style, localization, options);
 }
 function stripTrailingZero(value) {
     const text = value.toString();