ezmedicationinput 0.1.49 → 0.1.52

package/dist/index.cjs

@@ -62,6 +62,7 @@ __export(index_exports, {
   AdviceModality: () => AdviceModality,
   AdvicePolarity: () => AdvicePolarity,
   AdviceRelation: () => AdviceRelation,
+  BODY_SITE_ADMINISTRATION_TARGET_COUNT_EXTENSION_URL: () => BODY_SITE_ADMINISTRATION_TARGET_COUNT_EXTENSION_URL,
   BODY_SITE_SPATIAL_RELATION_EXTENSION_URL: () => BODY_SITE_SPATIAL_RELATION_EXTENSION_URL,
   DEFAULT_BODY_SITE_SNOMED: () => DEFAULT_BODY_SITE_SNOMED,
   DEFAULT_BODY_SITE_SNOMED_SOURCE: () => DEFAULT_BODY_SITE_SNOMED_SOURCE,
@@ -86,6 +87,7 @@ __export(index_exports, {
   SNOMED_CT_TOPOGRAPHICAL_MODIFIER_CODE: () => SNOMED_CT_TOPOGRAPHICAL_MODIFIER_CODE,
   SNOMED_CT_TOPOGRAPHICAL_MODIFIER_DISPLAY: () => SNOMED_CT_TOPOGRAPHICAL_MODIFIER_DISPLAY,
   SNOMED_SYSTEM: () => SNOMED_SYSTEM,
+  buildBodySiteAdministrationTargetCountExtension: () => buildBodySiteAdministrationTargetCountExtension,
   buildBodySiteSpatialRelationExtension: () => buildBodySiteSpatialRelationExtension,
   buildBodySiteSpatialRelationExtensions: () => buildBodySiteSpatialRelationExtensions,
   buildBodySiteTopographicalModifierCoding: () => buildBodySiteTopographicalModifierCoding,
@@ -99,6 +101,7 @@ __export(index_exports, {
   formatSig: () => formatSig,
   formatSigBatch: () => formatSigBatch,
   fromFhirDosage: () => fromFhirDosage,
+  getBodySiteAdministrationTargetCount: () => getBodySiteAdministrationTargetCount,
   getBodySiteCode: () => getBodySiteCode,
   getBodySiteCodeAsync: () => getBodySiteCodeAsync,
   getBodySiteText: () => getBodySiteText,
@@ -117,6 +120,7 @@ __export(index_exports, {
   lookupBodySite: () => lookupBodySite,
   lookupBodySiteAsync: () => lookupBodySiteAsync,
   nextDueDoses: () => nextDueDoses,
+  parseBodySiteAdministrationTargetCountExtension: () => parseBodySiteAdministrationTargetCountExtension,
   parseBodySiteSpatialRelationExtension: () => parseBodySiteSpatialRelationExtension,
   parseSig: () => parseSig,
   parseSigAsync: () => parseSigAsync,
@@ -134,60 +138,6 @@ __export(index_exports, {
 });
 module.exports = __toCommonJS(index_exports);
 
-// src/prn.ts
-function getCanonicalPrnReasonText(reason) {
-  var _a2, _b;
-  return (_b = reason == null ? void 0 : reason.text) != null ? _b : (_a2 = reason == null ? void 0 : reason.coding) == null ? void 0 : _a2.display;
-}
-function joinCanonicalPrnReasonTexts(reasons, conjunction = "or") {
-  var _a2;
-  if (!(reasons == null ? void 0 : reasons.length)) {
-    return void 0;
-  }
-  const texts = [];
-  for (const reason of reasons) {
-    const text = (_a2 = getCanonicalPrnReasonText(reason)) == null ? void 0 : _a2.trim();
-    if (!text) {
-      continue;
-    }
-    texts.push(text);
-  }
-  switch (texts.length) {
-    case 0:
-      return void 0;
-    case 1:
-      return texts[0];
-    case 2:
-      return `${texts[0]} ${conjunction} ${texts[1]}`;
-    default: {
-      let combined = "";
-      for (let index = 0; index < texts.length; index += 1) {
-        if (index === 0) {
-          combined = texts[index];
-          continue;
-        }
-        if (index === texts.length - 1) {
-          combined += ` ${conjunction} ${texts[index]}`;
-          continue;
-        }
-        combined += `, ${texts[index]}`;
-      }
-      return combined;
-    }
-  }
-}
-function getPreferredCanonicalPrnReasonText(reason, reasons, conjunction = "or") {
-  var _a2;
-  const direct = (_a2 = getCanonicalPrnReasonText(reason)) == null ? void 0 : _a2.trim();
-  if (!(reasons == null ? void 0 : reasons.length)) {
-    return direct;
-  }
-  if (!direct) {
-    return joinCanonicalPrnReasonTexts(reasons, conjunction);
-  }
-  return /[,/;]/.test(direct) || /\b(?:or|and|and\/or)\b/i.test(direct) || /\s(?:หรือ|และ)\s/.test(direct) ? joinCanonicalPrnReasonTexts(reasons, conjunction) : direct;
-}
-
 // src/types.ts
 var EventTiming = /* @__PURE__ */ ((EventTiming4) => {
   EventTiming4["Before Sleep"] = "HS";
@@ -455,6 +405,328 @@ var AdviceArgumentRole = /* @__PURE__ */ ((AdviceArgumentRole2) => {
   return AdviceArgumentRole2;
 })(AdviceArgumentRole || {});
 
+// src/timing-summary.ts
+var MEAL_TIMING_DETAILS = {
+  ["ACM" /* Before Breakfast */]: { relation: "before", meal: "breakfast" },
+  ["ACD" /* Before Lunch */]: { relation: "before", meal: "lunch" },
+  ["ACV" /* Before Dinner */]: { relation: "before", meal: "dinner" },
+  ["PCM" /* After Breakfast */]: { relation: "after", meal: "breakfast" },
+  ["PCD" /* After Lunch */]: { relation: "after", meal: "lunch" },
+  ["PCV" /* After Dinner */]: { relation: "after", meal: "dinner" },
+  ["CM" /* Breakfast */]: { relation: "with", meal: "breakfast" },
+  ["CD" /* Lunch */]: { relation: "with", meal: "lunch" },
+  ["CV" /* Dinner */]: { relation: "with", meal: "dinner" }
+};
+var MEAL_ORDER = {
+  breakfast: 0,
+  lunch: 1,
+  dinner: 2
+};
+var INFERABLE_DAILY_EVENT_TIMINGS = /* @__PURE__ */ new Set([
+  "HS" /* Before Sleep */,
+  "ACM" /* Before Breakfast */,
+  "ACD" /* Before Lunch */,
+  "ACV" /* Before Dinner */,
+  "PCM" /* After Breakfast */,
+  "PCD" /* After Lunch */,
+  "PCV" /* After Dinner */,
+  "CM" /* Breakfast */,
+  "CD" /* Lunch */,
+  "CV" /* Dinner */,
+  "MORN" /* Morning */,
+  "MORN.early" /* Early Morning */,
+  "MORN.late" /* Late Morning */,
+  "NOON" /* Noon */,
+  "AFT" /* Afternoon */,
+  "AFT.early" /* Early Afternoon */,
+  "AFT.late" /* Late Afternoon */,
+  "EVE" /* Evening */,
+  "EVE.early" /* Early Evening */,
+  "EVE.late" /* Late Evening */,
+  "NIGHT" /* Night */,
+  "WAKE" /* Wake */,
+  "PHS" /* After Sleep */
+]);
+function uniqueValues(values) {
+  const seen = /* @__PURE__ */ new Set();
+  const result = [];
+  for (const value of values) {
+    if (!seen.has(value)) {
+      seen.add(value);
+      result.push(value);
+    }
+  }
+  return result;
+}
+function getMealTimingGroup(when, options) {
+  if (!(options == null ? void 0 : options.groupMealTimingsByRelation)) {
+    return void 0;
+  }
+  const uniqueWhen2 = uniqueValues(when);
+  if (uniqueWhen2.length < 2) {
+    return void 0;
+  }
+  let relation;
+  const meals = [];
+  const groupedCodes = [];
+  let sawFirstMeal = false;
+  for (let i = 0; i < uniqueWhen2.length; i += 1) {
+    const code = uniqueWhen2[i];
+    const detail = MEAL_TIMING_DETAILS[code];
+    if (!detail) {
+      if (sawFirstMeal) {
+        break;
+      }
+      continue;
+    }
+    if (!sawFirstMeal) {
+      sawFirstMeal = true;
+    }
+    if (!relation) {
+      relation = detail.relation;
+    } else if (relation !== detail.relation && detail.relation !== "with") {
+      break;
+    }
+    meals.push(detail.meal);
+    groupedCodes.push(code);
+  }
+  if (groupedCodes.length < 2) {
+    return void 0;
+  }
+  for (let i = 1; i < meals.length; i += 1) {
+    const current = meals[i];
+    let j = i - 1;
+    while (j >= 0 && MEAL_ORDER[meals[j]] > MEAL_ORDER[current]) {
+      meals[j + 1] = meals[j];
+      j -= 1;
+    }
+    meals[j + 1] = current;
+  }
+  if (!relation) {
+    return void 0;
+  }
+  return {
+    relation,
+    meals,
+    codes: groupedCodes
+  };
+}
+function inferDailyOccurrenceCount(input, options) {
+  var _a2, _b, _c, _d;
+  if (!(options == null ? void 0 : options.includeTimesPerDaySummary)) {
+    return void 0;
+  }
+  if (input.frequency !== void 0 || input.frequencyMax !== void 0 || input.timingCode) {
+    return void 0;
+  }
+  if (input.period !== void 0 || input.periodMax !== void 0 || input.periodUnit !== void 0) {
+    return void 0;
+  }
+  if (((_b = (_a2 = input.dayOfWeek) == null ? void 0 : _a2.length) != null ? _b : 0) > 0) {
+    return void 0;
+  }
+  const uniqueWhen2 = uniqueValues((_c = input.when) != null ? _c : []);
+  for (let i = 0; i < uniqueWhen2.length; i += 1) {
+    if (!INFERABLE_DAILY_EVENT_TIMINGS.has(uniqueWhen2[i])) {
+      return void 0;
+    }
+  }
+  const uniqueTimes = uniqueValues((_d = input.timeOfDay) != null ? _d : []);
+  const occurrences = uniqueWhen2.length + uniqueTimes.length;
+  if (occurrences === 0) {
+    return void 0;
+  }
+  return occurrences;
+}
+
+// src/localized-timing.ts
+function uniqueWhenEvents(schedule) {
+  var _a2;
+  const when = (_a2 = schedule == null ? void 0 : schedule.when) != null ? _a2 : [];
+  if (!when.length) {
+    return [];
+  }
+  const unique = [];
+  const seen = /* @__PURE__ */ new Set();
+  for (const code of when) {
+    if (!seen.has(code)) {
+      seen.add(code);
+      unique.push(code);
+    }
+  }
+  return unique;
+}
+function filterLocalizedWhenEvents(schedule) {
+  const unique = uniqueWhenEvents(schedule);
+  const specificAfter = /* @__PURE__ */ new Set();
+  const specificBefore = /* @__PURE__ */ new Set();
+  const specificWith = /* @__PURE__ */ new Set();
+  for (const code of unique) {
+    if (code === "PCM" /* After Breakfast */ || code === "PCD" /* After Lunch */ || code === "PCV" /* After Dinner */) {
+      specificAfter.add(code);
+    }
+    if (code === "ACM" /* Before Breakfast */ || code === "ACD" /* Before Lunch */ || code === "ACV" /* Before Dinner */) {
+      specificBefore.add(code);
+    }
+    if (code === "CM" /* Breakfast */ || code === "CD" /* Lunch */ || code === "CV" /* Dinner */) {
+      specificWith.add(code);
+    }
+  }
+  const hasAllAfter = specificAfter.has("PCM" /* After Breakfast */) && specificAfter.has("PCD" /* After Lunch */) && specificAfter.has("PCV" /* After Dinner */);
+  const hasAllBefore = specificBefore.has("ACM" /* Before Breakfast */) && specificBefore.has("ACD" /* Before Lunch */) && specificBefore.has("ACV" /* Before Dinner */);
+  const hasAllWith = specificWith.has("CM" /* Breakfast */) && specificWith.has("CD" /* Lunch */) && specificWith.has("CV" /* Dinner */);
+  const filtered = [];
+  for (const code of unique) {
+    if (code === "PC" /* After Meal */ && hasAllAfter) {
+      continue;
+    }
+    if (code === "AC" /* Before Meal */ && hasAllBefore) {
+      continue;
+    }
+    if (code === "C" /* Meal */ && hasAllWith) {
+      continue;
+    }
+    filtered.push(code);
+  }
+  return filtered;
+}
+function collectLocalizedWhenPhrases(schedule, grammar, options) {
+  const filtered = filterLocalizedWhenEvents(schedule);
+  if (!filtered.length) {
+    return [];
+  }
+  const mealGroup = getMealTimingGroup(filtered, options);
+  if (!mealGroup) {
+    const phrases2 = [];
+    for (const code of filtered) {
+      const text = grammar.whenText[code];
+      if (text) {
+        phrases2.push(text);
+      }
+    }
+    return phrases2;
+  }
+  const groupedCodes = new Set(mealGroup.codes);
+  const phrases = [];
+  let insertedGroup = false;
+  for (const code of filtered) {
+    if (groupedCodes.has(code)) {
+      if (!insertedGroup) {
+        phrases.push(grammar.summarizeMealTimingGroup(mealGroup));
+        insertedGroup = true;
+      }
+      continue;
+    }
+    const text = grammar.whenText[code];
+    if (text) {
+      phrases.push(text);
+    }
+  }
+  return phrases;
+}
+function inferExplicitDailyFrequency(schedule) {
+  var _a2;
+  if (!schedule) {
+    return void 0;
+  }
+  if (schedule.frequency !== void 0 && schedule.frequencyMax === void 0 && schedule.periodUnit === "d" /* Day */ && (schedule.period === void 0 || schedule.period === 1) && schedule.periodMax === void 0) {
+    return schedule.frequency;
+  }
+  switch ((_a2 = schedule.timingCode) == null ? void 0 : _a2.toUpperCase()) {
+    case "QD":
+      return 1;
+    case "BID":
+      return 2;
+    case "TID":
+      return 3;
+    case "QID":
+      return 4;
+    default:
+      return void 0;
+  }
+}
+function isBedtimeOnlyWhen(schedule) {
+  const filtered = filterLocalizedWhenEvents(schedule);
+  return filtered.length === 1 && filtered[0] === "HS" /* Before Sleep */;
+}
+function combineLocalizedFrequencyAndEvents(schedule, frequency, events, grammar, options) {
+  var _a2, _b, _c;
+  if (!frequency) {
+    if (!events.length) {
+      return {};
+    }
+    return { event: grammar.joinList(events) };
+  }
+  if (!events.length) {
+    return { frequency };
+  }
+  if (events.length === 1 && isBedtimeOnlyWhen(schedule)) {
+    const dailyCount = (_a2 = inferExplicitDailyFrequency(schedule)) != null ? _a2 : inferDailyOccurrenceCount(schedule != null ? schedule : {}, options);
+    const style = (_c = (_b = grammar.bedtimeJoinStyle) == null ? void 0 : _b.call(grammar, dailyCount)) != null ? _c : "separate";
+    if (style === "adjacent") {
+      return { frequency: `${frequency} ${events[0]}` };
+    }
+    if (style === "conjunction") {
+      return { frequency: grammar.joinList([frequency, events[0]]) };
+    }
+  }
+  return { frequency, event: grammar.joinList(events) };
+}
+
+// src/prn.ts
+function getCanonicalPrnReasonText(reason) {
+  var _a2, _b;
+  return (_b = reason == null ? void 0 : reason.text) != null ? _b : (_a2 = reason == null ? void 0 : reason.coding) == null ? void 0 : _a2.display;
+}
+function joinCanonicalPrnReasonTexts(reasons, conjunction = "or") {
+  var _a2;
+  if (!(reasons == null ? void 0 : reasons.length)) {
+    return void 0;
+  }
+  const texts = [];
+  for (const reason of reasons) {
+    const text = (_a2 = getCanonicalPrnReasonText(reason)) == null ? void 0 : _a2.trim();
+    if (!text) {
+      continue;
+    }
+    texts.push(text);
+  }
+  switch (texts.length) {
+    case 0:
+      return void 0;
+    case 1:
+      return texts[0];
+    case 2:
+      return `${texts[0]} ${conjunction} ${texts[1]}`;
+    default: {
+      let combined = "";
+      for (let index = 0; index < texts.length; index += 1) {
+        if (index === 0) {
+          combined = texts[index];
+          continue;
+        }
+        if (index === texts.length - 1) {
+          combined += ` ${conjunction} ${texts[index]}`;
+          continue;
+        }
+        combined += `, ${texts[index]}`;
+      }
+      return combined;
+    }
+  }
+}
+function getPreferredCanonicalPrnReasonText(reason, reasons, conjunction = "or") {
+  var _a2;
+  const direct = (_a2 = getCanonicalPrnReasonText(reason)) == null ? void 0 : _a2.trim();
+  if (!(reasons == null ? void 0 : reasons.length)) {
+    return direct;
+  }
+  if (!direct) {
+    return joinCanonicalPrnReasonTexts(reasons, conjunction);
+  }
+  return /[,/;]/.test(direct) || /\b(?:or|and|and\/or)\b/i.test(direct) || /\s(?:หรือ|และ)\s/.test(direct) ? joinCanonicalPrnReasonTexts(reasons, conjunction) : direct;
+}
+
 // src/snomed.ts
 var SNOMED_SYSTEM = "http://snomed.info/sct";
 var SNOMED_CT_FINDING_SITE_ATTRIBUTE_CODE = "363698007";
@@ -481,6 +753,24 @@ function normalizeLocaleKey(locale) {
 function cloneI18nRecord(i18n) {
   return i18n ? __spreadValues({}, i18n) : void 0;
 }
+function mergeI18nRecords(...records) {
+  var _a2;
+  const merged = {};
+  for (const record of records) {
+    if (!record) {
+      continue;
+    }
+    for (const locale in record) {
+      const normalizedLocale = normalizeLocaleKey(locale);
+      const content = (_a2 = record[locale]) == null ? void 0 : _a2.trim();
+      if (!normalizedLocale || !content) {
+        continue;
+      }
+      merged[normalizedLocale] = content;
+    }
+  }
+  return Object.keys(merged).length ? merged : void 0;
+}
 function cloneExtension(extension) {
   var _a2, _b, _c, _d;
   return {
@@ -567,6 +857,32 @@ function buildTranslationPrimitiveElement(translations, base) {
     extension: nextExtensions
   };
 }
+function mergeTranslationPrimitiveElement(base, translations) {
+  var _a2, _b, _c, _d;
+  const nextExtensions = (_b = (_a2 = base == null ? void 0 : base.extension) == null ? void 0 : _a2.map(cloneExtension)) != null ? _b : [];
+  const existingTranslationLocales = /* @__PURE__ */ new Set();
+  for (const extension of nextExtensions) {
+    if (extension.url !== FHIR_TRANSLATION_EXTENSION_URL) {
+      continue;
+    }
+    const { locale, content } = getTranslationParts(extension);
+    if (locale && content) {
+      existingTranslationLocales.add(locale);
+    }
+  }
+  const additions = (_d = (_c = buildTranslationPrimitiveElement(translations)) == null ? void 0 : _c.extension) != null ? _d : [];
+  for (const extension of additions) {
+    const { locale } = getTranslationParts(extension);
+    if (locale && existingTranslationLocales.has(locale)) {
+      continue;
+    }
+    if (locale) {
+      existingTranslationLocales.add(locale);
+    }
+    nextExtensions.push(extension);
+  }
+  return nextExtensions.length ? { extension: nextExtensions } : void 0;
+}
 function getTranslationParts(extension) {
   var _a2, _b;
   const parts = (_a2 = extension.extension) != null ? _a2 : [];
@@ -610,6 +926,24 @@ function getPrimitiveTranslation(element, locale) {
   }
   return languagePrefixMatch;
 }
+function getPrimitiveTranslations(element) {
+  var _a2;
+  if (!((_a2 = element == null ? void 0 : element.extension) == null ? void 0 : _a2.length)) {
+    return void 0;
+  }
+  const translations = {};
+  for (const extension of element.extension) {
+    if (extension.url !== FHIR_TRANSLATION_EXTENSION_URL) {
+      continue;
+    }
+    const { locale, content } = getTranslationParts(extension);
+    if (!locale || !content) {
+      continue;
+    }
+    translations[locale] = content;
+  }
+  return Object.keys(translations).length ? translations : void 0;
+}
 
 // src/body-site-spatial.ts
 var SNOMED_SYSTEM2 = "http://snomed.info/sct";
@@ -1201,10 +1535,11 @@ var DEFAULT_BODY_SITE_SNOMED_SOURCE = [
     }
   },
   {
-    names: ["both eyes", "bilateral eyes", "\u0E15\u0E32\u0E17\u0E31\u0E49\u0E07\u0E2A\u0E2D\u0E07\u0E02\u0E49\u0E32\u0E07", "\u0E15\u0E32\u0E2A\u0E2D\u0E07\u0E02\u0E49\u0E32\u0E07"],
+    names: ["both eyes", "bilateral eyes", "each eye", "\u0E15\u0E32\u0E17\u0E31\u0E49\u0E07\u0E2A\u0E2D\u0E07\u0E02\u0E49\u0E32\u0E07", "\u0E15\u0E32\u0E2A\u0E2D\u0E07\u0E02\u0E49\u0E32\u0E07"],
     definition: {
       coding: { code: "40638003", display: "Structure of both eyes" },
       text: "both eyes",
+      administrationTargetCount: 2,
       i18n: { th: "\u0E15\u0E32\u0E17\u0E31\u0E49\u0E07\u0E2A\u0E2D\u0E07\u0E02\u0E49\u0E32\u0E07" },
       routeHint: RouteCode["Ophthalmic route"]
     }
@@ -1218,10 +1553,19 @@ var DEFAULT_BODY_SITE_SNOMED_SOURCE = [
     }
   },
   {
-    names: ["ears", "both ears", "bilateral ears", "inside ears", "\u0E2B\u0E39\u0E17\u0E31\u0E49\u0E07\u0E2A\u0E2D\u0E07\u0E02\u0E49\u0E32\u0E07", "\u0E2B\u0E39\u0E2A\u0E2D\u0E07\u0E02\u0E49\u0E32\u0E07"],
+    names: [
+      "ears",
+      "both ears",
+      "bilateral ears",
+      "each ear",
+      "inside ears",
+      "\u0E2B\u0E39\u0E17\u0E31\u0E49\u0E07\u0E2A\u0E2D\u0E07\u0E02\u0E49\u0E32\u0E07",
+      "\u0E2B\u0E39\u0E2A\u0E2D\u0E07\u0E02\u0E49\u0E32\u0E07"
+    ],
     definition: {
       coding: { code: "34338003", display: "Both ears" },
       text: "both ears",
+      administrationTargetCount: 2,
       routeHint: RouteCode["Otic route"]
     }
   },
@@ -1239,10 +1583,18 @@ var DEFAULT_BODY_SITE_SNOMED_SOURCE = [
     }
   },
   {
-    names: ["ear canals", "both ear canals", "inside ear canals", "both external auditory canals"],
+    names: [
+      "ear canals",
+      "both ear canals",
+      "each ear canal",
+      "inside ear canals",
+      "both external auditory canals",
+      "each external auditory canal"
+    ],
     definition: {
       coding: { code: "181178004", display: "Entire external auditory canal" },
       text: "both ear canals",
+      administrationTargetCount: 2,
       routeHint: RouteCode["Otic route"]
     }
   },
@@ -1279,8 +1631,12 @@ var DEFAULT_BODY_SITE_SNOMED_SOURCE = [
     }
   },
   {
-    names: ["nostril", "nostrils"],
-    definition: { coding: { code: "1797002", display: "Naris" }, routeHint: RouteCode["Nasal route"] }
+    names: ["nostril"],
+    definition: {
+      coding: { code: "1797002", display: "Naris" },
+      text: "nostril",
+      routeHint: RouteCode["Nasal route"]
+    }
   },
   {
     names: ["left nostril", "left naris"],
@@ -1297,8 +1653,22 @@ var DEFAULT_BODY_SITE_SNOMED_SOURCE = [
     }
   },
   {
-    names: ["nares", "anterior nares"],
-    definition: { coding: { code: "244506005", display: "Anterior nares" }, routeHint: RouteCode["Nasal route"] }
+    names: [
+      "nostrils",
+      "both nostrils",
+      "bilateral nostrils",
+      "each nostril",
+      "nares",
+      "anterior nares",
+      "\u0E23\u0E39\u0E08\u0E21\u0E39\u0E01\u0E17\u0E31\u0E49\u0E07\u0E2A\u0E2D\u0E07\u0E02\u0E49\u0E32\u0E07"
+    ],
+    definition: {
+      coding: { code: "244506005", display: "Anterior nares" },
+      text: "both nostrils",
+      administrationTargetCount: 2,
+      i18n: { th: "\u0E23\u0E39\u0E08\u0E21\u0E39\u0E01\u0E17\u0E31\u0E49\u0E07\u0E2A\u0E2D\u0E07\u0E02\u0E49\u0E32\u0E07" },
+      routeHint: RouteCode["Nasal route"]
+    }
   },
   {
     names: ["nose"],
@@ -1824,6 +2194,24 @@ var DEFAULT_BODY_SITE_SNOMED_SOURCE = [
     names: ["affected area", "affected areas", "affected site", "\u0E1A\u0E23\u0E34\u0E40\u0E27\u0E13\u0E17\u0E35\u0E48\u0E40\u0E1B\u0E47\u0E19"],
     definition: { text: "affected area", routeHint: RouteCode["Topical route"] }
   },
+  {
+    names: ["lesion", "skin lesion"],
+    definition: {
+      coding: { code: "95324001", display: "Skin lesion" },
+      text: "lesion",
+      routeHint: RouteCode["Topical route"],
+      i18n: { th: "\u0E23\u0E2D\u0E22\u0E42\u0E23\u0E04" }
+    }
+  },
+  {
+    names: ["lesions", "skin lesions"],
+    definition: {
+      coding: { code: "95324001", display: "Skin lesion" },
+      text: "lesions",
+      routeHint: RouteCode["Topical route"],
+      i18n: { th: "\u0E23\u0E2D\u0E22\u0E42\u0E23\u0E04" }
+    }
+  },
   {
     names: ["left head", "left side of head"],
     definition: { coding: { code: "64237003", display: "Structure of left half of head" }, routeHint: RouteCode["Topical route"] }
@@ -4403,6 +4791,7 @@ var BODY_SITE_FEATURE_SCORE_BONUS = bodySiteFeatureScoreBonus(lexical_classes_de
 var CONNECTORS = setOf(lexical_classes_default.connectors);
 var ROUTE_SITE_PREPOSITIONS = setOf(lexical_classes_default.routeSitePrepositions);
 var SITE_DISPLAY_FILLERS = SITE_FILLERS;
+var SITE_MULTIPLICITY_WORDS = setOf(["both", "each", "bilateral"]);
 var NON_SITE_ANCHORED_PHRASES = setOf(lexical_classes_default.nonSiteAnchoredPhrases);
 var EXTERNAL_SITE_LOCATIVE_PREFIXES = setOf(lexical_classes_default.externalSiteLocativePrefixes);
 var ROUTE_BLOCKED_BY_FOLLOWING_PARTITIVE_HEADS = setOf(
@@ -4596,7 +4985,7 @@ function buildBodySiteCoding(definition) {
     code: coding.code,
     display: coding.display,
     system: (_a2 = coding.system) != null ? _a2 : SNOMED_SYSTEM3,
-    i18n: definition == null ? void 0 : definition.i18n
+    i18n: mergeI18nRecords(definition == null ? void 0 : definition.i18n, coding.i18n)
   };
 }
 function cloneBodySiteCode(coding) {
@@ -4608,7 +4997,7 @@ function cloneBodySiteCode(coding) {
     code: coding.code,
     display: coding.display,
     system: (_a2 = coding.system) != null ? _a2 : SNOMED_SYSTEM3,
-    i18n: coding.i18n
+    i18n: mergeI18nRecords(coding.i18n)
   };
 }
 function lookupDefinitionForCanonical(canonical, customSiteMap) {
@@ -4900,186 +5289,52 @@ function inferPreferredPreposition(canonical, features, definition) {
   if (routeHint === RouteCode["Topical route"] || routeHint === RouteCode["Transdermal route"]) {
     return "to";
   }
-  if (routeHint === RouteCode["Per rectum"] || routeHint === RouteCode["Per vagina"] || routeHint === RouteCode["Subcutaneous route"] || routeHint === RouteCode["Intramuscular route"] || routeHint === RouteCode["Intravenous route"] || routeHint === RouteCode["Nasal route"]) {
-    return routeHint === RouteCode["Nasal route"] ? "into" : "to";
-  }
-  const words = canonical.split(/\s+/).filter((word) => word.length > 0);
-  for (const word of words) {
-    if (OTIC_SITE_WORDS.has(word) || OPHTHALMIC_SITE_WORDS.has(word)) {
-      return "in";
-    }
-    if (NASAL_SITE_WORDS.has(word)) {
-      return "into";
-    }
-  }
-  return void 0;
-}
-function resolveBodySitePhrase(text, customSiteMap, context) {
-  var _a2, _b, _c, _d, _e, _f, _g;
-  const trimmed = text.trim().replace(/\s+/g, " ");
-  if (!trimmed) {
-    return void 0;
-  }
-  const lookupCanonical = normalizeBodySiteKey(trimmed);
-  const contextualCanonical = resolveContextualBodySiteAlias(lookupCanonical, context);
-  const displaySourceText = contextualCanonical != null ? contextualCanonical : trimmed;
-  const displayText = normalizeSiteDisplayText(displaySourceText, customSiteMap);
-  const canonical = normalizeBodySiteKey(displayText);
-  const definition = (_e = (_d = (_c = (_b = (_a2 = lookupBodySiteDefinition(customSiteMap, lookupCanonical)) != null ? _a2 : contextualCanonical ? lookupBodySiteDefinition(customSiteMap, contextualCanonical) : void 0) != null ? _b : contextualCanonical ? DEFAULT_BODY_SITE_SNOMED[contextualCanonical] : void 0) != null ? _c : DEFAULT_BODY_SITE_SNOMED[lookupCanonical]) != null ? _d : lookupBodySiteDefinition(customSiteMap, canonical)) != null ? _e : DEFAULT_BODY_SITE_SNOMED[canonical];
-  const coding = buildBodySiteCoding(definition);
-  const finalDisplayText = (_f = definition == null ? void 0 : definition.text) != null ? _f : displayText;
-  const features = parseBodySiteFeatures(finalDisplayText, coding, customSiteMap);
-  const spatialRelation = (_g = definition == null ? void 0 : definition.spatialRelation) != null ? _g : buildSpatialRelation(features, finalDisplayText, customSiteMap);
-  return {
-    lookupCanonical,
-    resolutionCanonical: contextualCanonical != null ? contextualCanonical : lookupCanonical,
-    canonical: normalizeBodySiteKey(finalDisplayText) || canonical,
-    displayText: finalDisplayText,
-    coding,
-    spatialRelation,
-    definition,
-    features,
-    englishObjectText: renderBodySiteObject(features),
-    preferredPreposition: inferPreferredPreposition(
-      normalizeBodySiteKey(finalDisplayText) || canonical,
-      features,
-      definition
-    )
-  };
-}
-
-// src/timing-summary.ts
-var MEAL_TIMING_DETAILS = {
-  ["ACM" /* Before Breakfast */]: { relation: "before", meal: "breakfast" },
-  ["ACD" /* Before Lunch */]: { relation: "before", meal: "lunch" },
-  ["ACV" /* Before Dinner */]: { relation: "before", meal: "dinner" },
-  ["PCM" /* After Breakfast */]: { relation: "after", meal: "breakfast" },
-  ["PCD" /* After Lunch */]: { relation: "after", meal: "lunch" },
-  ["PCV" /* After Dinner */]: { relation: "after", meal: "dinner" },
-  ["CM" /* Breakfast */]: { relation: "with", meal: "breakfast" },
-  ["CD" /* Lunch */]: { relation: "with", meal: "lunch" },
-  ["CV" /* Dinner */]: { relation: "with", meal: "dinner" }
-};
-var MEAL_ORDER = {
-  breakfast: 0,
-  lunch: 1,
-  dinner: 2
-};
-var INFERABLE_DAILY_EVENT_TIMINGS = /* @__PURE__ */ new Set([
-  "HS" /* Before Sleep */,
-  "ACM" /* Before Breakfast */,
-  "ACD" /* Before Lunch */,
-  "ACV" /* Before Dinner */,
-  "PCM" /* After Breakfast */,
-  "PCD" /* After Lunch */,
-  "PCV" /* After Dinner */,
-  "CM" /* Breakfast */,
-  "CD" /* Lunch */,
-  "CV" /* Dinner */,
-  "MORN" /* Morning */,
-  "MORN.early" /* Early Morning */,
-  "MORN.late" /* Late Morning */,
-  "NOON" /* Noon */,
-  "AFT" /* Afternoon */,
-  "AFT.early" /* Early Afternoon */,
-  "AFT.late" /* Late Afternoon */,
-  "EVE" /* Evening */,
-  "EVE.early" /* Early Evening */,
-  "EVE.late" /* Late Evening */,
-  "NIGHT" /* Night */,
-  "WAKE" /* Wake */,
-  "PHS" /* After Sleep */
-]);
-function uniqueValues(values) {
-  const seen = /* @__PURE__ */ new Set();
-  const result = [];
-  for (const value of values) {
-    if (!seen.has(value)) {
-      seen.add(value);
-      result.push(value);
-    }
-  }
-  return result;
-}
-function getMealTimingGroup(when, options) {
-  if (!(options == null ? void 0 : options.groupMealTimingsByRelation)) {
-    return void 0;
-  }
-  const uniqueWhen2 = uniqueValues(when);
-  if (uniqueWhen2.length < 2) {
-    return void 0;
-  }
-  let relation;
-  const meals = [];
-  const groupedCodes = [];
-  let sawFirstMeal = false;
-  for (let i = 0; i < uniqueWhen2.length; i += 1) {
-    const code = uniqueWhen2[i];
-    const detail = MEAL_TIMING_DETAILS[code];
-    if (!detail) {
-      if (sawFirstMeal) {
-        break;
-      }
-      continue;
-    }
-    if (!sawFirstMeal) {
-      sawFirstMeal = true;
-    }
-    if (!relation) {
-      relation = detail.relation;
-    } else if (relation !== detail.relation && detail.relation !== "with") {
-      break;
-    }
-    meals.push(detail.meal);
-    groupedCodes.push(code);
-  }
-  if (groupedCodes.length < 2) {
-    return void 0;
-  }
-  for (let i = 1; i < meals.length; i += 1) {
-    const current = meals[i];
-    let j = i - 1;
-    while (j >= 0 && MEAL_ORDER[meals[j]] > MEAL_ORDER[current]) {
-      meals[j + 1] = meals[j];
-      j -= 1;
-    }
-    meals[j + 1] = current;
-  }
-  if (!relation) {
-    return void 0;
-  }
-  return {
-    relation,
-    meals,
-    codes: groupedCodes
-  };
-}
-function inferDailyOccurrenceCount(input, options) {
-  var _a2, _b, _c, _d;
-  if (!(options == null ? void 0 : options.includeTimesPerDaySummary)) {
-    return void 0;
-  }
-  if (input.frequency !== void 0 || input.frequencyMax !== void 0 || input.timingCode) {
-    return void 0;
-  }
-  if (input.period !== void 0 || input.periodMax !== void 0 || input.periodUnit !== void 0) {
-    return void 0;
-  }
-  if (((_b = (_a2 = input.dayOfWeek) == null ? void 0 : _a2.length) != null ? _b : 0) > 0) {
-    return void 0;
+  if (routeHint === RouteCode["Per rectum"] || routeHint === RouteCode["Per vagina"] || routeHint === RouteCode["Subcutaneous route"] || routeHint === RouteCode["Intramuscular route"] || routeHint === RouteCode["Intravenous route"] || routeHint === RouteCode["Nasal route"]) {
+    return routeHint === RouteCode["Nasal route"] ? "into" : "to";
   }
-  const uniqueWhen2 = uniqueValues((_c = input.when) != null ? _c : []);
-  for (let i = 0; i < uniqueWhen2.length; i += 1) {
-    if (!INFERABLE_DAILY_EVENT_TIMINGS.has(uniqueWhen2[i])) {
-      return void 0;
+  const words = canonical.split(/\s+/).filter((word) => word.length > 0);
+  for (const word of words) {
+    if (OTIC_SITE_WORDS.has(word) || OPHTHALMIC_SITE_WORDS.has(word)) {
+      return "in";
+    }
+    if (NASAL_SITE_WORDS.has(word)) {
+      return "into";
     }
   }
-  const uniqueTimes = uniqueValues((_d = input.timeOfDay) != null ? _d : []);
-  const occurrences = uniqueWhen2.length + uniqueTimes.length;
-  if (occurrences === 0) {
+  return void 0;
+}
+function resolveBodySitePhrase(text, customSiteMap, context) {
+  var _a2, _b, _c, _d, _e, _f, _g;
+  const trimmed = text.trim().replace(/\s+/g, " ");
+  if (!trimmed) {
     return void 0;
   }
-  return occurrences;
+  const lookupCanonical = normalizeBodySiteKey(trimmed);
+  const contextualCanonical = resolveContextualBodySiteAlias(lookupCanonical, context);
+  const displaySourceText = contextualCanonical != null ? contextualCanonical : trimmed;
+  const displayText = normalizeSiteDisplayText(displaySourceText, customSiteMap);
+  const canonical = normalizeBodySiteKey(displayText);
+  const definition = (_e = (_d = (_c = (_b = (_a2 = lookupBodySiteDefinition(customSiteMap, lookupCanonical)) != null ? _a2 : contextualCanonical ? lookupBodySiteDefinition(customSiteMap, contextualCanonical) : void 0) != null ? _b : contextualCanonical ? DEFAULT_BODY_SITE_SNOMED[contextualCanonical] : void 0) != null ? _c : DEFAULT_BODY_SITE_SNOMED[lookupCanonical]) != null ? _d : lookupBodySiteDefinition(customSiteMap, canonical)) != null ? _e : DEFAULT_BODY_SITE_SNOMED[canonical];
+  const coding = buildBodySiteCoding(definition);
+  const finalDisplayText = (_f = definition == null ? void 0 : definition.text) != null ? _f : displayText;
+  const features = parseBodySiteFeatures(finalDisplayText, coding, customSiteMap);
+  const spatialRelation = (_g = definition == null ? void 0 : definition.spatialRelation) != null ? _g : buildSpatialRelation(features, finalDisplayText, customSiteMap);
+  return {
+    lookupCanonical,
+    resolutionCanonical: contextualCanonical != null ? contextualCanonical : lookupCanonical,
+    canonical: normalizeBodySiteKey(finalDisplayText) || canonical,
+    displayText: finalDisplayText,
+    coding,
+    spatialRelation,
+    definition,
+    features,
+    englishObjectText: renderBodySiteObject(features),
+    preferredPreposition: inferPreferredPreposition(
+      normalizeBodySiteKey(finalDisplayText) || canonical,
+      features,
+      definition
+    )
+  };
 }
 
 // src/format.ts
@@ -5573,73 +5828,22 @@ function summarizeMealTimingGroup(group) {
   }
   return `${relationText} ${joinWithAnd(group.meals)}`;
 }
-function collectWhenPhrases(schedule, options) {
-  var _a2, _b, _c;
-  const when = (_a2 = schedule == null ? void 0 : schedule.when) != null ? _a2 : [];
-  if (!when.length) {
-    return [];
-  }
-  const unique = [];
-  const seen = /* @__PURE__ */ new Set();
-  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 === "PCM" /* After Breakfast */ || code === "PCD" /* After Lunch */ || code === "PCV" /* After Dinner */) {
-        hasSpecificAfter = true;
-      }
-      if (code === "ACM" /* Before Breakfast */ || code === "ACD" /* Before Lunch */ || code === "ACV" /* Before Dinner */) {
-        hasSpecificBefore = true;
-      }
-      if (code === "CM" /* Breakfast */ || code === "CD" /* Lunch */ || code === "CV" /* Dinner */) {
-        hasSpecificWith = true;
-      }
-    }
-  }
-  const filtered = [];
-  for (const code of unique) {
-    if (code === "PC" /* After Meal */ && hasSpecificAfter) {
-      continue;
-    }
-    if (code === "AC" /* Before Meal */ && hasSpecificBefore) {
-      continue;
-    }
-    if (code === "C" /* Meal */ && hasSpecificWith) {
-      continue;
-    }
-    filtered.push(code);
-  }
-  const mealGroup = getMealTimingGroup(filtered, options);
-  if (!mealGroup) {
-    const phrases2 = [];
-    for (const code of filtered) {
-      const text = (_b = WHEN_TEXT[code]) != null ? _b : code;
-      if (text) {
-        phrases2.push(text);
-      }
-    }
-    return phrases2;
-  }
-  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;
+var EN_TIMING_GRAMMAR = {
+  whenText: WHEN_TEXT,
+  joinList: joinWithAnd,
+  summarizeMealTimingGroup,
+  bedtimeJoinStyle: (dailyCount) => {
+    if (dailyCount === 1) {
+      return "adjacent";
     }
-    const text = (_c = WHEN_TEXT[code]) != null ? _c : code;
-    if (text) {
-      phrases.push(text);
+    if (dailyCount === 2 || dailyCount === 3 || dailyCount === 4) {
+      return "conjunction";
     }
+    return "separate";
   }
-  return phrases;
+};
+function collectWhenPhrases(schedule, options) {
+  return collectLocalizedWhenPhrases(schedule, EN_TIMING_GRAMMAR, options);
 }
 function joinWithAnd(parts) {
   if (!parts.length) {
@@ -5653,23 +5857,14 @@ function joinWithAnd(parts) {
   }
   return `${parts.slice(0, -1).join(", ")} and ${parts[parts.length - 1]}`;
 }
-function combineFrequencyAndEvents(frequency, events) {
-  if (!frequency) {
-    if (!events.length) {
-      return {};
-    }
-    return { event: joinWithAnd(events) };
-  }
-  if (!events.length) {
-    return { frequency };
-  }
-  if (events.length === 1 && events[0] === "at bedtime") {
-    const lowerFrequency = frequency.toLowerCase();
-    if (lowerFrequency === "twice daily" || lowerFrequency === "three times daily" || lowerFrequency === "four times daily") {
-      return { frequency: `${frequency} and ${events[0]}` };
-    }
-  }
-  return { frequency, event: joinWithAnd(events) };
+function combineFrequencyAndEvents(schedule, frequency, events, options) {
+  return combineLocalizedFrequencyAndEvents(
+    schedule,
+    frequency,
+    events,
+    EN_TIMING_GRAMMAR,
+    options
+  );
 }
 function buildRoutePhrase(clause, grammar, hasSite) {
   var _a2, _b;
@@ -5974,7 +6169,7 @@ function formatLong(clause, options) {
       eventParts.push(`at ${timeStrings.join(", ")}`);
     }
   }
-  const timing = combineFrequencyAndEvents(frequencyPart, eventParts);
+  const timing = combineFrequencyAndEvents(schedule, frequencyPart, eventParts, options);
   const dayPart = describeDayOfWeek(schedule);
   const countPart = schedule.count !== void 0 && !standaloneOccurrenceCount ? `for ${stripTrailingZero(schedule.count)} ${schedule.count === 1 ? "dose" : "doses"}` : void 0;
   const durationPart = describeDuration(schedule);
@@ -9769,6 +9964,81 @@ function listSupportedBodySiteGrammar() {
   };
 }
 
+// src/body-site-target.ts
+var BODY_SITE_ADMINISTRATION_TARGET_COUNT_EXTENSION_URL = "urn:ezmedicationinput:body-site-administration-target-count";
+function normalizeAdministrationTargetCount(value) {
+  if (!Number.isFinite(value) || value === void 0) {
+    return void 0;
+  }
+  const rounded = Math.trunc(value);
+  return rounded >= 2 ? rounded : void 0;
+}
+function siteTextFromLike(site, options) {
+  if (!site) {
+    return void 0;
+  }
+  if (typeof site === "string") {
+    return site;
+  }
+  if ("text" in site && site.text) {
+    return site.text;
+  }
+  const coding = "coding" in site ? Array.isArray(site.coding) ? site.coding.find((candidate) => candidate == null ? void 0 : candidate.code) : site.coding : void 0;
+  return (coding == null ? void 0 : coding.code) ? getBodySiteText(
+    {
+      system: coding.system,
+      code: coding.code,
+      display: coding.display
+    },
+    { siteCodeMap: options == null ? void 0 : options.siteCodeMap }
+  ) : void 0;
+}
+function buildBodySiteAdministrationTargetCountExtension(targetCount) {
+  const normalized = normalizeAdministrationTargetCount(targetCount);
+  if (normalized === void 0) {
+    return void 0;
+  }
+  return {
+    url: BODY_SITE_ADMINISTRATION_TARGET_COUNT_EXTENSION_URL,
+    valueInteger: normalized
+  };
+}
+function parseBodySiteAdministrationTargetCountExtension(concept) {
+  var _a2;
+  const extension = (_a2 = concept == null ? void 0 : concept.extension) == null ? void 0 : _a2.find(
+    (candidate) => candidate.url === BODY_SITE_ADMINISTRATION_TARGET_COUNT_EXTENSION_URL
+  );
+  return normalizeAdministrationTargetCount(extension == null ? void 0 : extension.valueInteger);
+}
+function getBodySiteAdministrationTargetCount(site, options) {
+  var _a2;
+  if (!site) {
+    return void 0;
+  }
+  if (typeof site !== "string" && "administrationTargetCount" in site) {
+    const direct = normalizeAdministrationTargetCount(site.administrationTargetCount);
+    if (direct !== void 0) {
+      return direct;
+    }
+  }
+  if (typeof site !== "string") {
+    if ("extension" in site) {
+      const fromExtension = parseBodySiteAdministrationTargetCountExtension(site);
+      if (fromExtension !== void 0) {
+        return fromExtension;
+      }
+    }
+  }
+  const text = siteTextFromLike(site, options);
+  if (!text) {
+    return void 0;
+  }
+  const resolved = resolveBodySitePhrase(text, options == null ? void 0 : options.siteCodeMap, {
+    bodySiteContext: options == null ? void 0 : options.bodySiteContext
+  });
+  return normalizeAdministrationTargetCount((_a2 = resolved == null ? void 0 : resolved.definition) == null ? void 0 : _a2.administrationTargetCount);
+}
+
 // src/parser-state.ts
 var ParserState = class {
   constructor(input, tokens, customSiteHints) {
@@ -10031,6 +10301,7 @@ var ParserState = class {
     for (const reason of value) {
       reasons.push({
         text: reason.text,
+        i18n: cloneI18nRecord(reason.i18n),
         spatialRelation: cloneBodySiteSpatialRelation(reason.spatialRelation),
         coding: reason.coding ? {
           code: reason.coding.code,
@@ -10038,7 +10309,7 @@ var ParserState = class {
           system: reason.coding.system,
           extension: cloneExtensions(reason.coding.extension),
           _display: clonePrimitiveElement(reason.coding._display),
-          i18n: reason.coding.i18n
+          i18n: cloneI18nRecord(reason.coding.i18n)
         } : void 0
       });
     }
@@ -10070,7 +10341,7 @@ var ParserState = class {
       system: value.system,
       extension: cloneExtensions(value.extension),
       _display: clonePrimitiveElement(value._display),
-      i18n: value.i18n
+      i18n: cloneI18nRecord(value.i18n)
     } : void 0;
   }
   get siteText() {
@@ -10103,7 +10374,7 @@ var ParserState = class {
       code: value.code,
       display: value.display,
       system: value.system,
-      i18n: value.i18n
+      i18n: cloneI18nRecord(value.i18n)
     } : void 0;
   }
   get siteSpatialRelation() {
@@ -10138,6 +10409,20 @@ var ParserState = class {
       sourceText: value.sourceText
     };
   }
+  get siteAdministrationTargetCount() {
+    var _a2;
+    return (_a2 = this.clause.site) == null ? void 0 : _a2.administrationTargetCount;
+  }
+  set siteAdministrationTargetCount(value) {
+    if (value === void 0) {
+      if (this.clause.site) {
+        delete this.clause.site.administrationTargetCount;
+        this.cleanupSite();
+      }
+      return;
+    }
+    this.ensureSite().administrationTargetCount = value;
+  }
   get additionalInstructions() {
     if (!this.clause.additionalInstructions) {
       this.clause.additionalInstructions = [];
@@ -10210,7 +10495,7 @@ var ParserState = class {
     if (!site) {
       return;
     }
-    if (site.text === void 0 && site.coding === void 0 && site.spatialRelation === void 0 && site.source === void 0 && site.inferred === void 0 && site.evidence === void 0) {
+    if (site.text === void 0 && site.coding === void 0 && site.spatialRelation === void 0 && site.administrationTargetCount === void 0 && site.source === void 0 && site.inferred === void 0 && site.evidence === void 0) {
       delete this.clause.site;
     }
   }
@@ -10288,12 +10573,12 @@ function selectCanonicalSiteCoding(site, options) {
   );
   return (options == null ? void 0 : options.bodySitePostcoordination) === true ? postcoordinated != null ? postcoordinated : site == null ? void 0 : site.coding : (_a2 = site == null ? void 0 : site.coding) != null ? _a2 : postcoordinated;
 }
-function buildSiteCodingArray(siteCoding) {
+function buildSiteCodingArray(siteCoding, options) {
   var _a2;
   if (!(siteCoding == null ? void 0 : siteCoding.code)) {
     return void 0;
   }
-  const displayElement = buildTranslationPrimitiveElement(siteCoding.i18n);
+  const displayElement = (options == null ? void 0 : options.includeTranslationExtensions) ? buildTranslationPrimitiveElement(siteCoding.i18n) : void 0;
   return [
     __spreadValues({
       system: (_a2 = siteCoding.system) != null ? _a2 : SNOMED_SYSTEM5,
@@ -10313,6 +10598,18 @@ function getFallbackSiteText(site) {
     display: siteCoding.display
   }) : void 0;
 }
+function codeableConceptTranslationI18n(concept, coding, fallback) {
+  return {
+    text: mergeI18nRecords(
+      fallback,
+      getPrimitiveTranslations(concept == null ? void 0 : concept._text)
+    ),
+    display: mergeI18nRecords(
+      coding == null ? void 0 : coding.i18n,
+      getPrimitiveTranslations(coding == null ? void 0 : coding._display)
+    )
+  };
+}
 function lowerFirst(value) {
   const trimmed = value == null ? void 0 : value.trim();
   return trimmed ? trimmed.charAt(0).toLowerCase() + trimmed.slice(1) : void 0;
@@ -10559,7 +10856,7 @@ function appendWarning(warnings, warning) {
   return warnings;
 }
 function canonicalToFhir(clause, textOverride, options) {
-  var _a2, _b, _c, _d, _e, _f, _g, _h, _i, _j, _k, _l, _m, _n, _o, _p, _q, _r, _s, _t, _u, _v, _w, _x, _y, _z, _A, _B, _C, _D, _E, _F, _G, _H, _I;
+  var _a2, _b, _c, _d, _e, _f, _g, _h, _i, _j, _k, _l, _m, _n, _o, _p, _q, _r, _s, _t, _u, _v, _w, _x, _y, _z, _A, _B, _C, _D, _E, _F, _G, _H, _I, _J, _K, _L, _M, _N;
   const dosage = {};
   const repeat = {};
   let hasRepeat = false;
@@ -10659,21 +10956,36 @@ function canonicalToFhir(clause, textOverride, options) {
   }
   if (((_l = clause.site) == null ? void 0 : _l.text) || ((_n = (_m = clause.site) == null ? void 0 : _m.coding) == null ? void 0 : _n.code) || ((_o = clause.site) == null ? void 0 : _o.spatialRelation)) {
     const siteCoding = selectCanonicalSiteCoding(clause.site, options);
-    const siteTextElement = buildTranslationPrimitiveElement(siteCoding == null ? void 0 : siteCoding.i18n);
+    const siteTextElement = (options == null ? void 0 : options.includeTranslationExtensions) ? buildTranslationPrimitiveElement((_p = clause.site.i18n) != null ? _p : siteCoding == null ? void 0 : siteCoding.i18n) : void 0;
+    const siteTargetCount = (_r = (_q = clause.site) == null ? void 0 : _q.administrationTargetCount) != null ? _r : getBodySiteAdministrationTargetCount(clause.site);
+    const inferredSiteTargetCount = getBodySiteAdministrationTargetCount({
+      text: (_s = clause.site) == null ? void 0 : _s.text,
+      coding: siteCoding ? {
+        code: siteCoding.code,
+        display: siteCoding.display,
+        system: siteCoding.system,
+        i18n: siteCoding.i18n
+      } : void 0
+    });
+    const siteTargetCountExtension = siteTargetCount !== void 0 && siteTargetCount !== inferredSiteTargetCount ? buildBodySiteAdministrationTargetCountExtension(siteTargetCount) : void 0;
+    const siteExtensions = [
+      ...(_u = buildBodySiteSpatialRelationExtensions((_t = clause.site) == null ? void 0 : _t.spatialRelation)) != null ? _u : [],
+      ...siteTargetCountExtension ? [siteTargetCountExtension] : []
+    ];
     dosage.site = __spreadProps(__spreadValues({
-      text: (_p = clause.site) == null ? void 0 : _p.text
+      text: (_v = clause.site) == null ? void 0 : _v.text
     }, siteTextElement ? { _text: siteTextElement } : {}), {
-      coding: buildSiteCodingArray(siteCoding),
-      extension: buildBodySiteSpatialRelationExtensions((_q = clause.site) == null ? void 0 : _q.spatialRelation)
+      coding: buildSiteCodingArray(siteCoding, options),
+      extension: siteExtensions.length ? siteExtensions : void 0
     });
   }
-  if (((_r = clause.method) == null ? void 0 : _r.text) || ((_s = clause.method) == null ? void 0 : _s._text) || ((_u = (_t = clause.method) == null ? void 0 : _t.coding) == null ? void 0 : _u.code)) {
+  if (((_w = clause.method) == null ? void 0 : _w.text) || ((_x = clause.method) == null ? void 0 : _x._text) || ((_z = (_y = clause.method) == null ? void 0 : _y.coding) == null ? void 0 : _z.code)) {
     dosage.method = {
-      text: (_v = clause.method) == null ? void 0 : _v.text,
-      _text: clonePrimitiveElement((_w = clause.method) == null ? void 0 : _w._text),
-      coding: ((_y = (_x = clause.method) == null ? void 0 : _x.coding) == null ? void 0 : _y.code) ? [
+      text: (_A = clause.method) == null ? void 0 : _A.text,
+      _text: clonePrimitiveElement((_B = clause.method) == null ? void 0 : _B._text),
+      coding: ((_D = (_C = clause.method) == null ? void 0 : _C.coding) == null ? void 0 : _D.code) ? [
         {
-          system: (_z = clause.method.coding.system) != null ? _z : SNOMED_SYSTEM5,
+          system: (_E = clause.method.coding.system) != null ? _E : SNOMED_SYSTEM5,
           code: clause.method.coding.code,
           display: clause.method.coding.display,
           _display: clonePrimitiveElement(clause.method.coding._display)
@@ -10681,14 +10993,14 @@ function canonicalToFhir(clause, textOverride, options) {
       ] : void 0
     };
   }
-  if ((_A = clause.additionalInstructions) == null ? void 0 : _A.length) {
+  if ((_F = clause.additionalInstructions) == null ? void 0 : _F.length) {
     dosage.additionalInstruction = [];
     for (const instruction of clause.additionalInstructions) {
       dosage.additionalInstruction.push({
         text: instruction.text,
-        coding: ((_B = instruction.coding) == null ? void 0 : _B.code) ? [
+        coding: ((_G = instruction.coding) == null ? void 0 : _G.code) ? [
           {
-            system: (_C = instruction.coding.system) != null ? _C : SNOMED_SYSTEM5,
+            system: (_H = instruction.coding.system) != null ? _H : SNOMED_SYSTEM5,
             code: instruction.coding.code,
             display: instruction.coding.display
           }
@@ -10696,9 +11008,9 @@ function canonicalToFhir(clause, textOverride, options) {
       });
     }
   }
-  if ((_D = clause.prn) == null ? void 0 : _D.enabled) {
+  if ((_I = clause.prn) == null ? void 0 : _I.enabled) {
     dosage.asNeededBoolean = true;
-    const reasons = ((_E = clause.prn.reasons) == null ? void 0 : _E.length) ? clause.prn.reasons : clause.prn.reason ? [clause.prn.reason] : [];
+    const reasons = ((_J = clause.prn.reasons) == null ? void 0 : _J.length) ? clause.prn.reasons : clause.prn.reason ? [clause.prn.reason] : [];
     if (reasons.length) {
       dosage.asNeededFor = [];
       for (const reason of reasons) {
@@ -10706,15 +11018,18 @@ function canonicalToFhir(clause, textOverride, options) {
         if (reason.text) {
           concept.text = reason.text;
         }
-        const reasonTextElement = buildTranslationPrimitiveElement((_F = reason.coding) == null ? void 0 : _F.i18n);
+        const reasonTextElement = (options == null ? void 0 : options.includeTranslationExtensions) ? buildTranslationPrimitiveElement((_L = reason.i18n) != null ? _L : (_K = reason.coding) == null ? void 0 : _K.i18n) : void 0;
         if (reasonTextElement) {
           concept._text = reasonTextElement;
         }
-        if ((_G = reason.coding) == null ? void 0 : _G.code) {
-          const displayElement = (_H = clonePrimitiveElement(reason.coding._display)) != null ? _H : buildTranslationPrimitiveElement(reason.coding.i18n);
+        if ((_M = reason.coding) == null ? void 0 : _M.code) {
+          const displayElement = (options == null ? void 0 : options.includeTranslationExtensions) ? mergeTranslationPrimitiveElement(
+            reason.coding._display,
+            reason.coding.i18n
+          ) : clonePrimitiveElement(reason.coding._display);
           concept.coding = [
             __spreadProps(__spreadValues({
-              system: (_I = reason.coding.system) != null ? _I : SNOMED_SYSTEM5,
+              system: (_N = reason.coding.system) != null ? _N : SNOMED_SYSTEM5,
               code: reason.coding.code,
               display: reason.coding.display
             }, displayElement ? { _display: displayElement } : {}), {
@@ -10754,14 +11069,19 @@ function canonicalFromFhir(dosage) {
   const siteCoding = selectPreferredSiteCoding(dosage.site);
   const siteSpatialRelation = parseBodySiteSpatialRelationExtension(dosage.site);
   const siteText = getFallbackSiteText(dosage.site);
-  if (siteText || (siteCoding == null ? void 0 : siteCoding.code) || siteSpatialRelation) {
+  const siteI18n = codeableConceptTranslationI18n(dosage.site, siteCoding);
+  const siteAdministrationTargetCount = getBodySiteAdministrationTargetCount(dosage.site);
+  if (siteText || (siteCoding == null ? void 0 : siteCoding.code) || siteSpatialRelation || siteAdministrationTargetCount !== void 0) {
     clause.site = {
       text: siteText,
+      i18n: siteI18n.text,
       spatialRelation: siteSpatialRelation,
+      administrationTargetCount: siteAdministrationTargetCount,
       coding: (siteCoding == null ? void 0 : siteCoding.code) ? {
         code: siteCoding.code,
         display: siteCoding.display,
-        system: siteCoding.system
+        system: siteCoding.system,
+        i18n: siteI18n.display
       } : void 0,
       source: "text"
     };
@@ -10816,16 +11136,21 @@ function canonicalFromFhir(dosage) {
     };
   }
   const prnReasons = ((_y = dosage.asNeededFor) == null ? void 0 : _y.length) ? dosage.asNeededFor.map((concept) => {
-    var _a3;
+    var _a3, _b2;
     const coding = (_a3 = concept.coding) == null ? void 0 : _a3.find((code) => Boolean(code.code));
+    const defaultDef = (coding == null ? void 0 : coding.code) ? findPrnReasonDefinitionByCoding((_b2 = coding.system) != null ? _b2 : SNOMED_SYSTEM5, coding.code) : void 0;
+    const i18n = codeableConceptTranslationI18n(concept, coding, defaultDef == null ? void 0 : defaultDef.i18n);
     return {
       text: getFallbackPrnReasonText(concept),
+      i18n: i18n.text,
       spatialRelation: parseBodySiteSpatialRelationExtension(concept),
       coding: (coding == null ? void 0 : coding.code) ? {
         code: coding.code,
         display: coding.display,
         system: coding.system,
-        extension: cloneExtensions(coding.extension)
+        extension: cloneExtensions(coding.extension),
+        _display: clonePrimitiveElement(coding._display),
+        i18n: i18n.display
       } : void 0
     };
   }) : void 0;
@@ -11832,73 +12157,22 @@ function summarizeMealTimingGroupThai(group) {
   }
   return `${relationText[group.relation]}${joinMealNamesThai(meals)}`;
 }
-function collectWhenPhrasesThai(schedule, options) {
-  var _a2;
-  const when = (_a2 = schedule == null ? void 0 : schedule.when) != null ? _a2 : [];
-  if (!when.length) {
-    return [];
-  }
-  const unique = [];
-  const seen = /* @__PURE__ */ new Set();
-  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 === "PCM" /* After Breakfast */ || code === "PCD" /* After Lunch */ || code === "PCV" /* After Dinner */) {
-        hasSpecificAfter = true;
-      }
-      if (code === "ACM" /* Before Breakfast */ || code === "ACD" /* Before Lunch */ || code === "ACV" /* Before Dinner */) {
-        hasSpecificBefore = true;
-      }
-      if (code === "CM" /* Breakfast */ || code === "CD" /* Lunch */ || code === "CV" /* Dinner */) {
-        hasSpecificWith = true;
-      }
-    }
-  }
-  const filtered = [];
-  for (const code of unique) {
-    if (code === "PC" /* After Meal */ && hasSpecificAfter) {
-      continue;
-    }
-    if (code === "AC" /* Before Meal */ && hasSpecificBefore) {
-      continue;
-    }
-    if (code === "C" /* Meal */ && hasSpecificWith) {
-      continue;
-    }
-    filtered.push(code);
-  }
-  const mealGroup = getMealTimingGroup(filtered, options);
-  if (!mealGroup) {
-    const phrases2 = [];
-    for (const code of filtered) {
-      const text = WHEN_TEXT_THAI[code];
-      if (text) {
-        phrases2.push(text);
-      }
-    }
-    return phrases2;
-  }
-  const groupedCodes = new Set(mealGroup.codes);
-  const phrases = [];
-  let insertedGroup = false;
-  for (const code of filtered) {
-    if (groupedCodes.has(code)) {
-      if (!insertedGroup) {
-        phrases.push(summarizeMealTimingGroupThai(mealGroup));
-        insertedGroup = true;
-      }
-      continue;
+var TH_TIMING_GRAMMAR = {
+  whenText: WHEN_TEXT_THAI,
+  joinList: joinWithAndThai,
+  summarizeMealTimingGroup: summarizeMealTimingGroupThai,
+  bedtimeJoinStyle: (dailyCount) => {
+    if (dailyCount === 1) {
+      return "adjacent";
     }
-    const text = WHEN_TEXT_THAI[code];
-    if (text) {
-      phrases.push(text);
+    if (dailyCount === 2 || dailyCount === 3 || dailyCount === 4) {
+      return "conjunction";
     }
+    return "separate";
   }
-  return phrases;
+};
+function collectWhenPhrasesThai(schedule, options) {
+  return collectLocalizedWhenPhrases(schedule, TH_TIMING_GRAMMAR, options);
 }
 function joinWithAndThai(parts) {
   if (!parts.length) {
@@ -11912,20 +12186,14 @@ function joinWithAndThai(parts) {
   }
   return `${parts.slice(0, -1).join(", ")} \u0E41\u0E25\u0E30 ${parts[parts.length - 1]}`;
 }
-function combineFrequencyAndEventsThai(frequency, events) {
-  if (!frequency) {
-    if (!events.length) {
-      return {};
-    }
-    return { event: joinWithAndThai(events) };
-  }
-  if (!events.length) {
-    return { frequency };
-  }
-  if (events.length === 1 && events[0] === "\u0E01\u0E48\u0E2D\u0E19\u0E19\u0E2D\u0E19" && frequency.includes("\u0E27\u0E31\u0E19\u0E25\u0E30")) {
-    return { frequency: `${frequency} \u0E41\u0E25\u0E30 ${events[0]}` };
-  }
-  return { frequency, event: joinWithAndThai(events) };
+function combineFrequencyAndEventsThai(schedule, frequency, events, options) {
+  return combineLocalizedFrequencyAndEvents(
+    schedule,
+    frequency,
+    events,
+    TH_TIMING_GRAMMAR,
+    options
+  );
 }
 function isOralRouteThai(clause) {
   var _a2, _b, _c;
@@ -11984,7 +12252,7 @@ function buildRoutePhraseThai(clause, grammar, hasSite) {
   return text;
 }
 function formatSiteThai(clause, grammar) {
-  var _a2, _b, _c, _d, _e, _f, _g, _h, _i, _j, _k, _l, _m, _n, _o;
+  var _a2, _b, _c, _d, _e, _f, _g, _h, _i, _j, _k, _l, _m, _n, _o, _p, _q, _r, _s, _t, _u, _v;
   const text = ((_b = (_a2 = clause.site) == null ? void 0 : _a2.text) == null ? void 0 : _b.trim()) || ((_e = (_d = (_c = clause.site) == null ? void 0 : _c.coding) == null ? void 0 : _d.display) == null ? void 0 : _e.trim());
   const lower = text == null ? void 0 : text.toLowerCase();
   const codingCode = (_g = (_f = clause.site) == null ? void 0 : _f.coding) == null ? void 0 : _g.code;
@@ -11999,14 +12267,14 @@ function formatSiteThai(clause, grammar) {
   if (isVaginalRoute && isVaginaSite) {
     return void 0;
   }
-  const translated = text ? translateSiteThai(text, codingCode, (_l = clause.site) == null ? void 0 : _l.spatialRelation) : translateSpatialSiteThai(void 0, (_m = clause.site) == null ? void 0 : _m.spatialRelation);
+  const translated = (_t = (_q = (_m = (_l = clause.site) == null ? void 0 : _l.i18n) == null ? void 0 : _m.th) != null ? _q : (_p = (_o = (_n = clause.site) == null ? void 0 : _n.coding) == null ? void 0 : _o.i18n) == null ? void 0 : _p.th) != null ? _t : text ? translateSiteThai(text, codingCode, (_r = clause.site) == null ? void 0 : _r.spatialRelation) : translateSpatialSiteThai(void 0, (_s = clause.site) == null ? void 0 : _s.spatialRelation);
   if (!translated) {
     return void 0;
   }
-  if (((_n = clause.route) == null ? void 0 : _n.code) === RouteCode["Nasal route"]) {
+  if (((_u = clause.route) == null ? void 0 : _u.code) === RouteCode["Nasal route"]) {
     return `\u0E40\u0E02\u0E49\u0E32${translated}`;
   }
-  const preposition = (_o = grammar.sitePreposition) != null ? _o : "\u0E17\u0E35\u0E48";
+  const preposition = (_v = grammar.sitePreposition) != null ? _v : "\u0E17\u0E35\u0E48";
   const separator = /^[\u0E00-\u0E7F]/.test(translated) ? "" : " ";
   return `${preposition}${separator}${translated}`.trim();
 }
@@ -12304,7 +12572,7 @@ function formatLongThai(clause, options) {
       eventParts.push(`\u0E40\u0E27\u0E25\u0E32 ${timeStrings.join(", ")}`);
     }
   }
-  const timing = combineFrequencyAndEventsThai(frequencyPart, eventParts);
+  const timing = combineFrequencyAndEventsThai(schedule, frequencyPart, eventParts, options);
   const dayPart = describeDayOfWeekThai(schedule);
   const countPart = schedule.count !== void 0 && !standaloneOccurrenceCount ? `\u0E08\u0E33\u0E19\u0E27\u0E19 ${stripTrailingZero2(schedule.count)} \u0E04\u0E23\u0E31\u0E49\u0E07` : void 0;
   const durationPart = describeDurationThai(schedule);
@@ -12736,6 +13004,12 @@ function sameOptionalScalar(left, right) {
 function mergeOptionalScalar(left, right) {
   return left !== void 0 ? left : right;
 }
+function mergeI18nRecords2(left, right) {
+  if (!left && !right) {
+    return void 0;
+  }
+  return __spreadValues(__spreadValues({}, left != null ? left : {}), right != null ? right : {});
+}
 function sameCoding(left, right) {
   var _a2, _b;
   if (!(left == null ? void 0 : left.code) || !(right == null ? void 0 : right.code)) {
@@ -12798,6 +13072,7 @@ function mergeSite(left, right, context) {
   }
   return {
     text: mergeOptionalScalar(left.text, right.text),
+    i18n: mergeI18nRecords2(left.i18n, right.i18n),
     source: mergeOptionalScalar(left.source, right.source),
     coding: mergeOptionalScalar(left.coding, right.coding),
     spatialRelation: mergeOptionalScalar(left.spatialRelation, right.spatialRelation),
@@ -13145,6 +13420,7 @@ var TOKEN_SITE_CANDIDATES = {
   le: [{ text: "left eye", route: RouteCode["Ophthalmic route"], source: "abbreviation" }],
   ou: [{ text: "both eyes", route: RouteCode["Ophthalmic route"], source: "abbreviation" }],
   be: [{ text: "both eyes", route: RouteCode["Ophthalmic route"], source: "abbreviation" }],
+  au: [{ text: "both ears", route: RouteCode["Otic route"], source: "abbreviation" }],
   vod: [
     {
       text: "right eye",
@@ -15694,6 +15970,9 @@ function inferRouteFromContext(ctx) {
 // src/hpsg/rules/site-rules.ts
 function siteBoundary(lower, context) {
   var _a2, _b, _c;
+  if (SITE_MULTIPLICITY_WORDS.has(lower)) {
+    return false;
+  }
   const siteLike = Boolean(resolveBodySitePhrase(lower, (_a2 = context.options) == null ? void 0 : _a2.siteCodeMap, {
     bodySiteContext: (_c = (_b = context.options) == null ? void 0 : _b.context) == null ? void 0 : _c.bodySiteContext
   }));
@@ -15755,7 +16034,7 @@ function shouldSuppressEyeSiteAbbreviation(context, start, lower) {
 }
 function siteLexicalRule() {
   return lexicalRule("hpsg.lex.site", (context, start) => {
-    var _a2, _b, _c, _d, _e, _f, _g, _h, _i, _j, _k, _l, _m, _n, _o, _p, _q;
+    var _a2, _b, _c, _d, _e, _f, _g, _h, _i, _j, _k, _l, _m, _n, _o, _p, _q, _r;
     const token = (_a2 = tokensAvailable(context, start, 1)) == null ? void 0 : _a2[0];
     if (!token) {
       return [];
@@ -15821,7 +16100,7 @@ function siteLexicalRule() {
         continue;
       }
       phraseTokens.push(candidate);
-      if (!SITE_DISPLAY_FILLERS.has(candidateLower)) {
+      if (!SITE_DISPLAY_FILLERS.has(candidateLower) || SITE_MULTIPLICITY_WORDS.has(candidateLower)) {
         displayTokens.push(candidate);
       }
     }
@@ -15867,6 +16146,7 @@ function siteLexicalRule() {
           valence: {
             site: {
               text: displayText,
+              i18n: (_r = resolved == null ? void 0 : resolved.definition) == null ? void 0 : _r.i18n,
               source: "text",
               coding: resolved == null ? void 0 : resolved.coding,
               spatialRelation: resolved == null ? void 0 : resolved.spatialRelation,
@@ -15894,7 +16174,7 @@ function siteLexicalRule() {
 }
 function bareSiteLexicalRule() {
   return lexicalRule("hpsg.lex.site.bare", (context, start) => {
-    var _a2, _b, _c, _d, _e, _f, _g, _h;
+    var _a2, _b, _c, _d, _e, _f, _g, _h, _i;
     const signs = [];
     const first = (_a2 = tokensAvailable(context, start, 1)) == null ? void 0 : _a2[0];
     if (!first) {
@@ -15940,6 +16220,7 @@ function bareSiteLexicalRule() {
             valence: {
               site: {
                 text: displayText,
+                i18n: (_h = resolved.definition) == null ? void 0 : _h.i18n,
                 source: "text",
                 coding: resolved.coding,
                 spatialRelation: resolved.spatialRelation,
@@ -15947,7 +16228,7 @@ function bareSiteLexicalRule() {
                   originalText,
                   text: sourceText,
                   normalized: sourceText.toLowerCase(),
-                  canonical: (_h = resolved.resolutionCanonical) != null ? _h : normalizeBodySiteKey(displayText),
+                  canonical: (_i = resolved.resolutionCanonical) != null ? _i : normalizeBodySiteKey(displayText),
                   isProbe,
                   inputText: context.state.input,
                   sourceText,
@@ -16654,7 +16935,7 @@ function applyRouteSiteDefault(state) {
       system: (_i = definition.coding.system) != null ? _i : "http://snomed.info/sct",
       code: definition.coding.code,
       display: definition.coding.display,
-      i18n: definition.i18n
+      i18n: mergeI18nRecords(definition.i18n, definition.coding.i18n)
     };
   }
 }
@@ -17967,13 +18248,16 @@ function applySiteDefinition(internal, definition) {
     code: coding.code,
     display: coding.display,
     system: (_a2 = coding.system) != null ? _a2 : SNOMED_SYSTEM9,
-    i18n: definition.i18n
+    i18n: mergeI18nRecords(definition.i18n, coding.i18n)
   } : void 0;
   if (definition.text) {
     internal.siteText = definition.text;
   } else if ((_b = internal.siteLookupRequest) == null ? void 0 : _b.text) {
     internal.siteText = internal.siteLookupRequest.text;
   }
+  if (definition.administrationTargetCount !== void 0) {
+    internal.siteAdministrationTargetCount = definition.administrationTargetCount;
+  }
   if (definition.spatialRelation) {
     internal.siteSpatialRelation = definition.spatialRelation;
   } else if ((_c = internal.siteLookupRequest) == null ? void 0 : _c.spatialRelation) {
@@ -18324,8 +18608,11 @@ function seedKnownSiteCoding(state) {
     system: (_b = definition.coding.system) != null ? _b : SNOMED_SYSTEM10,
     code: definition.coding.code,
     display: definition.coding.display,
-    i18n: definition.i18n
+    i18n: mergeI18nRecords(definition.i18n, definition.coding.i18n)
   };
+  if (state.siteAdministrationTargetCount === void 0) {
+    state.siteAdministrationTargetCount = definition.administrationTargetCount;
+  }
 }
 function parseClauseState(input, options) {
   const tokens = tokenize(input);
@@ -19656,6 +19943,21 @@ function normalizeClock(clock) {
   }
   return `${pad(hour)}:${pad(minute)}:${pad(second)}`;
 }
+function doseUnitSupportsPerTargetMultiplication(doseUnit, context) {
+  const semantics = getDoseUnitSemantics(doseUnit, context);
+  if (!semantics) {
+    return false;
+  }
+  return semantics.kind !== "metric" && semantics.kind !== "biologic_unit";
+}
+function getAdministrationTargetMultiplier(dosage, context) {
+  var _a2, _b, _c, _d;
+  const doseUnit = (_c = (_b = (_a2 = dosage.doseAndRate) == null ? void 0 : _a2[0]) == null ? void 0 : _b.doseQuantity) == null ? void 0 : _c.unit;
+  if (!doseUnitSupportsPerTargetMultiplication(doseUnit, context)) {
+    return 1;
+  }
+  return (_d = getBodySiteAdministrationTargetCount(dosage.site)) != null ? _d : 1;
+}
 function getDateTimeFormat(timeZone) {
   let formatter = dateTimeFormatCache.get(timeZone);
   if (!formatter) {
@@ -21075,7 +21377,8 @@ function calculateTotalUnitsSingle(options) {
     2e3
   );
   const doseQuantity = (_j = (_i = (_h = (_g = dosage.doseAndRate) == null ? void 0 : _g[0]) == null ? void 0 : _h.doseQuantity) == null ? void 0 : _i.value) != null ? _j : 0;
-  let totalUnits = roundCalculatedUnits(count * doseQuantity);
+  const targetMultiplier = getAdministrationTargetMultiplier(dosage, context);
+  let totalUnits = roundCalculatedUnits(count * doseQuantity * targetMultiplier);
   if (roundToMultiple && roundToMultiple > 0) {
     totalUnits = roundCalculatedUnits(Math.ceil(totalUnits / roundToMultiple) * roundToMultiple);
   }
@@ -21626,11 +21929,12 @@ function cloneBodySiteCoding2(coding) {
   return {
     code: coding.code,
     display: coding.display,
-    system: coding.system
+    system: coding.system,
+    i18n: cloneI18nRecord(coding.i18n)
   };
 }
 function buildNormalizedMetaFromClause(clause, fhir, options) {
-  var _a2, _b, _c, _d, _e, _f, _g, _h, _i, _j, _k, _l, _m, _n, _o, _p, _q, _r, _s, _t, _u, _v, _w, _x, _y, _z, _A, _B, _C, _D, _E, _F;
+  var _a2, _b, _c, _d, _e, _f, _g, _h, _i, _j, _k, _l, _m, _n, _o, _p, _q, _r, _s, _t, _u, _v, _w, _x, _y, _z, _A, _B, _C, _D, _E, _F, _G, _H;
   const additionalInstructions = ((_a2 = clause.additionalInstructions) == null ? void 0 : _a2.length) ? clause.additionalInstructions.map((instruction) => ({
     text: instruction.text,
     coding: cloneCoding2(instruction.coding)
@@ -21643,22 +21947,23 @@ function buildNormalizedMetaFromClause(clause, fhir, options) {
     unit: (_h = clause.dose) == null ? void 0 : _h.unit,
     unitKind: unitSemantics == null ? void 0 : unitSemantics.kind,
     unitSemantics,
-    site: ((_i = clause.site) == null ? void 0 : _i.text) || ((_k = (_j = clause.site) == null ? void 0 : _j.coding) == null ? void 0 : _k.code) || ((_l = clause.site) == null ? void 0 : _l.spatialRelation) ? {
-      text: (_m = clause.site) == null ? void 0 : _m.text,
+    site: ((_i = clause.site) == null ? void 0 : _i.text) || ((_k = (_j = clause.site) == null ? void 0 : _j.coding) == null ? void 0 : _k.code) || ((_l = clause.site) == null ? void 0 : _l.spatialRelation) || ((_m = clause.site) == null ? void 0 : _m.administrationTargetCount) !== void 0 ? {
+      text: (_n = clause.site) == null ? void 0 : _n.text,
       coding: siteCoding,
-      spatialRelation: cloneBodySiteSpatialRelation((_n = clause.site) == null ? void 0 : _n.spatialRelation)
+      spatialRelation: cloneBodySiteSpatialRelation((_o = clause.site) == null ? void 0 : _o.spatialRelation),
+      administrationTargetCount: (_p = clause.site) == null ? void 0 : _p.administrationTargetCount
     } : void 0,
-    method: ((_o = clause.method) == null ? void 0 : _o.text) || ((_q = (_p = clause.method) == null ? void 0 : _p.coding) == null ? void 0 : _q.code) ? {
-      text: (_r = clause.method) == null ? void 0 : _r.text,
-      coding: cloneCoding2((_s = clause.method) == null ? void 0 : _s.coding)
+    method: ((_q = clause.method) == null ? void 0 : _q.text) || ((_s = (_r = clause.method) == null ? void 0 : _r.coding) == null ? void 0 : _s.code) ? {
+      text: (_t = clause.method) == null ? void 0 : _t.text,
+      coding: cloneCoding2((_u = clause.method) == null ? void 0 : _u.coding)
     } : void 0,
     patientInstruction: clause.patientInstruction,
-    prnReason: ((_u = (_t = clause.prn) == null ? void 0 : _t.reason) == null ? void 0 : _u.text) || ((_x = (_w = (_v = clause.prn) == null ? void 0 : _v.reason) == null ? void 0 : _w.coding) == null ? void 0 : _x.code) ? {
-      text: (_z = (_y = clause.prn) == null ? void 0 : _y.reason) == null ? void 0 : _z.text,
-      coding: cloneCoding2((_B = (_A = clause.prn) == null ? void 0 : _A.reason) == null ? void 0 : _B.coding),
-      spatialRelation: cloneBodySiteSpatialRelation((_D = (_C = clause.prn) == null ? void 0 : _C.reason) == null ? void 0 : _D.spatialRelation)
+    prnReason: ((_w = (_v = clause.prn) == null ? void 0 : _v.reason) == null ? void 0 : _w.text) || ((_z = (_y = (_x = clause.prn) == null ? void 0 : _x.reason) == null ? void 0 : _y.coding) == null ? void 0 : _z.code) ? {
+      text: (_B = (_A = clause.prn) == null ? void 0 : _A.reason) == null ? void 0 : _B.text,
+      coding: cloneCoding2((_D = (_C = clause.prn) == null ? void 0 : _C.reason) == null ? void 0 : _D.coding),
+      spatialRelation: cloneBodySiteSpatialRelation((_F = (_E = clause.prn) == null ? void 0 : _E.reason) == null ? void 0 : _F.spatialRelation)
     } : void 0,
-    prnReasons: ((_F = (_E = clause.prn) == null ? void 0 : _E.reasons) == null ? void 0 : _F.length) ? clause.prn.reasons.map((reason) => ({
+    prnReasons: ((_H = (_G = clause.prn) == null ? void 0 : _G.reasons) == null ? void 0 : _H.length) ? clause.prn.reasons.map((reason) => ({
       text: reason.text,
       coding: cloneCoding2(reason.coding),
       spatialRelation: cloneBodySiteSpatialRelation(reason.spatialRelation)
@@ -21673,7 +21978,8 @@ function buildParseResult(state, options) {
   const shortText = formatCanonicalClause(clause, "short", localization, options);
   const longText = formatCanonicalClause(clause, "long", localization, options);
   const fhir = canonicalToFhir(clause, longText, {
-    bodySitePostcoordination: options == null ? void 0 : options.bodySitePostcoordination
+    bodySitePostcoordination: options == null ? void 0 : options.bodySitePostcoordination,
+    includeTranslationExtensions: Boolean((options == null ? void 0 : options.locale) || (options == null ? void 0 : options.i18n))
   });
   const consumedTokens = [];
   const leftoverParts = [];
@@ -21856,6 +22162,7 @@ function resolvePrimaryLintResult(results, input, options) {
   AdviceModality,
   AdvicePolarity,
   AdviceRelation,
+  BODY_SITE_ADMINISTRATION_TARGET_COUNT_EXTENSION_URL,
   BODY_SITE_SPATIAL_RELATION_EXTENSION_URL,
   DEFAULT_BODY_SITE_SNOMED,
   DEFAULT_BODY_SITE_SNOMED_SOURCE,
@@ -21880,6 +22187,7 @@ function resolvePrimaryLintResult(results, input, options) {
   SNOMED_CT_TOPOGRAPHICAL_MODIFIER_CODE,
   SNOMED_CT_TOPOGRAPHICAL_MODIFIER_DISPLAY,
   SNOMED_SYSTEM,
+  buildBodySiteAdministrationTargetCountExtension,
   buildBodySiteSpatialRelationExtension,
   buildBodySiteSpatialRelationExtensions,
   buildBodySiteTopographicalModifierCoding,
@@ -21893,6 +22201,7 @@ function resolvePrimaryLintResult(results, input, options) {
   formatSig,
   formatSigBatch,
   fromFhirDosage,
+  getBodySiteAdministrationTargetCount,
   getBodySiteCode,
   getBodySiteCodeAsync,
   getBodySiteText,
@@ -21911,6 +22220,7 @@ function resolvePrimaryLintResult(results, input, options) {
   lookupBodySite,
   lookupBodySiteAsync,
   nextDueDoses,
+  parseBodySiteAdministrationTargetCountExtension,
   parseBodySiteSpatialRelationExtension,
   parseSig,
   parseSigAsync,